WEBVTT

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[sil.]

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[music]

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A teaching nursing home is a nursing
home that\'s affiliated with

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a collegiate school of nursing. And
they, these two institutions come

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together for the purpose of
enhancing the quality of care

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by utilizing the expertise of faculty.
Our tie

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with the nursing home enabled us to have
good clinical experiences for students.

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In addition to that, it has helped
us understand some of the realities

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of, uh, the real world of patient care, particularly
some of the problems in long-term care,

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the reimbursement systems, the problems of
attracting health professionals to work in those

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facilities, and an understanding
of the real complexities of caring

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for elderly people or chronically ill.
The public image is,

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uh, of a day in the nursing home is

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this, uh, barren room with, a, a

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person isolated in his bed, uh,
shut away from all encounters

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with decent society as he knows it,
and that frightens people. Working

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in a long-term care facility, it\'s less
medical care and it\'s more nursing care. Yes,

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we\'re giving the pills and, and that sort of thing,
but we\'re really monitoring the whole patient,

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the whole person. OK. Just breathe
in and out for me. Just relax. OK?

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Yeah. OK. Thanks, Margaret.
What did you get? It\'s

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much better than the last time I listened. You\'ve
got some time to get to know your patients,

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to get to know their peculiarities.
Um, you have time to meet

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their families and, and include them in the plan.
And I just feel like that this is an ideal

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setting to practice what is really nursing. Joan Lynaugh OK. I\'ll check
with you later. The most exciting thing about practicing on a nursing home,

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I think, is that 97% of
the kinds of problems

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residents present in nursing homes are
nursing problems. And they are very

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complicated, very
challenging, and they\'re, uh,

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thick on the ground. They\'re everywhere. He\'s
in wheelchair when he is kind of out and about,

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except for the time that you walk him. When he
announces that he is tired, he is going to sit.

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And that\'s all the notice that you are going to get.
So you just follow right behind him very closely

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with that chair so that when he sits, you\'ll be
there with the chair. Aren\'t you glad you asked?

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The other way the clinical nurse specialist works
is through students who come to the nursing home

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and become the protégé of the clinical
nurse specialist. Undergraduate students

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who are learning, uh, how to talk to
patients, how to help them get out of bed,

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how to give baths, how to do dressings,
all those regular nursing skills. Let

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me just tell you then who the nurses are on
the units and who the aides are that have

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your, um, people. And then graduate students
who are developing specialty skills,

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learning how to analyze and deal with,

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uh, the kinds of clinical nursing problems
that one sees among nursing home residents,

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among the frail elderly. Wonderful. Oh.
You don\'t know. I don\'t see why

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that thing is so hard to
wear and breathe. It just

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seems to suck the air out of me. Oh. Well, I
think it\'s too tight. Well, I don\'t know. I,

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I never ever liked it. I really
encourage the students at all

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levels to get real involved with the patients. And
that means hands-on stuff, where they are taking

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them to the bathroom. They are getting them dressed.
They are doing those kinds of intimate kinds of care

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so that they really get a sense of where their
disabilities are and how to best approach,

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you know, working with that patient. So then they
can go back to the staff and make some suggestions.

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It\'s real important if you are going to be working with
the staff with problem patients that you really get

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involved so that you don\'t just sit at a desk and
tell them how they should do it. But you go down.

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You observe what they are doing, how they
are doing it. And maybe for a period of

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time, you work with them to try to make
some changes. You were saying that when you

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started working with her that there were problems. Can you tell me
about what those were? Uh, well, she was very angry because she was

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in this place. And I keep telling her, you know, \"This is
a home,\" and she said, \"No. It\'s not my home.\" And then

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she just (crosstalk) Nurse! Is this Mrs. Moss you\'re talking
about? Mm-hmm. Yes. Nurse! She has gotten more manageable.

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Mm-hmm. Is that her yelling? Yes. OK.
She does this constantly. During

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the day too? Yes. Before it was constantly, you
know, \"Nurse, Nurse,\" but she has become a lot

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more quieter. And I think she has moments that she
needs to be reassured, you know, what is going

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on and what the sounds are and the activities and
stuff. But like I said, she has come a long way.

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Have you done like a mini mental on her? It\'d
be real interesting to get a score for her

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on that just to see. Can you
tell me what year it is?

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I don\'t know. \'40, 1949, is it?

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Well, it\'s \'87. 1987? Mm-hmm.

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Oh dear. I was way off, wasn\'t I?
Well, how about this season? Oh,

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this is spring. Right. Another memory test

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is I want you to start at the
number 100, subtract seven, and

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keep taking away seven until I stay stop.
Well, let\'s see.

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93 minus seven is 86

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minus seven is 79

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minus seven is 72? You can stop. That was

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excellent. OK. Did I pass?
You did a beautiful job.

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Thank you. Oh. You\'re welcome. But your hands
are cold. I know they are. My goodness.

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Get some gloves Thanks for
helping me out with that.

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We\'ll go see her today. She is, she is sho-, I think she is gonna be
a lot clearer than you saw her last time. You\'re gonna be impressed.

