Letters

Washington Monthly, April, 1999

Our Story

In the January/February edition, Charles Peters, in his "Tilting at Windmills" column, cites a Washington Post report on underreporting of crime in Philadelphia.

For the record: The Post report was a summary of investigative disclosures by The Philadelphia Inquirer, which, in a series of articles over the last year, brought to light a longstanding Police Department practice of "downgrading" crimes to make the city's crime statistics look better.

The Inquirer reports prompted numerous changes, including an overhaul of incident reporting procedures in Philadelphia and the creation by Police Commissioner John F. Timoney of an independent panel to audit the department's crime figures and help him ferret out fakery.

MARC DUVOISIN CITY EDITOR THE PHILADELPHIA INQUIRER Philadelphia, PA

Shut Out

I enjoyed the "Tilting at Windmills" piece on social workers in welfare (March 1999) and was pleased that someone understands the contributions our profession can make.

It wasn't so much disillusionment that drove the social workers from eligibility work, though. The implementation of the 1968 amendments to the Social Security Act specifically required the separation of "eligibility" from "services" such as foster care and adoption. Eligibility workers could be clerks with high school level education. Social workers were to be used for services programs.

Before then, the strategy was to assign all welfare applicants to trained social workers who could help them overcome their poverty through collecting child support, marriage, and work. Social workers were eliminated from the process--they didn't simply withdraw.

LEON GINSBERG, Professor, College of Social Work, University of South Carolina Columbia, SC

Code Blue

At about 4 a.m. last night I finished reading Robert Worths disturbing article "Exhaustion That Kills" (January/February 1999). I was awake at this hour because my girlfriend, a third-year medical student, was up preparing to go to the hospital for work. She will be home tomorrow evening.

It is in their third year as medical students that our future doctors begin hospital rotations and start keeping outrageous hours. Shifts are long, sleep is infrequent, and though such hours may lead to more teaching time, the result is that students hardly care about patients. I know my girlfriend is more concerned with getting even a modicum of sleep than with actually taking care of her patients. If this is the attitude we are instilling in young, impressionable students, it does not bode well for our medical systems. Thanks to Robert Worth for addressing this troubling issue.

THADDEUS MCBRIDE Brookline, MA

I sought in vain for some mention of the changes in nursing staffing of hospitals as a major factor in the difficulties of residents experiencing horrendous exhaustion in Robert Worths "Exhaustion that Kills" (January/February 1999). Worth does not take into account the fact that well-prepared nurses in emergency rooms, operating rooms, intensive care units, and step-down units of hospitals can mitigate problems for physicians caring for patients. Nurse practitioners and advanced practice nurses in many specialty areas have been introduced to hospital tertiary care practice to mitigate the problems faced by residents. However, many highly prepared nurses have been let go.

Colleagues and I are hearing from nurses who tell us they are dealing with ratios of one RN to ten patients on the day shift, one to fifteen, or even one to twenty on some shifts. According to a study conducted by The American Hospital Association, three-quarters of all American hospitals are restructuring, which, in most cases, means they are laying off nurses. A 1996 report in Modern Healthcare noted that "from 1993 through January of 1996, 140 hospitals or systems laid off a total of 23,910 workers, or an average layoff of 171 workers per hospital." Another article carried the results of a survey of hospital administrators. Most said they would cut their staff to save money rather than limit research and development.

In 1994, when the American Nurses Association surveyed its members, 70 percent of all respondents said their employers were cutting back on staffing by leaving vacant positions unfilled. In many instances, nurses have been replaced by unlicensed assisting personnel. While these folks can be very helpful assisting nurses, it is hard to imagine them providing the backup that young physicians need.

CLAIRE FAGIN PH.D., R.N. DEAN EMERITA UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING Philadelphia, PA

You Try It

Having been a member of academe for some 40 years, I have been interested in Charles Peters' drive to promote more teaching by top professors at elite universities, especially at the undergraduate level ("Tilting at Windmills," January/February 1999).

First let me raise the question: what is the primary function of a university? My answer is fairly classical. It is to create and disseminate knowledge. Peters' contention seems to be that the elite institutions are more interested in the creation of knowledge. I certainly agree. The reason for this ought to be clear. The primary function of almost all our American universities is no longer to do research and teaching, but to make money in order to pay administrators, who neither do research nor teach, top salaries. Funding a substantial research program is much more effective. It brings in money in the form of both government and private grants.