Professionalism vs. Realism

A few years ago (1998) the IOM released a report/White Paper on patient safety, titled "To Err is Human." Detailing how bad the health care system was in America... how up to 98,000 preventable patient deaths a year, were associated with poor processes, medical errors, etc.

How far have we come?

There have been billions, if not even trillions of dollars spent on the creation of new Organizations, Governmental and Quasi-Governmental Agencies, mandatory reporting databases, Consultants to help health care providers comply; the list goes on and on!

I am still looking for a good, critical research paper that outlines and details the changes and progress that has been made. What the "best demonstrated practice" is. What works and doesn't work.

What I would like the most, is for the original researchers, or new researchers using the same method, sample size, data stream, etc., to repeat the study! Let's compare oranges to oranges, as best we can! Although I fear it will be oranges to tangerines at best, maybe citrus to citrus...

Please don't get me wrong! There have been substantial improvements! Massive changes! Heck, I hardly recognize the profession I am in from when I started 15 years ago. There are so many variables involved in providing health care services; the training and education, the technology, the care models, the collaborative team models, the drugs, the interventions, staff mix, patient acuity, patient demographics, insurance reimbursements, medical malpractice... all of it has changed! I don't think the original study could even be correctly, that is scientifically, reproduced!

What worries me the most is that health care services, are de-evolving into a consumer-driven industry... Door to Doctor time, Average Wait time, Patient Flow, Patient Throughput time... about the only thing I can agree with is the Insult to Intervention time! At least that has some science behind it! The old mantra of "time is muscle" for an acute myocardial infarction (AMI)... that made sense! And it makes sense in quite a few other conditions too!

And believe me! You come to the ED and you have a true emergency or even a potentially true emergency... you don't wait! You are brought straight back, and multiple health care workers are at your bedside and are doing multiple things, almost simultaneously, to determine if it is real, potential, or not happening.

My patient is "dissatisfied" because they had to wait in the ED lobby for 2 hours to see a Doctor for a non-emergent condition? Or they were "rushed back but ended up waiting hours!"? Or perhaps it took me 15 minutes to answer there call/request for something to drink, pain medicine, a warm blanket, or the best... the ultimate question: "how much longer is 'this' going to take?"

How does that reflect on my overall patient care? So I should leave the patient that I am doing critical interventions on, giving IV fluids, blood products and vasopressors to... due to a blood pressure of 60/40, an H&H of 5.6/14, a Platelet count of 2, and a raging sepsis... to get a Percocet for someone who is complaining of back pain that has been chronic for three months and suddenly became an emergency tonight?

And I am not even to the number of patients that get admitted to a hospital for obviously very legitimate reasons, that spend a day or more in the ED, due to lack of available inpatient hospital beds!

I am probably one of the most compassionate and caring people you will ever meet. That's part of what makes me a good nurse!

Another part is that I will strongly, even forcefully, advocate on your behalf if I feel you need something. I have "literally" stood toe to toe, face to face, with other health care team members, to make sure that the patient I was caring for got what they needed, when they needed it! And there were sometimes red faces, loud voices, and elevated blood pressures involved too!

I now must apologize.

I am sorry I went on this diatribe, stepped up on this soapbox. In a way, it might even be considered a tad unprofessional.

I had more than a few taxing moments these past few shifts. I wonder how I can overcome, deal with, find solutions for, and prevent future occurrences?

I just hope and pray I made a difference, an impact, and helped save those three lives just this last night...

One last thing, and this will make some people upset, mad, even outraged...

I am an ED Nurse... I save your ass! I don't have to kiss it.


Peace!