The Final Straw - Suffocating In The Hospital System.

Working in the hospital brought a great many rewards.  I loved the variety of patients, the high level of skills and critical thinking required plus the sharp people I worked with.  I was discontent, however with the amount of time I spent satisfying regulatory requirements (there are at least 90 regulatory agencies monitoring hospitals, just at the federal level, and they don't communicate with each other very well), the dangerous nurse-to-patient ratios, the time constraints not allowing me to truly communicate with my patients (I'd easily spend 60% of my 12-hour shift charting on a computer) and the unsubtle push to maximize profits. I'd work three days in the hospital and three days in home health every week and looked forward to the home health days as vacation days from the stress of the hospital.  Home health felt like the model of what healthcare should be. It also didn't pay nearly as well.

Three closely-spaced events inspired me to finally leave the hospital, take a 50% pay cut and work in home health full-time.

1.) I worked as a weekend float nurse in a smaller 100-bed hospital that was part of a massive non-profit system.  This hospital prided itself on having a 26% profit margin, the highest of any hospital in NC (depending who you ask, most hospitals have anywhere from 5% to 12%).  As a float nurse I spent the majority of my time working in the Emergency Dept. (ED) treating everything from gunshot wounds and drug overdoses to asthma attacks. When someone would come in with an asthma attack, the standard of care is to start them on a breathing treatment (inhaled nebulized medicine that opens the airway) immediately.

Nebulized mist of life-giving medicine.

The word came down that nurses would no longer give breathing treatments - it must be done by a respiratory therapist (RT).  On the weekends there was only one RT in the hospital, and they were typically busy with the vent patients in the ICU; calling them to provide a treatment (a common occurrence) delayed care by at least 10 minutes.  The patient would sit in the exam room, whistling and struggling with every breath, while the RT tried to find a free five minutes.  This seemed so ludicrous to me that I asked the RT why the change was made.  He told me that when nurses give the treatment the hospital can only charge for the medicines, but when an RT is present the patient can be charged an extra $175.00 for a "specialty consult".  It seemed, from my limited perspective, a bald attempt to bump that precious 26%.

2.) Part of the Affordable Care Act (ACA) financially penalizes hospitals that have poor patient satisfaction ratings. To increase this rating my hospital leadership enacted a mandatory program entitled "Just Say Hi!"  We were to greet everyone we met with a cheery "Hi!", even if they'd just spent 4 hours writhing in the waiting room. Participation was non-negotiable and there would be "spies" (their word) on the lookout for sullen rebels. Punishment would entail a verbal warning for first offense followed by termination for the second, skipping the traditional step of a written warning.  It was like 1930's Germany.  I felt worse for the "spies" more than anything.

Big smiles!  Big smiles!

3.) I read Stephen Brill's "The Bitter Pill", a Time article detailing the mystery and insanity of how hospitals charge for health care.  It was the longest article I'd ever seen in Time, and by far the most disturbing because I was inside the system seeing the madness first-hand.  

 Not for the faint-of-heart.

These events were the final straws for me.  I didn't have time to provide good care for my patients and what I was providing was largely placebo and costing them far more than they could afford.  I wasn't proud to be a hospital nurse anymore.  I put in my notice.

I don't regret my decision, although there are times I miss the intellectual rigor of the ICU.  If possible I'm even more disgusted with hospitals now, two years later.  They whine in the press about how the ACA is forcing them to slash their budgets and lay off nurses.  They find small sympathy in the legislature; I was speaking with one of my senators about it last year and he said, "they're gonna scream, alright, but they've been riding that gravy train long enough!"   

I admit I was a bit taken aback at his venom - as much as I'd like to see hospitals charge reasonable fees for a job well done which is exactly opposite of what's happening now, they do still play a vital role in society.  If you're interested in the fascinating tale of how America went from house-call doctors getting paid in eggs and potatoes to today's slick, investor-driven mega-systems, I recommend Paul Starr's The Social Transformation of American Medicine.  Perhaps we can't turn back the clock, but perhaps, with soft hearts, sharp minds and a handle on our greed we can dial back the insanity.  No one should be suffocated for a profit margin.