Who Are We Really Helping?

I was inspired to be a nurse because I wanted to help. I wanted to do whatever I could to make a positive change in the life of my patients. Am I able to do this in a literal sense? The short answer is “yes”. My issue, having only experienced the inpatient side of medicine, is that I do not have the ability to dedicate a sufficient amount of time or energy to each individual patient; the time needed to adequately comb through charts, lab results, and notes that would allow me to have a better grasp on why this patient is here and how did we get to this point.

Because of COVID, hospitals have seen their business practices shift gears and resort to loading nurse assignments up to unprecedented levels of acuity and unsafe staffing ratios.

**Side Note** I know that my fellow PCTs are reading this and I want them to know that I think about them every time I write these posts; I am beyond thankful for their help and support each night I walk onto my unit and each morning I drag myself off. Like nurses, PCTs are overworked and driven into the ground with unrealistic and unsafe patient assignments; they are used and abused and never get the credit they deserve.

Honestly, the majority of hospital issues come back to staffing ratios. One cannot provide the quality of care needed to treat patients when they are expected to care for seven or more patients. Variables are constantly overlooked; this is an everyday occurrence. You cannot properly treat a patient without having all the pieces of the puzzle. Short example: a patient has had a history at some point in the past, where they have been found drunk, admitted, and placed on an alcohol withdrawal protocol (CIWA). This time around, the patient had no alcohol in their system, and the toxicology screen was benign; yet, they were placed on the alcohol withdrawal protocol. A part of this protocol involves scoring a patient based on certain criteria and administering particular dosages of medications called Ativan Valium based on the results (the PCU and ICU have more intense medication and protocols; like placing a patient on a sedative drip to keep them unconscious while withdrawing). It has been known that administering Ativan to elderly patients, especially those who are not withdrawing, can lead to an exacerbation of delirium as well as other metabolic complications. Okay, now that y’all are caught up in the situation; why are we having this patient be placed on the CIWA protocol when he has no alcohol in his system?

I believe the short and cynical answer is this: to sedate the patient enough so that a hospital bed is filled and the nurse (in charge of that patient) is able to care for their six other patients.

Hospitals are filling specialty floors with med-surg patients instead of diverting them to other hospitals for what I pessimistically see as filling beds to charge insurance to make as much money as possible, regardless of whether we are fixing the patient’s problem or developing an appropriate plan of care.

I ask again, “Who are we really helping?” The answer seems to point us in the direction of the administrators of the healthcare system; not those who are doing the grunt work or the patients themselves.

We are not solving problems, we are putting Neosporin and Band Aids on wounds that require wound vacs and a deep dive with an interdisciplinary approach. The whole deplorable concept of the revolving door of healthcare systems is exactly what keeps medical facilities in business. It’s the same thing if we look at Pharmaceutical industries; they do not make profit off of drugs that cure diseases, rather, they make their money off people staying sick and prolonging the lives of the human race so that more comorbidities arise and they require more drugs. It’s depressing and why I have gravitated towards this mindset.

What am I really doing to help my patients? I place them on a morphine drip to take away the pain as they actively die in front of my eyes; I order a social services consultation for someone who I see as being a victim of abuse or neglect at home, or a psych consultation for someone who I have come to find out has underlying and unaddressed psychological issues. As hard as I try to see the “small wins” of each shift, I do not see it as enough. I should be in the room with the 90+ year old patient with dementia who is crying because they are scared they are going to die; I should be holding their hand and consoling them to ensure that everything is going to be okay. I want to be there for the family of the dying patient; I want to make sure that these patients pass in peace and free of pain. But guess, what? I do not have the ability to do that because I have six other patients to tend to, and at this point in the pandemic, I have to tend to geriatric psych patients and those going through alcohol withdrawal who are trying to attack the medical staff.

Who are we helping? Certainly isn’t the patients.

From my experience, it seems as if the nursing profession has turned into placing band aids on problems instead of addressing root causes. A patient is composed of a multitude of variables, variables which each need to be adequately addressed and altered. At this point in time, just making it to the end of my shift keeping everyone safe/alive/sane (including myself) is why nursing is my cardio.