Thursday, August 13, 2009

Health Care Reform--One Nurse's View

My career as an RN has been diverse and has included both indirect and direct care of patients of all ages and in varying states of health. I entered the field after earning my bachelor's degree in nursing and out of a desire to contribute more towards patient education, I later completed a master's degree which concentrated exclusively on public health. Although I am "only" a part-time RN in a large hospital, I'm still very immersed in "what's going on" in the nursing field specifically, and health care as a whole. In the hospital setting the opportunity to provide patient education is practically zero in my current setting. It's a struggle to meet the basics of rudimentary patient care.

Honestly, I don't know all that's contained in the huge trillion-dollar health care reform bill that is currently under consideration in Congress. But I suspect that the kind of "reform" I'm hoping for isn't going to be found in this giant bag of tricks. You see, the reform I know we need depends upon enhancing the quality of health care rather than the quantity. The powers-that-be cannot fathom the ways in which the health care we currently have is marginalized.

Those of us not living or working in ivory towers are all too familiar with the slap-dash care that's doled out to us, even when we DO have good insurance. Personally, in the hospital setting I have no interest in my patients' insurance (or lack of it). Even if it was of interest to me, it would be a hassle and too time consuming to look it up. After all, when I'm working I am very, very, VERY busy . . . because I'm not the kind of nurse who is going to let my patients HURT, or allow them to linger in a wet or soiled bed, or remain un-turned for hours on end. I'm hustling myself through all the tasks set before me--exacerbated by a too high patient-to-nurse ratio and a nurse's aide who is equally overworked.

In the last few weeks my cousin went for a physical on my advice and recommendation. We collaborated in advance so that she could be an informed health consumer and advocate for the type of COMPLETE physical she wanted. She was partly successful. By no means did she get the thorough exam she went in for. A quick glance in our ears, eyes, and mouth, a stethescope momentarily applied to our chest and, very rarely, a brief palpation of the abdomen . . . that's more than a lot of patient's have come to expect from a so-called "physical" these days.

One week ago a dear family friend in good health underwent a "simple" surgery that resulted in her death a few days later. I don't know all the circumstances, but based on past experience with family and friends in that same hospital, I have serious concerns about the quality of health care that was given in response to her urgent post-operative needs.

I did a stint as an LPN nursing instructor last year. The students scared me. They were all too aware of the "nursing shortage." And most were very vocal about their a desire to enter the field to make a quick buck. These young folks were at least honest about their intentions. At a professional meeting I lunched with nursing instructors from various other colleges and universities. Amazingly, they were wholeheartedly unimpressed with the quality of nurse their schools were turning out. The group concurred on the need to "be there" with a loved one all night long to ensure appropriate care in a hospital setting.

What I want in health care reform is a system that I have faith in . . . For starters, I would like to see physicians hold themselves accountable for actually performing physical assessments and taking the time to discuss important findings and recommendations with their patients. I'd like to see better educated nurses (yes, a 4-year-degree for RNs!) and absolutely better staffing in hospitals. I'd like to see more RN's and a better quality of all employees in long-term care settings. I'd like to see more patient education--either in person, via telephone, or the web. Most of all I'd like to see TIME spent in absolutely ensuring that the individual needs of our patients are met. This is not happening now--and it grieves me.

My final assertion is aimed specifically at the nursing shortage. There are an abundance of experienced nurses who choose not to subject themselves to a system that puts them at risk of harming patients and themselves due to over staffing. They are "out there," but choosing to work part-time, in a totally different career field, or not at all. Direct patient care in a hospital setting is the place in which we need excellent, experienced nurses who are also empathetic towards patients' needs. To truly reform the system, we need to make the changes necessary to get these nurses back . . .



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