NURSES
Jessica Wheeler works the night shift as an oncology nurse at
Wilkes-Barre General Hospital in northeastern Pennsylvania—but her
patients are usually wide awake. “When they have a new cancer diagnosis
or they’re going to have a biopsy in the morning, they don’t sleep,”
says the 25-year-old Wheeler (which is not her real name). “They’re
scared.” Other patients are in their final hours of life, surrounded by
grieving family. What she wants is to be there to comfort them, to talk
them through those difficult hours, to hold their hands and attend to
their pain. But, mostly, she can’t.
According to hospital policy, night nurses on her floor should care
for no more than six and a half patients, but they typically have ten.
When things go bad with one or two, the floor quickly tips into chaos.
Wheeler recalls one night when she had a patient who couldn’t breathe
and several others under her care. “I called the supervisor to ask for
anybody—a nursing assistant, anybody! And I didn’t get it, and my
patient ended up coding.” Another night, Wheeler had a post-op patient
who required constant attention; the patient was confused and sick, and
she soon escaped her restraints and pulled out her drains, spraying
fecal matter all over the wall. Early the next morning, her heartbeat
became irregular just as another patient was dying. “Those nights are
scary,” Wheeler says. “I think I’ve seen everybody on our floor cry.”
Another young nurse describes a shift when she had only been on the
job a few months and was saddled with ten patients, including one whose
incision was leaking badly, requiring her to administer blood all night
long. “I was drowning,” the nurse says. She called for help multiple
times, but it never came. At the 7 am shift change, she confused two patients’ blood-sugar numbers and medicated the wrong one.
Wilkes-Barre was not always this out of control. For decades, it was a
nonprofit community hospital serving the onetime coal town. It was
bought in 2009 by what is now the nation’s largest for-profit healthcare
chain, Tennessee-based Community Health Systems, which operates 207
hospitals in twenty-nine states. The Pennsylvania Association of Staff
Nurses and Allied Professionals (PASNAP), the nurses’ union, counts
fifty-one fewer nurses since the CHS acquisition, a reduction of more
than 10 percent—and that’s on top of the elimination of dozens of
nursing aides and secretaries. The nurses are not only juggling more
patients, says Fran Prusinski, a critical-care nurse who’s been at the
hospital for thirty years, but “they have to change the linens, empty
the garbage and answer the phones.”
Some of the job’s intensity is due to broad national trends in
healthcare. The rise of HMOs and cost-cutting in the 1990s mean patients
who are stable and ambulatory—some nurses call them
“walkie-talkies”—are now quickly released, so those left in the hospital
tend to be sicker and harder to care for. “The patients we’re taking
care of on a general medical floor now were the patients twenty years
ago we took care of in an ICU [intensive-care unit] with a 2-to-1
patient-to-nurse ratio,” says Elaine Weale, an ER nurse who’s been at
the hospital for thirty-three years. “Now that nurse may have five
patients, six patients, seven patients.” And as technology has advanced,
gravely ill patients who once would have died are now being kept alive,
requiring constant care.
taken from here
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