The times, they are a changin'

Before I begin this entry, I must inform you that the writings that follow are from my own consciousness.  I do not seek to express or reflect the visions, practices, or opinions of any medical organization whom I have represented - past or present. Eva Morris

Ask any ER nurse and they'll tell you that nursing isn't the same as when they started.  Those of us who have maneuvered the white water rapids of change in healthcare have done so by riding the waves, getting tossed about, and hanging on for dear life.  I've been in the river long enough to see fee-for-service reimbursement turn into Diagnostic Related Group (DRG) reimbursement and the changes which ensued.  Soon after came the Core Measures, National Patient Safety Goals, and all of the other patient care standards that drive the practice of medicine today.  My belief is that these processes and expectations were implemented to standardize care and assure that treatment was optimal and consistent for all patients.  But with reimbursement attached to successful outcomes of patients, the picture changes dramatically.  Emergency Nurse Directors spend hours relentlessly coaching the nursing staff about mandatory charting to recoup maximum reimbursement, as the nurse gets pulled away from the patient's side and over to the computer keyboard.  I can't leave this paragraph pertaining to reimbursement without verbalizing my belief that Patient Satisfaction Scores have contributed to the Opioid crisis today.  Every ER I've ever worked in has struggled with appropriate management of patients infatuated with or addicted to pain medication. So what happens when the addicted patient doesn't get the quantity or type of pain medicine desired?  A bad review means Patient Satisfaction Scores decline, along with the reimbursement tied to it; there it is, a direct link to the opioid crisis in America.

Speaking of changes... Emergency Departments have become the family clinics, drunk tanks and make-shift psych wards (thanks to the powers that be for cutting money for mental healthcare!) and ambulances have become taxis.  Patients roll in on an EMS stretcher with a cell phone to their ear, requesting a blanket as they roll past the nurses' station, and all of this is a pre-cursor to "can I get something to eat?" This is a daily source of frustration for ER staff and EMS crews alike.  I speak for myself at this point, but probably for thousands of ER nurses too when I say that we pride ourselves in being able and willing to manage any emergency breaching our doors - it's what we trained for years to do and what we continue to educate and prepare ourselves for.  A good day for us is one in which we walk to the time clock knowing that someone continues to live or feels better because of our efforts.  Helping the frail, the sick, the broken and helpless feeds our professional souls.