In the spirit of learning through social media, I’m inspired to follow up on Dr. Eric Levi’s post on The Dark Side of Doctoring.
In case you haven’t read about it, it is regarding a physician who committed suicide. It is about how something is wrong with the basis of our healthcare system. It’s about how nearly 1 in 12 people who go into healthcare — to help people — end up needing help themselves because of our system. Our system continues to fail us because we push people to — and then beyond — their limits.
It is not simple enough to say, take a mindful minute.
It is not simple enough to say, just take a break or two.
It is not simple enough to say, get the help you need. Because even when we are surrounded by the resources that we need, we still fail. People often see a healthcare provider within 30 days before committing suicide.
We are in a culture where it is expected to be short staffed. We are in a culture where it is expected to:
- squeeze each healthcare provider —
- do something a specific way dictated by people who have never taken care of patients before,
- refuse to discuss changes to an OR schedule because it’s mandated by the administration,
- take call and expect to be a fully functioning person the next day.
It is one thing to be resilient. It is another thing to damage the human spirit.
One of the worst experiences in my career started at the beginning. I was a brand new nurse working at the nursing home/rehabilitation center. The LPN (licensed practical nurse) who worked there for years, knew her residents, knew the medications that the residents received. But one day, she called in sick. Of course, that meant I had to give all of the medications. 50 residents. 6 with PEG tubes. In 2 hours.
It takes at least 5 minutes to verify the resident’s name, the medications in the paper copy of the medication records AND the electronic medical record, give the medication, wait for them to swallow. Nevermind that medications still needed to be popped into the cup. Nevermind that I had to find each resident (because they do move around). And the patients with PEG tubes often require more time to crush and dilute. And don’t forget that when the tubes get clogged that it took additional time to rinse.
5 minutes x 50 residents = 250 minutes. Yeah, I was on a path to failure.
By the time I finished giving the morning medications, it was already time for noon or afternoon medications to be given. I didn’t go on break (no one was there to relieve me). I didn’t eat lunch. I didn’t have any support. I cried that day. Shortly after that, I never went back again. I was lucky enough to quit.
I couldn’t deliver quality nursing care. I felt that I could lose my shiny new license. I knew it wasn’t the right way and I knew I didn’t want to practice this way. I didn’t have any support.
And this situation doesn’t just apply to me. It applies to nearly every nurse giving medications. Giving the appropriate amount of time for each nurse to talk to their patients regarding their medications, their medical condition, and spending time with them when their loved ones aren’t around is vital. Giving each nurse the appropriate patient to nurse ratio is so vital.
The appropriate patient to nurse ratio gives the nurse more time, effort, and energy to take care of each patient. There needs to be more time
- to provide nursing care,
- to educate,
- to prevent medication errors, infections, falls, deaths,
- to question, coordinate and provide treatments,
- to monitor the patients’ status,
- to be the patients’ advocate, and
- to be a resource for patients, their families, and other healthcare providers.
Michigan is currently pushing for a Safe Patient Care Act to decrease the patient to nurse ratio. If we want to reduce readmissions, preventable deaths, and provide safe and quality care, then we should pass this act. There have been multiple studies that prove this to be true. We need to care more about patients than the bottom line.
Changing Culture
The healthcare culture needs to change. To take care of others, we must take care of ourselves. But we cannot take care of ourselves if the culture does not allow us to do so.
We value being a hardworking person. That’s why we say it’s ok to do overtime, then being on call, then being at work the next day. That’s why we work way over 40 hours a week — pushing 60-80 hour workweeks.
We value being helpful. We want to help patients, and if we don’t do overtime, then we would be abandoning patients.
We value money. That’s why hospital administrators short staff the hospital and push up their profits.
These are our primary drivers. Instead, we should shift our fundamental values to:
Healthcare providers’ health.
- Valuing the healthcare providers’ health should be one of the most important values in healthcare. We are people and require a work-life balance (including students, interns, and learners of all type). We need time to be human, time be with friends and family, time to eat, exercise, and sleep. We need time when we aren’t thinking about healthcare and can destress.
