October 16, 1997 in City

Profit Centers Offer Cold Comfort

Pat Wynne San Francisco Examiner
 
Tags:column

My friend, Sue, is a registered nurse. “I hate nursing,” she tells me.

“No, I don’t really hate nursing. I hate the working conditions. There just aren’t enough of us to do the job right. I used to love to help patients but now there just isn’t enough time.”

In the past 10 years, health care has become increasingly profit driven. To find out how the new focus on dollars has affected the service providers and their patients, I asked Sue what changes she’d noticed in her 20 years as an on-call nurse.

One important difference, she pointed out, is that these days, the patients she sees are all gravely ill and they’re shifted out of the hospital in a minimum of time.

“We used to have time to prepare patients for surgery and get to know them. Now there is no time on either end. The patient is immediately operated on and gets no recovery time before he is sent home. Finished!”

Improvements in technology - surgery by means of microscopes, lasers and tiny telescopes - make some procedures less dangerous, reduce suffering and the risk of complications, and allow patients to heal more quickly.

“This is the good news,” Sue says. “But don’t be fooled. Surgery is still a very serious affair.”

After many operations, patients feel the effects for weeks and months. Mastectomy is a good example.

Yet, Sue says, “I’ve had friends who have been sent home one or two days after surgery, with drains, open wounds and with little help in how to cope with the loss of their breast. They and their families are expected to provide the services we used to provide.”

As patients are sent home sooner and sooner, families are thrown into the role of care givers. As Sue points out, most insurance companies no longer pay for home care nurses, either.

The result is that “patients and families still pay large amounts of money for a reduced level of care.”

Working conditions for nurses are complicated by a recent change in hospital staffing policies.

“In the ‘80s, hospitals tried to get rid of as many LVNs (licensed vocational nurses) and aides as they possibly could. Then, RNs (registered nurses) were responsible for the total care of all the patient’s needs.”

In the 1990s, however, hospitals want to have a “skill mix” and have introduced a team approach to patient care, with RNs, LVNs and aides on each team.

The problem, according to Sue, is that many experienced LVNs and aides lost their jobs and were driven out of the profession in the 1980s. Their current counterparts tend to be hastily trained and inexperienced.

“The hospitals rush these lower-paid workers on the hospital floor as soon as possible. Therefore, patients are getting much less experienced people caring for them.”

Consequently, “a lot less care is being given to the patient.”

These working conditions take a toll on staff morale.

“There are days when I feel that I have failed my patients,” Sue told me. “Because their physical needs were so profound, there was not enough time to take their psychological and spiritual needs seriously. Also, they were just one of so many patients I had to take care of.”

What discourages her is that the hospitals’ “rush to save money extracts a large human cost,” especially for patients and their families.

Her last words on the subject were these: “Don’t get sick! More so than not, we take our lives into our hands going into a hospital, and it costs more than ever. We really can’t afford to get sick anymore.

“Is there a conspiracy against decent health care?”

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