Wednesday, November 30, 2011

A Nurse is a Nurse is a Nurse?

Many years ago, I was a nursing student, pregnant with twins. I was placed on bedrest shortly after graduating, and ended up going into premature labor because of food-poisoning, which we later learned was Listeria. The boys were born 8 weeks early, were both on ventilators for a week, and stayed in the neonatal ICU for about 5 weeks before we could bring them home. My experience mothering those tiny boys inspired me to choose a position in the neonatal ICU, and eight months later, I started working. Most RNs fresh out of nursing school do not go straight into ICU, but I couldn't think of anything I wanted to do more. It was very challenging at first, and scary! I was part of the neonatal resuscitation team, which involved attending high risk deliveries as well as C sections, and intervening in whatever way necessary to stabilize a sick or premature infant. The neonatologists in our ICU were quite progressive: we were on a first-name basis with one another. We were permitted to become checked off in a variety of procedures, such as arterial and umbilical line placement and needle decompression of a punctured lung, in addition to ventilator management and routine care of these sick babies. Because of the nature of our work and our passion for it, we all became very highly specialized with a unique set of skills. Then, a for-profit, managed care organization took over our hospital. This brought about many changes in personnel and procedures, the most disturbing of which was the notion that "a nurse is a nurse is a nurse." For us, this meant that we were expected to cross-train in labor and delivery, another highly specialized branch of nursing. This was an absolutely preposterous, and potentially disastrous, plan. We were expected to spend three 12 hour shifts in labor and delivery, working alongside with a preceptor, and at the end of this 36 hour period, voila, we were going to be obstetric nurses! At the time, I was finishing up my bachelor's in nursing, and taking chemistry and physics courses in preparation for application to medical school. The internet had only recently become widely accessible, and I started doing a bit of research into cross training. What I found didn't surprise me; there were a wealth of papers already written on the subject, many of which focused on concerns about patient safety. The statistics on cross training weren't good: patient safety was jeopardized, job satisfaction went down, and the quality of care did not improve. I think what bothered me the most was the idea that we were now being perceived as warm bodies to fill a slot, instead of the professional, specialized nurses that we were. I compiled the statistics into a letter to our director of nursing, explaining why I would not be participating in the cross-training experience. Many of my co-workers initially signed the letter, but then, whited out their signatures for fear that they would lose their jobs. I was a little worried, too, but felt I had provided solid evidence to prove my point. A couple of days after receiving my letter, the director of nursing called me for a meeting. To my surprise and relief, she agreed with me on this issue. Shortly after that, I got accepted into medical school, and left nursing altogether. I think this incident was probably the genesis of my deeply rooted commitment to patient advocacy and professionalism...the idea that 36 hours of training on labor and delivery would make me competent to care for obstetric patients was just so incredibly absurd, dangerous, and disrespectful that I simply had to fight back.


  1. There are so many insidious abuses perpetrated on nurses all the time. Thanks for sharing this one example. Sadly, nurses are not of the mindset to protest thus the abuses perpetuate. (THAT is another long dialogue). Ultimately, patient safety is compromised...which really is your point here.

  2. Kris,
    This is awesome! If a for-profit, managed care organization does things like this to save money, don't you think the government would do this and more? How can things like this be circumvented?

    --Lisa Cadora

  3. Great post. The problem now a days is that the only thing that matters is the bottom line. The almighty dollar. There is a hospital not too far from here that gives bonuses to all the administrators every year because the hospital is in the black at that time of the year. But, when it is time to give raises to all the employees that have actual hands on care to the patients the hospital is losing money and can't give raises. Unfortunately, patient care went out the window a long time ago.
    Orange sleeper

  4. @ Lisa, wow, now THAT is a loaded question! The short answer is that i don't think there is a perfect system. That being said, i am in favor of a single payer, publicly funded health care system which permits equal access to all Americans. This concept has posed a great deal of fear and loathing in our capitalist society, especially among the business people who are currently running the show: they stand to lose the most. Let me assure you, it's not the doctors who are getting rich, it's the hospital and insurance CEOs! Canada's system works pretty well, and the Canadian physicians I know are paid decent salaries. My Canadian relatives don't complain about their healthcare, and they don't understand why national healthcare is such an issue here. I think the government has more checks and balances than independent insurance companies do, and I would like to think there would be far less corruption in publicly funded healthcare than we are currently experiencing. I find it abhorrent that healthcare is considered an "industry", sort of like fast food. I do NOT consider my patients to be customers because this negates a very unique doctor-patient relationship. Of course, national health care would require a paradigm shift for the American public: they would be required to take a much more active role in preventing disease and managing their health than they are now. By and large, Americans expect to pop a pill or receive a procedure for what ails them, without having to take any personal accountability for making lifestyle changes and modifying risk factors. Staying healthy takes personal commitment, and this may be one of the biggest obstacles to overcome. Honestly, I don't understand how a 500 lb person will benefit from a knee replacement; they are simply too obese for a new knee to improve his/her quality of life to any appreciable degree. I think that patient selection is very important, and that we shouldn't operate just because we can.

  5. Thanks, Kris. You are so right about how inappropriate it is for healthcare to be handled as an industry, and about how we want to pop a pill for everything instead of taking responsibility for our own bodies.