On November 11, 2008, I published an account of my own recent experience in an American hospital titled: Every Hospital Patient Has a Story: The Decline of Compassionate Care giving in American Hospitals. I have gotten many thoughtful responses from readers which will comprise a future article. But first, I want to place the care giving issue in perspective.
While hospital stays may be traumatic, most of us come out cured and alive. Some of us do not.
For years, politicians have been talking about universal health care–which I agree, we must have in America. According to one estimate, about 18,000 Americans may die each year because they are uninsured.
But guess how many insured people die in hospitals each year? An estimated 195,000 Americans or more die each year because of medical errors and negligence in hospitals. According to Dr. Samantha Collier, “The equivalent of 390 jumbo jets full of people are dying each year due to likely preventable, in-hospital medical errors, making this one of the leading killers in the U.S. See HERE. The “errors” include “patient safety deaths,” “failure to rescue,” “bedsores,” “postoperative sepsis” and “postoperative pulmonary embolism.”
But wait. An additional 103,000 Americans die because they have contracted avoidable, drug resistant hospital infections. This is largely due to a lack of hygiene. Vigorous hand washing between patients takes time. Vigilant cleaning of equipment between patient use takes time. An overworked staff has no time.
Thus, the hospital infections are avoidable. They are due to hospital staff neglect, abuse, or incompetence. This is true for physicians as well as nurses, aides, and technicians.
Thus, nearly 300,000 deaths a year in American hospitals are due, arguably, to poor medical judgment, incompetence and neglect. Perhaps if hospitals are financially penalized for these deaths, they will take better care of their patients.
In June of 2008, Medicaid in New York State announced that as of the fall, it will cease reimbursing hospitals which commit “avoidable errors” that are “identifiable, preventable, and serious in their consequences to patients.” Included are “surgical errors such as procedures performed on the wrong body part or the wrong patient,” “serious medication errors,” “complications such as unintentionally leaving a foreign object in a patient or administering incompatible blood.” See HERE. Of course, this might also encourage hospitals to cover up the cause of death.
Yes, I know: Hospitals are struggling heroically to make ends meet. Despite limited budgets, they still save many lives. Insurance companies and the state demand a horrendous amount of staff paperwork which means less time to deal with patients.
Mandatory overtime, staggering patient loads, unpleasant patients, arrogant physicians, and presumably “capped” salaries, have either demoralized or driven many good nurses out. They often become administrators or private duty nurses. Nursing has also been “outsourced.” What this means is that more and more foreign nurses, trained outside the United States, and without a good command of English (or Spanish) have created an often terrifying communication barrier for patients in distress.
Thus, many staff members, (orderlies, aides, nurses, technicians, physicians), often act as if they are indifferent to patient suffering. Many have no time to relate to patients and many cannot or refuse to do so in a humane way.
More paperwork will not solve this problem. How do we raise standards, quality control performance, and reward excellence? First, what are we going to do about the nursing and nursing aide infra-structure?
But first, let me note: We have different and higher standards for nurses, most of whom are women, than we do for doctors, at least half of whom are men. Psychologically, nurses (and female doctors) are expected to “mother” us. Doctors (and male nurses) are “fathers” whose absence or lack of bedside manner we take for granted and forgive or do not challenge. I have seen female patients complain bitterly about their pain to female nurses whom they mistreat as lowly housemaids–and I have seen these same female patients flirt with their male doctors and tell them that “everything is alright.”
I do not want to scapegoat nurses for what is a systemic problem. But I would like to ask some questions.
Why go into nursing? According to the U.S. Labor Department, registered nurses “constitute the largest health care occupation with 2.5 million jobs.” And, “employment of registered nurses is expected to grow 23 percent from 2006 to 2016.” Further, in 2006, the median annual earning for registered nurses in the United States was $57,280.00. Half of all registered nurses earned between $47,710.00 and $69,850.00. The highest ten percent earned more than $83,440.00. However, a reliable source tells me that many nurses who work at the hospital where I stayed make at least $90,000 a year—not counting overtime.
This is not a fortune but it is more than–or as much as–what many police and firefighters earn. It is certainly more than foreign-born nurses can make at home (in India, Central Asia, Africa, the Far East and the Caribbean), even when adjusting for differences in the cost of living. Brand-new nurses from foreign countries can earn five-ten times in America what they might be able to earn at home.
Second, nursing is an opportunity to obtain a green card, American citizenship, or a privileged union position. A nurse can join United Health Care workers (1199) in New York State, Massachusetts, Maryland, and Washington, D.C. It boasts a membership of two hundred and seventy five thousand health care workers and successfully fights for “limited mandatory overtime,” “fully paid family health benefits,” “job security,” and “improvements in wages and benefits.” It also protects workers from “disciplinary actions” and “layoff.” See HERE.
It is difficult to fire a nurse who is a union member and difficult to learn of serious nursing failures and abuses of power. Occasionally, the media will report that nurses have been fired for taking drugs, violating patient privacy, and for sexually harassing and abusing patients. See Colorado, Washington State, and Oceanside, CA. It is also dangerous to accuse a nurse of wrongdoing. Even if you yourself are a physician, you might find yourself suspended for doing so. See Gallop, NM.
Some nurses are still fighting for their patients. Registered nurse Adrian Zurub in Cleveland is a member of the National Nurses Organizing Committee. She sounds like the nurses I used to know and with whom I worked in the 1970s and 1980s. On June 15th, 2008, in a rally in Columbus, Ohio, she and other nurses called for “legislative action.” “Patients are dying because nurses are mistreated and overworked” Zurub said. They want a smaller “nurse to patient ratio” and claim that in some hospitals the ratio was 1 nurse for 14 patients. A safe ratio is more like a quarter of that.”
The National Nurses group insist that the corporate heads of hospitals are themselves getting rich “at the expense of both nurses and patients.”
This must stop. But given human nature and its propensity for greed, accomplishing this is the equivalent of solving the three-body problem in physics.
Nurse Terry Gallagher said: “We have restrictions on the number of kids in a classroom…and on how many can ride a bus. But there are no standards on how many patients nurses can be assigned to take care of.” Ronda Risner Hanos, a registered nurse from Dayton said: “Nurses will lead this fight. We’ll face powerful corporate opponents when this bill is introduced…but we’ll have powerful friends as well.” The AFL-CIO is expected to support the legislation known as the Ohio Patient Protection Act. Go HERE.
Most nurses do not (and cannot) spend their off duty time organizing and do not sound like Zurub, Gallagher, or Hanos.
Here is my final question of the day: Will hospital and health care improve if we allow free-market capitalism to prevail? If hospitals and insurance companies actually had to compete for our business would standards of care and coverage improve? Or if we give over more and more to government authority, so that more people will be insured and covered, will such a “fairness” doctrine actually lower standards and coverage for everyone–except for the super-rich?