It's Getting Scary Out There in Healthcare-Land!

That healthcare in the U.S.A. is in a state of upheaval is a given.  The ‘game’ has changed at every level. National health policy is being written, monitored & enforced in part by people who’ve never been near a patient. Hospitals are closing and merging and giving way to giant medical centers, limiting access to care, in the name of savings and profit. We’re in the midst of an unprecedented shift in the health insurance model that’s as much a leap of faith as anything. Private health insurance companies continue their stranglehold on policy coverage, but the Affordable Care Act has set new terms about at least pre-existing condition coverage and preventive care screening tests. Pharmaceutical companies continue to push drugs during family television time, though not without regulation intended to give at least the appearance of propriety. 

The traditional model of medical care delivery, where most decisions about a person’s care are made by the attending physician, is slowly giving way to a patient-centered delivery model where the patient makes the decisions, and that also allows for nurse practitioners and physician assistants to function as primary clinical providers. The American Medical Association is trying to hold on to the traditional model, but the tide is changing.

With that, the nursing profession also seems to have lost its footing, at least temporarily, by virtue of a persistently nebulous definition of what the profession has to offer in today’s health care delivery system. Recently, in an alleged cost-cutting move that speaks volumes to the ease with which the nursing profession can be beaten down and manipulated, Vanderbilt Medical Center circulated a memo directing that nurses are to assume duties such as cleaning bathrooms, sweeping and mopping floors, and emptying trash. (Sent to me by a friend). http://www.wsmv.com/story/23364976/vanderbilt-medical-center-to-have-nurses-cleaning-up. 

Today, minimally trained nursing assistants perform many of the patient care duties that RN’s once considered the domain of the profession, and the hierarchy within the profession creates confusion as to who should be providing the care – the ADN, BSN, MSN or PhD-level nurses!  Everyone wants to be the boss, and the bosses all want the least trained people to be administering the care to the patient, who is supposed to be the center of the care.  If Vanderbilt has its way, the nurses will be the housekeepers. How much more upside down can it get?

For all the changes, I always believed that there was one stronghold of the nursing profession that would never give way to those who would overpower it. Advocacy. The soul of the nursing profession, in my opinion, is advocacy. Nurses are the guardians of the patients. We keep safe those under our care, provide education, help with decision-making, assist with efforts, walk with our patients and their loved ones wherever the path leads, help guide to autonomy, independence.  Nurses have always been advocates.

Ah, but advocacy has changed as well. It seems today that random people can hang out  shingles and call themselves “patient advocates” – and get paid for it! And so they are, regardless of whether or not they’ve ever been near a patient, or if their entire healthcare experience occurred when they once had to take care of a family member at home. This so-called “patient advocacy” is an unregulated industry that has no legislative mandates and demands no license, particular training, standard of practice or code of ethics. There’s absolutely no national entity that is creating, monitoring or enforcing rules, and the potential for fraud and abuse is chilling. The catastrophe that could occur when a lay ‘advocate’ would dare to practice medicine or nursing, by so advising the patient, is downright scary.  Yes, there are emerging programs that are moneymakers for colleges and others who’ve never laid hands on a patient. Sadly, some nurse entrepreneurs have become the trainers. 

Why are nurses giving away, or selling, what little is left of the profession – the very soul of it – just to turn a quick buck?  Will the profession be rendered obsolete by delegation and sale to the highest bidder?