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Nursing in America and the Right to Healthcare
Since the debate is ongoing about healthcare, let’s think about what this is really going to affect: healthcare workers. I’m looking, specifically, at the nurses. Yes, doctors, we know that you are also over-worked, but with 10-15 minutes a patient, you can see more patients than nurses can. Given how much hands-on inpatient and outpatient care we provide, the stretch in healthcare is going to be felt most acutely by the nurses who will have to do more with less (always doing more with less).
If we are not going back to outright slavery, then we have to acknowledge that there are limits to service. We cannot make people work in healthcare. As things get worse, fewer and fewer people will choose this career. Why? It isn’t just the money. It’s about safety.
A nurse was recently erroneously described as “unharmed” while being held hostage. Most nurses face violence and threats on a daily basis in what is often described as a “normal day at the hospital.”
I know all of this because I face it daily. Beyond the care and concern for my patients, I have risked life and limb. I have had patients hit me, kick me, use telephones as a club, scratch me, and bite me. Luckily, it hasn’t usually broken the skin. I have also had HIV+ and Hepatitis + patients rip out IVs in my face and fling blood in my general direction.
I have never filed a report regarding a patient.
Why bother when it does nothing anyway? Nurses are to be superheroes. We are supposed to stand up to administration, doctors, other staff, and even family, all on behalf of our patients. We protect them to our own detriment, sometimes even failing our own physical and mental well-being.
I re-watched an episode of Gray’s Anatomy today. It seems counter-intuitive to bring to mind a show that is notorious for medical inconsistencies and stupid drama, but one episode always struck me as being entirely too true. Someone who assisted in this episode knew too much and it affects medical practitioners similarly. In the 11th Season, Episode 21, there is a car crash. Everyone in medicine knows these phrases: “He was trying to die on me.” “No. Not another one. We’re full and we’re not even trauma.” Everyone sees it coming. Doctors too full of themselves to answer the call. Supervising doctors uninterested in the priorities. Advocating (in futility!) for your patient’s best interests. “He needs a brain CT.” “No, his GCS is stable.” Trying to do the right thing over and over and hitting a wall. Over. And. Over.
The episode is nearly traumatic upon viewing if you have had these experiences yourself. Watching the anguish from the outside, the poor outcomes, and the sheer frustration, is almost too much. I cried when I saw this episode. Not because I had any particular love of the characters, but because everything was wrong and it was too familiar.
The worst part is that this is just TV. It attempts to reflect the basic truth of the reality.
In real life, in hospitals every single day, nurses struggle to do right by their patients. Even if these patients bit them, kick them, slap them, or pull a knife on them, the nurses still try to do their best and to get the best possible outcome. With universal healthcare, we will be forcing nurses to neglect themselves. Even more than now, we will have to encourage nurses to think of themselves as super human or somehow subhuman because only those can possibly endure that kind of daily degradation. Only people who are superhuman are able to smile and offer jello immediately after being spat on by a patient, yelled at by a doctor, and bullied by a fellow nurse.
Universal Healthcare is another word for indentured servitude.
As long as healthcare is a matter of service, we cannot force workers to provide. We simply cannot. We cannot force nurses to neglect their physical integrity, well-being, and frankly, sanity. A right cannot exist if it violates the natural right of self-determination of another.
Healthcare never has been and should never be a right. Nurses are not super-heroes. Eventually, they will break and there will be no one to care for the masses.
Published in Healthcare
I would like an answer to Jeff Peterson’s question.
Why in the heck do we think a factory worker should only work 8 hours a day, while nurses and doctors that work in life or death situations should work 12+ hour days?
And it’s healthcare personnel in general that have these issues (to a greater or lesser degree). My 95-year-old mother would not still be around if it were not for the dedicated caregivers who assist her in the independent living facility where she lives. I still work, so I can’t attend to her 24 hours a day, and she’s still in good enough condition that she doesn’t require 24-hour care. However, she does need assistance at various times throughout the day, and the dedicated caregivers we’ve been able to provide make her continued “independent” living possible. They also provide her with companionship and love. Looking at what these people (some of them nurses) have to put up with on a daily basis helping others throughout the facility, I’m amazed that they continue to do this kind of work (and many don’t; they burn out and leave). And being a hospital nurse must be light-years worse! My hat’s off to you @therightnurse!
