I passed my RN state boards in 1972, and went to work for a large hospital affiliated with the Mayo Clinic, on the surgical orthopedic unit. I invite you to join me on this trip back to the days when medicine was still considered the healing arts, before it all got sold out to profit making corporations. And lets say you name is Joe, and you are facing surgery to replace a worn out hip.
You arrived the evening before your surgery, and were immediately assigned to your Primary RN (me). I would let you get settled in your room, then come in to visit. First I'd explain that for your whole stay, I will be in charge of coordinating all aspects of your care, as your Primary Nurse. If you have any problems of any kind, with anyone, or with any aspect of your care, you could turn to me, and I would facilitate a solution.
I'd probably spend an hour or so taking a complete medical/social history, do an initial physical assessment, and then together we would write your plan of care for your stay with us. This included not only physical/medical needs, but social, emotional and spiritual needs. We'd also discuss preliminary aftercare planning.
This also gave you the chance to talk about your fears and questions regarding the surgery to come. If you were anxious and didn't think you could sleep,medication was willingly dispensed. You see, the whole focus of my training was on insuring optimal care for well being of my patient, physically, mentally and emotionally.
Before I left my shift that night, your care plan would be written up and placed on the cardex, visible to any other caregiver you would have on my off shifts. No one including the nurses aids, took care of any patient without first reading the condensed care plan, and the nurses notes from the preceding shifts. It all worked. Any change in condition or need to deviate from the written care plan was marked with colored flags, which were also communicated nurse to nurse at shift change. Night shift nurses would go through all the doctors orders from the day just past to make sure every single one was transcribed in all the necessary places.
By the time I got back on duty the next day, your surgery would be over, and you'd be back in your room floating in and out of your comforting cloud of good drugs. This was when I'd go over every note since I'd last seen you, and make sure all orders had been followed, and nothing missed. I would also do all of your personal cares, which gives a nurse the best possible opportunity for acute observation of condition.
We were also well trained in pain control measures, fully aware that it works much better to stay on top of the pain, than wait till it's severe and then try to control it. I'd coordinate with physical therapy and keep an eye on progress, and we' d also start talking about discharge plans. It was part of my job to make sure that when you were discharged, whatever help you needed at home was arranged, including special equipment.
Almost always, when that day came, it was like saying goodbye to another new friend. You went home with a phone number you could call and reach me for a few weeks more. In other words, I was with you or a phone call away, every step of the way, start to finish.
At the most, in this kind of Primary Nursing, I'd have full responsibility for the coordination of care for 4 to 5 patients at a time, never any more than that. It was intensely satisfying work, and as a Primary Care RN, I was a respected member of the Team.
But this was back in the GOOD old days, when the whole circle of health care providers revolved around the patient, who was always in the center of the circle. I loved my profession then: I was proud of it. It truly was all about healing, first and foremost.
Then it all came apart before my very eyes, over the next 25 years. As we turned away from defining health care as the healing arts, and turned it into a profit making business, the patient, once the center of the circle, was slowly spun off to an outer ring of that circle, and profit took his place in the center. For me, the process of being forced to abandon patient centered principles of care and replace them with cost centered measures, that took me further and further away from my patients was literally excruciating.
People who had nothing to do with health care, but everything to do with efficiency and time management and counting beans were calling the shots now. We saw our work loads double and triple, based solely on the minimum amount of time some "expert" determined it should take us to do Procedure A or Procedure B.
None of it left any time for listening to a frightened patient, or sitting with a grieving one, or hands on comfort measures. It was soon determined it wasn't cost effective to provide all those services anymore, and when my work load got to the point where I couldn't even provide safe monitoring of post op patients, I left to find a less critical kind of nursing, in psych and long term care. Both of which were turning into equal nightmares in their own particular ways.
One thing was always the same: it was the patients who suffered the most as this went on. Oh not the wealthy ones: they had very loud voices and wouldn't stand for anything but top level care, and they could afford to buy it.
It was the non wealthy, the poor, the sickest, the oldest, the weakest ones who had NO voices, that paid the highest cost, as always. And us old school professionals who had to watch this atrocity happen and were unable to do a damned thing to stop it.
I am still surprised I survive it at all. I can't even describe the heart pain of having to walk past suffering people day in and day out, people you know you could comfort or relieve their pain so easily, but no longer being allowed to do so, at risk of being fired for "poor time management" skills, and yes, my file was full of that kind of accusation.
My back injury probably saved me from an actual heart attack, and although I held on in part time positions for several years, I had to quit at age 55 and go on disability. By that time, my on-duty hours in a geriatric setting consisted mainly of pushing pills and shuffling paper. I saw little of my patients unless they were falling down, bleeding or needing CPR. I am glad to be done with all of it.
Those of us who are still around to remember how it was have an obligation, in my eyes, to share this information with those who have no way of knowing. Once we really did know how to treat the sick and the aged and the vulnerable as valuable human beings, and we really did know how to help people heal. And we knew how to value the healers, too.