I’ll tell you. Cue the music, bring in the actors. Namely, the three big ones, and the 2-3 small ones.
The big ones: Nurse, CNA, and Doctor. <– in order of importance to you, the main character.
The Small ones: Respiratory Therapy, Physical Therapy, and The Janitor. <– not necessarily in order of importance to you.
Let’s start out with a bunch of hypotheticals. Lets say that not only am I a nurse, but that I’m *your* nurse. You can already sense the compassion flowing from me, just from my writing can you not? I thought you could. We’ll get along just fine.
Second hypothetical, I show up for my shift, and take report from the nurse before me. In theory this is occurring while the CNA is getting report from the person they are relieving.
Third hypothetical, you are not a patient at the hospital I currently call my employer, but are smart enough to go someplace good. Where basic supplies, such as silk tape, IV kits, standing orders for cardiac patients, and beds for you to lie in, are not in short supply causing every nurse to run for it like its the last Tickle Me Elmo on the shelf circa 12-24-1996.
Fourth hypothetical, you have done research, you know what a Magnet Hosptial, or a Thompson’s Top 100 Hospital is, and you, being the smart and self actualized person that you are, you have actualized yourself to going to one of those.
So lets say that you are now at this fantastic place. We’ll call it General Hospital. Quite appropriate considering the amount of drama that is about to ensue.
You arrive. More than likely through the Emergency Department. (As a side note, most people who work in the Emergency Department will give you nasty looks and plot your humiliation when you refer to it as the ER. As they will quickly inform you, with words etched in acid(don’t ask whose), the Emergency Department is more than a room! So it becomes appropriate to make fun of ED instead of ER.)
But let’s say you get past that. Lets say the triage nurse takes one look at you and says, “Holy St Nightingale” or something to the effect of: You have shocked this seasoned woman/man into clutching her pearls, or whatever it is a man clutches at such times, because you look like hell. Lets say your heart rate is in the range of the 160s (normal range 60-100). Lets also say you’re having trouble breathing slowly, that you’re experiencing severe but not yet excruciating back pain, you have a fever of 103.2, and are feeling very dizzy and light headed.
So the triage nurse bumps you up closer to the top using whatever mysterious power they use to do these things.
So you wait. and get called back. A quick evaluation, a quick talk to the doc (faster than you can imagine), and they take you back. You think to yourself, hooray! Action at last. They sit you down, stick an IV in you and start pumping you full of what you assume must be good for you. Being an average person, the bag is actually labeled in hieroglyphics disguised as english. But you have trust in whats going on.
You are taken to a bed in the ER after a while. Things continue to deteriorate for you. pain increases, but they bring you nothing. Until you are found still in your bed, having asked for something for your pain 2 hours ago, and now you are sobbing (in the most masculine way you can contrive) in pain.
The nurse comes back in less than a moment and brings blessed Morphine. God of all pain medicines. Your pain subsides, barely. This scares you because normally a percocet will take one look at you, laugh, and proceed to knock you on your ass for a solid 6 hours of feel-good time. So, you’d think that Morphine being the bigger brother will send you straight to lala land. It does not. But it takes the barest edge off. Well that’s something, but you’re kind of getting annoyed at this point because its been about 4 hours and no one has really told you whats going on. You’re in pain, and you don’t know why, but the intensity is certainly enough to make you feel like perhaps you should be concerned that certain organs have taken a hit out on each other, or possibly on you.
Finally, when it has been decided that Morphine is not the god that it pretends to be, they move up to Dilaudid. Even your nurse, (Me), is reverential with this drug. And being that I’m a good nurse, I know that you have to push it quite slowly, especially on someone who’s never had it before. So I do this. Immediately you feel chemical bliss descend on your pain wracked body, making it not hurt anymore. But somewhere in the back of your head is this nagging thought of, if they are bringing in the drugs that even the nurses treat with respect, there must be something really wrong with me. But as the drug takes effect you realize that actually, everything is just fine. In fact, you might have just discovered the meaning of life in the way the light overhead shines down on you.
Unfortunately, your fears return and become confirmed when a doctor pokes her head in, says “We still don’t know whats going on. We need tests.”
So you are sent for tests to a room that is blindingly white, and has what looks to be a Faberge Doughnut in the center of the room. You can just tell that anything to do with this is going to be expensive. But you lie down and try to enjoy its incredibly extravagant taupe exterior and pray that whatever deadly emissions it emotes, you will come out of it with your sanity, and reproductive organs intact.
You are returned to your bed. At this point, something must have shown up on this Magical CT because they decide to stick a catheter in you. You begin to grow concerned, but since you’re also taking hardcore pain meds, this concern is more on the level of: huh, I wonder whats going on? Well, at least that’s the level it descends to once the excruciating pain of having a tube shoved violently inside you, where no tube has gone before. You sort of wonder if it was a bad idea to wear a red shirt that day.
You soon find out that you are scheduled for a second CT scan. This time of your chest. Still being heavily medicated, this barely registers as anything alarming, other than that you thought it was kidney problems. You return from this CT and the nurse, (Me again), hooks you up to the cardiac monitor. The logical assumption you make is that since this last CT was of the chest, and now your level of care has increased to cardiac monitoring, something must be wrong. You turn to me and ask, “What’s going on?” I tell you,”Let’s wait for the doctor to come talk to you.”
