I've been a nurse now for 13 years. 13 freaking years. That sounds like such a long time. It's definitely the longest single job I've ever had in my life.
It hasn't always been easy...in fact, easy is not a word I would ever use to describe nursing. My first year of nursing felt like I was running the gauntlet. There were sleepless nights, never-ending days, and there was nothing that could have prepared me for the physical, emotional, and mental stress that comes along with caring for people who are sick. But through it all, the bad days, the good days, the long hours, I managed to persevere and to become, in my opinion, good at what I do. I like people, I like medicine, I like trying to find a solution to make people feel better and to live healthier lives. I thought that working with patients at the bedside was something that I could do for the rest of my working life. The changes that I've seen in healthcare in the last few years have me seriously questioning the logistics of that idea.
Back when I started nursing, I felt that nurses received a great deal of respect, both from patients and from their peers in healthcare. Granted, patients are not at their best when they're sick...they tend to be sullen, snappy, and generally dissatisfied with most things pertaining to their illness and treatment. But for the most part, they were able to rein in their negativity and try to work towards a solution with their healthcare team. Throughout the years, I've worked side by side with doctors, lab techs, radiology technicians, and many other forms of hospital personnel, all for the good of the patient. I don't feel that I'm any less respected by my coworkers these days, but the respect I get from my patients has plummeted significantly, and I've almost been driving myself crazy trying to get to the bottom of it. I've been wondering if it's me, if it's the hospital I work for, the unit I'm assigned to...or if it's something more, something bigger, something pertaining to healthcare that is rapidly on a course towards something ominous.
Healthcare is very quickly becoming a business. Well, it's always been a business of sorts, but it's becoming more so these days. I've worked in some hospitals where they refer to individuals seeking care as "clients," rather than "patients." Many think it may just be semantics, that the two are interchangeable, but the implication I see in changing the name has ramifications that go along with it that we are just beginning to see, and will continue to see with increasing consequences as the years go on.
For one, a client is someone who seeks out the expertise of someone in a certain profession. They are paying for that expertise, and they have a say in whose expertise they commission. It is implied that a client knows a little something about the professional who they are commissioning, and that they have an idea of an expected outcome, and more often than not, that outcome will be a positive one. A client is also someone who wants something, but who doesn't necessarily need something. For instance, if a person wants to put granite countertops in their house, they find someone who specializes in granite countertops. They work together with this person to find an outcome that is favorable to the client, and they proceed accordingly. Sometimes things don't go as planned, and a different plan is drawn up to remedy those variances. Typically things can be resolved with little to no harm to the client. And typically, everything is done within reason to assure the complete satisfaction of the client. In the event that a favorable outcome is not reached, there is typically money or additional services provided in exchange for their satisfaction.
When a person comes to the Emergency Department of a hospital with an ailment of some sort, like abdominal pain, they don't know what is needed to treat them. They don't know what's wrong with them. They don't know the testing procedures, the specialists, or the care involved in determining the cause for their pain. All they know is that they are in pain, they don't feel good, and they want to feel better. Becoming a "client" of a hospital doesn't guarantee that their problem will be solved, but there is a very real possibility that it could be. And here is the difference between abdominal pain and granite countertops...there is a very real possibility that the abdominal pain might never be fixed. There is a very real possibility that a temporary fix might be obtained, but that the problem night resurface again in days, weeks, months, or even years. There is a very real possibility that the patient might die from their ailment, or even the treatment of that ailment. These are all outcomes that happen in hospitals every single day. Not all of them are favorable, but not all of them are unexpected. Patients have come to expect that after years of self-abuse, they can come to the hospital when their bodies are falling apart and that we can fix them. Sometimes we can, sometimes we can't.
There is this culture in healthcare known as Patient Satisfaction, and it's revolutionizing the healthcare industry, but not for the better, in my opinion. Hospitals and their staff are graded on a patient's perception of their experience by a post-hospital survey. Their ratings are known as Patient Satisfaction Scores, and they are tied to hospital reimbursement and overall hospital ratings on a national scale. They're very quickly becoming a very big deal, and hospitals are pulling out all the stops to try to rate an "excellent" in as many fields as possible. And honestly, I think that Patient Satisfaction is important, and that there is a place for it the healthcare industry, but I don't think that it should have financial ties. There are several problems with this model. First of all, it's a hospital. No one goes to the hospital because they want to be there. It's already a place that has negative associations. Assume then, for a minute, that the patient is suddenly hospitalized and diagnosed with a life-altering ailment. His treatment consists of tests that are expensive and uncomfortable. Couple that with the fact that the patient is required to miss meals for these tests, that his test times keep changing because emergencies take priority, he is woken up in the night for medications and treatments, and that he can't see a specialist until Monday because that particular doctor doesn't work on the weekend. How likely is he to give favorable scores for his care? Not very. Even if we do everything right, his perception of his care is what dictates his overall satisfaction.