Sorry! It double posted!
Don’t get me wrong, Jim, there are wonderful patients too (see what I said about sweet little ol’ men giving away kisses). We have great patients too. Indeed, in ICU I think it might be even easier to see the good side since most of the patients are intubated/sedated. The nurses are wonderful people. I don’t think I was intimating otherwise.
However, I don’t think people know the kind of danger that comes with the job. Perhaps worse is the training that this is simply part of the job. As caregivers, we are supposed to just take it with a smile, excuse the behavior (because, you know, they’re sick!), and move on with our day. Not everyone is like that, but some patients are. The verbal abuse is only part of it. I’m not even wasting my breath with that part.
Honestly, 12 hour days is better than 8. In 8 hours, I feel like I get nothing done. It’s not enough time to see changes in a patient or to really know your patient. Plus, with neurological patients the changes are sometimes very subtle. If you have two nurses sharing the patient over 3 days, you’ll have a better outcome (generally) because they notice things. With 3 nurses each day, it gets very complicated. I prefer 12 hours.
No. Not all nurses do. Some finish nursing school with their ideas about it being a good job and good money intact. There are people who do not have a passion for it but simply think it’s a good paying job. Those are often people who go to work at the VA or at union hospitals where they can’t get fired easily. For them, it’s another job. When you meet those nurses, you know them. They don’t sit and chat with their patients. They don’t even try. They’re just doing the work and getting through the day.
Some nurses start with a passion and get burnt out by the realities.
Most nurses think that certain things are taught (a certain level of detachment, understanding for the positions doctors are in) but that good nurses have an instinct. Some people are caring people and they gravitate toward careers in service. Sometimes, though, it requires more strength than these people have. I know someone who was a great nurse; she had a wonderful mind for it. She worked in the ER, which was her ideal job. She saw a baby die and immediately left. She never went back to nursing.
No I understand it. People do not want to be in a hospital. They are tired, hurting, stressed and may only be rational at the margins. In the hospital is where the human meets the animal. It is a place of pain, suffering and death. The fight or flight urges are out of control for some. Nurses are the angels of human society working where the divine man reaches out to the rising ape and sometimes get bit and beat for the trouble
My darling stepdaughter is a nurse, and she already has some hair-raising stories (she trades them with her step-sister the cop…there’s probably a reason cops and nurses often end up getting hitched?).
My hope (and practice thus far) is to spend as much time as possible with my loved one in the hospital. When my daughter was nine, and had pneumonia, I was able to stay with her the entire five days. The nurses told me this was the difference between her remaining on the pediatric ward and going to the ICU—nothing like having your very motivated Mom sitting right beside you, noticing when the oxygen cannula fall out of your nostrils, helping the respiratory therapist thump you, or fetching you ginger-ale as soon as you’re thirsty. Not everyone can do this, of course, but I have to think that it was helpful to the nurses as well as for my daughter to have me there. I hope so, because the nurses were wonderful.
I should think that fewer patients per nurse might help at least as much as shorter hours?
I worked as a nurses’ aid for awhile, and the hard part was not having time to do things slowly and gently, with time for chatting. On those occasions when I did have time to give a nice, warm bed-bath, for example, it was fantastic. (I remember one elderly woman being in a sort of trance of comfort, just from having a really luxurious bed bath and massage!)
But the hard parts were hard. There’s a reason I’m not still doing that work.
Last winter I had to take my wife to the ER. She had some sort of infection that was bad enough to cause her hallucinations.
While we were in an ER exam room, a man was admitted who was belligerent. He was throwing feces around, pulling out IVs obviously on some kind of high. A few minutes later, 5, big, tough, armed, security men arrived. He was calmed down. It was scary though because his room was near my wife’s.
Meanwhile, the nurse who was helping us was also helping the druggie. She was extremely nice to us and when asked about the druggie just blew it off saying he was under control now. She had been the primary target for the feces. I thought I noticed wings under sweater. She was truly an angel.
A couple of years ago, I had a hip replaced. The evening after the surgery, I called my brother who was coming to see me anyway, to bring a couple of dozen chocolate chip cookies. I gave them to the nurse that evening and told her to take them to the nurse’s station and share.
