It's 0700 and the night shift is scrambling to give report as us day-shifters struggle in with our coffee breath and slightly askew hair. Part of the way through the patient history of the terrible triad (coronary artery disease, diabetes, COPD...) I hear through the grapevine that not one, but BOTH of our CNAs have called out. My ears perk up like a hunting dog and I scramble. I interrupt my own report in order to find the best-working COW (computer on wheels) and a fully functioning dynamap. Of which I sadly realized was nowhere to be found. It makes for a terrible time post cardiac cath if all the MP-5s are claimed and there are no dynamaps equipped with all of the appropriate fixings (temperature, blood pressure, oxygen monitor). Needless to say, I felt as though I was drowning before the day had truly started. As report finished and we had rounded in each room, I could see the gleaming flat screen TV, the arm-chair full of overstuffed pillows, toiletries strewn about the room, and our 6-page menu stuck to the floor in some sort of goo. The manual blood pressure cuff on the wall was either falling off, missing parts, or not there at all and the thermometers on the walls wouldn't turn on. We were operating at a 5 to 1 flex ratio with patients post cardiac procedures, on a multitude of drips, BiPAPs buzzing, and rapid responses flooding in.
Where did this money come from?!
I am no expert in funds when it comes to profit and not for profit hospitals. My father always corrects me on the rant of "where did this money come from?!" "Where did THAT money come from?!" (He would tell me that it's from a different allocated fund). To be completely honest, I am sure that it does. What I would like to know is when did flat-screen TVs with more than just local cable and overstuffed armchairs become more important than an extra doppler on the unit? Or maybe an extra staff member?
A Shift In Healthcare
There has been a shift in healthcare in the last couple of decades (even the last hundreds of years). I sit and talk with my grandmother often who was a nurse when they sterilized the baby bottles in the NICU and had steel bedpans for the adults. Then, thermometers were made of glass (eek! mercury) and there were visiting hours. She explains the vast differences between the times on many accounts, and seems perplexed with "the way things are going".
In truth, there are many things that we are doing right. What I think is a good reminder to patients and their families is that we are at work to help heal and to help give comfort. Sometimes this means that you are going to miss your 2100 showing of "Blue Bloods" (though I do love a good mustache)! It's not that we don't want people to feel safe, comforted with mutual trust but we ALL do want to do a great job. Personally, I want to have the opportunity to catch your sepsis before your blood pressure tanks and your organs start to shut down. Is that so much to ask?
I know that nurses have difficulty allocating their time with the increased pressure from patient flow coordinators to "treat and get them out" or to address multiple social concerns and battles between family members. It's not for lack of trying. As a floor nurse, I get more calls about a TV not working, anger at not being able to have a diet with salt, frustration that someone forgot their iPhone cord and their phone is dead, or that the internet is terribly patchy and they can't watch Netflix. Like I said before, how do we fix the idea that hospitals are not hotels but rather places of healing that warrant a focused approach on labs, tests, assessment, addressing a plan of care, holistic approaches to care and outpatient follow up? Where is the line drawn?
In the past year I've had patients elope for cigarettes who've had NSTEMIs, invited friends to visit at the bedside to give heroin or cocaine IV through a PICC line (by barring the door, mind you), and get in a full-on yelling match with nurses because we sent a patient for an ultrasound and they missed "The Price is Right".
It is a difficult line for each one of us to walk. Communication is always key, but sometimes words can fail. I've explained on multiple accounts why we do the things we do, and how our number ONE priority is patient care and prevention. At times that trumps an extra lounger in your room, or me refusing you to have take-out when you are going for an EGD in the morning.
Do Patient Satisfaction Scores Improve?
Always in the back of my mind, I want to know when (if it hasn't already happened) will our interventions of prioritizing register in our patient satisfaction scores? Is there a differentiation between patients being dissatisfied with their stay due to things in the hospital's control, or rather that they didn't get to maintain their normal routines that warranted a hospital stay that likened a Hilton experience?
I don't write any of these things to accuse patients in any way or to declare that our duties as nurses do not include ADLs and kindness in our daily care. But the chatter continues between nursing professionals of the staffing shortages, equipment issues, and the stress of meeting expectations that seem to be near impossible to fulfill.
Where do we go from here? Where is the line? What is our place?
Should the nurses get surveys concerning how their hospital allocates funds and writes up scopes of practice? Should there be a public service announcement video for each patient and their family upon arrival notifying them of the hospital's roles in patient care and what their satisfaction surveys really mean for healthcare?
I know that this article is loaded with multiple issues, it is difficult to stay on task when one thing reflects another. But with all that said, the issues facing us today ARE focused on money, are reflected by patient satisfaction surveys and are loaded with resources dwindling and the expectations rising. So, my friends, what do we do next?
