Day 9 - Women and Work
After more than three decades in nursing, I'm retiring at the end of June. I'd to share with you some of the changes I've witnessed first hand in the healthcare system in California. It's been quite a journey.
The most obvious change is what we nurses wear, or perhaps I should say, what we no longer wear. When I started in nursing, we all wore white uniforms of our own choosing: white shoes, white stockings, and a white dress, or occasionally a pantsuit. As dress and comportment became less formal, hospital workers followed suit, with the nursing staff changing to white slacks paired with colored tops in the eighties and eventually to colored scrubs in the late nineties. Everyone wears flat shoes, and walking or even running shoes are commonplace.
Two years ago when we moved to our brand new hospital building, my employer took the opportunity to impose a new dress code on all of the employees, except for the physicians, social workers and other professional staff.
"The patients are confused. They say they don't know who is a nurse and who is a housekeeper," one of the administrators proclaimed.
I had a hard time believing that. We nurses all wore scrubs, albeit in different colors and patterns, and had stethoscopes hanging around our necks. We all introduced ourselves by name, and said, "Hello, I'm going to be your nurse today." We took our patients' temperatures and changed their dressings and gave their medications, held their hands and listened to their stories. We helped them walk and showed them how to cough so they wouldn't get pneumonia. We called their families for updates and their doctors for sleeping pills and emergencies. We gave nursing care. The housekeeping staff wore uniforms supplied to them by the hospital. They all said "Housekeeping," when they entered a room. They emptied waste baskets and linen hampers, cleaned the floors and performed other essential tasks, but that's not nursing.
But the hospital consultants said our patients wanted to know without being told that their nurse was a nurse, like it was back in the day when we wore white uniforms and caps. So now we nurses all wear identical employer-supplied dark blue scrubs with Registered Nurse embroidered above the chest pocket. Nurses aids all wear olive green. The housekeepers wear dark gray and white uniforms and the diet techs are dressed as waiters. Everyone, from the person who cleans the toilet to the person who does their breathing treatments, has a special uniform.
Administration made other changes as well. The nursing staff now has a hospital approved speech we are expected to say when we enter the patient's room, and one to say when we leave. We must answer the phone using a script, too. "Uniformity makes people feel safe," our managers tell us.
People stand in the hallway with clipboards, watching to see if we clean our hands before we enter and after we leave a patient's room. Nearly every day, a volunteer comes and asks my patients questions about how I delivered their care. Did I tell them about their medication side effects? Was I always respectful? Did I bathe them properly? The level of scrutiny feels so obtrusive now, I wonder if it's not interfering with my ability to care for my patients.
After they leave the hospital, the patients are sent questionnaires that ask them about the care they received. There is enormous pressure because we get graded on our patient's answers and the volunteers' observations, then financially rewarded-or not-based on those grades. The data gets entered and tallied. Our results get compared with other units and with other hospitals, too. There is a company who is being paid millions of dollars to make sure all of the data is being properly programmed, categorized and easily referenced.
For most of my career, I believed I was a professional but I was wrong. Professionals don't get told how to answer the phone or what to say to their clients. They don't have people following them around and listening to their phone conversations making sure they follow the script. Professionals hold themselves accountable. They aren't treated like interchangeable drones.
Nurses are one of the most trusted categories of workers in my country, which makes me wonder what we have to do to become trustworthy again in the eyes of our employers. I became a nurse to earn a living certainly, but I also believed it was a calling, a way for me to help others and ease suffering. I liked that kind of nursing. No, I lived and breathed that kind of nursing. Maybe, eventually, I might come to see the merits of this sort of nursing, too, but as things stand, my last day of work can't come too soon.
I'd like to call your attention to two outstanding nursing organizations. Nurses House is a national fund for nurses in financial need due to acute illness or disability. The California Nurses Association lobbied tirelessly for twelve years over the objections of the hospital industry to get a mandatory safe staffing law passed in 2004 that requires minimum, specific, and numerical direct-care Registered Nurse-to-patient staffing ratios by clinical unit for all acute-care hospitals in California. We want our patients to feel safe, too.