Editorial: Nurses Hold the Health Care System Together

By Becky O’Malley
Tuesday July 11, 2006

In my voicemail this Monday morning: a message from one of my many red-diaper-baby chums, born again to political activism after a brief mid-life flirtation with Republicanism. “Schwarzenegger is trying to bust the nurses’ union! Come to a rally on Tuesday! If you don’t we’ll soon see 100 patients to every nurse!” Well, she might exaggerate a bit, but she’s oh, so right in principle. Things are bad in hospitals now, and if the medical industry has its way they’ll be getting worse. 

How do I know this? Well, a week ago last Thursday my father, in his nineties and suffering from osteoporosis, took a fall in his back yard. He complained of back pain, but since it was the Fourth of July weekend, and following his primary care doctor’s telephone advice, my mother decided to wait until Monday to have him checked, having too many times suffered though multi-hour waits in the emergency room at Alta Bates. But he was worse by Monday morning, couldn’t stand or walk any more, so at 9 a.m. she called 911 and the splendid team of Berkeley firefighters who responded took him in to the emergency room. 

Those of you who have been lucky enough not to get very sick yet, or who belong to Kaiser, might not realize that the emergency room is now the main locus for urgent care for almost all patients who aren’t part of Kaiser, whether well-insured or homeless. My parents have the very best insurance coverage (my father is a retired UC administrator) but when they have any medical problem of any complexity outside of business hours, it’s the ER or nothing.  

It turns out that waiting until Monday didn’t help. The two of them, both over 90, arrived at 9:30 a.m., and stayed there until 10:30 at night, when my father finally made it into an upstairs hospital bed.  

The diagnosis was predictable: a compression fracture of a vertebra, confirmed by imaging, not life-threatening but very painful, too much for my mother to deal with at home. One might question why 13 hours in the emergency room were needed to arrive at this conclusion, and one would be given an answer based on prioritization of life-threatening cases, but that’s not the whole story. The story is also about profits, and capacity, and yes, nurses, very few of them in the ER that day, doing the labors of Hercules.  

The nurse who checked in on my parents from time to time was from Nigeria, and said that she’d had to send her children back there to be taken care of by their grandmother because having them live here and paying for child care was too expensive on her wages. I’d just heard an NPR story about African nurses who need to work abroad for convertible currencies because of their countries’ debts to the international banking system. Many of the nurses at Alta Bates seemed to have been recruited from other countries for similar reasons.  

My mother made sure that she told the doctors the patient had previously suffered from adverse reactions to drugs in the narcotic/opiate category and that he should not be given such drugs, which was duly noted in the record. However, the first night my father was in the hospital the on-call neurosurgeon wrote a prescription for a morphine patch anyhow, possibly because he’d neglected to read the history. A nurse caught the mistake before the patch was used.  

Those of us who are lucky enough to be seldom ill might imagine that if we go to the hospital “our own doctor” will be monitoring our care. No such luck. These days there’s a specialty called “hospitalist,” doctors who do nothing but care for patients in the hospital under the hospital’s management. Other specialists, for example the errant neurosurgeon, are also selected by the hospital, not by “your own doctor” (though my parents’ particular very experienced outside primary care physician is not shy about putting in his own opinion if he’s asked and thinks he should). Even Kaiser has now adopted the hospitalist model. 

But it’s the nurses who are the glue that’s holding the whole shaky system together at this point. They’re vastly, dramatically overworked, but by and large they still seem to care about doing a good job. They do read the patient’s charts, almost all the time. Most nurses are efficient, intelligent and kind, though many other kinds of medical personnel these days seem to have only one or two of these three traits. 

And it’s the nurses’ union that has consistently fought for decent working conditions and staffing models that make it possible for them to do their best against all odds. The health care industry, which includes the insurance industry, is sucking profit out of the medical economy instead of spending it on patient care. Health care statistics in the United States are not improving—they’re getting worse, as compared with all sorts of other countries, for example Canada. It doesn’t matter what kind of insurance you have, either. Even people like my father who have the very best insurance spend hours on gurneys being cared for in hospitals by nurses who have too many patients and are paid too little. 

Nurses are currently worried that a pending National Labor Relations Board decision could end up denying many nurses their right to organize because they’re “supervisors.” It’s true that increasingly key decisions about patient care are being made by nurses because they’re the last functional part of the damaged health care system, but they still need their union to back them up when they insist on a rational workplace.  

All of us need to work as hard as we can to remind voters of this incident, as reported by the Guardian last year: “‘Pay no attention to those voices over there,’ Schwarzenegger told a conference as it was disrupted by a group of nurses protesting against him. ‘They are the special interests. Special interests don’t like me in Sacramento [California’s capital] because I kick their butt.’” 

Almost all of us are indeed part of a special interest group: “Future Patients of America.” Sooner or later, most of us will eventually need help from nurses, and it’s in everyone’s best interest to make sure that they’re supported in their efforts to be able to do their best on the job. In this fall’s election, Governor Schwarzenegger needs to be frequently and forcefully reminded that we the voters, as Future Patients, won’t let him kick nurses around anymore.