I am proudly a 'floor nurse' and a generalist. I do my job well, I am caring, and advocate for my patients whose needs are met. I have 5 to 6 assigned patients at any given time. Why is the number of patients I have important? Well, each of my patients get only 10 to 12 minutes of my time every hour, including charting. It is impossible to be in more than one place at a time. So you or your loved one may really only have my physical presence for 5 to 7 minutes every hour. Really, if I spend more time with you, I'm actually taking time away from someone else. And this time does have to factor in my own physical needs. At least once or twice in my 12 or 13 hour shift, I do have to use the restroom. My employer deducts a 30 minute lunch break that I'm supposed to take to eat. In theory I should sit down and eat.
The health care industry really does need reform. It functions now for most people slightly adequately. There is lots of room for improvement. But all the talk of health care reform scares me. The Bottom Line. Nurses' salaries are the number one operating expense of a hospital. And it is an expense. Inpatient nursing care is not reimbursable, and is considered part of room and board; as opposed to a procedure, like an x-ray, that could be covered by your insurance. I fear that I'm going to be required to do more in the same amount of time with less support staff. I think of wages. A nurses' aide costs about ½ to 1/3 less than a nurse. If I'm to take a heavy load, why can they not get us more aides? Do I really need specialized, formal education and training to make a bed? Empty a bedpan or commode? Can unskilled labor not do a good portion of what I do? Leave me what tasks must be done by someone with my specialized, formal training.
'Pay for performance' is the standard. Soon, Medicare/Medicaid will be basing reimbursement on patient satisfaction. The theory is great. Good care is rewarded with more money; bad care is penalized with less money. I see the point. But patient satisfaction scores are not an objective measure of good, quality care. My cardiac patients are often on a low-salt diet, sometimes with a fluid restriction. I may not be allowed to bring them salt or water if requested. Often, I am left to explain why the doctor decides this and even inform the patient of the doctor's order for the diet. But these patients are usually dissatisfied, and that is the only measure of quality being judged. Take pain, for another example. Personally, I think pain sucks. The doctors decide which pain medication, how much medication, how often you can have it, and how it is given; not the nurse. We just follow the prescription as ordered. If it is not adequate, we call and bug the doctor and try to get them to change it. Pain medications also do have side effects. I tell quite a few of my patients this - "I am happy to bring your pain medications as liberally as ordered by the doctor. But you must do a few things for me: you must continue to breathe; you must maintain a blood pressure; you must have a pulse; and you must be awake or aware enough to communicate with me." It usually gets a laugh, but drives home my point. Alas, the survey only asks if you were satisfied with your pain management, not if we killed you with pain meds (a very real concern.) Which is the indicator of quality care?! Adequate pain relief is often not achieved for a certain percentage of the population for whatever reason.
Now I'm just rambling on. But I want to be judged on my care. Not the doctors, not the lab, not the other nurses, not anything other than what I am actually responsible for. I want to only be accountable for myself and my own actions. Maybe it's time to leave the bedside.
