Nation/World

Nurse Struggles With Rising Burden Health-Care System Hurts Patient Care, Rn Says

FOR THE RECORD: 1-28-98 Nurse layoff correction: The licensed practical nurses laid off at St. Luke’s Rehabilitation Institute in August were not replaced by less-skilled personnel. A story in Sunday’s paper indicated otherwise.

Linda Fadeley juggles ice chips, morphine and a forest of paperwork as she zips down the hall, a pinball of a woman powered by new tennis shoes.

She helps patients walk with IV poles as crutches. A quick hug for one, a tug at a robe of another, then she’s off, making sure a third has a new IV bag.

She tries to ease one patient’s second thoughts about surgery. She gives cotton-mouthed patients the ice. She watches bowel movements with the interest of a new mother.

This is an average day for Fadeley, a registered nurse on the 4-North wing of Sacred Heart Medical Center. The patients here are recovering from general or vascular surgery.

Fadeley and a certified nurses aide are caring for six patients. She is one of seven registered nurses on the unit this shift, helped by three nurses aides and two licensed practical nurses. There are 35 patients on the unit. Every bed is full.

Fadeley is 47, two years older than the average registered nurse in the country. She’s worked at Sacred Heart for 21 years and has lived the changes in health care.

“The patients are sicker now,” Fadeley says. “A lot of patients are frustrated by the system, and justifiably so. It’s up to the nurses to explain why things are the way they are. And sometimes, the nurses don’t even know.”

Nurses at Sacred Heart have been working without a contract since Dec. 31. They are considering what’s being called the final offer from management.

Administrators want contract changes they say will help Sacred Heart compete in the increasingly cost-conscience hospital industry.

For example, management wants authority to use more unlicensed staff and to put nurses on mandatory call at times.

Nurses fear the proposals would replace skilled employees with lowerpaid aides, increase heavy workloads and harm patient care. They also complain that wages are falling farther behind those paid at comparable Seattle hospitals.

The nurses will decide whether to accept the contract on Feb. 4 and 5. Union negotiators are recommending the offer be rejected, and say a strike or picketing is possible.

Nurses and administrators at other area hospitals are watching. Deaconess and Valley medical centers base their contracts on Sacred Heart’s, and Holy Family nurses start negotiations next month.

Nurses nationally say they are frustrated by a health-care system that rewards hospitals for moving patients out the door quicker. Only the sickest spend the night.

At the same time, nurses say they’re working faster and caring for more people with less help. They say they no longer have time to teach patients about their health.

A national survey from 1996 said almost nine in 10 nurses polled were seriously concerned about cost-saving practices eroding patient care.

“I have to say nurses felt like they were crying in the darkness for a while about how care was deteriorating,” says Judith Shindul-Rothschild, the assistant professor at Boston College who did the survey for the American Journal of Nursing.

In the same survey, most Washington state nurses said care in their hospitals was very good or excellent.

Starting the day

Fadeley is one of 1,137 registered nurses at Sacred Heart.

Her day is punctuated by ringing phones and beeping pagers. Her fashion is functional, toothpaste-white Easy Spirit tennis shoes, white pants, a gray button-up shirt and a blue stethoscope for a necklace.

She arrives at the hospital just before 7 a.m. Along with other unit nurses, she listens to the daily report from the night staff.

Then Fadeley starts assessing each patient by filling out a checklist on every one.

Don McBride, who is 69, has been in the hospital since Christmas Eve, and his family is trying to work out a visiting nurse so he can go home.

Another patient is scheduled for surgery.

A third, Frank McCauley, is a 61-year-old retired firefighter who will be leaving the hospital soon. He’s recovering from surgery to the aorta and the main artery that supply blood to his lower legs.

His roommate, 78-year-old Conrad Neste, had a small bowel resection.

Next door is Gertie Zeiger, who has pancreatic cancer. She is 64. The hospital is trying to make her comfortable so she can go home, but she still can’t eat.

Zeiger’s been through five roommates since she came into the hospital on Dec. 31. Dorothy Cole is the sixth. Cole is recovering from the same surgery McCauley had. She’ll go home soon.

Hospital work moves in fast motion. Nurses cram 10 tasks into a minute, running here, there, answering phones and talking about patients.

Unexpected problems crop up. An aide sits an entire shift with a man who woke up at 4 a.m., yanking at his life-saving tubes.

A woman who isn’t supposed to eat anything walks off the ward for the second day in a row. When she was caught the first time, she was eating an ice cream sandwich, cookies and Lifesavers.