We now live in a culture of instant gratification...smart phones, wifi, the internet, Amazon Prime...everything is fast, efficient, and almost instantaneous. Patients are under the illusion that healthcare ought to be the same. The idea of patience has completely gone out the window when it comes to healthcare, and it's only getting worse. Patients will bring up WebMD on their phone, trying to dictate their course of treatment as though they are on equal footing with the doctors who have spent a significant portion of their lives learning how to treat these very ailments. Patients latch on to any information online that resonates with what they already believe to be wrong with them, convinced that the medication we are giving them is causing itching and headaches, but it's inappropriate of me to suggest that their skin might be itchy because they haven't bathed themselves since admission, or that their headache is due to the fact that they haven't had coffee in 3 days. They want medications, they want a cure, they want to feel like something is being done when sometimes all an ailment needs is time and support. I've had patients yell and swear at me because they are under the impression that once their MRI has been completed, it should be read instantly and their results should be presented to them by the time they get back to their patient room. I've seen MRI results before. It's nothing but black, grey, and white blobs...I can't make sense of it. The doctors who read these scans are brilliant, and it takes time to interpret the scans to make sure that nothing is missed. But patients aren't concerned about that. They want everything to happen right now, or they're going to complain. And what happens when things are rushed in healthcare? The same thing that happens when you rush anything else in life...mistakes are made.
Patients complain that our jello selection is poor, that the TV channels are inept, that they don't like their roommate, that interrupting them to take their blood pressure is annoying. What they don't understand is that I'm a college educated professional who has worked with some of the most brilliant minds in the healthcare industry; I know things about their illness, their diagnosis, and their treatment that they can't even fathom...but I'm "just a nurse." I'm not taking their blood pressure in the sole interest of annoying them. I monitor their vital signs and their lab results and their medications and I am expected to react accordingly the instant that something is amiss. And I do all this while juggling the care of multiple patients at a time. One error on my part could result in patient injury or death; interrupting my train of thought could very well have dire consequences for themselves or someone else. Pulling me aside to complain about the jello or the TV takes my valuable time and concentration away from another patient who might be struggling with something serious.
And here's the kicker...I have to treat every jello complaint, every TV gripe as if it were something legitimate that I actually cared about...I have to pretend to care for the sake of our Patient Satisfaction Scores. I could care less what you think about the jello or the TV. I hate that there are TVs in patient rooms, because patients would rather watch TV than listen to their plan of care. They would rather watch Duck Dynasty than hear about how smoking 2 packs of cigarettes a day for 40 years is the reason they can't breathe, and that there's no treatment for poor health choices.
I can't remember that last time I had a full shift where every patient treated me with respect. It just doesn't happen anymore. I am their servant, I am the reason their MRI hasn't yet been read, I am the reason the jello selection sucks. According to the patient, everything that goes wrong while they are in the hospital is my fault, because I'm the nurse, I'm the beat-up-boy, I'm the idiot who can't get it done. And to be quite frank, I'm sick of it. I'm tired of being disrespected, I'm tired of being treated like a second-class citizen, I'm tired of being treated like I'm stupid, I'm tired of going home emotionally and mentally exhausted from having to cater to ridiculous demands and poor attitudes all night long. I'm tired of working for healthcare systems who don't support their own staff, who legitimize complaints of unreasonable individuals and penalize us mentally, emotionally, and financially for it. The problem with treating healthcare like a business, and patients like clients, is that patients now have this perception that everything can be fixed. And not only should everything be fixed, but it should be fixed within a time frame that is dictated by the patient. Failure to comply with the patient's timeline results in unfavorable Patient Satisfaction Scores, which then affects hospital reimbursement, which then trickles down to the salaries of everyone who works in the hospital. What incentive is left for me when my effectiveness as a nurse is being graded by people who place jello flavors higher on the list of importance than adequate, safe, and effective healthcare?
Human bodies are not granite countertops: there is no money-back guarantee or extended warranty on your appendix, or your heart, or your endocrine system. The longer you survive on this earth, the more chances you have for your body to fail. That's reality. And the reality of healthcare is that it's not going to fix everything that ails you, but given a decent amount of patient compliance and some modern medical techniques, it might be able to buy you some time and comfort. That's it. The fact that we've let healthcare advance to the state it is, where a patient who knows nothing about medicine is the one calling the shots is tragic, and I'm not sure that it's something I want to be a part of for the long haul.
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