Patients, safety, money, nurses

By Sandi L. Carver, Special to the BDN
Posted Nov. 29, 2010, at 8:10 p.m.

I am a critical care nurse in our Eastern Maine Medical Center Intensive Care Unit who has the opportunity to act as housewide resource several days a month. Sometimes I work as a charge nurse. Sometimes I am in the role of direct patient care with an assignment.

I am privileged to see how health care runs on most levels with the exception of administration. I have a good pulse on how our hospital runs day to day.

I also attempt to feel all sides of an issue.

I have been reading the articles and propaganda regarding the issues at EMMC between the union nurses and the administration. I have read all correspondence sent from the hospital’s Lorraine Rodgerson and Greg Howat. I read what union president Judy Brown and the union representatives send out.

I hear the talk around the hospital. And, I am more than disheartened. Personally, I think both sides are holding positions that are outside of reason. And I’m dispirited with the actions and voices that are portraying our hospital in such a negative light.

I won’t pretend to understand what each aspect of health care costs these days. Nor do I grasp the magnitude of effort it must take to ascertain balance regarding income vs. expense, necessary vs. unnecessary, “employees” vs. “owners.”

I am an owner. This is my hospital. These people are my family. These patients are people I love and care for. I understand health care at the patient-care level.

I understand that it is unfair to ask for staffing ratios that are different from what they are. I do not believe that is the answer. The way things operate are adequate from a numbers, paper and pencil viewpoint.

But at the bedside, they are not adequate. The nurses are right in voicing concern. It is not safe, adequate or “patient-first” in any way when floors are so overwhelmed that their resource and charge nurses are pulled to take assignments. Acuity fluctuates, census fluctuates, nursing availability and expertise fluctuate. Access to resources fluctuates. And we are adaptable, but we cannot expand to be more than what we are in numbers. We don’t have enough resources at times to expand to what is required.

When I am in charge or working as a resource nurse, it is not uncommon for a “floor” patient’s health to take a downward turn, and for them to spiral quickly if not attended to promptly. If a critical care bed is not readily available, then the patient on the floor stays on the floor. And if that floor happens to have pulled its resource nurse and its charge nurse to take an assignment, someone’s or several someones’ care is compromised.

And I see the floors. They are overwhelmed with tasks and documentation.

I know it must have been budget-driven to change our numbers the way it happened last year. And likewise, the switch from eight- and nine-hour shifts to 12-hour shifts must also have been related to money. But what I don’t understand is that when nurses say, “This is unsafe,” how is it possible that nobody is listening?

I, personally, have worked week after week of extra and overtime. I have been in charge when we’ve been scheduled short the next shift and spent hours calling on the same people over and over to find someone who will work extra to fill the void. We will stay hours into the next shift to cover patients who would otherwise not have proper coverage.

We need a bigger pool of resource from which to draw in unsafe situations. Charge nurses need to step up and say when situations are unsafe. Department heads and administration need to know when this is happening. Attention needs to be placed on patients primarily and on tasks-documentation second.

Nurses need to eat. They need to breathe fully. They need to be relaxed enough to make safe assessments and decisions.

It has become far too common for nurses to work through lunch, barely look up during the day, and then go home sore and exhausted — physically, emotionally and spiritually.

I don’t know the solution, as I don’t know what kind of financial commitment is involved in hiring more nurses. But I do know that we are the second-largest hospital in this state and a level II trauma center. The people who arrive and stay in our institution are sicker than they used to be. With the complex nature of the human system and ever-advancing practice of medicine, we cannot expect to do more with less when it comes to the nurse.

Sandi L. Carver is a critical care nurse at Eastern Maine Medical Center.

http://bangordailynews.com/2010/11/29/opinion/patients-safety-money-nurses/ printed on September 19, 2014