Monday, October 10, 2005

Nursing: What Do You Think Hospitals Are For?

We didn't have toys like this when I was a kid! Heck, I still want it! This is from Playmobil. Check out the bed; it's adjustable! With a trapeze thingy! The drawer of the bedside table opens! All we need is a linen hamper and a sharps container and we're in business.

It's funny, nurses do not wear caps anymore, but caps are still recognized as a symbol of nursing. I noticed this in both the Playmobil and the Fisher-Price medical/nursing toys.

Do you realize that the only reason for hospitalization is the need for nursing care? Think about it. If you don't need the 24 hour presence of a nurse, you can go home. You can come to the hospital for surgery and go home the same day unless you need nursing care. You can come in, have your baby and go home the same day unless you need nursing care. You can come to get your intermittent infusions from an infusion center nurse and then go home, unless you need nursing care. If you took away the nurses, you would not have a hospital.

Let's take "downsizing", for example. In the world of nursing this means:

  • Nurse as pharmacist: when they "downsize" pharmacy by not keeping it open 24 hours, the nursing supervisor delivers needed medications if they don't lock the pharmacy. Or the ER nurses give out "starter packs" of medication during the off hours, including counseling the patient on the medication itself. Hmmm...that sounds a lot like "dispensing" and I thought only a pharmacist could do any rate, the pharmacy budget looks great because nursing has taken up their slack.
  • Nurse as housekeeper: there is only one housekeeper at night for the entire hospital because they have "downsized" the department. That housekeeper is kept on the run by the ER and L&D units. So the nurses empty the garbage, the nurses change the linen bags and the nurses mop up the mess on the floor in addition to all their other patient care duties. Now that was okay in Florence's time, but we have just a tad more responsibility these days, wouldn't you say? So the Housekeeping department's budget looks great because nursing has taken up their slack.
  • Nurse as Phlebotomist: why have phlebotomists come and draw blood when nurses are available? So let's "downsize" the lab to a skeleton crew of a few techs and nurses will draw all the patients. Which means that all nursing responsibilities stop at 0500, so that the nurses can now take on the lab responsibilities; draw all the ordered bloods and get it to the lab on time. And the Lab budget looks great because nursing has taken up their slack.
  • Nurses as Registrar: why have a registrar when the nurses can take down all the information and copy the ID and insurance cards? So the nurses take the information and register the patient. The Admitting department budget looks great because nursing has picked up their slack.
But god forbid that a nursing floor EVER be overstaffed. Staff will be sent home mid-shift if the census drops due to the budget. Nurses will be cancelled if the census drops due to the budget. No chance of being able to spend extra time with fewer patients or more time with acute patients because the Nursing Department might be "overbudget". I've had supervisors tell me that their hands are tied because they will get in trouble if they do not staff by specific acuity numbers. I've had supervisors tell the ER that they need "one more admission" or they will have to cancel a nurse.

None of the scenarios above are fictional; I've been witness to every one of them.

Who would take care of the patients if the nursing department were downsized? I can bet it wouldn't be the pharmacist, the housekeeper, the phlebotomist or the admitting clerk. Not even the doctors have licenses to practice nursing.

Kinda makes you wonder why hospital administrations don't treat us with a little more respect, doesn't it?


At 10/11/2005 05:36:00 AM, Blogger Wendy, S.N. said...

That is too cute!

Check out the size of the bottle in the nurse's hand in the baby picture!!

W. :)

At 10/11/2005 05:50:00 AM, Blogger Heather said...

Beth Israel's medical director makes it clear to the docs that work there that patient's are only in teh hospital because they need nursing care. This helps them value the nurses expertise. It seems like a no-brainer, but most docs would rather die than admit that.

At 10/11/2005 10:11:00 AM, Blogger donna y said...

Toys these days have gotten so detailed!! I've always loved all things tiny. The more realistic, the better.

At 10/11/2005 10:18:00 AM, Blogger kenju said...

I love the toys, and I agree with you about the lack of respect. I cannot believe that nurses are expected to sweep floors. Seems kind of contradictory to the budget, since nurses are surely paid more than cleaning people.

At 10/11/2005 04:47:00 PM, Blogger I am a Milliner's Dream, a woman of many "hats"... said...

Kim--I have been telling my childbirth classes and doula clients forever that you are only in the hospital when you ill and need nursing care for years. This is one of the reasons that people have trouble seeing birth as normal.

I appreciate this post as we are learning all of this in this quarter of school and I feel like each time I visit you are reinforcing important stuff for me. I still think you ought to teach. :)

And off the subject--it does rather frustrate me that along with caps being associated with nursing that bottles and pacifiers are so closely associated as childbirth icons. I do believe that toy bottles and toys that feature toy bottles influence children, especially little girls, to think of bottle-feeding before breastfeeding. (Especially since many parents would freak out if their little girl "breastfed" her doll, which further says, "Don't do that, it's wrong!" by their reaction.) ;)

At 10/11/2005 07:18:00 PM, Blogger Kim said...

I am all for breastfeeding. I was able to breastfeed my youngest for a full six months before going back to work and she was the healthiest of all three kids. Did not have a cold until she was almost four!

At 10/14/2005 05:08:00 AM, Blogger Dr. Deborah Serani said...

Just have to say that this is the very hospital set I use in play therapy.

I also agree that nurses don't get the respect,thanks and recognition they deserve. I always make my gratitude known, but so many don't...including other professionals.


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