Nurses Paying the Price For Cooperate Greed
The landscape for the practice of nursing has progressively changed and not for the better. Nurses remain well educated, capable, caring providers for the sick and injured. The American healthcare system has however, insidiously changed from being patient centered to profit centered. Consequences of the deterioration of American healthcare is reflected in the increase of nurses experiencing bullying, intimidation and harassment that are behaviors often aimed at protecting the cult of silence. Keeping quiet has always been highly regarded in nursing. A prevailing fear being don’t cause waves if you do not want to find yourself in trouble and your job on the line. True, issues of concern and conflict should be dealt with appropriately and nurses need to “pick their fights.” Some appropriate available avenues to affect change in the work environment is to be involved with committees and policy making groups. What do nurses do however, when threats to patient care or mistreatment of the nurse are regular occurrences? The answer for an increasing percentage of nurses is to throw in the towel and leave the profession.
New graduate nurses leave the profession at an alarming rate and only remain at the bedside for one to two years. This is down from only five years ago when nurses remained at the bedside, caring for patients, for five years. Something has changed and is driving nurses away from the practice of nursing. Further, reducing those nurses available to provide care for Americans is experienced nurses are retiring. The future would seem to be one of mostly dissatisfied, novice nurses being the majority of the nursing workforce. We are facing a crisis and it is time to address the issues that adversely affect nurse satisfaction, retention and ultimately patient safety.
Many of the issues that force nurses to abandon the practice of nursing are ones of fear and significant stress from being mistreated. The issues are serious enough that even good salaries, sign on bonuses and excellent benefits are not enough to keep our nurses committed to the profession.
Nurses should not have to be afraid to go to work. Nurses should be able to expect support from management when they speak up regarding threats to patient safety. And they certainly should not have to tolerate abusive behavior from Physicians, peers or leadership. Nurses report that negative, stress producing influences in nursing such as bullying, and the use of intimidation have increased. Research has well established the big problem of lateral violence and nurses “eating their young.” What has not been well talked about is the prevalence of horizontal violence and an increasing culture of fear. Nurses fear being treated with disrespect, verbally abused, and retaliated against. At the far end of the spectrum nurses fear being reported to the Board of Nursing and suffering often overly punitive consequences instead of remedial discipline aimed at helping the non-malicious nurse become a safer provider. Fear does not promote communication. Being treated punitively increases fear and then the cycle repeats.
Breakdown in communication is recognized as the most common causative factor for adverse patient outcomes related to preventable error. It is difficult to communicate with a Physician and advocate for patients when the nurse knows they will face an angry, degrading response and have no recourse. The natural response is to avoid such conflict and keep quiet, placing patients in harms way. Not unlike dysfunctional family systems the less empowered nurse learns to walk on glass and keep quiet. Millennials especially grow tired of such dysfunctional and abusive settings and choose to leave.
Preventable medical error is the third leading cause of death. A statistic that should prompt a call to action and reform. There however, has been no such stirring. It is beyond comprehension that this statistic has not prompted urgent intervention. This horrifying reality framing healthcare came about with the change of American healthcare to a profit driven cooperate structure. Hospitals and health care systems are now owned by large cooperation’s who aggressively seek to make money off of patient care. The resulting cooperate environment is a cut throat one with new pressures on providers and nurses to perform to increase the bottom line. Elisabeth Rosenthal in her ground breaking book An American Sickness. How Health Care Became Business and How You Can Take it Back, comments on the change from healthcare for the patient’s benefit to healthcare care for profit:
“I n the past quarter century, the American medical system has stopped focusing on health or even science. Instead it attends more or less single-mindedly to its own profits.”
Cooperate owners of hospitals have instituted strict patient metric requirements that providers and nurses are expected to meet. The goal is to decrease such as emergency room and hospital length of stays. Patients are rushed through their admission from door to door. Physicians have historically practiced for themselves and not the hospital. Now providers are expected to engage in improving the hospitals profit making. The pressure on providers is enormous. Failure to meet metric expectations results in providers and nurses facing negative consequences. Rushing patient care turns up the pressure on both providers and nurses increasing the risk of error and poor patient outcomes. The pressure of expectations to increase profit are enormous and nurses often bear the brunt of the stressed provider. An argument can be made that stressed providers feel entitled to be abusive to nurses because after all they are making the hospital money.
The culture of fear also keeps nurses from self reporting or reporting others that may have made an error or been negligent. Nurses are afraid to self report because of the wrath of State Boards of Nursing. Nursing Boards operate with impunity. In Texas the number of active investigations against nurses had increased dramatically. So has the number of formal punitive disciplinary actions. Nurses are afraid of their regulatory Boards, afraid of having their career stripped from them. They fear the overly lengthy investigations that place their and their families lives in limbo. They fear having their career crippled by stipulations attached to a so called “warning.” Warning or not, stipulations such as having to have supervision pretty well guarantees a nurse will not be able to gain employment. For certain violations of the practice act such stipulations are necessary. Complaints to the Board however, most often are in regard to failures to completely and accurately document or medication errors that did not result in patient harm. Such violations occur without intent and are often an unfortunate result of mitigating circumstances that the Board does not consider.
It may well be that violations of the standard of care by nurses is up. Review of the published details of nurses disciplinary action reveals that nurses testify in their defense that they were subject to an unreasonably overwhelming and acute patient assignment and that the entire unit was short staffed. Errors are predictable in such circumstances and management knows it. Yet Boards of nursing do not take action against the very nurse manager that place their nurses in no win situations where errors are bound to happen. Instead nurses are again sacrificed for the profit driven practices of hospitals. Hospitals have become dangerous places on the backs of nurses. Nurses are often reported to the Board of Nursing when preventable errors occur as the hospital attempts to protect themselves. Hospitals have become dangerous places on the backs of nurses. Nursing as a whole is paying a price for cooperate greed and patients are paying an even higher price.