I write in response to the topic of the Nursing Shortage, sharing experiences reported to me by nurses working in acute care facilities located along the East Coast of the United States. I believe the patient’s metaphor of the "Broken Machine" will help us better understand how the loss of human caring can be associated in part with our current and projected nursing shortages.
A nurse who was responsible for the care of patients on a geriatric unit in a community hospital found herself in the all too frequent position of being understaffed. In an effort to facilitate and expedite the scheduled procedures for the day, she decided to forego an administrative meeting and pitch in with routine morning care activities. She approached a somewhat demented patient, explained she would be bathing him today, and proceeded to do just that. As she did this she reflected that it had been a long time since she had been able to spend that much time with any one patient; that was a luxury these days, and she missed it.
Her reverie about this was interrupted when in the midst of bathing the patient, the patient turned his head to look directly into her eyes and naively said, "Is the machine broke today?" The nurse smiled at what at first seemed to be a humorous remark by a patient whose perception of reality was probably distorted by an organic process. The real impact of this statement, uttered with childlike innocence, however soon dawned upon her. Her musing on missing some of the satisfaction of relating directly with patients and having hands on contact with them was dwarfed by the profound sense of loss of human caring expressed by this patient, which unfortunately is illustrative of the increasing dehumanization of health care.
The loss of human caring can be associated in part with nursing staff shortages. Nurses still desire and need the time to "care" for their patients; they leave the profession when and they are unable to give the human caring they know their patients need in order to recover. One solution to the nursing shortage is to delegate responsibilities to ancillary staff who have minimal preparation in interpersonal and technical skills, such as "the machine." However, the registered nurse in these situations is still held responsible, both ethically and legally, for the quality and safety of the care that ancillary staff provides. The precariousness of this situation was dramatically brought home to another RN when an aide gave her updated vital signs for a patient who had died two hours before. The realization that this person for whom she was held responsible was in fact not doing her job and the potential ramifications of that were quite troublesome.
I dare say that a main source of the problems cited above is the "economic turn" in health care. Investors, drug companies, managed care executives, accountants, policy makers, and hospital administrators consider health care a business rather than a service to society. Therefore the highest priority of many decisions is the impact it will have on profits. In view of this, there has been a concurrent decrease in the emphasis on patient comfort, safety, ethics, competence, and professional satisfaction of the nurse. As nurses, we need to resist the trend toward the dehumanization of health care and take it up as a challenge. We must do this not only as a part of the service that we provide to the community, but also as a matter of a statement of a professional standard of nursing care, a standard essential for retaining the nurses we have and for recruiting new nurses into the profession.
Dr. Susan Kleiman, PhD, RN, CS, NPP
Assistant Professor of Nursing
City University of New York