the World Socialist Website received this letter from Sheri, a nurse in Kentucky, outlining the transformations in hospitals, the exploitation of nurses and the impact of the COVID-19 pandemic.
The day I graduated from kindergarten, I made it clear that I intended to become a nurse. I worked as a nursing aide from 1988 to 1996. In the fall of 1996, I finally started nursing school. My mother passed away in 1985. My father attended my graduation, and you would have thought of the pride I saw on his face that I had just earned a doctorate. in neurosurgery.
When I started my career, we still wore white uniforms. And people respected those uniforms. We took our work seriously because it is serious work. We have comforted the bereaved, held the hands of the scared and dying alone, offered relief to those in pain and, most gratifyingly, we have saved lives.
I felt good in what I did. Now all I feel is tired… and angry, and used, and overworked, and pressured, fearful, and threatened. But above all, I feel betrayed.
Over the weekend, my most recent incident, I disarmed a patient and took his gym bag full of weapons. You won’t find this story in any newspaper or TV news. Not even in a hospital report. It’s not a story my employer wouldn’t want to repeat because it would be bad for business.
And that brings me to my point.
The biggest and most detrimental change I’ve seen in medicine is that it’s not about medicine anymore. It’s just business. Hospitals have always been a business, but medicine came first. This emphasis has changed.
I remember that in 2004, hospitals across the country hired public relations firms to teach nurses about “customer service”, in order to better serve families. We were actually told to focus on visitor Needs. Then, in 2006, the Centers for Medicare & Medicaid Services (CMS) implemented the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys to make certain nurses understand their customer service missions.
As a result of this priority shift, I now have to deal with situations like (and it’s true) a family member walks into a room during a code and asks for a coffee! What do you think is the priority under these new guidelines: saving a life or getting that visitor their coffee?
It does nothing to help the patient. All of this means more time serving as a waitress or maid to visitors and less time caring for patients. Hospital administrators know that surveys typically completed by family members determine their performance in national surveys, which means more customers and profits.
In 2011, CMS established the Electronic Health Records (EHR) Incentive Program for Medicare/Medicaid. Hospitals had to implement the program by January 2014 in order to be eligible for reimbursement of beneficiary costs. The expensive nature of these records meant more time spent maintaining records on computers and less time spent on patient care.
And to save cost, they expect nurses to clean rooms, pick up trash, bring food and feed patients while asking us to take more patients. What does it mean?
Nurses now go back and forth to fetch soft drinks and snacks, cater to the every whim of visiting family and friends, rush to computers to plot every hour and tick boxes every every two hours (even if there is no change in the patient’s condition), running for scheduled medications, emptying bedpans, giving a bath or shower to a patient, cleaning feces from hair, of a patient’s walls and ceilings as well as deal with the unexpected that happens every day.
It’s not uncommon for patients to use their call lights not for emergencies, which they were intended for, but to “change the channel on the TV” or “pull up my blanket a bit” or ” fluff up my pillow” or “me my purse” or “give me a Sprite”. But all this patient care still needs to be done!
But above all, you have to draw! Management knows the nurses will stay and finish the case even if it means staying two hours on your shift.
Have you ever heard of “Warning Fatigue”? [Alarm fatigue describes how busy workers, especially in health care, become desensitized to safety alerts, and as a result they ignore or fail to respond appropriately to such warnings.] I don’t know of any other profession apart from nursing that suffers more. Honestly, I do not know. Alarms, sirens, whistles, bells, shouts, pulsating flashing lights that constantly attract the nurse’s attention.
WARNING for drugs one minute late. WARNING to attempt to give programmed potassium when the patient’s lab value is within normal limits. WARNING for PRN [Pro re nata, or simply “as needed”] the medicine is scanned five minutes before the end of the four hours. WARNING to document the location of the IV site before administering medication even if there is a separate diagram describing the location of the IV.
CAUTION Fatigue is TRUE!
Recent events regarding RaDonda Vaught have brought attention to this next situation and compounded the additional pressures. If the pharmacy, for whatever reason, is unable to enter newly ordered medications, we must replace the PYXIS (automated mediation dispensing systems). We have the order to give the drugs but no direct access to the drugs. (Keep in mind there can’t be a minute delay or WARNING!) After canceling, we then need to type an explanation for each drug we’re deleting.
I recently had a patient with dangerously low blood sugar. The attending physician ordered the immediate administration of a solution of D50 (concentrated dextrose). But the medicine was not available in the PYXIS. It took 45 minutes for the pharmacy to deliver it. The patient could not eat. I mixed sugar in a lubricant and administered it rectally. Although it is not a policy, it saved his life.
What if I hadn’t? What if I had just waited at the pharmacy? In 45 minutes, this patient could have slipped into a coma and died. Could I have been charged with murder? Anyone taking diabetes medication should have D50 ordered as a PRN order, and it should have been available at PYXIS.
Things have to change.
Hospital policies should focus on patient care, not shareholder portfolios, staff increases, or CEO end-of-year bonuses.
Nurses have worked on COVID units for more than two years without proper personal protective equipment. Disposable N95 respirators intended for use on every isolated patient were suddenly good enough for ten 12-hour shifts.
True to form, on March 1, 2020, laws were put in place to protect money on the health and well-being of essential workers (and by extension those workers’ families), stating that employers cannot be held responsible if employees contracted COVID.
How many nurses lost their lives as hospitals continued to make money in spades?
Nurses do not intentionally harm patients. We have been crying for over 20 years that health care is in trouble. But those cries always fell on deaf ears. We face many distractions, obstacles, roadblocks and increasing abuses and legal pitfalls that could be eliminated…if it didn’t reduce the CEO’s salary.
The United States is seeing the beginning of a mass exodus from the nursing field. People better start preparing to take care of their emergencies themselves. If changes aren’t made soon, you’ll be on your own!