Tag Archives: The Good Doctor

The Principle Of The Thing.

 

My partner is a registered nurse.

He works in the hospital where I was born.

But, it’s not a hospital, anymore. A medical center complex, owned by a huge health corporation which also provides insurance, it is one of the area’s largest employers.

One would think that, being enormous in scope and financially well endowed, said corporation would be able to sustain the employment of at least one person whose job it would be to enforce fair practices.

Like, staff scheduling.

Instead, the man I love is forced to fill his week with days which often run fifteen consecutive hours or more on site. And then, add being on call, which ties his hands and his imminent presence at least one day per week until 5:30 am the following morning.

And, he isn’t even in the Emergency Room, the scenario which provides fodder for more televised drama than the field of poorly managed medicine deserves. He’s in the dialysis department. This is where patients come, three times a week, to have their kidneys flushed so that they don’t die in a matter of hours from uremic poisoning. And, unlike other departments, such as the cardiac catheterization lab, the doctors aren’t actively on site throughout the shift; the entire week is managed by the nurses, and their supervisor.

Most dialysis patients are in house, admitted, many for weeks or even months at a stretch. These are individuals who are vastly unwell; most have multiple afflictions, including morbid obesity, all of which must be factored in when the four hour, tri-weekly dialysis commences. Each is wheeled to the department on a gurney, where the line forms in the narrow hallway leading to the shallow bay of treatment cubbies.

But, unlike a hair salon, which effectively staggers multiple customers between wash, rinse, cut, set, dry, and style, each of these patients must be watched carefully. First, their vital signs must be monitored for sudden drops in pressure or heart rate; next, potassium levels must be regulated, these directly affecting heart rate. In short, each nurse must be ready to administer the safest, most effective intravenous cocktail of chemicals intended to maintain patient stability throughout the four hour procedure.

Imagine some fourteen patients, in the course of a shift, all of them in a long line awaiting treatment. Visualize eight of these, in active dialysis, at various stages across their four hours. Now, realize that several may be in significant discomfort. One may be thrashing about, yelling; another may be hovering at death’s door.

But, then, there are those patients who have been admitted to the ICU. These are critically ill, but in need of dialysis, perhaps due to drug overdose or sudden sepsis.

Now, consider how many nurses would make for secure, attentive coverage of fourteen patients plus ICU in a given fifteen hour shift. Would you be surprised to discover that the dialysis department currently employs only 5 nurses?

That’s five, in total. Scheduled across a six day work week. Covering a contingent of sick patients, patients who don’t get well. Not on dialysis.

Dialysis is extended palliative care. Patients on dialysis either get a kidney transplant, or expect to reach the end of their lives within five to seven years.

And, for their troubles, these get: five nurses. (There had been six, but the one most willing to work the longest hours tore her meniscus, and now needs surgery.) Has the medical center hired her replacement? Oh, no. Easier just to stretch the remaining five thinner than a dime.

Money. Money drives everything. Money is allegedly the reward for a job well done. At least, it used to be. Now, we have to ask “Who benefits?” Why? Because a job well done is no longer rewarded. Now, a good worker is exhausted, with little recourse against a killer schedule which, especially critical in the health field, renders most nurses chronically sleep deprived, socially constrained, and increasingly embittered.

Let’s require of our massive corporations that they use their equally vast resources to establish a department for accountability to devoted workers. Delegated supervisory roles only work as far as the individual assigned is willing to make the extra effort necessary to create scheduling which both serves and benefits those over which he or she has domain. On principle.

Principle used to represent that moral, conscience-driven act to which one adhered, in process and procedure, even when one stood to benefit nothing. Now, unless there is something in it for the “me”, nobody does anything.

Except the nurses.

The nurses will always do the hard thing. The dirty thing. The critical thing. And, they’ll be asked to do it all on four hours’ sleep, five days a week, irrespective of their advancing age or the responsibilities they maintain when they finally get home at night.

An army of these rising up would force a revolution.

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© 11/2/18    Ruth Ann Scanzillo.   littlebarefeetblog.com