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Uh, this is not a hospital. Uh, this
is a chronic care facility with people

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that have chronic problems. And the issues for the nursing
staff as well as for the medical staff are different

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than those in the hospital. That\'s
one of the things that I think makes

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the educational program at the teaching nursing
home so important because it brings together

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student nurses and student physicians
and students in other long-term care

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disciplines, uh, at a time when they are
developing all their feelings and opinions about

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each other and about the way the services are developed.
Uh, if you can get that kind of connection early

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on, I think we have a better chance of having nurses
and physicians that will be open-minded about

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their relationships once they finish school.
Having nursing students here is more work

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for the staff. However, um,
it\'s also a real quality tool.

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I\'ve heard nurses saying, \"Oh. The students
are coming. We have to be careful and,

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uh, look up the procedure for this
and see that we\'re doing it right.\"

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and they learn from students.
I do think that a student who

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observes nurses working in a
nursing home will see a very

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different kind of nursing practice.
Certainly,

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the students will have
their spirit of inquiry

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piqued because they will see and
experience things for which we do not have

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answers. OK. Let\'s just
try, try a couple. OK? Say,

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\"I\'m tired.\" I\'m tired. Good. \"Hurry up.\"

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You hurram up Good.

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\"Stop that.\" Hmm snom nat. Good.

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\"See you later.\" See

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you later. Wonderful! You
went through \'em wonderful!

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[sil.] Oh. You did great.

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[sil.] Another headache?

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[sil.]Or are you

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just tired?

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[sil.]Tired?

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Well, I got my little sheet and it said
\"brain damage\" and to what extent,

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I didn\'t know. And so I just thought a car accident
and a little brain damage. He is gonna be a little

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slow. So I introduced myself to him and he didn\'t
look at me. He just looked at me like this and

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nothing. And so I was going, \"Great.
I can\'t. This patient can\'t tell me

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anything. This patient can\'t do anything.\" Yeah.
It\'s, like, I was just a little frustrated

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and disap-, not disappointed because I know it was gonna
be a challenge and I was excited to get someone that was

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younger. But it worked out good.
I\'m glad I,

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I was able to take care of him or tried to.
And I think he gets

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to know you. You know, when we were eating lunch, he\'d
tap me on the knee and, you know, \"I want more food\"

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and stuff. And so we were
communicating, sort of, but he\'d mouth

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words and it was so frustrating. Especially for
him, I\'m sure, because I didn\'t know what he was

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saying. Yeah. That\'s a good comment. It\'s sort
of hard to know who is, it\'s more frustrating

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to, you or, or Bob. He didn\'t, he didn\'t
(crosstalk) I know that not everybody

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is gonna come away from here and wanna work in a
nursing home, and that\'s fine. Um, but I think

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that some of those students will come away from
here thinking, \"This is a, an area of nursing

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that perhaps I hadn\'t thought of as a
career, um, option before.\" And I think

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they\'ll think about it now. My grandpa just passed away
in a rest home. And I had this vision in my head of

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rest homes are a place you go and die and they are
depressing and they smell bad and the patients are treated

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terribly, and I didn\'t wanna go there. And now we\'ve
been here and we see what a nursing home can be

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like. And before, I thought I would never wanna
work, you know, in a nursing home. Now, I can see

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what you can make it be like and how we could make a
difference now that we\'ve been to a quality place like this.

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And I think we figured we were gonna
make a big difference, and we\'re not.

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And I, it takes a while to realize that, but you\'re not.
You\'re just gonna make it a little bit better or maybe a

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little bit more comfortable. But you\'re
not gonna fix it. Yesterday, I went to

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therapy with, with Daisy. And she raised
her arm, like, 10 degrees higher. It was

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so exciting to think she is getting better.
And I didn\'t think of that as a little thing.

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I thought that was a, it was a big thing because that\'s
a big step in her progress, is being able to do that.

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And it, it takes a special commitment
wanting to make things better. I feel like

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in a hospital, people are kind of in and
out, and you can make their day better

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just as you\'re making their
lives better. [music]

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The Serve (ph) Group is a group
activity that we developed here to

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meet the needs of the confused elderly. Their needs
in group situations are very different than the

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population at large. So we thought perhaps if we
could take them off the unit for the, for a while,

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give them something that was just designed
for them, and then bring them back

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to the unit, uh, that they would be able to function at a
higher level and the agitation and some of the wandering

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would be diminished. [music] I can
tell you\'ve been a basketball

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player. OK. You know, he really gets

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into the way he throws the ball. And
you can see that he\'s done this before

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in his past. And so you can really bring out
his past skills and his past, um, experiences.

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Ready? Uh-oh.

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That was pretty tricky. Ready?

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Great! OK. Ready? That\'s good. Good!

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You have a very strong swing
there, Elizabeth. Well, I was a

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captain of a baseball team in high school.
Is that right? Well,

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it shows. Believe it or not. I believe it.
Mm-hmm. Mm-hmm. Do you

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remember your first boyfriend? My first
boyfriend? Mm-hmm. Charles Sears (ph).

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Ooh. I never forgot him. (crosstalk)
And is this your husband now? Nah.

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He is not my husband. Ooh. And
I mean I never forgot him.