Was it enlightened self-interest to bribe the nurses with cookies? Maybe, but it was also something that lightened their day, too. We all got along really well. They deserved the treat.
You haven’t spent much time in manufacturing, have you?
I am thinking of the UAW contracts where the line worker starts collecting time and a half as soon as he has been on the job more than 8 hours.
Yep. We have had that. Not often that we get poo-flingers, but we do get them. A trend recently has been tearing the IV tubing in half rather than trying to untape it. The problem is, then, that there’s a nice wide open vein just spurting blood everywhere. Usually this happens when people attempt to get up to the bathroom alone. This means there’s usually urine and blood pooled everywhere and flung around the room. There’s been more than one where the partition curtains had to be changed, the cabinets cleaned and even the ceilings wiped down.
Because they also believe that the state is the source of all good? You would think that the realities of single-payer would deter them, however, they live in a bizarro-land where somehow scare resources are shared, everyone gets perfect healthcare, there’s no staffing shortage, and we all get paid for our clinical expertise.
This is what happens when pot gets legalized, folks.
Legally, we are not able to discuss our patients’ care with others. It is excruciating when you have had a patient die or code or just been dressed down by a doctor. You have to still come in, red-faced or not, and pretend that everything is fine, you were just overheating and that patient was just having a momentary problem.
I’ve had patients running down the halls. People came out of their rooms to watch.
Manage that one, I dare you. Answering those questions without being derogatory…is a challenge.
My mother (a nurse) told me not to go into it because I was not a take care or your sorry a** kind of person. I might have been the kind of nurse some of these people need. Patient satisfaction scores are now how hospitals get paid (from what I heard at least in part). Like it is a trip to DisneyWorld or something.
That’s very true. It’s brilliant, isn’t it? Medicare is going bankrupt, so what do you do? Make payment contingent upon something that no one can really control: satisfaction scores. These scores don’t mean that you didn’t provide excellent medical care. They can sometimes just mean that you didn’t bring the chocolate cake to the diabetic patient who couldn’t swallow properly and they were still pissed off about it.
Thus, the government saves money, people feel in control of their “experience”. It’s win-win, right?
They put that in the contracts because they are working more than 8 hours a day. Nurses aren’t working for free, either.
Personally as an ER doc I think 10 hours is just right. Only 4 a week, plus allows overlap of shifts (3 10’s instead of 2 12’s).
This kind of scheduling is used in a variety of settings where I live; particularly small, specialty manufacturing *and* healthcare. Family members in both settings seem to like it.
I always think the work hours topic as funny / odd. As an infrastructure IT guy I tend to work 10+ hours 4 or 5 days a week with oncall after hours and weekend. This has been the norm for me most my life. It is what you have to do to be successful.
When I worked in IT for the hospital, I worked 8 hour days. Really more like 8-12, some 14 and a couple of 24. If I’d continued on, I would have done that much, much more. It was more stressful than codes.
It’s every American’s dream: You get what other Americans think you deserve!
My hair is a bit shaggy (what can I say? I grew up in the ’60’s and never fully recovered, now I need to partly cover my ears to hide my hearing aid so no one will know that I have it; you all keep my secret now), and when I was doing clinical rotations in my mid 40’s I had a 75 year old guy with mental issues pawing me. First time I’ve ever been mistaken for a female.
I’ve respectfully waited this conversation out, but I think it’s ok to say now. Sounds like Fargo! Sorry, I’m the movies guy…
I’m sorry but that’s pretty funny! I had a conversation with a patient go something like this:
Me: “Whew! I’m sorry. It’s been warm in the hospital. I’m pretty hot.”
Him: “I’d say you’re hot!”
I had to give him 5 for that. Well played man, well played.
You always think it’s okay to say. Sorry they didn’t make a movie of it for you so that you’d actually watch it!
Not sure I’d watch it if they made the movie. I lack the taste for trainwreck!
Quick summary:
Well, that and treating it as a right.
Would half of this happen if you were able to throw patients out of the hospital for flinging HIV positive blood at nurses? (Those with mental illness are a different story.) Want to bite a nurse? Call your family and have them figure out how to transfer you.
But health care is a right, which means that people expect to be given it unconditionally. That’s wrong on several levels.