When I was working the night shift, one of my patients- a 44 year old man, had just gone for an angiogram. He had been brought back to the floor afterwards, but began hemorrhaging from his femoral artery. I’d added pressure dressings, laid on heavier sandbags, and then called the intern. The intern took a while to get to the floor and all the while the patient kept bleeding heavily. When the intern just shook his head and did nothing, I called his resident. When the resident didn’t respond, I called the attending. Now I knew I was in big trouble. It didn’t matter that the patient’s blood pressure was 60/40 by the time I called, it mattered that I had broken protocol.
Because I knew this Directress of Nursing was good and fair, when she called me into her office, I decided to try to listen to her with an open mind, even though the whole thing made no sense to me.
She was sitting at her big oak desk and she hardly looked up as she waved her hand, indicating that I should sit in the chair across from her.
“You’re a good nurse,” she said, “that’s not the problem.” She smiled just a bit when she added, “I’m even beginning to believe that you’re a good person.” She looked straight at me when she added, “But you’re difficult to deal with. You’re headstrong – a lot for a supervisor to handle. Though you’re supposed to be part of a team, you often make independent decisions that I have to be responsible for.”
“No one else was available. That patient almost bled out and not one of those doctors paid any real attention,” I said. “And how often have I been wrong?” I asked.
“That’s not the point,” she said, her voice soft, patient. “So far you’ve been right. But what if we let every smart young nurse make independent decisions-how well would that work for the organization, for the business of medicine? Who will be liable?”
“So what am I supposed to do?” I asked defensively. “Stand by and let the patient die until I get an okay?”
She stiffened. Her voice was steely when she spoke now. “That’s one alternative,” she said. “The other is to go back to school and get more education. Get enough degrees that you can run your own show and take your own responsibility.”
When she saw I was really listening, she added, “You’re not going to do anybody much good if you behave in a way that gets you fired.”
So I went back to school and got more degrees, as many other women and men have done, based on the promise of nursing in an evolving health care system. We, as nurses, understood the value of education for autonomy, and knew what we needed to do as professionals. In other words, we grew up.
But today, thirty years later with many more nurses with degrees, have any of the organizations, who are supposed to back us, grown into “professional organizations” that can support us?
Are we paid as independent professionals who’ve been trained to think, consider treatments, help patients and their family through the difficulties of life and death, if necessary?
Have doctors suddenly begun to treat us like colleagues, with any real understanding of what a better education has done to change our role and the way we can work together?
Has the business of medicine stopped stacking us with the bedpans and the gauze pads as part of their budget so that we can’t be “cut” whenever they have a budget shortage?
And while– for budgetary reasons –they are even considering putting us in the place of primary caregivers because there are fewer doctors who are willing to work for the wages the corporations (that we now call healthcare) are willing to pay, who has our back?
Nurses have gotten better educations, they’ve grown up. They’ve done their part.
But what about the rest of Healthcare?
Are they going to grow up too and let the patients know how important nurses are to their well-being? Are they going to pay us and treat us with the respect we deserve?
Or is the business of medicine going to watch the mass exodus of the smartest and best nurses as they hit the road for a profession that offers respect for work well done, autonomy to go with responsibility, decent pay without intimidation, and most of all for caring for what happens to another?
If not, if they stay stuck, what happens to the patients? All those mothers, fathers, husbands and wives, all the sick children and new babies to whom life deals a tragic blow and who depend on us to keep them safe and advocate for them? Who will be there to observe, educate, nurture, comfort, call, soothe and help them through the hardest times? Who?
To Congress and to the Business of Healthcare I say:
This is not the Golden Goose, it is the Golden Calf. Beware.