Some local nurses would like to amend the patient satisfaction surveys their hospitals use. In addition to rating "hotel issues" like hot food and friendly service, they want to ask: "Did you die?"
They're only half kidding.
"There is no hospital in this city we would feel safe in without a 24-hour advocate at our side," said Cheryl Townsend, who has 21 years of critical-care nursing.
"It's a national issue, a health care issue," said Annie Hamilton, who has 18 years of experience and works in an intensive-care unit. Both work at University Hospital. Both are members of Concerned Nurses Coalition, trying to alert the public to a nursing shortage "so they can help us fight for better care."
"At the turn of the century, hospitals were a place people went to die," said Mrs. Townsend. "We're going back to that."
Along with other local nurses, they have filed stacks of ADO reports - "Assignment Despite Objection" - to protest that there are not enough nurses on duty to safely care for the number of patients on their shifts.
"We had 12 beds, with 15 staffers to cover 24 hours a day, seven days a week," said Mrs. Hamilton. That's less than two nurses for each eight-hour shift.
"There should have been six to seven nurses. We would have been happy with five. Sometimes there's one scheduled," said Mrs. Townsend.
They talk about two nurses trying to cover a unit with 18 patients hooked to heart monitors - and no one to watch the screen.
As low staffing drives nurses to quit, hospitals offer hiring bonuses to new nurses - who often lack the experience for acute-care jobs that demand highly technical skills.
And in too many cases, nurses of any kind are replaced by "care extenders" who have no training or experience. "It's not just a matter of bringing in a warm body, but we have lowered standards to that level," said Mrs. Townsend.
Mistakes can extend hospital stays or abruptly shorten the visit by killing the patient, they say: "If someone didn't notice that a blood pressure was too low for two hours, now you're in acute renal failure and on dialysis."
When nurses complain, they get "take an aspirin" answers: Plan A: "We're getting by." Then Plan B: "Well, nobody died." And the last resort: "Hey, people have always died."
"Hospitals should be fighting the insurance companies more, but then they can lose their contracts and don't get patients," said Mrs. Hamilton. "Physicians are worried, but they're bought out by the HMOs. That leaves nurses in a prime position to speak out." Most nurses are afraid to protest, "But we are part of a bargaining unit," Mrs. Townsend said. "That's why we can speak up."
Cynics will say such complaints are a union strategy to raise salaries. I don't buy it. The nurses insist they don't want more money - just more nurses. We should listen.
Mrs. Hamilton's diagnosis: "Where does society want health care to go? There are limited resources. Do you want them to go to insurance companies or to patient care?"
Mrs. Townsend wishes HMOs could be sued for malpractice like doctors, nurses and hospitals. "I don't see them putting profits back into the hospitals. Somebody's making a lot of money."
Somebody like Dr. Daniel Gregorie, CEO of ChoiceCare, Cincinnati's largest HMO, sold last week to managed care giant Humana for $250 million.
A year ago, I wrote: "Dr. Gregorie took a 61 percent pay increase in 1995, from about $436,000 to more than $702,000. A ChoiceCare spokesman said that Dr. Gregorie's salary is still too low."
Not anymore. In the past year, he was bumped another 14 percent, to more than $800,000, including bonuses. And with the sale of ChoiceCare, he hit the superlotto.
Humana's offer to pay $16.38 for stock shares valued at $10 gives Dr. Gregorie a $2.5 million profit on his 400,000 shares - a 64 percent increase.
If he is canned, reports say, Humana must pay him five times his annual salary: $4 million. And if he sticks around three years, he pockets a $1.6 million bonus.
Either way, he makes from $4 million to $6.5 million - not including salary. The sale gives all stockholders $30 million in profits. That's enough to hire about 1,000 nurses. And it means Dr. Gregorie is worth at least 130 nurses.
I'd say it's the other way around: One nurse is worth 130 HMO bosses who sponge up savings from staff cuts and amputated care.
It's enough to make you sick. But take the nurses' advice - stay away from a hospital or you might not live long enough to fill out your patient satisfaction survey.
Peter Bronson is editorial page editor of The Enquirer. Call 768-8301, or write to 312 Elm Street, Cincinnati, Ohio 45202.
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