When most of us think about our national healthcare crisis we think about the legislative changes we've been fighting for. Our thoughts might also turn to the big pharmaceutical and insurance companies. Today, I would like for you to ponder another looming healthcare crisis, the nursing shortage. I'll tell you what it probably means for you when you or a loved one enters a hospital, and I'll tell you some things you can do to stay safe.
The next time you're inside a hospital, look at the nurses you see. Most of them look like they've been around for a while, don't they? I've been reading statistics and studies for days now, and they consistently agree that the average age of RN's in this country is somewhere between 45 and 50 and climbing. Worse, the percentage of RN's less than thirty years of age is in the single digits and dropping. The demand for nurses has never been higher, the shortage has never been greater, and the implications have never been more dire. What's going on here?
Before we can add nurses to the workforce we have to educate them. One of the most serious bottlenecks is a nursing faculty shortage. We can build classrooms and order textbooks and offer scholarships and grants, but nurses with advanced degrees who are willing to teach can't be ordered from Amazon. Their available resource pool is aging along with the rest of us. Nurses with advanced degrees have opportunities in advanced practice, nursing management, hospital management, and research -- to name just a few areas that pay much better than teaching. Until this problem is resolved the nursing shortage will grow.
If we can't educate more nurses rapidly, we should hang on to the ones we have, right? HR types call this retention. Unfortunately, as the shortage of nurses becomes more dire and as the population ages, the job satisfaction of bedside nurses goes down. Our nurses are taking care of sicker patients, they're taking care of more patients per shift, they're getting older themselves, and they are leaving bedside nursing in increasing numbers. Some, like me, suffer career-ending injuries at work. Some take early retirement. Some go into other areas of nursing, working in schools and public health and, yes, for insurance companies. Some become pharmaceutical sales reps. Whatever is was that drew many nurses into the profession -- and it's different for each of us -- is no longer there for too many nurses.
Even before there was a nursing shortage, hospitals looked for ways to cut overhead. They hired aides to take vital signs, give baths, and change linens. Bedside nurses were paired with aides and assigned larger numbers of patients. Before long, their entire shifts were spent dispensing medications, changing dressings, starting IV's, charting, assessing admissions, and trying to squeeze in patient education. Less and less time was spent with their patients. The problem with this change is that nurses are trained and educated to observe subtle things about their patients, things an aide won't observe. An aide can take your pulse but most likely won't notice that it has become irregular. An aide can take your temperature, but might miss the fact that you are sweating in spite of a normal temperature. An aide can take your blood pressure, but will miss a widening pulse pressure. When a nurse gives a bed bath she has the opportunity to talk to her patient, answer questions, check skin integrity, observe tolerance to activity, notice respiratory functioning, determine effectiveness of pain control measures, and teach, teach, teach. Patients who are dealing with a difficult diagnosis, who may be dying, who may be alone, who may have significant social issues or who just can't poop need time with their nurses. While most of us enjoy cutting-edge technology, the true heart of nursing is laying a kind, reassuring hand on a frightened patient's arm, having time to sit down, make eye contact, and make a difference. Patients often have significant needs. Many nurses are so stressed out because they cannot meet their patients' myriad needs that they are leaving the profession.
Nurse Kelley initially wanted to be Doctor Kelley. It wasn't until I spent an extended period of time observing the care given to my very ill father in a hospital that I had my lightbulb moment. The doctors and surgeons came in once a day, asked a few questions, wrote a few orders, and left. The nurses stuck around. They collected vast amounts of data, knew what it all meant, and knew when something -- a lab value, a vital sign, a heart rhythm, the color of Daddy's nailbeds -- indicated a need for new orders. Sometimes things got very bad very fast, and nurses were there doing lifesaving interventions, ordering STAT labs and x-rays, and pushing meds, keeping patients alive until the docs rode in. Nurses are healthcare's infantry. I realized that's where I wanted to be. I spent my career in the NICU (neonatal intensive care unit) and on neonatal transport teams. My patients were babies, mostly premature, all clinging to life by a thread. I stood by their warmers and incubators throughout countless long nights, using my knowledge and skill to be able to pass their care along to someone else at dawn. If my babies had a good night, I went home and slept like a baby. I miss them. I miss their young parents. I hope someone like me will be there if one of your babies ends up in some NICU somewhere.
Don't expect Florence Nightingale when you or someone you love is hospitalized. While a precious few hospitals have managed to maintain high staffing levels, most have not. A friend of mine left the profession after one terrible shift when she had to choose between a patient who was hemorrhaging and a patient in respiratory failure. A nurse will assess you when you are admitted. You'll get your medications, hopefully the right ones, but seldom on time. It's a good idea to shower before you arrive because bathing is becoming a lost art in hospitals. If you are restricted to bed, good luck finding someone to bring you a bedpan. Don't count on your linens being changed with much regularity, either, and try not to touch anything you haven't disinfected yourself. In spite of the presence of superbugs in hospitals, housekeeping has been cut to the bone in many. If you have an IV, monitor the site yourself and start raising hell if you see swelling or redness, or if it starts to leak or hurt. If you have a urinary catheter remember three things: The collection bag should never be allowed to touch the floor, it should never be raised higher than the level of your bladder, and it should be measured and emptied by someone every shift or when it gets full. If you have a wound from trauma or surgery, keep an eye on your dressings. Report obvious bleeding immediately. If you have a cast on an extremity, the fingers or toes should be watched for swelling, coldness and color change.
Don't let anyone touch you until you see them wash their hands. Don't let anyone use a non-invasive instrument on you -- stethoscope, blood pressure cuff, that kind of thing -- until you see them disinfect it. If your physician wears a necktie, ask him to tuck it into his shirt. Create a "clean zone" around yourself, your bed, your bed table, your call button, and anything else you may touch, using the strongest disinfectant you can lay your hands on. NEVER let your bare feet touch the floor. Wear slippers when you get up and take them off before you swing your legs back into the bed. Whenever you touch any surface that you haven't personally disinfected -- doors, anything in the bathroom -- wash your hands. Nosocomial (hospital acquired) infection should be your greatest fear, and there's a lot you can do to protect yourself. Make your family and visitors take the same precautions. I don't care if you're a shrinking violet in every other aspect of your life, be assertive while you're a patient. Get madder than a pet monkey if you have to. Your life may depend on it.
Another area that requires vigilance is medications. I know you wouldn't be in the hospital if you were at your best, but please, please try to monitor your medications. There are times when mistakes are more likely to occur. When you're admitted, all your meds are entered into the hospital's pharmacy software. Transcription errors occur. When you're transferred between services, say from the ICU to a floor, misunderstandings about what you've already been given and what you need to be given can lead to over- and under-dosages. All orders are suspended when you have surgery and must be re-entered, with appropriate changes, afterwards. Finally, any change in medications can lead to an error: your doctor decides to switch your antibiotic or try another painkiller, and someone has to look at the last dose of the terminated drug when scheduling the beginning dose of the new drug. It gets complicated.
Nurse Kelley knows nursing from both sides of the bed. I've had ten surgeries in the past eight years, and I've seen both the true heart of nursing and its dark, understaffed side. The one thing I know for sure is I will never enter a hospital alone. Someone is always with me, even at night, asking questions and keeping watch. When someone I love is hospitalized, I'm there with them. Keeping watch.
Let's talk.