READER’S VIEWS: How the nursing “team” is changing in hospitals

( There are only two hospital systems in Virginia that have achieved “Magnet” designation. Most small community hospitals will have a difficult time earning the coveted status that would allow them to market themselves as a high quality institution.

The barriers are unavailability of BS RN nurses and the lack of resources to institute the dramatic change in staffing. Right now, most hospitals do not want to face the labor problems that they would have to face by just talking about possible changes in nursing staff.

Another barrier is money. Magnet designation may be more than a small community hospital can afford.

What is happening in many Virginia hospitals is that more and more they are relying in “Contract” nurses and part-time nurses to provide services to their patients. Contract nurses are in some cases traveling nurses that move from place to place and mostly work part-time in hospitals that are short of RNs. Hospitals do not hire these nurses, they contract with companies that serve as agents for the nurses.

The introduction of part-time nurses has further eroded the “continuity of care” in hospitals that employ them.

A patient relating his experience with part-time nurses while recently hospitalized, was unhappy with the care. “You never know who your nurse is going to be tomorrow,” he said. “And nurses coming in must learn all about your condition and your treatment in a half hour or less report from those ending their shift, you multiply that times ten or more patients and the incoming nurse will not be able to provide the best service to each patient,” the patient concluded.

Direct patient care suffers under those circumstances and so does communication between nurse and other staff. It is like having new staff coming into every shift. Not good for the nurses working alongside of strangers and not good for the patients that rely on the nurses for their care.

In a hospital that employs full-time staff to care for patients, the staff becomes more confident about the care of their patients since after one or more shifts in the same section they get to know the patients and the patients get to know them. This not only improves the quality of care, but it also makes the patient more comfortable knowing that his or her nurse knows him or her and their needs.

Patients feel better and are happier during their hospital stay when they see stability and continuity in their care. Quality control in the care of patients is difficult to achieve when the “team“ concept is lost. It takes time to forge an effective working team in the best of circumstances but it is nearly impossible when staff is constantly changing.

And then, there is the larger “team” that needs to be in place and that is all of the support systems in a hospital must operate as a “team” to deliver quality, timely, care. The pharmacy, the laboratory, infection control, diagnostic imaging (x-rays, CAT scans, MRIs, etc.), physical therapy, nutritional services, and all other departments and sections must work together to create an environment that is conducive to a successful outcome.

Contract and part-time nurses give hospitals more flexibility in staffing according to their needs which helps them to control cost in the nursing services but patient care suffers as a result of these cost cutting measures.

Some patients complain that hospital care is becoming more and more impersonal and that all the changes in nursing staffing may well lead to more harmful and even fatal mistakes but there is no evidence of that happening.

Hospitals should strive to retain that very special relationship that exists between nurse and patient because it improves patient care and because it is good for “business.“ The relationship is “personal and compassionate” care.