Nurse Ratchet High on Attitude

0 Comments | Insight on the News, Nov 20, 2000 | by Suzanne Fields

Patient's bill of rights" sounds as high-minded as some of those things the Founding Fathers guaranteed to us, one of those "inalienable rights" that we hold to be "self-evident."

What that bill of rights should include depends on who you ask, or maybe whether you've ever heard of the Dingell-Norwood bill that Al Gore went on so about in the third debate. Or whether you ask someone who wants to sue his health-maintenance organization or who wants to choose another doctor. It all depends, maybe, on that fine print in the insurance policy.

Or you could ask anyone who ever has rung for a pain-killing pill at 4 o'clock in the morning in a strange hospital bed. You could ask me. I recently spent five days in the hospital for surgery on my poor achin' back. Just as all politics is local, all pain is personal. Anecdotes are not supposed to replace hard "objective" facts, but when it's your body, you can skip the objectivity, thank you.

So there I was, flat on it, after five hours of hammering and nailing on my interior superstructure and at the mercy of nurses on call. I had the doctor's permission to receive a painkiller at four-hour intervals, which I monitored very carefully. I understood Parlor's dogs.

It was 6 a.m. and my four hours were up. I rang for the nurse. No reply. Ten minutes later, I rang again. No reply. Thirty minutes later, ditto. Finally, a young woman in white, the twin sister of Nurse Ratchet, flew in from the cuckoo's nest, popped her head in my door and with the malevolent enthusiasm of Mary Poppins on crack asked what I wanted.

"I would like a pain pill," I replied, trying to show enough passive politeness to cover up internal rage.

"Don't you know we're changing shifts?" asked Nurse Ratchet. "I have paperwork to do."

"But I'm in pain and I need the medication my doctor wants me to have."

"Well," she said, "you'll just have to wait. I need another half-hour and when I finish my paperwork I'll bring it to you."

"But I can't wait another half-hour. I've already waited 45 minutes."

"You will if I say so. And if you don't stop taking up my time with talk, you'll wait another 45 minutes."

My rage erupted in exact proportion to my pain. Nurse Ratchet, her fingers no doubt worn to a nub from all the wear and tear with her pencils, hurried out and scrounged a pill. The shift transferred without bringing down either the republic or the District of Columbia.

But what about those either unable or incapable of rage? In talking to others who recently have spent time in the hospital, I've learned that my experience is closer to typical than not.

There are lots of reasons for the decline in nursing standards -- low pay, long hours, low status. Like teachers, many nurses, maybe even most, are a hardworking, well-trained group of skilled professionals. But as in teachers encouraged by their unions to develop an attitude, "attitude" often has replaced pride and dedication.

Before the arrival of contemporary feminism, becoming a nurse was a respected goal but, now that so many women are training to be doctors, nurses have become the Rodney Dangerfields in the corridors of the sick: They don't get no respect. In 1970, fewer than 10 percent of the newly minted doctors were women; by 1997 that figure had grown to more than 40 percent. By the end of the decade half of all medical degrees will be earned by women.

Fewer women are entering nursing schools and increasing numbers of experienced nurses are leaving the profession. If you ask them why, they'll tell you that it's the paperwork, the bureaucratic mentality that is taking over the practice of medicine.

One study predicts that in 10 years 40 percent of all nurses will be older than age 50. High tech outpatient clinics can handle the more ambulatory medical patients, but hospitals will be filled with the really sick -- those who require immediate and constant attention. "Old" used to refer to those older than age 85. Today it's as likely to mean those older than age 90. Such circumstances do not make for a happy family triage, especially when the green-eyeshade administrators determine who gets loving care and who just gets a hard time.

The nurses at the hospital where my achin' back collided with Nurse Ratchet's attitude are on strike, rebelling against mandatory overtime to cover a shortage of nurses. They want more pay. They've been replaced by out-of-town temps. When I remarked to doctors, therapists and other aides that the nursing care wasn't what it should be, I invariably was told, often in a whisper: "You're lucky to be here during the strike. The temps are better."

It's enough to make a body ache.