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Oh. (crosstalk)

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The first group was real funny. The
first boyfriend. that\'s how we

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get on the subject. And one thing led
to another in the senior workout

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class that we\'ll try it once a week.
When it makes them feel that they\'re

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not alone, that they can always fall back
on their past history, you know, and so

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it makes them feel better. What are some of the
things you\'ve been talking about? We talk about you

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all the time. It\'s a teaching nursing

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home. My tenure here was short, short-term. It
was four and a half months and that was it.

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Um, and so that we wanted it to continue
because you don\'t wanna let the people

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down. And um, Alison in particular was, her
personality kind of lent itself to this. She is

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very outgoing and very interested in the concept.
So that for me to teach her something, the

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reminiscing idea was just perfect. And we\'d all
dance together. [music] They have to talk.

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They have to reflect on their lives. I think it gives
a sense of completeness that, you know, yes, I am

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here now, but this is what I did
when I was younger. And, you know,

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it\'s, um, it kind of gives them a sense of integrity,
I think, about what their lives have been.

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[music] One of the things that we\'ve
done that has really harmed particularly

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children who have parents that they
have some difficulty in taking care

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of is to let them feel guilty
about putting their parent away.

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And that was the old way of looking at it. You know, how
could you ever place your relative in a nursing home?

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We as nurses have some
responsibility to let people know

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that you can have good care. And so we just have
to change that image. And there a lot of people

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who have to come to nursing homes
because they have no other alternative.

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\'Morning, Byron. Are you
ready for your trach change?

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Is it still on? Byron has, in layman\'s

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terms, it\'s Lou Gehrig\'s disease.
He is on a respirator. Otherwise,

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he would not be able to breathe.
He is totally paralyzed

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except for just his head, um, movement.

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He has a trach which is
connected to the ventilator

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that makes it so that he can\'t even talk.
Uh, we have to read his

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lips. He is mentally alert
and does participate

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in his own care. We always ask
him what he wants and doesn\'t

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want. He came to us and they
said that he would probably

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only be with us about six months,
but he has been here seven years.

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Has had numerous respiratory inspections,
but we have been able to manage

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those. I\'m gonna take you off here
for a minute. I\'m gonna change

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\'em.

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[sil.]

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You need more air in your cuff? I think so.

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OK. His life depends on quick reaction to

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the ventilator needs. For most people
who have to do it the first time,

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it\'s very scary for them,
um, and for the patient.

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Byron gets, knows his symptoms enough that

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he gets very apprehensive if it\'s
left to go very long because

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it is his lifeline. We have a, a, a
group of residents in nursing homes

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who have lost so much function
that they require help with almost

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every activity. And then the other group
who are admitted to the nursing home

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because they are, uh, at the end stage
of a chronic illness, often cancer.

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The thought of dying isn\'t
one of my greater thoughts.

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But I\'m right with my Lord.

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There won\'t be any pain.
There won\'t be any, uh,

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I don\'t know how to express it.
I have pain 24

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hours a day. The medication,
is, is, it just takes the edge

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off of it. Because it\'s tricky to use

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enough to keep the pain under control but not, you
know, not to do too much because it can cause

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respiratory problems. Actually, I guess
I sort of owe it to Ben what I know

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about that kind of pain control because
when he came here, he was a big, um,

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pain management problem for us. And
I really felt like I was kind of

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almost out of my realm. And then it just dawned on
me that I needed more information. And so I went to

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the library up at school and did a literature
search and got all of this material together.

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That\'s really then how I knew what was

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appropriate and what was correct in his situation.
OK. Let\'s see. Ben, can you just put your arm

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down and just slide it right underneath
the table and turn it palm up? He

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needs to have as much as he needs to feel comfortable.
110/70, Ben. Very good. Part of what I do

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is monitoring his comfort level and
making sure that the staff feels OK

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about giving him more. Um, when
you start talking about 20

00:18:25.000 --> 00:18:29.999
mg of Dilaudid, it\'s scary because that is
such a high dose. And if you or, you or

00:18:30.000 --> 00:18:34.999
I took that dose, well, it would be very devastating. But
for somebody who has been on it chronically for as long

00:18:35.000 --> 00:18:39.999
as he has been on it, well,
he tolerates it very well.

00:18:40.000 --> 00:18:44.999
That all? That\'s all.

00:18:45.000 --> 00:18:49.999
[sil.]Did they all go down?
OK. Good. Thanks,

00:18:50.000 --> 00:18:54.999
Ben. You\'re welcome. You\'re welcome. I\'ll check on
you later and see how you\'re doing. OK. His wife has

00:18:55.000 --> 00:18:59.999
also felt some comfort in that, um, we can
always give him more. She was real concerned

00:19:00.000 --> 00:19:04.999
and came to me. \"Will there ever, will we ever get to
a point where we won\'t be able to manage his pain?\"

00:19:05.000 --> 00:19:09.999
And she was real concerned about that. And I said no,
that we would always be able to keep giving him more.

00:19:10.000 --> 00:19:14.999
And she found some real comfort in that because
she was afraid that he would have to suffer.

