This is a cartoon from a book that I bought at my local thrift store for 10 cents. Yep, I’m a big spender. The title of the book is, Nursing in Today’s World: Challenges, Issues, and Trends by Janice R. Ellis and Celia L. Hartley. It’s the fourth edition, and it was published in 1992. I bought the book because I liked the pictures. Take this example for instance. This is what I look like when I can’t sleep because I’m stressed out about work. I want to give good patient care, but it’s getting harder to do everyday. Nurses are asked to do more with less time, less staff, and less money.

When did things start going wrong? I was working at a hospital in the Midwest when HMOs came out. I noticed a red dot on the side of a few of the charts, and I asked what the red dots meant. My nursing manager explained that those charts belonged to patients that were members of a new HMO, and it was our job to get those patients out of the hospital ASAP so the hospital could make more money. I was shocked. Back then, saying something like that was blasphemy, but now it’s standard operating procedure. It’s no secret; the health care system is more focused on making a profit than it is on delivering good patient care.

I know that I am going to offend some people by saying this, but I don’t understand how nursing mangers can do their job within today’s profit driven health care system. I’m not suggesting that every manager is in a league with Satan, far from it, but I’ve known a few mangers over the years that have sold their soul to the devil. Look at the unit manager in the cartoon. She looks like she’s sleeping well at night, yet she’s telling the staff nurse that her first priority must be cost containment. I don’t remember cost containment being mentioned in the Florence Nightingale Pledge. The patient is always the nurse’s first priority. Good nurse mangers stand up for their staff and patients. They burnout quickly because their job eats away at them. The bad managers sell out and they seem to stick around forever.

I have no room in my nursing practice for sellouts.