Checking and rechecking

Fadeley quickly moves from patient room to nurses station to drug cabinet to supply room.

She calls patients “honey” and talks about giving them “TLC.”

“Did you get breakfast?” Fadeley asks McCauley loudly, because McCauley’s hard of hearing.

She then talks to the patient scheduled for surgery, who’s now having doubts about the operation. Fadeley and a doctor persuade the patient to have the surgery.

She checks Cole’s medical card. She checks and rechecks medicine orders. She checks doctors’ orders that a secretary has transcribed. She tries to guard against error.

Neste needs a new IV bag. Fadeley heads for the supply room, looking for the right bag.

“I don’t have an LPN working with me now, which would be nice,” Fadeley says. “If I had an LPN working with me, she could give most of the meds, hang the IVs, just do a lot of things the nurses aides can’t do and aren’t qualified to do.”

A registered nurse has more training than a licensed practical nurse, or LPN. An LPN has more training than a certified nurses aide, who helps with patient hygiene and checks some vital signs, but can’t give out medicine.

Nurses are worried that LPNs are being replaced by unlicensed nurses aides. This national trend appeared in Spokane at St. Luke’s Rehabilitation Institute, where all the LPNs were laid off last August.

‘Make you feel special’

Fadeley ducks in to see McBride, the longtime patient, and talk about arranging a home-health nurse. His room is a shrine to family, with two bulletin boards of photographs and cards and a counter of family games.

McBride’s wife worries that he’s still being fed through a IV nutrition line in his arm. “I thought he’d eat something or drink something here before going home,” she says. “But it doesn’t look like it.”

McBride is the type of patient who used to stay longer in the hospital. Now, he’ll be sent home with the nutrition line, one of the legions of patients turning their living rooms into hospital rooms.

Back in the hall, Fadeley puts her arm around Zeiger, the cancer patient, who’s taking a walk. “OK, honey, don’t go too far,” Fadeley says.

Zeiger walks whenever she wants, watching the nurses zip by.

“The thing that’s so amazing to me about them is they can have so many people around and yet they make you feel so special, like they’re yours alone,” Zeiger says. “I don’t know what they’re paid, but they’re underpaid at twice the price.”

At Sacred Heart, a nurse starts at $16.34 an hour. A nurse with 25 years of experience makes $26.82 an hour. Nurses at Northwest Hospital in Seattle start at $17.19 an hour and make $31.69 an hour with 25 years of experience.

Nurses rarely strike over wages. At Sacred Heart, nurses say they’re more concerned about staffing than pay.

“There’s nothing wrong with economic strikes,” says Julie Pinkham, labor relations director for the Massachusetts Nurses Association, which saw four strike votes in the past year.

“But for registered nurses, what pushes them is patient issues. It’s not a field where you feel comfortable being mediocre, because it means that people aren’t getting the care they need. There’s been so much turmoil and change, nurses are at the end of their rope.”

A late lunch

Fadeley goes to lunch about 12:25 p.m. in the staff break room. She heats up a taco and cuts up an apple, and together with other nurses watches “All My Children.”

Another nurse grabs her after 45 minutes because her patient has returned from surgery and is angry with the doctors.

“I feel sorry for you,” the patient tells Fadeley. “The nurse gets stuck in the middle.”

Fadeley pages a doctor, and then checks in with two other patients.

Her day almost done, she goes into a room cramped by boxes of Christmas ornaments, Halloween decorations and walkers. She talks into a tiny tape recorder at a small desk and describes her patients for the next shift.

She gives up her beeper and key to a nurse on the evening shift, then visits every patient once more. Zeiger is surrounded by her family.

“She has pancreatic cancer, you know,” says her husband, who marks off every hospital day on a calendar on the wall.

Fadeley finally talks to the doctor she paged, and leaves the hospital for the day at 3:45 p.m. to go to her yoga class next door.

“It’s the max,” she says. “It’s definitely, definitely the top level of patients we feel like we could handle. Today was really good.”

But after yoga, at 5 p.m., she’s back at the hospital for another half-hour to make sure the patient who was angry after surgery is OK.

“I felt guilty,” she says. “I don’t like to leave patient issues for other people to resolve.”

The surgery patient left for home in the evening. The other patients trickled home during the rest of the week. McBride still has an IV nutrition line, and hospice, which cares for patients with less than six months to live, visited Zeiger later in the week. , DataTimes ILLUSTRATION: Color Photo



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