00:19:15.000 --> 00:19:19.999
Let\'s look at the next picture here.
What is that? Then there is another

00:19:20.000 --> 00:19:24.999
group of residents that are people
who are there convalescing. And so

00:19:25.000 --> 00:19:29.999
they have to have some kind of sustaining
and creative rehabilitative care

00:19:30.000 --> 00:19:34.999
before they can live by themselves.
And those, uh, individuals

00:19:35.000 --> 00:19:39.999
now make up more and more of the residents
in nursing homes. Wipe (inaudible)

00:19:40.000 --> 00:19:44.999
. Wipe your hand and hold your,
and, uh, wipe your hands

00:19:45.000 --> 00:19:49.999
and, uh. Wipe your hands
in your face with the?

00:19:50.000 --> 00:19:54.999
I can\'t read it. How about

00:19:55.000 --> 00:19:59.999
T-O-W? Tow? Towel. Towel. Oh dear. Mm-hmm.

00:20:00.000 --> 00:20:04.999
Towel. I think there are some words that
I had never heard until of before in

00:20:05.000 --> 00:20:09.999
my life (crosstalk) So strange words come out of your mouth
that you (crosstalk) Yes, yes. They just come out there

00:20:10.000 --> 00:20:14.999
you don\'t know where they come from. But you
can hear when you\'re saying the wrong words?

00:20:15.000 --> 00:20:19.999
Yes. Yes. And we\'ve talked about that,
how if you listen to yourself, you

00:20:20.000 --> 00:20:24.999
can try to take time to change the words.
Yes. But you know,

00:20:25.000 --> 00:20:29.999
you know, after this, uh, after this
work, a, a, as old as I am now,

00:20:30.000 --> 00:20:34.999
in 90, 96, yes, years,

00:20:35.000 --> 00:20:39.999
96 yars, years, you know,
I will never learn

00:20:40.000 --> 00:20:44.999
very many, a few new amount of words, uh,

00:20:45.000 --> 00:20:49.999
like, like, uh, uh, wor-, words
that have never been used

00:20:50.000 --> 00:20:54.999
before. But do you feel like you are able to
get your needs known and what you\'re feeling

00:20:55.000 --> 00:20:59.999
known? Oh, yes. Uh, I can. I can do that.
I can do that.

00:21:00.000 --> 00:21:04.999
What kinds of things do you
do on your farm, Joe? Uh.

00:21:05.000 --> 00:21:09.999
Do you drive a tractor? Oh yeah.
The person who needs to live in

00:21:10.000 --> 00:21:14.999
a nursing home because they\'ve lost mental
capacity, the person who can\'t remember where

00:21:15.000 --> 00:21:19.999
he is, the person who wanders
really can be helped by

00:21:20.000 --> 00:21:24.999
interventions that clinicians trained in
psychiatric nursing know how to apply,

00:21:25.000 --> 00:21:29.999
and more importantly, know
how to teach to other staff.

00:21:30.000 --> 00:21:34.999
For Joe, he, he sees this facility
as his farm. And just walking around

00:21:35.000 --> 00:21:39.999
with him and allowing him to tell me
where he was and not putting my own

00:21:40.000 --> 00:21:44.999
perceptions onto him but asking him
just enough questions to clarify

00:21:45.000 --> 00:21:49.999
where he was in his mind was enough.
Um, his yelling behavior

00:21:50.000 --> 00:21:54.999
at night was incredibly disruptive for
the other patients. So, I came in

00:21:55.000 --> 00:21:59.999
and worked with the staff around midnight, the time
when he was normally the noisiest, to see what it

00:22:00.000 --> 00:22:04.999
was that was triggering him to start the yelling
again. Jelene took that concept of agenda

00:22:05.000 --> 00:22:09.999
behavior and applied that in Joe\'s
case and really was able to

00:22:10.000 --> 00:22:14.999
tease out where he thought he was, what
he thought he was doing, and come up with

00:22:15.000 --> 00:22:19.999
some real concrete approaches for the staff
to use in interacting with Joe that really

00:22:20.000 --> 00:22:24.999
have dramatically decreased his agitation.
Can you open your eyes?

00:22:25.000 --> 00:22:29.999
Yeah. Yeah? Yeah. Aren\'t they open?
Well, they\'re kinda

00:22:30.000 --> 00:22:34.999
open. Oh. Yeah. The first night that I worked
with the aide, he left me a note and told

00:22:35.000 --> 00:22:39.999
me that it was the first night that Joe had slept
completely through that\'s made a tremendous

00:22:40.000 --> 00:22:44.999
difference in the amount of medication he needs. And
just the overall tension on the unit in regards

00:22:45.000 --> 00:22:49.999
to the other staff and patients.
How are you doing, Pop? Hi. Hi.

00:22:50.000 --> 00:22:54.999
How is it going today, huh? So it\'s not
uncommon for us to get relatives here who

00:22:55.000 --> 00:22:59.999
have had really bad experiences in the past.
Well, I know the ones that I worked in

00:23:00.000 --> 00:23:04.999
before coming back here were
nightmares, a great many of them

00:23:05.000 --> 00:23:09.999
understaffed, and patients didn\'t
get the care they needed. And I,

00:23:10.000 --> 00:23:14.999
I think, for the most part, you know,
people tend to see nursing homes as that

00:23:15.000 --> 00:23:19.999
image. And I know for a fact that it\'s
not true because of my experience here.

