Nurses as Housekeepers at Vanderbilt Medical Center: An Untold Story Behind the Story

by Rosemary Gibson, Senior Advisor, The Hastings Center and Author, Battle Over Health Care: What Obama’s Reform Means for America’s Future

Hospital budget cuts became viscerally visible earlier this month when Vanderbilt Medical Center announced that nurses must now perform housekeeping duties — cleaning patients’ rooms and bathrooms.

In case you missed the video of the internal announcement secretly recorded by a nurse that aired on  Nashville’s WSMV television station, here it is.

http://www.wsmv.com/story/23364976/vanderbilt-medical-center-to-have-nurses-cleaning-up?autoStart=true&topVideoCatNo=default&clipId=9280584

It is hard to think of a worse way to demoralize professionals who want to practice at the top of their license.  Invoking Florence Nightingale’s name as a spoonful of sugar to help the budget medicine go down is no salve for deep wounds of disrespect.

For patients, they are at greater risk, an inevitable outcome as nurses spend less time at the bedside.

All of this begs the question, “Where does all the money go in hospitals, who is getting it, and what are they really doing with it?”

The direction of the budget axe is being determined by an unspoken battle between labor and capital.

Nurses, pharmacists, housekeepers and increasingly, doctors, are employed labor.

Medical equipment and supplies, medical devices, drugs, computers and information technology are the products of capital investment.  Companies that manufacture these products need constantly increasing revenue to keep stock prices and earnings per share headed north.  Stockholders and other investors – their unforgiving owners – demand bigger, better, quicker returns.

Consequently, companies are programmed to take more money for themselves, which leaves less for everyone else, especially nurses.  I wrote about the uncanny parallels between the health care industry and the banking sector in Battle Over Health Care: What Obama’s Reform Means for America’s Future.  Both have price bubbles, toxic assets, too-big-to-fail syndrome, and privatized gains and socialized losses.

Implicit tradeoffs between labor and capital are made every day.

Companies have to create a stream of so-called new, innovative products every year to pump up earnings per share.  As nurses know, new is not always better.  It might be worse.  A steady torrent of new stuff: equipment, technology and a bevy of consultants causes money to trickle up.

Meanwhile, hospitals are not exactly shopping at the equivalent of Costco and getting a competitive price.  And they buy too much that ends up in landfills.  A hospital supply chain executive at a large public teaching hospital estimates that at least 10 percent of hospital purchases in inventory are expired.  Good for Wall Street investors.  Bad for people taking care of patients.

To correct the misallocation of the public’s money, transparency of billion-dollar hospital budgets would shed light on where all the money is really going.

In the meantime, we cannot let the material abundance of a few create a chasm of indifference to the plight of many.

by Rosemary Gibson, Senior Advisor, The Hastings

On Duty

This is  repost by guest blogger Sybil Shalo Wilmont originally published in Columbia Journalism Review.  Sibyl Shalo Wilmont is a healthcare journalist and emergency department nurse with insider experience in the pharmaceutical industry, academic medicine, and patient advocacy. She is a graduate student in Hunter College’s dual-degree Master’s in Community/Public Health Nursing/Master’s in Public Health program. Follow her on Twitter @nursesibyl.

The other night, my father, a lawyer, sat down with a fistful of hospital-related news clippings—as he often does when we haven’t seen each other for a while—and began to read aloud this headline from a blurb in the New York State Law Digest:

Hospital owes no general duty to drunk patient, brought in by friend, to bar him from leaving hospital.

You know that sound effect they play on kiddie shows, the one that sounds like a record being yanked off a turntable? That’s what I heard over my father’s voice as he continued reading. The blurb summarized a June New York State Court of Appeals decision that, although it changes absolutely nothing about the way healthcare providers and hospitals care for intoxicated patients, offers valuable insights into the moral and ethical underpinnings of our pubic health philosophy, which values autonomy over paternalism—even when people might not be making the best decisions for themselves.

A little digging revealed a bounty of legal and insurance trade coverage and analysis of the case, but almost nothing in the way of consumer press. Two reporters for small New York newspapers figured the case of Kowalski v. St. Francis was at least important enough to cover as the local news that it was. Chris Valdez, an investigative reporter at the Poughkeepsie Journal, and Hudson Valley Reporter editor Bob Dumas wrote the only two non-trade pieces about the case I could find since the June 26th ruling.

Briefly, the 2006 case involved a severely alcohol-intoxicated man (Kevin Kowalski) who was brought to the St. Francis Hospital ED in Poughkeepsie, NY by a friend to be voluntarily admitted to the hospital’s detox program. While waiting for a transfer to the program, he told a nurse that he wanted to take a taxi and leave. She told him to call a friend to come pick him up and he agreed, but walked out of the building when the nurse wasn’t looking.  (continue reading here)

 

 

 

This is  repost by guest blogger Sybil