What Could Be Wrong with the IOM Committee on the Future of Nursing?

I have great respect for the IOM and am sure that the folks on the committee that is exploring the future of nursing have excellent intentions.   But here’s the problem, if you check out who is on this committee it includes only high level management and corporate representatives.  One of the people on the committee is John Rowe, who is the former CEO of Aetna.  According to researchers on health care overhead and administrative costs, Rowe  — a former geriatrician –earned more than $200,000 a day as CEO of Aetna.  I did the math and turned that into an hourly wage — assuming that Rowe worked a ten hour day — and came up with guess how much he earned each hour?  Over $18,000 an hour.  Is anyone on earth worth that?  So one man earned, in say three hours, more than the average nurse makes in a year.  I am sure Rowe is well-intentioned, but like the traders on Wall Street who are now guaranteed bonuses without regard to performance, such corporate compensation without regard to how an insurance company like Aetna performs for its subscribers/patients strikes me as a disqualifier for someone talking about the future of nursing.  Aetna was obviously very profitable for Rowe, but like other insurers it routinely denied sick patients needed services, forced  them to wait for hours on 800 lines, and routinely denied coverage because of preexisting conditions.

Check out who is on the committee.  There is no staff nurse representation .  No union representation even though unions make up the majority of nurses who belong to an organization within nursing.  More to the point, IOM recommendations tend to be exclusively voluntary.  I am therefore dubious that this committee, well intentioned as it maybe, will be able to grapple with the serious issues that face the profession.  What are some of those issues?

Well of the most crucial ones is work intensification — i..e  nurses are constantly asked to do more with less, while their CEOs  seem to be rewarded for doing less with more.  Today, I was reading an article in the New York Times about Wall Street firms guaranteeing bonuses to traders — even if they lose money for a firm or client.  Seems that Wall Street firms — who have done so much to advance our well-being economically and otherwise — are so eager to attract talent that they will tell traders they are assured say an extra $100 million even if they screw up.  Yet, our society, which supposedly values and trusts nurses is not willing to even guarantee a nurse a day’s pay.  Nurses all over the country come to work only to be told to go home when there aren ‘t enough patients.  Or they’re told not to come in on a scheduled day and take a sick, vacation or personal day instead.  Is this the way we treat a valued professional?  When I cancel an appointment with my massage therapist less than 24 hours in advance I have to pony up the entire fee for the hour I missed.  But RNs with years of educaiton and experience are supposed to live on air and altruism.  Will the new IOM committee consider this?

What about the way that hospitals are racing patients through the hospital bed via computerized bed tracking programs.  Nurses all over the country are complaining that the moment the patient comes into the bed, what concerns their management is not what happens when the patient is actually in the bed, but how quickly the nurse can get the patient out of the bed.  It is critical to consider how  this corporate focus on through-put impacts nursing practice.  “The moment the patient arrives, we have to estimate how quickly they will be discharged,” one nurse told me recently.  What is most important to her managers, she said, was the patient’s exit not what happens to the patient when he or she is in the hospital.  Of course, discharge planning is a crucial part of any attempt at patient management.  But if or when planning for the discharge seems to overshadow planning and delivering exquisite care to  the patient before they leave the hospital, then something is very wrong.  Yet nurses on the ground say this is precisely what is happening.  I am curious to know whether the IOM will look into this.

Perhaps the most distressing thing we see in all this is how the mechanisms of the factory assembly-line are invading health care.  Strategies to intensify work — to get nurses to do less with more –defeat nurses’ attempt to maintain a professional practice.  Although all of these assembly-line strategies come neatly packaged in the rhetoric of patient-centered care,   it is clear that efficiency, defined in classic economic terms as how few inputs can produce a particular output so that the cost is cheaper, often compromises patient outcomes.  Moreover, the industrialization of nursing work also compromises nurses’ sense of job satisfaction and ability to maintain professional standards.  Those who consider themselves to be nursing leaders talk alot about professionalism and professional integrity.  Yet many of the policies they promote Taylorize the work and deprofessionalize the worker.  Moreover, they convince working nurses that management is not merely not on their side but actually against them.  When a computerized bed utilization system was introduced in her hospital, one new nurse– who’d only been out of nursing school for a couple of years– had this to say.  “They (hospital management) hate us. Why do they hate us?”

I’d like to hear from working nurses about these work intensification issues and also let me know what you think about all this.  Do you have experience with new computerized systems?  Do you feel that your workload has increased with the introuduction of computerized systems?  Do you feel supported by management?

If you’re a manager how do you feel about what I’ve said?