With the exception of Pawn Stars, Flipping Out, Ladies of London, and Wahlburgers, I’m not a fan of reality TV. Okay, so maybe that’s a bit of a lie. I do like a little reality TV, just not the obnoxious shows. You know the ones I’m talking about, they start with a K and a R?
Anyway, my all time favorite reality show is NY Med, a documentary-like series following ER nurses and doctors at hospitals in NYC and NJ. Unfortunately, NY Med is no longer on, but when it was, I was obsessed. I was obsessed, mostly, because of one of the show’s featured nurses, Katie Duke. I loved her energy, specifically her motto, “deal with it.” That motto stuck with me in the early days of my husband’s cancer diagnosis (I was watching the show when my husband was first diagnosed). It still does, to be honest, which is why I continue to follow Katie on social media, including her YouTube show on the Scrubs Beat channel.
Speaking of her show, on one of her recent episodes of The Katie Duke Show, Katie and her friend and former colleague discussed how nurses are assigned patients, and debated if assignments should be made based on the number of patients needing nursing care, or by acuity. Thankfully, they both agreed that the patient-nurse ratio should be based on acuity. I say thankfully because, I mean, why would it be any other way? Think about it, why should a patient who does not need a lot of care, but obviously needs some care (otherwise, would he/she be in the hospital?) be left for last (for a lack of a better way to describe this) because his or her nurse has another patient who really requires 1:1 care? And vice versa?
Why am I so interested in this topic? Because I’ve spent the past six months by my husband’s hospital bedside as he deals with complications from cancer and a major infection. I’ve also experienced numerous hospitalizations with other close family members over the last few years. Between the two, I’ve seen a lot. A lot that has convinced me that making nursing assignments based on acuity is the only way to make assignments, and will always be my expectation as a healthcare consumer, whether as a caretaker or a patient.
Before I go any further, let me say that my husband’s experience has been fantastic (you know, as fantastic as a six plus month stay can be). No, really. I’m not lying. Our hospital team is amazing and is very aware of their patients needs. To say we’re lucky would be an understatement. But, unfortunately, as I mentioned above, I’ve had experiences at other institutions with other family members over the last few years, and those experiences have not been nearly as positive.
Here’s a scenario that describes why I’m for assignments based on patient acuity.
Now, I know I just said that my husband’s experience has been fantastic, and that is the truth, but for this example I’m going to use a scenario from husband’s stay and apply it to a setting similar to what my other family members experienced at other institutions.
Without sharing too much (but with my husband’s permission), my husband has been hospitalized since April. At first, he was critical. How critical? Well, numerous people have told us it’s a miracle he’s still with us. Today, he’s clinically well, but still has a major open wound that requires a lot of nursing care to keep it, and the skin around the wound, clean in order to keep him clinically stable. When his wound vac leaks, and believe me when I tell you it leaks a lot (not because his care team is not skilled at doing this, but because his wound is in an awkward position and is an awkward shape. Awkward all around), he’s laying in liquid that is extremely bad for his skin (think bile). Laying in it too long can cause his skin to break down, which could lead to an infection, and on and on and on. He’s facing another big surgery soon, so an infection is not something we’re interested in.
In the ICU, he obviously had 1:1 care, so we never thought much about what life would be like outside the ICU with this type of wound. But when my husband was moved to the step-down unit for a few short days, things were really bad. The dressing just would not hold, and his nurse, who I will call “Charlie” from here on, was in his room at least 8 of his 12 hour shift (give or take, a bit) trying to keep him and his skin dry while we waited for his docs to come up. Charlie also had one other patient that day. If I were that patient, or a loved one of that patient, I would be concerned about the ability for a nurse to properly care for me and/or my loved one in this situation. In fact, I was (note: my concern was not about the a lack of skill, but by the fact that Charlie only has two hands). Thankfully, because as I’ve said before, we are in a fantastic hospital, the other nurses in the unit covered for Charlie and all patients were properly cared for (I was assured). But what would have happened if this happened at a different hospital? Let’s say a different hospital that was severely understaffed? What if (again, if we were at a different hospital) my husband’s nurse had two patients just as needy (for a lack of a better word) as my husband? Would my husband lay in fluid for too long, risking infection? Would both patients suffer?
The main reason why nursing assignments are not always made based on acuity seems pretty obvious to those on the outside— it’s all about reducing overhead costs these days. But I know there’s more to it than that. With that said, though, and even when institutions claim to be invested in the “patient experience,” staffing always seems to be done on the lower end of projections. But if the patient experience is really important to an institution, then nursing assignments should always be made based on acuity. It’s the ethical way to care for the patients who are dependent on others to get them well.
This all said, of course, from the patient/caretaker/consumer perspective, with much respect to those who make assignment decisions! Also, like teaching, nursing is an unappreciated profession. Hug a nurse today, okay?