Friday, November 25, 2016

Politics In Nursing

Back when I was a young idealist, I decided I was going to be a nurse. I was going to go and change people's lives, take care of them and just be the kind of nurse that makes everyone feel better. Unfortunately, reality doesn't always mirror our expectations. When I first became a nurse, I had the best job ever. All of our patients were private pay, which meant we had a very low nurse/patient ratio, as well as enough staff to actually take care of the patients.

Then hubby and I moved, and I found out that my dream job was the exception, not the rule. Since then, I've worked skilled nursing where all their patients are Medicaid or Medicare patients. Every building scrapes and begs for enough patients to break even. I didn't even realize how much the patient population affected the pay rate of the building until I took a management position and saw the behind the scenes.

The behind the scenes is what really made me wish I'd chosen a different career.

There is so much politics involved in nursing. There's trying to convince the hospital's social workers or case managers to send the patients to you, and not to the other facilities. There's the importance of the documentation because if one nurse or one CNA charts something incorrectly, it can cost the building hundreds of dollars. Maybe even thousands. And if all your nurses and CNAs document incorrectly, you can lose hundreds of thousands. Then there's the politics of home health and hospices coming and trying to get you to discharge your patients to them. In the area I'm in right now, I'm astounded by how many home health companies there are. For as rural an area that we are, there always seems to be more and more popping up.

Oh, and while we're talking about money and trying to get patients, there's also the push toward not even needing skilled nursing. When I was management at an assisted living, we started taking more and more patients that should have gone to a skilled. We found ways to get nurses in the building, whether through home health or through myself being on call 24/7. We just needed the patients in the building. There were times when I seriously questioned whether a patient was appropriate for assisted living, but there was always a loophole. Yes, they can't transfer themselves, but home health will shower them for us. Yes, they have a tube feeding, but that's during the day, and I was in the building anyway, right?

Now that I work in the hospital, I find that it's exactly the same. It's different, obviously. The way we're funded is different. The way that we get patients is different, but the idea is the same. Money controls the nurse to patient ratio. Money controls how many CNAs are on the floor. We have to do extra charting so that we can get funded by the insurances, but in doing the extra charting, we don't have time to actually be in with the patients as much as we'd like.

I hated the politics when I was in management. I almost felt like we'd forgotten the patients half of the time while we were trying to figure out how to cut corners to keep from spending so much money. It's an unfortunate reality, and I know that every business, and every field has the same problem. We can't function without the politics.