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Posts tagged ‘opinion’

Mar 6

The White House Health Care Summit: A Nurse’s Perspective

On Thursday, President Obama held a summit to discuss our current state of health care. It was attended by representatives of various health care organizations as well as a sampling of senators and representatives. I also had the pleasure of attending. (Okay, I didn’t really attend but I watched the live stream and tweeted about it, so that’s kind of like attending, right?) At any rate, I think our health care woes can be summed up rather succinctly: We want better health care, for more people, and we want it to cost less. If only the answers were that simple. As you would expect at an event with plenty ‘o congressmen in attendance there was lots of complaining and pontificating. Despite that, I managed to suss out some interesting ideas for you ; ) Nurses were well-represented by Rebecca Patton, president of the ANA. As a nurse, I’m proud to say that she was one of the few people bringing actual ideas to the table, rather than just complaining about the situation. She presented the idea that nurses should be allowed to use the full extent of their clinical skills. I took this to mean nurse practitioners should be allowed to practice, and RNs should be utilized more for their clinical skills rather than just doing endless rote tasks and paperwork. She also suggested that more public reporting of outcomes and staff ratios should be required. I think this is a great idea, although it doesn’t address the issue of lowering health care costs. A facility that has a low nurse-patient ratio is certainly going to have higher costs, unless they choose to cut corners somewhere else. Daniel Smith, president of the American Cancer Society discussed raising the tobacco tax. The argument against this is if you raise the tax on cigarettes, you will disincentivize people to smoke, hence you will not raise more revenue in tobacco tax. But if the tax hike is significant enough (say by 75%) and the amount of smokers reduces by only 15%, you’re going to have a net increase in tobacco tax revenue. Bonus points: This could facilitate a reduction in lung cancer and COPD; thus saving more money down the road. The idea was also presented that we utilize more home care services for chronic illnesses and end of life care. I couldn’t agree more. First of all, it cuts down on nosocomial infections, and secondly, I think people would rather receive treatment in their own homes, particularly if we can show that this improves outcomes. Also, what a great way to utilize your nursing workforce. We still have a long way to go towards improving our health care system. There was also a lot of talk of “we’re all going to have to pay our share, and sacrifice a little bit,” (Wait – wasn’t the the whole point to NOT sacrifice better care, and to NOT have to pay more?) Really this just means that some of us will be required to pay higher taxes to fund all of this. One group that was conspicuously missing from the health care summit was doctors. That’s unfortunate. After all, doctors are the one group that really spend their time at the intersection between reimbursement and patient care. Shouldn’t we be listening to some of their ideas and solutions?

Oct 17

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Why I’ll Probably Quit Nursing

There’s been a lot of recent discussion about nursing salaries and the nursing shortage.

I wanted to chime in because (a) I love to over-simplify things, and (b) I am on the verge of becoming one of those nurses they refer to – the kind who works 2-3 years after school and then quits.

The reasons aren’t complicated. Here’s why I’ll probably end up quitting:

  • The money sucks.
  • It takes its toll on you physically.
  • I don’t want to work nights, weekends, or holidays.

Sure there are many peripheral issues – nurses dumping on each other, lack of autonomy, lack of time and resources to get the job done right. But other than that it’s a personally rewarding, and (at times) intellectually challenging job. It feels good to help people when they are sick. I love being the voice of calm in a storm. I love working as a team and saving lives (sometimes.)

I just don’t love it enough to get over the three points that I listed above.

It’s that simple. If I became a nurse when I was 22 I might have gotten a few more good years in, but sadly, I didn’t. So if there’s any constructive advice springing from this negative view of nursing it would be this: Get ‘em in while they’re young. The earlier you start your nursing career, the later your burnout will be.

Aug 26

What Does it Really Take to be a Good Nurse?

I’ve often heard the complaint that nurses aren’t handmaidens and shouldn’t be treated as such. Head Nurse does a great job of addressing this in her post Handmaidens, Helpmeets and the Problems of Nursing. As much as I want to believe this, though, I have never been able to convince myself that this isn’t true.

To illustrate my point, I’ll give you a day in the life of working in the recovery room:

The charge nurse hands me a paper with a very minimal patient report. It usually includes the name of the procedure the patient had, any outcomes of the procedure, current vital signs, sedation and any other meds the patient might have received.

The patient is rolled in to the recovery room. I hook them up to the monitor and do a very minimal assessment (Are they awake? Are they in any pain? Are their vital signs within normal limits? Is the incision/puncture/drain site dry, clean, and intact? And most importantly, do they have a ride home?)

When I’m finished, I call the waiting room and let the family member(s) know they can come in.

I record vital signs and check on the patient’s site every 15 minutes for an hour. Sometimes this is extended to every 30 minutes for the next hour, sometimes it isn’t. If the patient is hungry or thirsty I’ll give them a beverage, perhaps some crackers, maybe even a turkey sandwich. Sometimes I will help them on to the bed pan. If the patient is nauseous, I call the doc and ask for some phenergan. If the patient has pain issues, I call the doc and ask for some Tylox.

If the patient’s vital signs fall out of wack I page the appropriate MD. If they fall precipitously out of wack I will have someone go to the procedure room of the appropriate MD and grab him or her. If they have no vital signs I will imediately call for help and start ACLS (this has never happened.) Sometimes the patient will bleed, or develop a hematoma at the puncture site. If this occurs, I hold pressure until it stops and notify the MD.

If the patient is being admitted I call report to the floor nurse. I unhook the patient from our monitor. If the patient is going to a monitored floor, then I hook them up to a transport monitor and take them to their floor. If the patient is going to a non-monitored floor, then I arrange to have a patient escort take the patient.

If the patient is going home, I give them some pre-printed discharge instructions, verbally explain them to the patient, and answer any questions. Then I remove the patient’s IV(s) and send them on their way.

Is what I’m doing skilled and technical? Yes.

Am I using autonomy or intellect? No.

Am I using my skills of compassion and care? You bet I am. One of the only things that make the tedium of nursing bearable for me is when I get a patient who is anxious, or has questions, or wants to talk about their disease. They talk, I listen. I might even hold their hand. I answer questions. Sometimes I ask them questions because I know that they just need someone to talk to. They want someone with medical knowledge to help them process what is happening to them. I’m happy to be that person.

To further illustrate my point I’d like to say that some of the best, most effective, and knowledgeable nurses I’ve seen are either diploma nurses or associate degree nurses. It doesn’t take a bachelor’s degree to do what they do. So why is there this big movement to “intellectualize” the profession of nursing? At the university level they like to teach about the politics of the profession, and what nurses can do to gain more power. If that’s the agenda they want to push forward, fine. Maybe some day they will gain power and change our healthcare system for the better. But I think it does future nurses a disservice when they find themselves in their first hospital job, expecting to have all these autonomous, intellectual tasks but instead find themselves doing all the skilled, technical, and menial stuff. Sometimes I think that what the nursing shortage really comes down to is that there are these tasks surrounding patient care that need to be completed around the clock, and there aren’t enough nurses willing to do this kind of work.

But if the nurses aren’t going to do it, who will?