After 45 years as an ICU nurse specializing in surgical trauma ICU and eventually PACU nursing, Marsha wasn’t ready to retire. She was restless and bored and decided to continue her PACU expertise at a freestanding surgical center. While juggling that job and an endoscopy center, she started to notice a recurring theme: time is money.
The endoscopy freestanding clinic performed colonoscopies, EGDs, and sigmoidoscopies—up to 42 procedures a day. More endoscopy procedures meant more revenue for the system, making them lucrative money-makers.
Marsha prepared patients at both freestanding centers. She started IVs, administered medications, gathered medical histories, checked for allergies, and obtained signed consents. After the procedures, she would wait for the patients to wake up from anesthesia, then discontinue their IVs, discharge them, and escort them to their cars via wheelchairs. Other duties included sanitizing the stretcher, applying new linens, and preparing for the next patient, all while managing two other patients waiting in the PACU for her to recover.
She was responsible for ensuring all systems were functioning well: EKG rhythm, respiratory and heart rate, clear lungs, and patient alertness. Only then could she validate a discharge for the patient.
As we all know, not all patients are created equal. Some take more time to recover, especially those with many comorbidities, complicating discharge time.
Occasionally, the supervisor would reprimand Marsha for taking too long to discharge patients, telling her, “You talk too much,” or “You’re not fast enough.” With 42 patients in a day, the physicians would get upset if she didn’t move faster.
Marsha realized that some patients at the surgical center were not always ready to be discharged. Issues like shortness of breath, arrhythmias, and surgeries lasting over six hours required more recovery time than the allowed 20 minutes. Called into the office again, she saw that patients were treated as numbers with dollar signs on their foreheads.
Over the past decade, hospitals have turned into money-making corporations. The patient-first philosophy is no longer valid. The focus is on getting patients in and out quickly. CEOs, board members, and bean counters behind mahogany desks are counting the cases done in record time. More patients in quick turnover easily mean more money.
Trisha loved being a CRNA, specializing in pediatrics. She was professional, diligent, and considered an expert in her many years of administering anesthesia. Her little patients adored her, as did their parents. Trisha was a veteran, old school, who understood the value of good surgery, anesthesia, and postoperative care. She was quick to notice anything out of place, stalling surgery due to missed data on patients or incorrect name bands—mistakes that could potentially save lives. Surgeons often got angry at Trisha, feeling she was delaying surgery, though her findings ultimately protected the patients.
Surgeons would never blame patients for being late to surgery, but they would easily blame the nurse anesthesia. The repeated refrain was, “You’re not fast enough.” Though precise and accurate in her patient assessments, such as catching undocumented medications, chemotherapy-induced vomiting, or unreported arrhythmias, she was labeled “picky.” Some felt it wasn’t a big deal, like an incorrect name on a patient’s armband.
After more than 40 years as a CRNA, Trisha decided to retire, realizing that the hospital systems she worked for were too dangerous and haphazard. The blame game was rampant. Surgeons were upset because they couldn’t start surgeries on time, and PACU managers were frustrated when anesthetists or PACU nurses couldn’t transfer or discharge patients due to surgical complications. Some patients simply weren’t ready to be discharged. The recurring theme was always: time is money.
Patients, whom health care professionals valued and cared for deeply, were now considered mere footnotes. Nurses, CRNAs, AAs, physicians, PAs, and NPs, fearing for their licenses due to lack of support from higher-ups, started leaving hospital systems.
Trisha, CRNA, retired, disillusioned by a health care system that had lost its roots and allegiance to putting patients first. Marsha left her two jobs and joined hospice, realizing there was no “time management” with hospice. When patients are ready to die, they do so on their own time. Instead of always fighting to save lives, Marsha chose to hold the hands of patients, allowing them to leave this earth comfortably and peacefully.
The hospital systems and freestanding surgeries of yesteryear are now extinct. Trisha, Marsha, and many other health care professionals no longer fear the stopwatch, urgency, and assembly-line approach manufactured by health care CEOs, board members, and their bean counters.
Debbie Moore-Black is a nurse who blogs at Do Not Resuscitate.
