Nursing Voices

Tuesday, June 26, 2007

When Nurses Sell Out


This is a cartoon from a book that I bought at my local thrift store for 10 cents. Yep, I’m a big spender. The title of the book is, Nursing in Today’s World: Challenges, Issues, and Trends by Janice R. Ellis and Celia L. Hartley. It’s the fourth edition, and it was published in 1992. I bought the book because I liked the pictures. Take this example for instance. This is what I look like when I can’t sleep because I’m stressed out about work. I want to give good patient care, but it’s getting harder to do everyday. Nurses are asked to do more with less time, less staff, and less money.

When did things start going wrong? I was working at a hospital in the Midwest when HMOs came out. I noticed a red dot on the side of a few of the charts, and I asked what the red dots meant. My nursing manager explained that those charts belonged to patients that were members of a new HMO, and it was our job to get those patients out of the hospital ASAP so the hospital could make more money. I was shocked. Back then, saying something like that was blasphemy, but now it’s standard operating procedure. It’s no secret; the health care system is more focused on making a profit than it is on delivering good patient care.


I know that I am going to offend some people by saying this, but I don’t understand how nursing mangers can do their job within today's profit driven health care system. I’m not suggesting that every manager is in a league with Satan, far from it, but I’ve known a few mangers over the years that have sold their soul to the devil. Look at the unit manager in the cartoon. She looks like she’s sleeping well at night, yet she's telling the staff nurse that her first priority must be cost containment. I don't remember cost containment being mentioned in the Florence Nightingale Pledge. The patient is always the nurse's first priority. Good nurse mangers stand up for their staff and patients. They burnout quickly because their job eats away at them. The bad managers sell out and they seem to stick around forever.

I have no room in my nursing practice for sellouts.

9 Comments:

Blogger poody said...

this is why I do not work in the ospital anymore money over pt care sad but true!

4:06 PM  
Blogger Kris said...

We must've been on the same brainwave, because I just had a blog last week about bottom line vs. what's best for the patient. With my company in a legal battle with a prominent insurance provider, it's been rocky around here.

6:30 PM  
Blogger Forgotten Blue Line said...

We had a psych patient in the ER this week. The psych liason would not talk to the patient until their insurance called back. The patient was talking to her doctor, doctor Bob. Bb was a nice guy guy oh and did I mention he was green and she could only see him. They let her sit alone with Bob for hours until her insurance called. I sat with her until the psych liason got off her fat butt and spoke with the patient.

I understand what you are saying in this post.

12:05 AM  
Blogger Student Nurse Jack said...

If nurses won't stand up for their patients, who else will?

Bottom lines are important, but they shouldn't steer standards of practice on patient floors. And clever coding or acronyms are transparent - patients know when their care is being dictated by the almighty dollar. They're sick or injured, not dumb.

Our instructors refer to that time in the future when we'll be nurse managers. From what I've read on nursing blogs and seen in clinicals, I can't imagine myself ever wanting that job for the same reasons the woman in your cartoon can't sleep.

1:41 AM  
Anonymous RN in KS said...

I am conflicted about something - maybe you can help me out.

Sometimes I show up to work a shift in my ER and find that I am the charge nurse, and I only have a new grad to work with. Or a weak PRN nurse.

My gut tells me I should refuse to work in such a dangerously understaffed environment, but I will lose my job if I show up, then go home.

I worked a shift from hell one Saturday, and seeing that it would be the same Sunday, I called in. Got in big trouble.

Advice? Opinion?

8:40 PM  
Blogger Doc's Girl said...

I love getting good books for that cheap. :)

Too sad what goes on in the medical world...you think that managers would know better than to let such horrific things go on. :( With the bf telling me even more nightmares with other docs, I wonder if it will ever change. :(

9:05 PM  
Blogger Martyne said...

It's good to come across someone with integrity. Not many of us left. Health care should not be about money. It should be given whatever it needs to get the job done.
This is also official notification that you have been tagged by me to play "Eight Dirty Little Secrets", should you wish. Visit my blog to get all the details.

3:11 AM  
Blogger hannah said...

I just got back from a short stint IP in a hospital that I remember having a really, really good program. (Both adolescent and adult.) That was four-five years ago and, wow, have things really changed for the worse. They shut down the adolescent ward -- I assume because they can't afford the patient:staff ratios -- and the partial program. What used to be 6-7 hours of programming every day is down to three groups. They used to have a great art-rec-ot program covered by three different staffers -- cutbacks have merged it all into one person and one room. (Insurance won't cover rec therapy anymore. Hell, they won't even let us go up for fresh air where the old patient smoking area used to be.)

Unless you were over-medicated and could sleep all day, psychotic enough to keep yourself entertained, or depressed enough that you could stare at the tv for 12+ hours a day...but hey, I think I lost weight with all the pacing. :P

10:39 AM  
Blogger Mother Jones RN said...

Rn in KS:

I would run like hell, and get out of that ER. Your hospital is setting you up for a lawsuit, and you better believe that your employer will not back you up when shit hits the fan. Your nursing license and your patients are more important than your job.

MJ

1:39 PM  

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