RICHARD FERRI
A call to arms for nursing standardsIN 2002 I found out what it is like on the other side of a hospital bed. After more than 25 years of practice as a registered nurse, I became a critically ill patient. My left lung collapsed four times in as many months. This landed me in three different hospitals in Massachusetts, and ended up with my needing emergency open lung surgery. The trauma was coupled with the fact that I am HIV positive. Now toss in the issue that between my hospitalizations my parents died unexpectedly within weeks of each other. Life was more than challenging.
What I needed was expert and competent nursing care. But because there are no standards for setting the ratios of nurses to patients, I couldn't count on getting it. As my condition grew more severe, the nursing care I received was spotty at best, and sometimes totally absent. I often did my own nursing care. Sometimes I even had to comfort the overburdened nurses. The hospitals I was in are considered some of the finest in the country. They frequently make "best of the best" lists. Yet what I saw led me to a very different conclusion. Daily I unhooked myself from my machines and did my own respiratory care and ambulation. I carefully plotted out my diet and protein intake so that I would not waste away too much muscle. I made sure the catheter draining urine out of my bladder was emptied. I monitored my own pain management regimen, and had to demand pain relief. I was handed the wrong pills for my HIV infection, but when I told the nurse she told me just to "take them." She did not have time to track this down. I refused. I kept on telling people my parents had just died in between getting a horrendously painful tube placed in my chest to re-expand my lung. That must be tough, they said. However, no one mentioned that perhaps they could sit down and talk to me about the recent trauma of my parent's deaths, and my own illness. Many are probably shaking their heads, saying: "What a bunch of bad nurses." That is wrong. Nurses are by definition caring and competent professionals. What happened to me happens to a lot of patients everyday in Massachusetts. It has very little to do with uncaring nurses. The fact is, for nurses who are assigned to care for so many patients at once, simple acts of kindness are nearly impossible. Time spent in providing holistic nursing care does not get the right boxes checked on a flow sheet or meet the hospital hierarchy's mandate. Thus, even though I had tubes coming out of my body and was hooked up to more machines and drugs than I thought possible, I frequently was left to fend for myself because my nurses were tied up with other patients. The stress level was so tangible that I grew leery of falling asleep. I became hyper-vigilant. It seemed clear to me that I had better be in charge of my care because no one else was. Hospitals treat nurses as if they are some "one size fits all" commodity that can be taken down from the shelf, instead of the educated professionals that they are. This has to be stopped. It is not only unhealthy, it is killing people. Nurses are not window dressing for hospital administrators to admire. We are the 24/7 care-giving professionals. Nurses are in the trenches and save thousands of lives on a daily basis. We need a standard of care that clearly outlines nurse to patient ratios. Currently, these standards do not exist. Nursing care is the backbone of our health care system and yet it is frequently dismissed. The studies are in. When nurse-patient ratios are optimized there are fewer complications, fewer adverse events, and even fewer deaths. As a health care consumer I demand that a standard be established. As a nurse I simply do not see how being forced to practice in a dangerous situation can be allowed to continue. We need approval of legislation that would establish safe, minimum RN-to-patient ratios in all Massachusetts hospitals. It's a matter of dignity and respect, and given my experience, it truly is a matter of life and death.
Richard Ferri is a nurse practitioner and the managing editor of NUMEDX.com © Copyright 2004 Globe Newspaper Company.
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