- Depression and substance abuse is, unfortunately, high among healthcare providers. In media, we have an image of a drug addict. But healthcare providers have access to high potency drugs and can easily and quickly abuse substances. Addiction can hide behind a mask, a suit, and highly intelligent, functional people. A couple of weekends ago, I attended the Michigan Association of Nurse Anesthetists Spring Conference, and one of the topics was on addiction. It was eye opening. This was one of my favorite videos on addiction.
- If being on call is required, that they should be off the next day. Or there should be a rotation system so that you are not constantly called every night.
- That every effort will be made not to be short staffed.
- That working 40 hours a week — and not much more — is the norm.
- That means giving people adequate vacation time, paternal/maternal leave, and not making people feel bad about it or making it hard to take time off.
- That means giving 2 15 minute breaks and a 30-minute lunch for every healthcare provider for a 8 hour day (this does not happen on a medical-surgical unit, let alone over a 12 hour day).
- That means providing in-house educational opportunities.
- That means encouraging healthcare providers to do or implement research.
Patient’s health.
All of us have been a part of the healthcare system and therefore should care about this tremendously. A huge part of the problem is communication errors. Now instead of a scarcity of information, we have an abundance. We need to have a streamlined process. Electronic medical records (EMR) is a part of the solution, but there are still problems. Often, the EMR technicians have never worked in healthcare and are the ones putting together these systems. Instead of a single page where there is the patient’s history, treatments, labs, diagnostic reports., information is scattered. It requires going through several different tabs and is very time-consuming. And even then, it is still easy to miss information.
Instead of being focused on coding for such and such, it should be about improving the patient’s health. Giving enough time and energy for each patient will improve the patient’s health. Sitting down, understanding each patient’s situation, and developing a course of action together. We need to focus on patients’ health, and not on patients’ paperwork.
Healthcare providers’ input.
To improve healthcare, it requires input from those in the trenches. It does not make sense to ask outside consultants who have no healthcare experience to improve healthcare. Yes, this does happen frequently. And these consultants are expensive. Why are we so focused on making healthcare into a business model rather than a patient care model? Instead, we should ask the providers themselves on what they think needs to change.
Price Transparency.
What blew my mind the other day was reading an article about how parents who were worried about their daughter’s cut took her to the emergency room. The emergency physician said it was a nothing to worry about and put a bandaid on and sent them home. A month later the bill comes out to be $626 for a band-aid. It happened to be that there’s a facility fee for emergency rooms. But it is still ridiculous. Most people (especially those not in health care) need help triaging, or deciding how bad their condition is. When you’re the one in pain, it is always the worst thing that’s happening to you.
Part of the this problem is the blaming game. The doctors blame the insurance companies. The insurance companies blame the doctors and their coding. The patients blame the doctors, the insurance companies, the greedy hospitals and the government. I think what would help solve this problem is transparency about the cost of care. There’s a disconnect between the cost of healthcare and the services provided. For example, most people have no idea how much it costs to stay in the ICU for one day. Most people have no idea how much it costs to do one elective surgery. Sure, it’d be nice to call up the insurance companies and ask them but they come back and say, it depends on what your doctor bills. You ask your doctor and they say it depends on how much the insurance bills you. For the same exact surgery, the insurance will bill differently at each hospital (even surrounding a 50 mile radius). The cost of healthcare is just way too high because there’s no way to ‘shop’ for healthcare or healthcare insurance like you can with other services.
Transparency, or having a sticker price up front, would help patients decide where to go. In fact, there are already some places that often a total knee replacement for $15,499 that covers everything — the surgery, the rehabilitation, and any complications that occur afterward. Price transparency encourages facilities to provide high-quality care and decrease costs while still earning profits.
So I would like to ask, what is the ‘dark side’ of nursing for you? What do you think can change? Please comment below.
