Tuesday, May 8, 2018

It's Time More Respect Is Shown For Nurses - And We Address The Nursing Shortage!

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Nurse "Audrey"   Gives A Welcome Image for UC Health Memorial Hospital - but there are too few like her and her sisters in the U.S..

"Nurses are not just bed-making, drink- serving, poop-wiping, medication- passing assistants. They are, for example, reporters. They document and discuss patient status, serving at the main point of contact for doctors, surgeons, therapists, social workers and other specialists. They are watchmen, keeping vigil, meticulously monitoring vital signs and deciphering patients' trends and patterns, double checking dosages and medications. They are detectives, investigating deviations, asking questions, listening carefully, searching for clues. They are warriors, called to serve at the first sign of outbreak, fighting infection, containing disease.  ....They are advocates, lobbying physicians for or against procedures, for pain assistance, for a few more minutes of time. They are teachers, educating people about their condition, demonstrating home healthcare..."  Alexandra Robbins, The Nurses

My serious appreciation for nurses, nursing staff began after my first of two prostate cancer surgical procedures last year: a 3D staging biopsy taken through the perineum at UCHealth, Aurora, requiring 45 cores extracted from the prostate.   I had awakened in the PACU or Post-Anesthesia Care Unit, to the soft voice of a beautiful nursing grad student, "Rachel",  who was alarmed at the expression of pain on my face as I surfaced from the general anesthesia. After asking me the usual questions to confirm I knew where I was, the date etc. she asked about the pain, where it was and how bad on a 1-10 scale.  

She provided me with some ice chips first to soothe my parched mouth, and after gratefully swallowing a few down (I hadn't had any liquids for over 6 hours) I said:   "It's the pain from the catheter. It feels like my whole urethra is on fire, and it's about 8 on a 10 scale".  Without hesitation she brought me two hydrocodone tablets - 500 mg each- and remained with me while they took effect, and also to keep providing me with more ice chips. then water. 

She helped me get through a very rough hour, and then took the time to show Janice how my Foley catheter bag had to be emptied, and how the leg bag was changed to a longer lasting larger bag at night.  She and another nurse, Julie, also showed us how the catheter was to be safely handled and also cleaned.  They also indicated to me my breathing was still too shallow and I needed to get it back up to a higher threshold using a plastic breathing apparatus. 

Now that it's Nurses Week, I think of Rachel and Julie again, as well as the Nurse (Deb) who was there for me at the actual cryotherapy procedure (also at UC Health) five months later when I was under general anesthesia even longer. On that occasion I felt severe nausea soon after emerging from unconsciousness - and Deb stayed with me as I used the toilet, emesis bag in hand, then bringing me some ice chips after. 

Nurses. We hardly think of them until we need them, but we damned well should because this country is in the midst of a nursing crisis.  A crisis of too few trained, registered nurses. Without any hype we can aver that nurses comprise the rigid backbone of the entire health care industry. Without them, the entire thing collapses. At every level, the quality of care and human touch necessary for positive outcomes link directly to the quality of the nursing staff. That is true in hospitals, skilled nursing facilities, and in home care. Good health care cannot be created without good nurses. If you dispute this, then read again - if you haven't already- the quote at the top from Alexandra Robbins in her book (pp. 23-24) The Nurses.

The issue of nurses is critical now given that  between 2009 and 2030, as the elder population expands by more than 40 percent,  it will  need additional nurses available to provide care in different venues.   Among the more sobering stats: while  the country will have more than a million nursing job openings over that interval  — there will be only about 439,000 new nurses to fill those positions. States in the South and the West will bear the brunt of the impact. The projected scorecard for Colorado in 2030 grades out as a “D,” which sounds terrible until you realize only a few surrounding states do so well — most get an “F.” 

What accounts for this deplorable situation?

There are many reasons for this shortage but one often mentioned by our retired RN friend "Nan"  is constant burnout leading to large turnover, which often can't be filled.   This is a point of view reinforced in the book, The Nurses.  At the heart of this burnout is a lack of respect for nurses, who often behold physician - surgeon errors, and are also persecuted if they report them . But ...you never hear about those instances, do you?  As Alexandra Robbins writes (p. 55):

"A national study of 6,500 nurses and nurse managers conducted by the American Association of Critical Care Nurses reported that many nurses are too intimidated to voice their concerns when doctors make mistakes during surgery. Despite mandatory safety protocols like checklists, more than 80 percent of nurses are still worried about 'dangerous shortcuts', incompetence and disrespect at their hospitals. Of the nurses that admitted that patient harm or 'near misses' occurred because of a doctor's safety violation, 83 percent did not report the violation".

Why is this?  Robbins again:

"Nurses don't get the same level of protection as a physician. If nurses face the possibility of being outed and then prosecuted, they will think twice before turning in a dangerous physician."

Sad, but after years, decades of this sort of asymmetric treatment and lack of respect, one can more easily grasp why many nurses call it quits before they'd really like to. Such was the case with Nan.

Another reason, also cited by Nan concerns the disparity in pay between those who teach in Nursing schools and those who attain the upper echelon or what are Nurse Practitioners (NPs).  Limited staff and resources at the teaching level have led some Nursing schools to close and others to turn away tens of thousands of qualified applicants each year.  Turn away qualified applicants?! Well, yes, because there aren't the staff available to teach them, which is damned crime

But consider: when too many RNs who once worked on the floor or in ERs now seek NP status there is bound to be a labor gap left in teaching. Again, understandable  when nurse practitioners earn almost $100,000 per year, schools have difficulty recruiting the same people to teach for an $80,000 salary.  Isn't it time some genius figured out the pay for the latter - skilled teaching staff at Nursing schools - needs to be at least as much as for qualified NPs?

Look at it this way, the nursing school logjam means those private companies that pay for nursing aides to become licensed practical nurses and then RNs, now have to look for alternate means of addressing the problem:  Of filling the nursing staff "hole". Moreover,  this is a hole facing not only private companies but also clinics, primary care offices and hospitals

And this is a "hole" that will require a holistic strategy to fix, from properly paid teaching staff in Nursing schools, to treating nurses as equal medical professionals to physicians and surgeons - especially as they so often catch mistakes made by the former. We had better attend to this nursing shortage  and very soon, or we will pay - either individually one by one, or all at once, say when the next huge flu pandemic strikes.

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