00:23:20.000 --> 00:23:24.999
[sil.] There is a lot

00:23:25.000 --> 00:23:29.999
of very difficult patients that we have here
that our staff can cope with beautifully

00:23:30.000 --> 00:23:34.999
and they are willing to take on and they are willing to
take challenges because they know they are not alone.

00:23:35.000 --> 00:23:39.999
I guess what I hope
people will see from the

00:23:40.000 --> 00:23:44.999
teaching nursing home experience is that the
care of the elderly is probably the most

00:23:45.000 --> 00:23:49.999
demanding care that there is, but that
it can be done and it can be done well

00:23:50.000 --> 00:23:54.999
if you have the people that are committed and interested
in providing that kind of care to the patients.

00:23:55.000 --> 00:24:03.000
[sil.] [music] I heard the nurse say
you\'re gonna go home Friday. Yes.

00:24:30.000 --> 00:24:34.999
Yes I hope to get to your hometown.
Graduations to home are

00:24:35.000 --> 00:24:39.999
exciting. Each of us who has been involved in a
patient\'s care and in planning the admission

00:24:40.000 --> 00:24:44.999
and the discharge feels like it\'s
a victory to send someone home,

00:24:45.000 --> 00:24:49.999
even if it\'s only for a few weeks
or a month or two. To see someone

00:24:50.000 --> 00:24:54.999
walk out with a walker when they came
in on an ambulance stretcher looks like

00:24:55.000 --> 00:24:59.999
success. So we do watch the front
entrance, and there is a lot of cheering

00:25:00.000 --> 00:25:04.999
going on in the offices when people leave.
Well, it\'s a kind of a gloomy

00:25:05.000 --> 00:25:09.999
dim, uh (crosstalk) Gloomy day. Day. It\'s already,
isn\'t it? (crosstalk) That\'s okay. It\'s a good day

00:25:10.000 --> 00:25:14.999
anyway, isn\'t it? Yes. We\'ll
be fine anyway. How does

00:25:15.000 --> 00:25:19.999
it look to you? Oh yes. It looks,
it looks okay. That\'s for sure.

00:25:20.000 --> 00:25:24.999
I know I\'ll live and die here,
but I\'ve got no choice.

00:25:25.000 --> 00:25:29.999
I don\'t want to, but there is no other way.

00:25:30.000 --> 00:25:34.999
If I can just hold her hand as I
go out, I\'ll be happy. We sort of

00:25:35.000 --> 00:25:39.999
know, and in the backs of our minds, we\'re
preparing ourselves to know that, say,

00:25:40.000 --> 00:25:44.999
someone like Ben may not be here tomorrow,
um, and you can\'t ever be ready

00:25:45.000 --> 00:25:49.999
for that. And it is in everybody\'s mind.
We do know that tomorrow, he may not be

00:25:50.000 --> 00:25:54.999
here. When I graduated, I worked at
a couple of different facilities

00:25:55.000 --> 00:25:59.999
and never had the connection
I have here, the, um,

00:26:00.000 --> 00:26:04.999
the caring. um, so I came

00:26:05.000 --> 00:26:09.999
back. [music] I think any time you work

00:26:10.000 --> 00:26:14.999
with, um, people that closely,
you really tend to form a

00:26:15.000 --> 00:26:23.000
bond. And I\'ll miss him. Yeah. What
we, what we have here is a team,

00:26:25.000 --> 00:26:29.999
a team whose primary goal is to provide
the best possible care for the

00:26:30.000 --> 00:26:34.999
patients and their families. That\'s the most important
thing. That\'s the reason we\'re here. And I have

00:26:35.000 --> 00:26:39.999
an opportunity to be a nurse here,
to use all my nursing skill,

00:26:40.000 --> 00:26:44.999
to really practice nursing
as I believe in nursing.

00:26:45.000 --> 00:26:49.999
I see more qualified people
working in those settings

00:26:50.000 --> 00:26:54.999
and treating the residents in those
settings from a perspective of hope.

00:26:55.000 --> 00:26:59.999
They\'re not there because they\'re unloved. They\'re
not there because they\'re just going to die.

00:27:00.000 --> 00:27:04.999
They\'re there because that\'s the
best place to care for them.

00:27:05.000 --> 00:27:09.999
And there is hope. There is caring.
There is

00:27:10.000 --> 00:27:14.999
tomorrow. And I think those quality
changes will be what we will see

00:27:15.000 --> 00:27:19.999
in the nursing homes.

00:27:20.000 --> 00:27:28.000
[music]

00:28:45.000 --> 00:28:53.000
[sil.]

00:28:55.000 --> 00:29:03.000
[music]

00:29:25.000 --> 00:29:29.999
Newton-Wellesley Hospital, in a
suburb of Boston, Massachusetts.

00:29:30.000 --> 00:29:34.999
Like hospitals throughout the United States, it\'s
been forced to deal with a new kind of crisis in

00:29:35.000 --> 00:29:39.999
health care delivery. We have too many sick
patients and not enough nurses to take

00:29:40.000 --> 00:29:44.999
care of \'em, and that\'s it in a nutshell.

00:29:45.000 --> 00:29:49.999
And it\'s going to get worse
because the number of, um, sick

00:29:50.000 --> 00:29:54.999
patients is growing. And the
number of people either

00:29:55.000 --> 00:29:59.999
currently in nursing or entering
nursing programs is diminishing.