You are naturally frustrated by this reaction. Again, fortunately, you are on hardcore drugs that keep you very docile. Eventually you are admitted to the hospital. You still haven’t seen the doctor. You still have no idea what’s going on with you. You are transferred to the Cardiac Unit where they will continue to monitor you. In a unique twist of the space-time continuum, I continue to be your nurse.
You notice that your nurse looks about as stressed as you feel. You also notice that over the course of the next 12 hours, (lets hypothetically assume that your transfer to the Cardiac Unit occurred at exactly shift change) your nurse makes it into your room a total of 4 times. You also notice that the CNA is conspicuously absent from your room, but can be heard talking about his personal life just outside your door. You put on your call light frequently, but your nurse, Me, takes forever to get to you. You grow annoyed, and rightly so. This is a scary experience for you, there are tubes coming out of places that tubes don’t normally exit from, and you still haven’t seen the doctor.
Well fortunately, just as you are about to grow upset and write a letter to your senator complaining about the state of healthcare and can he please get off his overpaid lazy ass to do something about it, the doctor walks in, and all thoughts of how messed up the health care system is are supplanted by thoughts of self preservation in the face of whatever the doctor is about to reveal to you with his vast repository of specialized knowledge.
He tells you your CT scans came up clean. They still don’t know why the pain is occurring. But they are going to continue to monitor you, and promptly teleports out of the room. You realize what he just told you boils down to “We don’t know what’s wrong.” You call me and ask for more heavy narcotics to quell the rising panic attack. I oblige.
Now, from the nurse’s point of view, this is what has occurred.
I arrived for my shift, and discovered that my assignment was larger than usual. Which means that I will be stretched thinner than normal between 5 patients. Also, three of which are considered “primaries”. This translates to: I have no help with these patients, I must get all vital signs, empty all catheters, clean up any incontinence, get any and all ice water etc, on top of normal care.
I realize that if you break it down, and subtract my 30 minute lunch from the 12 hour shift, (which i don’t get paid for whether or not I have the chance to take it) this leaves me with 11.5 hours to divide equally (we hope) between five patients. This comes out to 2.3 hours. Oh but wait, I still have to take report, which takes another 30 minutes. So now we’re at 2.2 hours. So thats 126 minutes I can spend on each patient. During which time I must review the chart, make sure the previous shift did not miss any orders, review your medication list, make sure you’re not being given anything that could interact, or that you are allergic to, etc. Also, since we live in a state of paper charting, I must spend at least part of this 126 minutes writing a narrative of every single little thing that I do over the course of my shift, in order to cover my ass in the event that you decide to sue me, or the hospital. Charting takes at least 10 minutes for every one minute that I spend in your room. Because I must chart everything that is said, observed, performed etc. So this gives me roughly 15 minutes to actually interact with you in order to get my job done. However, remember that I now have to perform everything for my “primaries”. This is unfortunately going to eat into the time that I would normally be spending in your room. Not to mention that if something goes wrong with one of the other patients, let’s say for instance that they aspirate on something, this will also eat into the quality time we would spend together. Because I will now be suctioning this patient, charting in excruciating detail the time this event occurred, what was observed, done, said, time I called the doctor, what the doctor said, when I carried out his orders, etc. Not to mention calling the doctor, waiting for him to call back, getting orders, carrying out those orders, writing them in the chart, passing them on to the rest of the team (Respiratory Therapist, Physical Therapist, etc) and all that this involves. So at the end of the shift you are likely to have seen me for about 5 minutes. Long enough for me to ask you a bunch of questions which seem pointless, such as: are you dizzy? (No, you moron, I’m lying down in bed.) Can you wiggle your feet for me? (What am I? A Toddler? Yes I can wiggle my feet!) etc. And I also gave you some drugs. Hopefully you’re familiar with them because as much as I like you, I probably don’t have time to explain what they are to you.
So in a nut-shell, in an attempt to increase profit, hospitals are assigning more patients to their nurses, and less CNA’s, (because lets be honest, why pay two people when you can just pay one?) so that basically you get the minimal care needed in order to make sure you survive. And then you are charged several thousand dollars even after your insurance pays for most of it. But fortunately you can say: Well my life is of unlimited value, I’m happy to pay whatever I’m charged, and I’m just grateful to be alive.
However, it could be done better. In fact, most Magnet and Thompson Top 100 hospitals are much much better. Patient load is usually capped at 4, with 5 max if you have an easy load of patients and they get an admission. There is always a CNA for every patient, and due to the decreased level of stress this brings about, nurses are much more willing to help each other, and therefore your quality of care is better.
Point being, healthcare for profit results in a decrease in quality of care and you are left feeling like maybe you should have just stayed home and hoped and prayed you got better.
~Whyspir
Kind of like this, except without the hat.
May not be an entirely realistic depiction. Also, proof that I don’t have Photoshop skills.
Yeah, that could have been prevented.
