When I first came to the US, I worked in a nursing home as a Registered Nurse. As the RN on the floor, I usually had about 20 to 30 elderly patients to take care of, with four to six certified nursing assistants or CNAs to help me.
While my primary duties were patient assessment and medication administration, I also had to delegate the task of bathing, grooming and feeding of patients to my CNA's. Like any other health care facility, it was not uncommon for us to be understaffed. In fact, there were many days that I ony had two CNA's to help me with thirty patients! So, on top of my professional nurse duties, yes, I also had to clean up patients, give them baths, wipe their bottoms and change their diapers.
Good thing I only worked there for a year.
While most of my nursing career in Michigan was with the local county health department, I also worked part-time in a couple of hospital ICU and CCU. Because they were critical care units, we had a very low nurse-patient ratio. I got to be assigned only one, or at the most two, patients. But then, unlike medical-surgical floors that normally have CNA's to help RN's, critical floors only have RNs to do all the work. Again, aside from my other nursing duties like hourly monitoring of hemodynamics, ventilatory care, blood draws and medication administration, I also had to do the grooming and hygiene part. Yes, again, I had to clean up patients, give them baths and wipe their bottoms.
After more than ten years of being a Registered Nurse, I went back to school to obtain my Master's Degree in Nursing and became a Nurse Practitioner. I said goodbye to bedside nursing - good bye to medication administration, to blood draws, to suctioning and tracheostomy care, to bedmaking, to measuring I and O's (fluid intake and output), to paging and reporting to physicians, to assisting physicians in performing procedures.
Goodbye to wiping butts. Hello to making my own clinical decisions and giving out my treatment orders. I was in for a big surprise.
It's been five years now since I got my certification as a Nurse Practitioner. Yes, I get to perform advanced assessment. Yes, I diagnose patients, order labs and prescribe treatment and medications. But I also constantly kiss patients butts, figuratively-speaking.
The truth is, everybody else dictates patient care but the doctor or health care provider. The government (Medicare/Medicaid) sets payment fees. The healthcare insurance companies dictate the procedures and medications based on what they are willing to cover. The patients exercise their the rights to request or refuse treatment, even if it goes against medical advice.
Competition with other healthcare providers is steep and so, my physician-bosses expect me to keep our patients and not loose them to other practice groups. I make sure my patients are happy and satisfied with my service. I often have to give in to request for narcotic pain control or else they go to a different healthcare provider. I sit with them and listen to their life stories so that they can't complain that I hurry through them. I supply them samples of medications to save them financially with their prescription co-pays. Still many patients don't take our medical management to heart. If I order longer treatment time on the dialysis machine, they sign off and terminate their treatments early. I can't pick and choose patients. I wish I could - I would discharge the difficult ones and only take those who are easy to work with and are compliant with treatment.
Day in and day out, I spoil my patients. No, I don't wipe butts anymore. But I do kiss plenty of them everyday.
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