00:30:00.000 --> 00:30:04.999
Hospitals have always lived from
one crisis segment to another,

00:30:05.000 --> 00:30:09.999
be it internal or external, but never
to this degree. The problems that

00:30:10.000 --> 00:30:14.999
we find now is that we are truly
unable to meet the patient\'s needs.

00:30:15.000 --> 00:30:19.999
Not only the patient themselves but the families
of the patients. You know that when you

00:30:20.000 --> 00:30:24.999
leave a shift after eight hours whether or not you\'ve
done a good job. No one has to tell you. You know,

00:30:25.000 --> 00:30:29.999
after being a nurse for a while, whether or not you
have gone a good job. To have to leave everyday

00:30:30.000 --> 00:30:34.999
knowing that you haven\'t done a
good job, it\'s difficult to get up

00:30:35.000 --> 00:30:39.999
the next morning and wanna come back again.
What if there is an emergency? What if there is

00:30:40.000 --> 00:30:44.999
an arrest? What if there is something that
really requires 110% of your concentration

00:30:45.000 --> 00:30:49.999
and you\'ve only got 5% left to sputter
through with? That\'s frightening.

00:30:50.000 --> 00:30:54.999
There were cases where patients,
because of the lack of beds,

00:30:55.000 --> 00:30:59.999
the doctor may have taken a chance and said,
\"Well, you\'re not all that ill, and I

00:31:00.000 --> 00:31:04.999
know tomorrow we\'ll have a bed.\" And during that
eight-hour period, when he ordinarily would have

00:31:05.000 --> 00:31:09.999
been admitted but could not be, catastrophe
could have occurred, and there are cases

00:31:10.000 --> 00:31:14.999
in which it has.

00:31:15.000 --> 00:31:19.999
It\'s basically a day at a time, a
shift at a time, a week at a time.

00:31:20.000 --> 00:31:24.999
I mean we manage to deal
with it, but it\'s, it\'s

00:31:25.000 --> 00:31:29.999
piecemeal. It\'s, it\'s like taking a hill, you know.
You take three feet at a time. And you don\'t

00:31:30.000 --> 00:31:34.999
worry about what\'s, what\'s 20 feet ahead. You\'re just worried
about the three feet in front of you. We\'re starting

00:31:35.000 --> 00:31:39.999
beginning of the week worrying about what\'s gonna happen on the
weekend. We start, you know, early in the day worrying about what\'s

00:31:40.000 --> 00:31:44.999
gonna happen in the evening and, and, and worrying that
there aren\'t gonna be enough staff to manage patient

00:31:45.000 --> 00:31:49.999
care. Friday afternoon, the
hospital\'s nurse managers try to

00:31:50.000 --> 00:31:54.999
finalize staffing for the coming weekend. First of
all, let me tell you the problem. The ICU has got six

00:31:55.000 --> 00:31:59.999
boarders in it. So it mixed up
the services a bit. I know.

00:32:00.000 --> 00:32:04.999
But when I looked at it, at your, um, at, at those
transfers, and you, you need to take those,

00:32:05.000 --> 00:32:09.999
and I\'m gonna affect the others to Six
North, they\'ll be full. That\'s the problem.

00:32:10.000 --> 00:32:14.999
[sil.]. Well, we\'re gonna just
not have telemetry beds. I mean

00:32:15.000 --> 00:32:19.999
what can we do? I mean they\'re full, they\'re
full. So the other thing I\'m gonna do is

00:32:20.000 --> 00:32:24.999
I had someone maybe willing to stay through supper.
If I can get an RN to stay through supper \'til 7:30,

00:32:25.000 --> 00:32:29.999
which will give me four and a half in Agency A,
I think they\'re gonna have to fly with that.

00:32:30.000 --> 00:32:34.999
(crossover) It certainly is more than they are
gonna have tomorrow evening. All right. I\'m set

00:32:35.000 --> 00:32:39.999
with you until we know whether I have those discharges.
Right. And then I will choose. What I want you to do

00:32:40.000 --> 00:32:44.999
is, is, uh, let Jeff know who
you will take when they,

00:32:45.000 --> 00:32:49.999
if, when and if those (crosstalk) When and if? If. Just tell him
when and if, who you will take when and if. OK. Why? Because he\'s

00:32:50.000 --> 00:32:54.999
got four patients coming out of the operating room
and he is nervous. A hospital is a very complex

00:32:55.000 --> 00:32:59.999
place. Nursing in particular, the management
aspect is, is complex because we interface

00:33:00.000 --> 00:33:04.999
with every system in our hospital. There is a problem in
the pharmacy, we have to, uh, we have to do something to

00:33:05.000 --> 00:33:09.999
affect it. There is a problem with central supply, we have
to do something to affect it. So you have to teach people

00:33:10.000 --> 00:33:14.999
how to, n spite of tremendous stress,
maintain a positive attitude,

00:33:15.000 --> 00:33:19.999
run all the interference that you need to
run so that care is delivered ultimately.

