Doctors' perspective


    Memo From The Editor
    Nurses' problems are yours
    By Marianne Dekker Mattera
    In this issue, you'll find a report on the nationwide nursing shortage. (See "A medical crisis: Who'll care for your patients?".) It's a good, solid news story about what's happening in hospitals around the country.

    Like all good news stories, it's objective. But objectivity won't always shake you by the shoulders to make you see how bad things are. That's left for editorial writers like myself. So here goes:

    My friends, your patients will be getting sicker when they go to hospitals instead of getting better. Some will die.

    Those who have no family to keep watch, to question, to ring alarms, will languish. If they are conscious enough to realize their needs aren't being met, they will suffer psychic stress that's at least as debilitating as the physical ailments that put them there in the first place.

    The nurses who are supposed to be caring for them are forced to care for far too many patients at one time. They are doing so for far longer than the eight or 12 hours that their shift is supposed to run. They are doing so without lunch or dinner breaks, and sometimes without bathroom breaks. And some of them are doing so on units that they haven't been properly trained to staff.

    They're going through their own psychic suffering, too. Nurses go into the profession because they want to care for the sick--in the literal, hands-on sense of the word. They want to touch patients--spiritually as well as physically--to help them understand their illness and how to cope with it. But nurses don't have the time to do that any more.

    So most of this country's hospital staff nurses are working under conditions that wouldn't be tolerated by most major labor unions, at a job that no longer resembles the one they thought they would be doing when they entered the profession.

    In some places, nurses have gone on strike, or threatened to, and they've gotten concessions from administration on staffing and mandatory overtime. But by and large, it's not enough.

    In California, the first state to mandate safe nurse-patient staffing ratios, the commission set up well over a year ago to determine what those ratios should be has still not made a decision. And the state nurses association and state hospital association are far apart on their recommendations. The California Nurses Association has proposed, for instance, one nurse to every three patients on med/surg units; the hospital group proposes a 1-10 ratio.

    Whatever the number finally agreed upon, it may be moot. There may not be enough nurses to fill the slots. Fed-up nurses are leaving, significant numbers will be retiring soon, and new people are not enrolling in nursing schools in numbers big enough to fill the need.

    Nurses are your collaborators. They're your eyes and ears--and, yes, brains--when you're not there. But they need the time and focus to be able to detect the subtle changes exhibited by a patient who's about to go bad. And they need the stamina to keep on top of minute-by-minute changes in a patient's status.

    You must be willing to help them. You must lobby for their cause with hospital administrators. Nurses represent costs--the biggest single piece of a hospital's budget. Doctors represent revenue. If you don't admit patients, the hospital doesn't make money. Therefore, you have more clout than nurses do. Use it.

    Arm yourself with numbers--the director of nursing should be able to give you what you need to prove that your facility needs more nurses. Make nurse staffing the subject of a medical staff meeting. Then present your views to the administrators.

    You can't afford not to. When accidents happen, lawsuits follow. And who will be sued? The nurse and the hospital, of course, but you will be, too.

    If only for your own economic well-being, you need to care about the nursing shortage. You must make nurses' problems your problems.
  2. Visit natalie profile page

    About natalie

    Joined: Sep '00; Posts: 99; Likes: 2


  3. by   natalie
    (I couldn't paste this article because it was too long.)

    Medical Economics Archive
    May 7, 2001

    A medical crisis: Who'll care for your patients?
  4. by   natalie
    (This article also too long to paste. From AMA site.)

