It’s Enough To Make You … Not Get Sick
Aericans have asked for cheaper medical care, and by golly, they’re going to get it. A whole new industry, employing legions of clerks and computers, has grown up around our wish to have our bodies serviced for less. Unfortunately, amenities have to be cut to pay for the crowd of highly paid CEOs and their minions who are reducing the cost of medical insurance for your employer.
The latest to go will be the professional who has represented, for most of us, the embodiment of the humane and caring side of medicine. The medical industry is divesting itself of the registered nurse.
Four years ago, just before medicine became a commercial product, the demand for nurses seemed insatiable. But nurses are expensive. Experienced registered nurses who work in hospitals can make $40,000 to $50,000 a year.
Why hire one of them when you can get a licensed vocational nurse for just $25,000 a year, or better still, a certified nurse assistant at $15,000 a year? Dress them up in the same outfits and no one will guess that, compared with the RN’s four years’ intensive training and continuous education required for licensing, the CNA has had 18 weeks’ training during which time he or she gets really good at setting out dinner trays.
This is not to denigrate CNAs, most of whom are fine people who care about the well-being of their charges. They simply don’t have the training.
Some hospitals have established a “cross-training” approach, where lower-paid workers perform nursing tasks and one RN oversees the “crew.” It’s kind of an assembly line for bodies: One worker inserts the catheters, another does the baths, the respiratory therapist does the tracheostomy care. The problem with this approach - which saves a bundle of money - is that nurses, as they do routine patient care tasks, are continuously monitoring the clinical state of the patient. Fragmentation of care does not allow them to do this critical assessment.
A pivotal case on this issue will go to the courts this fall, when Alta Bates Hospital in Berkeley, Calif., defends itself against charges by the California Nurses’ Association that it has downgraded its nursing expertise by using lower-paid, less-trained personnel and isn’t coming clean to the public about the real purpose behind its “restructuring.”
The assumption of specific tasks by those who lack comprehensive training increases the risks for error. At Sutter Hospital in Sacramento, Calif., a life-sustaining respirator apparently was disconnected by aides bathing a patient, who died. An 11-month-old girl’s heart was fatally damaged at Rhode Island Hospital in Providence when an aide inadvertently filled a syringe with deadly potassium chloride.
Fourteen years ago, each nurse at Oakland Children’s Hospital in California, on average, was responsible for three or four patients. Today, each must look after five or six much sicker little ones, says Debbie Bayer, a staff nurse there.
Nurses are not the only ones being shoved into unemployment lines by the health care industry. Up to 10 percent of recently graduated doctors couldn’t find full-time jobs in the six months following the completion of their training, the Journal of the American Medical Association reported in March. The exception was urologists.
Does this indicate that we’re producing more health care workers than the market needs? Well, let’s look at the problem from another angle. If patients are seen very quickly, they don’t get a chance to mention potentially expensive medical concerns.
Luckily, nurses are a tough breed, and are fighting back for themselves and their patients. Their Patient Protection Act initiative, which needs many more signatures to qualify for California’s ballot, mandates that the Department of Health Services establish criteria for adequate staffing of medical facilities. It also addresses patient care issues that the lieutenants of the new robber-barons of managed care don’t mention at those nice free senior recruitment breakfasts.
We need to think about these things now. Because you can’t do much protesting about the adequacy of the care when you’re critically ill.
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