ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Sunday, November 24, 1996 TAG: 9611220076
SECTION: BUSINESS PAGE: 1 EDITION: METRO
COLUMN: HEALTH CARE
SOURCE: SANDRA BROWN KELLY
The push to care for more patients with fewer health care professionals is a national issue that is being played out painfully in Southwest Virginia.
Concerns that business decisions are threatening the quality of patient care have surfaced in recent weeks from nurses who work in the Roanoke Valley's Carilion Roanoke Memorial and Carilion Roanoke Community hospitals.
Some of the health care workers are discussing their frustration with two labor unions.
Both nationally and here, hospital nurses have less support staff, such as housekeeping workers and nursing assistants. Nurses are reassigned to areas in hospitals where they haven't worked before or have not worked for a long time. And they are working longer shifts and mandatory overtime.
Having enough staff to care for patients has been a perennial issue, only now it's different, said Rebecca Rice, a 30-year-nursing veteran and new president of the Virginia Nurses Association.
It's different because the definition of care has changed, she said.
As a fresh nursing-school graduate Rice said she was expected to look after six patients, but probably only two of them were really in need of more than occasional attention, Rice said.
These days, those four patients who didn't need close scrutiny wouldn't even be in the hospital. Insurance companies would forbid it.
A nurse responsible for six patients in today's hospitals is caring for six sick people, said the Arlington resident.
Nurses, and other patient caregivers, have nothing but patients who need full care, she said. The stress is greater and so is the potential for errors.
On a recent segment of the popular television show "ER," a nurse assigned to temporary duty in an emergency room almost killed a baby because she provided the wrong medicine for injection. No one has suggested anything like that has happened here, but health care workers worry that it could.
That's why some met with representatives of the Kentucky Nurses Association and the Service Employees International Union who were in Roanoke last week.
The reason the Kentucky Nurses group is in town and not the Virginia Nurses Association is because each state group makes its own decisions on whether to offer collective- bargaining services to members. The Virginia group chose not to do that but has no problem with the Kentucky Nurses' efforts here, Rice said.
Rice manages a health care project in Washington, D.C., for the Robert Wood Johnson Foundation, a national group that gives grants for specia-needs programs, but until last year she headed the nursing program at Norfolk State University. She also has a daughter who is a nurse, and she hears about today's hospital life from her.
The daughter works in a Tidewater hospital and on a recent night had to care for six to eight children who were quite sick, Rice said. She had only one helper, an unlicensed assistant, working with her.
In such situations, a nurse often is forced to delegate some duties that she might normally do herself, but she's also responsible for seeing that the tasks are done correctly.
If something goes wrong, the nurse's license is at risk, Rice said.
"Nurses are very vulnerable right now," she said.
But Rice points out that she also understands the pressures on health care companies. Cost-cutting trends are pinching everyone. But the midlevel nurses, the ones actually delivering care in hospitals, are catching it harder than most, she said.
After years in which specialization of nursing skills was the norm, they are expected to cross-train and become generalists. At the same time, the numbers of skilled staff are dropping.
"It's difficult for nurses to do the kinds of things being asked of them," Rice said.
Rice agrees with hospital managers who want to delegate more duties to lower-paid staff. She also agrees that unlicensed workers can be taught technical skills. Insertion of needles for intravenous liquids or medications or putting a tube through a patient's nostrils into the stomach are such simple procedures, she said.
"But what appears to be simple on the outside takes understanding to accomplish," Rice said. "Lots of things can go wrong when you're doing simple tasks. Nurses have the training and background to identify problems that would occur."
But Rice doesn't believe the changes are anywhere near stopping.
"The pendulum will swing further toward cost-cutting and efficiency before the public identifies it as a threat to quality," she said.
QUESTIONS YOU SHOULD ASK
The American Nurses Association has produced a brochure, "Every Patient Deserves a Nurse," to persuade consumers that patient care should be kept in the hands of licensed professionals. The brochure suggests that patients ask these questions to evaluate the care provided by a hospital.
BEFORE HOSPITALIZATION
*Will I have a registered nurse caring for me?
*Will a plan of care be developed? How will I learn about the plan of care and how will staff caring for me learn about the plan?
*How many patients are assigned to each RN on the unit where I will most likely stay?
*Compare the number of RNs on the weekday, night and weekend shifts.
*How does the hospital provide for RN staffing when there is an unexpected shortage in the unit?
*Will I be assessed by an RN at least once per shift?
*Will an RN provide education about what to expect before, during and after medical procedures and treatments?
DURING HOSPITALIZATION
*Will I have an RN assigned to me and will the RN be coordinating my care throughout my stay? What hours will my RN be there and assigned to me?
* What other health care personnel will be working with my RN? What are their qualifications? What tasks will they be doing?
*Will an RN review my plan of care with me? Will I understand who will be providing different aspects of my care?
AFTER HOSPITALIZATION
*Will an RN discuss plans for discharge and follow-up with me?
*Will an RN teach me about medications, diet, activity, wound care, and what to expect when I get home?
*Will I need nursing care at home? If so, who will provide it? Has it been arranged?
*Whom can I call for answers to questions once I am at home?
Sandra Brown Kelly covers health and medicine. You can contact her at 1-800-346-1234, x393, at 981-3393 or through biznews@roanoke.infi.net.
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