Heads in beds

I have two friends who are near and dear to me. Kim and Carol. The three of us used to work together back when I was working in Administration in the hospital. I spent 9 years as the Director of Nursing Services. Carol was the Director of Marketing/Public Relations and Kim was the Corporate Nursing QI Consultant from the corporate office.

Kim and Carol still hold their positions at the hospital. I quit my job in September 2002 and went to work as a real nurse for the hospice agency. I felt out of touch – – I was tired of the corporate politics…I wanted to make more of a difference than what I felt I was in Admin. at the hospital. After 9 years of doing it, I felt nothing more than a glorified babysitter of a nursing staff….the big ear for all their personal problems…and less of a nurse who actually made a difference in the lives of patients and their families.

When I quit – Kim and Carol felt betrayed. We were inseparable at work and we had a great team, with us at the helm. They were shock (and awed) when I left and couldn’t believe I’d make such a move. The pay cut alone was astonishing. Not too mention that generally, as a Director of Nursing for a large metro hospital . . . you usually get promoted up through the ranks into ‘more important corporate’ positions.

See . . that’s the thing I didn’t want. Of course, Kim – a bonafide corporate nurse herself couldn’t understand why I wouldn’t want that. I tried to explain that the farther up I went – – the more out of touch I felt with the things that were most important to me in my career in nursing. She thought it was simply amazing that I’d give up a three-figure salary and everything else that came along with my position just so I could feel good and go play nurse somewhere for awhile. She thought it was a bad career move.

That was a year ago…. almost to the day. I’m happier; more relaxed, saner than I’ve ever been in my career. My days aren’t as long. I don’t feel married to my job. I’m not connected to a pager 24/7. And I really feel like I’ve made a difference in the little that I do as a nurse in hospice. I have no regrets, whatsoever. Although, I think Kim still holds onto the illusion that someday soon I’ll come crawling back to her – desperate to once again don the business suit and high heels and sit in meetings all day long justifying money spent on patient care as if we were in the business of making widgets.

Bah. No thank you.

I know exactly what cinched the deal for me the week I decided to quit my job. We were sitting in our daily morning meeting. The hospital administrator was there and we were looking at patient census for the day. It had gone down considerably – – either patient’s were discharged home after recovery. Or they had died. Either way our census was down below the ‘budgeted numbers”. All of the Directors of the different departments were there in this meeting. She (the administrator) was extremely on edge because she has to answer to the corporate office when the numbers are down.

By this time – – I was already becoming somewhat cynical about the business. A month prior – I found a clipping in a magazine that I liked. So I cut it out nicely…matted it and framed it and hung it on my office door. It read, “I’m not in the business of compromising patient care for the sole purpose of managing the bottom line.” My boss hated that – – but didn’t have the guts to tell me to take it down because it wouldn’t look good for her to be against such a thing.

So, I was already getting a bit more than jaded …. back to the meeting.

The administrator was edgy. After this meeting she had a conference call with the powers-that-be at the corporate office and the topic of that call was:

1. How the census got so low? (uhh…we’re experiencing a lull in medical emergencies and sickness in the community, Sir – – I’ll get right on that)

2. What our team was going to do to increase the numbers (hmm…we’ll all take turns doing ’rounds’ in the community to see if we can trip a few elderly women crossing the street to see if we can get a few good, solid fractured hips in this week, Sir)

3. And what we were going to do to maintain the census once it got back up to where it needed to be (let’s see….we could cut staffing on the nursing units so it compromises quality care and maybe our patients wouldn’t get well so quickly)

That’s when she looked at all of us and said the following:

Heads in beds. No kidding. I had to take a double take. Did she really just refer to our sick patients as ‘heads in beds’?

Call me sensitive – but after 9 years of justifying this and that, I didn’t want to do it anymore. So I put in my resignation at the end of that week. I never told her that her ‘heads in beds’ comment really didn’t sit well with me. I just said the truth – – what I really want at this stage of my career is to be a nurse and try and make some kind of difference, if I can.

She told me I was being idealistic and hopeful, at best. She advised that with the current state of health care in this country – – for me to expect quality care for patients is like expecting to win the lottery and she thought I was going to be sorely disappointed and frustrated. I took her advice – – I worked out my 30 day notice and left.

That was a year ago, almost to the day. I work in home hospice care now as an RN Case Manager and have never ever heard of one person – – corporate or otherwise, within my organization refer to our dying patients as ‘heads in beds’. I’ve never had to financially justify the care that I give to my patients. I leave that up to the numbers people and don’t ever bother myself with it. I just do the best job that I can do and if some numbers guy somewhere comes down from his orifice office from ‘corporate’ to tell me that I’m costing the company too much money with the care I am providing to our patients…well, he’ll get a tiny piece of my mind, is all.