00:33:20.000 --> 00:33:24.999
In an organization whose,
um, dependent upon

00:33:25.000 --> 00:33:29.999
physicians to bring in the business, but it\'s
nursing care which is the business. (inaudible)

00:33:30.000 --> 00:33:34.999
The first place that many patients
will experience the impact

00:33:35.000 --> 00:33:39.999
of the nursing shortage is in the emergency
room. Who have we got waiting for

00:33:40.000 --> 00:33:44.999
beds? And what time did he come in to the emergency room?
Eleven? He came in at 11:20. And he is still there now?

00:33:45.000 --> 00:33:49.999
Yeah. There was one patient there who had been
waiting since 11 o\'clock this morning for a bed.

00:33:50.000 --> 00:33:54.999
That patient needed isolation. Cynthia in
Admitting told me, \"I know of a discharge at

00:33:55.000 --> 00:33:59.999
three PM. The patient at three PM has got a, has
got to go. Housekeeping is out to clean the room.

00:34:00.000 --> 00:34:04.999
He is talking another hour, an hour and a half.\" Then that patient
from 11 o\'clock this morning will probably get in their room

00:34:05.000 --> 00:34:09.999
about 4:30, which is quite a long wait.
We had one patient wait 14 hours.

00:34:10.000 --> 00:34:14.999
That\'s the longest it\'s ever been. That was during
the summer. I\'ve had patients wait up to six

00:34:15.000 --> 00:34:19.999
hours, average four hours. Not unusual.
Not unusual. The problem is not beds.

00:34:20.000 --> 00:34:24.999
We have beds. You can go upstairs and, you know,
walk down the hall and see plenty of beds.

00:34:25.000 --> 00:34:29.999
But you can\'t just put people in beds. You\'re putting
them in beds to be taken care of by nurses. So it\'s

00:34:30.000 --> 00:34:34.999
a lack of staff beds. So you,
you can only admit to a floor

00:34:35.000 --> 00:34:39.999
up to the amount of staff that you have.
And that\'s why if a floor is short

00:34:40.000 --> 00:34:44.999
one or two nurses, then they can only, they
can\'t admit their normal amount of patients.

00:34:45.000 --> 00:34:49.999
And it all comes to a head in the emergency
department because we can\'t turn people

00:34:50.000 --> 00:34:54.999
away. We can\'t deny access to care. And we\'re here
24 hours a day, seven days a week available all

00:34:55.000 --> 00:34:59.999
the time for anybody in need. And they
keep coming in. They can\'t get out.

00:35:00.000 --> 00:35:04.999
It just, you know, begins to become
a volcano. Somebody is not real

00:35:05.000 --> 00:35:09.999
sick, it may be a drag that they have to spend
eight or 10 or 12 hours in the emergency

00:35:10.000 --> 00:35:14.999
department. Nobody likes that. Uh, patients don\'t like
it. Their families don\'t like it. And it\'s hard for

00:35:15.000 --> 00:35:19.999
us, but we can deal with that. What happens
though is if a, an unstable patient has to

00:35:20.000 --> 00:35:24.999
spend four or six or eight hours in the emergency
department and then what if it takes one

00:35:25.000 --> 00:35:29.999
nurse to watch them the whole time they\'re here? It means
we have one less nurse to take care of everybody else.

00:35:30.000 --> 00:35:34.999
And right now, we have no, uh, critical
care beds in the hospital. Uh,

00:35:35.000 --> 00:35:39.999
and, uh, maybe by Saturday night, there won\'t
be any critical care beds in all of Metro

00:35:40.000 --> 00:35:44.999
West. When we first came on at three, it was very
busy, uh, to the point that there were people in the

00:35:45.000 --> 00:35:49.999
halls, not enough rooms to put people in. People
to be triaged in the waiting room, we had no place

00:35:50.000 --> 00:35:54.999
to put them. Uh, there were a couple of admissions
that had been here for a couple of hours, but

00:35:55.000 --> 00:35:59.999
we had two critically ill people in our
code room and that that is a nurse gone.

00:36:00.000 --> 00:36:04.999
That\'s it. Once she goes into that room, we\'ve
lost her. And that leaves a charge nurse.

00:36:05.000 --> 00:36:09.999
A nurse could be out front in triage and
literally, one nurse to run up and down this hall.

00:36:10.000 --> 00:36:14.999
The volume of patients has increased dramatically, and there
is a shortage of nurses. Frequently, they may be waiting

00:36:15.000 --> 00:36:19.999
to have a dressing put on or just a tetanus shot.
And there is just nobody free to run down that hall

00:36:20.000 --> 00:36:24.999
and do it. It puts a, a real mental
strain on you as well, knowing

00:36:25.000 --> 00:36:29.999
that whatever may happen, they are
gonna come to me and ask why. And

00:36:30.000 --> 00:36:34.999
a lot of nights, I don\'t, I won\'t know why. Not because
I haven\'t tried. It\'s just there is not enough of me

00:36:35.000 --> 00:36:39.999
to go around. There are nights when I
go home that I wonder why I had come

00:36:40.000 --> 00:36:44.999
back. You want, and so it goes back to, again, giving
the care that you\'ve been trained to give and want

00:36:45.000 --> 00:36:49.999
to give. And there are nights
that you just can\'t give it.

