Submitted by Pancho Valdez
“Constant attention by a good nurse may be just as important as a major operation by a surgeon.” – Dag Hammarskjold, Second Secretary-General of the U.N., 7/29/05- 9/18/61
A major concern for both patients and health care professionals is the safety and quality of care provided in our nation’s hospitals. An issue that draw attention to that concern is the practice of hospital administrators cutting back on the number of RNs on duty at any given shift or unit in attempt to reduce costs.
Hospital management defends these practices with statements such as; “We are conscious of both patient safety and the need to reduce costs in health care.” But what most hospital administrators are reluctant to talk about is the growing concern by registered nurses (RN) with work overload that puts patients’ care and lives at risk.
Another issue ignored by hospital administrators is the notion that hospitals must show worker “productivity” to justify expenses. Almost as if our hospitals are now being run as assembly lines rather than places for the ill and injured to go to heal.
Andrew Sivac was an RN for 34 years, 20 of which he served at University Hospital (UH), a Bexar County (San Antonio) operated health care facility in the South Texas Medical Center.
Sivac stated that at UH the units are staffed by numbers over acuity, the level of care needed by individual patients or the degree of their conditions. He worked at the Medical Coronary Intensive Care Unit where a safe staff to patient ratio would be between one to one or one to two, depending on the individual patient’s acuity.
Sivac said that there were many times that the unit nurses were working one to three, sometimes one to four ratios. When he and others would express their concern to the Unit Manager it was not unusual for her to begin yelling that she was “following her boss’ orders and so will her nurses!” Sivac remembers her stating one time that she expected “blind obedience from her staff.”
In order to be able to provide adequate (and sometimes inadequate care) nurses seldom take the 15 minute break that is supposedly available. UH policy is that these breaks are to be taken, IF work loads allow! Sivac says that 95-100 percent of the time, patient acuity does not permit this and the end result is that patient care suffers as nurses work exhausted and often forced to take “short cut measures” to address the patient’s needs.
He cited an example of patients who are either asleep or unconscious being restrained both by physical and chemical means in order to avoid the patient awakening agitated and possibly pulling out IVs and other needed tubing.
The sedative Porpofal is frequently given and patients are often “over sedated.” This results in patients not being turned as needed to prevent skin break downs and not being changed in the event of being incontinent of either bowel or bladder.
Rectal “pouches” are commonly used to address patients with loose stool. These pouches are attached to the patient’s rectum and buttocks with adhesive made from Benzoin resin. The adhesive can be irritating to the patient’s skin and the pouch does not prevent spillage of stool onto the skin or the patient’s bed.
Sivac said that nurses do not like to take these measures but see no other alternative so long as hospital management remains fixated on reducing labor costs.
Another fact that most hospital management don’t want made public is that Unit Managers along with hospital administrators are given bonuses for keeping costs to a minimum. This practice does not sit well with nurses who must depend on the whims of their supervisors to receive a pay raise and who are ethically concerned about the quality of care their patients receive over the issue of cost reduction done at both their expense and that of the patients.
When confronted by these concerns, University Hospital management lays the blame on the findings of outside time study consultants who Sivac says aren’t nurses and always find a way to squeeze more work out of the nurses with less and less staff. Given the fact that these “experts” are hired by UHS management, the practice of under staffing must lie with management according to Sivac and another nurse who works at University Hospital, but asked to remain anonymous for fear of retaliation.
Speaking to nurses employed at the Baptist Health Care System this writer learned that they are working under similar conditions for similar reasons. “Hospital management prioritizes cost reduction over quality patient care according to Betty and Alice, two nurses I interviewed who asked that their real names not be used to protect their identity for fear of retaliation.
They emphasized that at the North Central Baptist Hospital where they work the hospital CEO expressed anger over an increase in calls from NCBH RNs to the state Safe Harbor call line and threatened disciplinary action if the calls were deemed by the peer review committee “not being done in good faith.”
According to the Texas Board of Nursing, nurses are not to be retaliated against for making use of the Safe Harbor program. The Safe Harbor is part of the State Board of Nursing, but the peer review committee is composed of nurses employed at the hospital in question.
Andrew Sivac, the nurse who chose to remain anonymous, and Betty all agreed that the Safe Harbor program looks good on paper, but is rendered meaningless by the fact that the peer review committees are made up of supervisors and the required 50 percent of floor nurses are usually those friendly to management or who have ambitions of becoming management themselves.
Sivac feels strongly that the only real solution to this problem is for nurses to organize into a strong union. “Unfortunately UHS nurses are public employees with no legal right to collective bargaining or striking.
Nurses in the private sector are hesitant to organize because of the weak enforcement of federal labor relations laws that are supposed to “protect” workers right to join and form unions. In California, the National Nurses Organizing Committee pushed for and saw legislation passed that mandated stringent nurse to patient ratios.
Now in California there is no longer a “nurses shortage” as RNs feel secure enough to work in hospitals without putting their patient’s lives and their professional licenses on the line.
Sivac went on to say; “I am so glad that I am now retired. Thirty-four years of tolerating abuse, under staffing, being under paid and unappreciated was enough!”
Betty and the other RN are relatively young, but expressed their uncertainty of their future in nursing. “I love being a nurse, but my sanity, my license and my patients’ safety doesn’t appear to be of any concern to the hospital’s management. It is not a pleasant situation for nurses in San Antonio or Texas for that matter,” said Betty. This sentiment was echoed by both Alice and the anonymous nurse.