Wednesday, January 25, 2006

Grouse: It's What's For Dinner

Cindy-Lou Who looked across the table at me just before report began. She widened her big brown eyes and said, "Y'know, this working-short shit is really starting to blow."

Yep. Can't put it better than that. This working-short shit is really starting to blow.

We're working short because a lot of us have been working sick, because working sick is the only way to avoid working short. (Note: that will make sense only if you're a nurse.) Now our manager's down with a cough so bad she can't eat, one of our nurses has been confined to bed by his doctor on the threat of hospital admission if he gets up, and the rest of us are sort of sniffly.

Never mind that Management did some sort of wonky air-filter cleaning thing that filled the entire hospital with the smell of burning rubber and diesel fumes. What up with that, dawg?

There's been a lot o'yakking over the last decade about our Terrible Nursing Shortage and What A Tragedy That Is and How On Earth We Can Fix It. Suggestions have ranged from higher pay and better bonuses (which might work, if nurses weren't so inculcated with the idea that big bonus = scarily understaffed facility), on-site daycare (huh? Who would want to expose their child to the bugs in a hospital?), more flexible hours (now, cutting out mandatory overtime might help), and fun little bonuses like on-site massage and cool totebags.

Can I inject a little dose of reality here?

Going back over the many books I've read on history, both general and specific to nursing, I've noticed one thing: Good nurses have always been hard to come by. During each World War, there was talk of drafting nurses; incentives were offered to civilian women who were willing to take shortened training courses and go off to serve as RNs in the military. In the 60's and 70's, there were efforts by folks who ran hospital-based programs (usually three-year courses that produced on-the-spot-trained nurses who then worked for the hospital for a time) to make their curricula more attractive to students. The only blip I remember that bucked the Terrible Tragic Nursing Shortage Trend came sometime in the 1980's, I think, and I have only anecdotal evidence for that: a nurse I knew vaguely went off to be a stock trader.

Hell, my antique medical books mourn the lack of decent nursing care in hospitals, and the difficulty of finding a nice, sober woman to come in by the day to the house.

So, basically, we're working now with the same formula we've always been working with: There are more sick people than there are folks willing to care for them. Even if we doubled the number of working nurses tomorrow, nothing would change; hospitals would simply build more wings and schedule more surgeries to take care of the endless lines of sickies outside their doors.

Let's assume that we can't change the Terrible Tragic Shortage. What could make life better for your average working nurse?

It ain't tote bags or pedicures. It's not even higher pay, though that might make a few people more cheerful.

It's people in other professions Getting A Clue.

A third-year internal med resident asked me yesterday how much break time we got during a shift. I said we got fifteen in the morning, half an hour for lunch, and fifteen during the afternoon, though we took what we could when we could.

"Can you skip all your breaks and leave an hour early?" she asked. I peered closely at her to make sure she wasn't joking. She wasn't. She simply had no clue, after years of working with and around nurses at various hospitals, what the job entails. I'm not sure what she thinks we do.

Upper management in hospitals is usually comprised of people who've either never worked in hospitals as nurses or doctors or who did so so long ago that "I walked sixteen miles uphill in the snow to get to the ward where I supervised 29 patients by myself" isn't too much of a stretch. They're management experts and efficiency experts and safety experts, but they have no real gut sense for how acuity affects staffing levels. Most of the patients that I took care of yesterday would've been dead even fifteen years ago, in ICU eight years ago; now they're on the floor in a high-acuity unit. The people in charge of budgeting for our unit have no idea what it's like to work with an open ventriculostomy or three. For them, "brain injury" means Poppa's a little forgetful these days.

I got snarked at by an attending the other day for "turfing" a patient wrong. Apparently, that means I asked for a consult from some service that I shouldn't have; there's some obscure way of going from specialty to subspecialty (for this guy, at least) that I'd not heard of before. The fact that the patient was showing worrisome signs of Some Very Severe, Life-Threatening Complications didn't faze him; he was more worried about his "turf" as regards the case.

I would love to have Dr. Turf, that internal med resident, and our Great Leader follow me for a week. Hell, even a *day*, if I could be sure that they'd actually have to work during that day. I would love for them to get a clue, in other words.

Let's be honest: nine-tenths of the cleanup work, the tidying up of loose ends that's done in a hospital is done by a nurse somewhere. Most of the emotional support a patient gets from non-family members is provided by a nurse. The nasty complications that get caught early are caught by a nurse. The wonky test results get re-draw orders written by a nurse. And those three patients with tubes draining brain juice are taken care of by a nurse who's trying to make sure they don't end up with fulminant meningitis while she's doing re-draws and fixing doctors' mistakes on paperwork.

I hereby propose National Get A Clue Week. One week out of the year, at a time of their choosing, every resident and management person, as well as attendings selected for their attitudes and indolence, would work on the floor with nurses. Full twelve-hour shift, they break when their nurse breaks, they stick to her or to him like glue.

It wouldn't solve the shortage; there's not a lot we can do about that. But maybe, just maybe, it would imbue those folks who think of us as starched white angels with a sense of what it is we do all the hell day long. And that, perhaps, would change their attitudes and actions and make our jobs a little less insane.


Anonymous said...

I totally agree. But do you really get those breaks and that lunch most days? Thanks for putting this crap out there.

Kim said...

Lunch, yes. Breaks, no, unless you consider running into the back room to grab a dorito with guacamole or a handful of popcorn before running back out onto the floor.

Anonymous said...

At some point all nurses need to unite just like physicians do and go to congress. Until that happens things will continue to be the same with small in roads here and there.

Anonymous said...

please dont dispare i know that all hospatle nurses are over woked under payed but if you were not ther alot of people would be dead .for almost 30 years ive had my son in hospitals spending 30 or more days at a time for brain cancer.and the onley ones that knew what was going on were the nurses. the only ones that could tell me what the dr. said adn what it ment in plain people talk os i want you to know that you are so appreacheated .and i got here because a nurse took the time to teach me to knit in 1977 while i wated for my son to come out of a drug indused coma. thank you.