    Where's the nurse? Staffs stretched too thin
    As nursing shortages reach crisis proportions, both physicians and patients suffer the scarcity. Who will answer the call? The solution won't be easy.
    By Stephanie Stapleton, AMNews staff. June 18, 2001. Additional information
  5. by   rncountry
    Natalie, these are good. I believe we need to educate our docs as well as everyone else. I have talked with the different docs I work with on a regular basis. So much so that one day about two weeks ago one of the docs I work with called me specifically to tell me he had heard on the radio that the Michigan Nurses Association had asked the state attorney general to offer an opinion on mandatory overtime for nurses, and her opinion was that there was nothing in state law that allowed for mandatory overtime. We talked about it, and my thought is that the MNA was looking for some type of opinion from the Attorney general that would allow the MNA to bring a test case forward regarding it. But I thought it was great that this doc is thinking about the issues and took the time to call me from his car when he heard this news report. I have another physician talking about the amount of charting a nurse is doing, and why. Another who has talked with me extensively about the patient bill of rights and how it may be possible that if more lawsuits are able to be generated some of those lawsuits will pivot on rather the nursing care was there, and how the lack of nursing care will impact on the physicians ability to defend themselves. I'm thinking that I should print out these articles and start handing them out to the docs. Could be interesting.
  6. by   oramar
    Natalie you post the best stuff, I want you to know that I appreciate it. I wish I could remember where I read the article about the nephrologist that was protesting he had recently had 3 patients die because he could not get them dialized. It was a weekend and there were no nurses to do the proceedure.
  7. by   Cdn_Psych
    The LA Times did some stories on the deaths (which are related to the nursing crisis). Here's a link to one of them:
  8. by   jamistlc
    Greetings All Nurses,

    I am back my puter is up and running again. i am trying to catch it I think this post speaks the truth and we need to get our Docs to understand our problems from our prespective! This is easier said than done since they often have blinders on and think from their prespective, (some are owners in the hospitals they have privledges at) also they look for an escape goat when they are sued who do you think they will place the accountability upon? It will not be the hospital! So if they open the can of worms about case loads for nurses they are also opening up litigation for not taking action to correct the problem! Like an ostriach they prefer to put their heads in the sand and ignore the problem, this in a way protects them from litigation, as well as assign blame on us the low person on the totem pole!

    Of course as more patients die and families take it to court, the can of worms will be opened and the Docs/hospitals will be accountable, (if they allow the case to get to court)! I am not sure how to get our collaborative partners in healthcare (Hospitals and Doctors)- to recognize our problems and that we can not take much more on our plates! I think as more clients opt to dig into thiers (Docs and Hospitals) and our pockets they will see that the longterm effects out way the short term gains in cost containment. Besides the financial there is the word of mouth and badf PR from bad care due to there neglect (Administration). As well as there will be alot less Nurses when they do pull there heads out of the sand (I want to say out of somewhere else) LOL
  9. by   natalie
    (Thanks oramar!)

    This news is pretty astounding. AMA House of delegates directs the assoc. to work with us. I was glad to read "there was so much passion about the issue." I have not personally experienced this passion where I work, or atleast the Docs do not share it with the nurses.

    AMA house goes after nursing shortage issue
    Delegates also acted on credentialing and board certification issues for residents, carve-outs, access to mental health services and other medical practice-related business.
    By Julie A. Jacob, AMNews staff. July 9/16, 2001. Additional information


    Chicago -- Responding to physician concerns about the growing nursing shortage, the AMA House of Delegates directed the Association to work with the nursing profession to improve the recruitment and retention of nurses.

    Due to the increasing health care needs of aging baby boomers and a drop in the number of college students choosing nursing as a profession, the United States will face a shortage of 114,000 registered nurses by 2015, says an AMA Council on Medical Service report.

    AMA delegates testified at length about the nursing shortage. Kenneth Tuck, MD, chair of the reference committee dealing with medical practice, said he was surprised by the intensity of doctor concern about the problem.

    "That issue took more time in the reference committee than any other," said Dr. Tuck, a Virginia delegate and ophthalmologist from Roanoke, Va. "There was so much passion [about the issue]."

    The house directed the AMA to work with nursing, hospital and other organizations to improve recruitment and retention of nurses. The house also instructed the AMA to work with those groups to figure out ways to streamline the paperwork that nurses must do to help them work more efficiently and improve patient care.

    Some delegates noted that it was important for the AMA to work in partnership with the nursing profession to solve the problem.

    "The AMA shouldn't impose its ideas on easing the nursing shortage on the nursing profession. ... We should not be presuming to solve their problem for them," Steven Chen, MD, a surgeon and Michigan alternate delegate from Ann Arbor, said in the reference committee hearing.

    The AMA is sensitive to the importance of working collaboratively with the nursing profession, Dr. Tuck said. "The nursing associations welcome our input and assistance."