I am a retired RN, 40 years , mostly in ICU and Critical Care units. I did do a stint as a manager, so can see the issue from both sides. My position is that there is nothing to push hospitals to care about anything but profit for their shareholders. I am not a fan of Managed Health Care for profit. Managed Health Care itself is a fairly defensible idea. Medicine for profit is not and never will be a good idea. Ethically speaking, profiting from human suffering is unethical and immoral. Making a profit is not itself a bad thing, but having profit as the goal for any healthcare organization or unit is unacceptable.
The real problem in healthcare is structural. The sole unit of production (what the company actually sells or provides) is NURSING CARE. If doctors could do everything in their offices they would do so. The only unique service that the hospital provides that cannot be replaced is nursing care. This is why doctors send patients to hospitals, this is what actually keeps patients alive. Just ask any 2nd or 1st year intern who has relied on nurses to keep him from making potentially disastrous mistakes in a 3 am sleepless shift. You will not find any doctor who would even try to set up and maintain 4-5 different cardiopulmonary systemic infusions and calculate their titration to arterial and Swan Ganz line readings and a ventricular pressure measuring bolt inserted into the skull of the patient while monitoring 2-3 chest tubes, urinary output and respiratory status and maintaining a ventilator. All of this while keeping the patient clean and dressings clean and changed regularly, inserting peripheral IVs and dealing with patient and family anxiety. Until you have done this for two straight shifts with no breaks or anything to eat and have to go home and come back in after only 8 hours to do it all again, you have no idea what nurses deal with. Keep in mind that the nurse in question also may have another one or even two other patients to take care of and is worrying about his or her own exposure to disease or infection. And they have to document EVERYTHING they do and why
It is arguably one of the worst jobs on the planet, unless you are the particularly selfless and hardened personality that takes on this kind thing as a challenge and a beloved way of life. Like auto racing, the adrenaline high is pretty intoxicating. Most Nurses will tell you that "just getting through the shift without anything disastrous happening" is a true victory. Now you may understand why the high burnout rate exists in nursing . Unfortunately, Hospitals, Nursing Homes and other Healthcare organizations look at nurses as expendable and easily replaced. No one cars for the caregiver. This is why Nurses need advocates, and so far no one has stepped up to do so. Therefore, unions have become possibly the last line of defense against a complete collapse of the healthcare system.
The second and possibly core problem with Healthcare is that it is not run by the people who actually know what is needed, how things are done and have some expertise in the running of the system. Business and Hospital Administrations are full of MBAs whose sole bible is the bottom line, keeping staffing low as possible and ignoring anything but profit for the shareholder. Nurses should be making these decisions, not beancounters whose conscience was surgically removed during their graduate studies. Doctors are clients, and it makes about as much sense to have one of them in charge administratively as to have engineers who never drove a car, never ran an assembly line or ever designed a vehicle in charge of GM. If this structural deficiency is not corrected, Healthcare may well collapse sooner rather than later, Doctors do procedures, examine and diagnose patients and write orders. They do not and most cannot do direct patient care, as witnessed in studies where medical students tried to function as nurses, and failed dismally. It is apples and oranges.
Are traditional unions the answer? I don't know and have my doubts. Nursing needs some novel form of national advocacy, collective bargaining and protection under law, or there will be no nurses, and a lot of people will die needlessly. It is that dire. The present abuse of nursing cannot be sustained.
https://www.nytimes.com/2021/01/28/health/covid-health-workers-unions.html?campaign_id=9&emc=edit_nn_20210128&instance_id=26537&nl=the-morning®i_id=133856679&segment_id=50580&te=1&user_id=37f87df980a5d33c0706ba74f21e2042
