Link to this page: http://tinyurl.com/nurses-standing-up-for-us
Comment on this page: http://tinyurl.com/nurses-standing-up-comment
Several events from the last year have changed how we think about patient safety. We are beginning to appreciate the central role of nurses in our health care system. How do we think about the role of nurses?
Our language underscores our recognition of the central role of nurses in the healthcare system. Consider how we talk about vulnerable or sick patients. When we are sickest, we are "nursed" back to health. The highest level of care is one-on-one "nursing" care. Fragile newborns are cared for in the "nursery." Elderly can receive care in "nursing" homes, not "doctoring" homes or "hospital" homes. Despite the critical role of nurses, events of the last year suggest that nurses remain unappreciated.
February witnessed the Texas criminal trial arising out of two nurses, Anne Mitchell and Vicki Galle, having reported atrocious "medical" practices to the Texas Board of Medicine. http://tinyurl.com/NY-Times-on-Texas-Nurses This outrageous prosecution should have led to everyone who claims to support patient safety to stand up for these nurses. Curiously, the only professional societies who stood with these two Texas nurses were nursing societies. Despite the fact that the past AMA president was from Texas, the organization was curiously silent. Likewise, I could find no statements of support from any professional societies of physicians or hospital administrators. The deafening silence of the rest of organized medicine, except for the nurses' organizations, raises questions about whether the talk about patient safety is simply lip service. (Note: Please feel free to use the "comment" section below to share any support that Anne Mitchell and Vicki Galle received from physician or hospital organizations.)
A simmering dispute between the Temple University Hospital administration and nurses' union came to a boil in March and April.http://tinyurl.com/Temple-Gag-Order-on-Nurses-Un One of the central issues in the dispute was the administration's insistence on a "gag clause." As Mary Ellen Mannix explains:
According to the union leadership their main concern with the proposed contract is the disparagement clause that has been introduced. It state, in effect, "The Association, its officers, agents, representatives and members shall not publicly criticize, ridicule or make any statement which disparages Temple, or any of its affiliates or any of their respective management officers or medical staff members."
(See Examiner Blog by Mary Ellen Mannix, http://templewatch.org/, Temple Watch on Facebook, Philly Fox News. )
In Minnesota and California, nurses have begun taking stands on high patient to nurse ratios that threaten patient safety. According to Med City News, the president and CEO of Minnesota's HealthPartners, Mary Brainerd, rejects the demand of the nurses for staffing ratios. The union for the nurses is seeking to establish staffing levels that are safe for patients. Minnesota Nurse's Association. California nurses point to recent studies showing that staffing levels are associated with lower rates of patient deaths.
Implications of the California Nurse Staffing Mandate for Other States. Also see Sacramento Bee: California Nurse-Staffing Law Saves Lives, Study Says. San Francisco Chronicle: Pioneering Law on Nurses Found to Save LIves, Philadelphia Inquirer: More Nurses, Less Death.
The loudest voices for safe nurse-to-patient ratios comes from the ranks of the nurses. Their message:nurses are willing to strike for safer staffing levels. These are the same voices that inspired the phrases we use to describe the places and methods of care for the weak and the ill: "nursing homes," "newborn nurseries," and "nursing back to health."
When physicians and hospital administrators in Kermit, Texas, looked the other way on the dubious practices of Dr. Rolando Arafiles, it was two brave nurses who faced criminal prosecution for standing up. In Philadelphia, Minneapolis and California, the nurses are the ones willing to risk their jobs and strike for safer care.
Earlier this year, this blog asked all of us to "stand up for the Texas nurses. " http://tinyurl.com/stand-with-the-texas-nurses To quote another Texan, this request may have "misunderestimated" the importance of nurses. As this year has progressed, we have seen that nurses are the ones willing to risk what they have for our safety. These are the same nurses who enjoy less pay and prestige than physicians and hospital administrators. The nurses regularly staff the evening and midnight shifts, make sure we receive our medications, and clean up our bodily fluids. Was it the devotion of the nurses to our well being that attracted them to this profession? Was their experience of seeing how their care made a difference in our health what empowered them to risk their jobs for our safety? The answers to these questions can and will be disputed.
More important are the answers to some other questions. When it came time to expose Dr. Rolando Arafiles' misconduct, where were the physicians and hospital administrators? When it came time to protect the right of the Temple nurses to speak out against unsafe practices, where were the advocates for speaking out for patient safety? Even after studies show that ratios of nurses to patients affect the rate of patient death, only the nurses seem willing to take a stand for better ratios. Much remains to be accomplished on the patient safety front.
Nevertheless, one conclusion remains indisputable: it is the nurses who have been standing up for us all along.