00:36:50.000 --> 00:36:54.999
In some cases, lack of staff will mean that
patients must be transferred to other hospitals.

00:36:55.000 --> 00:36:59.999
The private physicians don\'t want their patients transferred.
You can\'t blame them. Some of them don\'t have admitting

00:37:00.000 --> 00:37:04.999
privileges elsewhere. The patients are used
to this hospital. They\'re coming here because

00:37:05.000 --> 00:37:09.999
they like it. They don\'t wanna be transferred.
The hospital, on some level, doesn\'t want us

00:37:10.000 --> 00:37:14.999
to transfer people because it means less
revenue. So there is all these forces

00:37:15.000 --> 00:37:19.999
mitigating against transferring patients.
But yet sometimes, you just

00:37:20.000 --> 00:37:24.999
can\'t admit one more patient and you do have
to transfer. I had an elderly gentleman,

00:37:25.000 --> 00:37:29.999
a father, uh, of some local
community residents who was very

00:37:30.000 --> 00:37:34.999
sick and came to this hospital emergency
department and I evaluated. And clearly,

00:37:35.000 --> 00:37:39.999
he was sick enough to require admission
to the hospital. We had no beds here.

00:37:40.000 --> 00:37:44.999
I called six other hospitals,
none of whom had beds.

00:37:45.000 --> 00:37:49.999
I finally managed to find him a bed at
another suburban hospital that, uh,

00:37:50.000 --> 00:37:54.999
literally, the patient was here for
over six hours. The family, initially,

00:37:55.000 --> 00:37:59.999
when they found out we didn\'t have a bed,
found out that I needed to transfer, was so

00:38:00.000 --> 00:38:04.999
angry that I thought the son-in-law
was gonna punch me out. The other

00:38:05.000 --> 00:38:09.999
hard part about this is the physicians are on the telephone all
the time making the calls. The nurses are on the telephone

00:38:10.000 --> 00:38:14.999
making calls. I have had patients
complain, saying, \"Doctors

00:38:15.000 --> 00:38:19.999
and nurses aren\'t taking care of anybody. All
they\'re doing is spending time on the telephone.\"

00:38:20.000 --> 00:38:24.999
Overall, uh, I think the quality
of care has to be compromised.

00:38:25.000 --> 00:38:29.999
Now, have, have I seen
this occurrence where

00:38:30.000 --> 00:38:34.999
something truly dangerous has happened?
Not yet. And I think that\'s because

00:38:35.000 --> 00:38:39.999
everybody is putting out a little bit more.
But if this pace

00:38:40.000 --> 00:38:44.999
continues, you know, you can only increase
your activities or your surveillance or your

00:38:45.000 --> 00:38:49.999
stress level so much, and then
you\'re not gonna be able to keep up.

00:38:50.000 --> 00:38:54.999
So I, I, I really worry about
the future for patients.

00:38:55.000 --> 00:38:59.999
Unless the general public says, \"Look, we
don\'t, we need the best of everything. We don\'t

00:39:00.000 --> 00:39:04.999
wanna spend the resources necessary
to hire the personnel to have

00:39:05.000 --> 00:39:09.999
facilities operating at capacity.\" And
if they don\'t wanna spend the resources,

00:39:10.000 --> 00:39:14.999
then they have to lower the
expectation of what we can deliver.

00:39:15.000 --> 00:39:19.999
[music] On a hospital\'s medical

00:39:20.000 --> 00:39:24.999
surgical floors, short-staffing contributes
to an almost constant level of stress.

00:39:25.000 --> 00:39:29.999
I\'m gonna call Level 3. No.
I\'m gonna call it just to

00:39:30.000 --> 00:39:34.999
have Joe be staffed. It ends up being mandatory over
time when one of my nurses are definitely gonna have to

00:39:35.000 --> 00:39:39.999
stay. And that will make two nurses until five
o\'clock. And then when the other nurse comes at five,

00:39:40.000 --> 00:39:44.999
they\'ll have three nurses. But the one
that stays from three, I would like

00:39:45.000 --> 00:39:49.999
to let her go home at eight o\'clock because she\'s been here all day,
and that will be 12 hours if she stays \'til eight. If she stays

00:39:50.000 --> 00:39:54.999
\'til 11, it will be her full 16 hours, and
I prefer not to do that. I don\'t want you

00:39:55.000 --> 00:39:59.999
to stay that late because you\'re gonna be too tired for tomorrow.
Right. And then you\'re gonna start all over again. OK?

00:40:00.000 --> 00:40:04.999
I appreciate you staying \'til eight. That\'s good. And then
you can go around and maybe finish six o\'clock meds or put

00:40:05.000 --> 00:40:09.999
people to bed and then go home so that they
feel settled before you leave. The only,

00:40:10.000 --> 00:40:14.999
I need your experience here. You know. We\'ve had
a real busy day today. She started out having

00:40:15.000 --> 00:40:19.999
nine patients, and we\'ve had a lot of,
um, discharges. She\'s had a very hectic

00:40:20.000 --> 00:40:24.999
day, and now, I\'m asking her to stay more
into the shift. It, it\'s really difficult.

00:40:25.000 --> 00:40:29.999
I feel like I am always asking them to do more.
And it\'s almost, it gets to the point where

00:40:30.000 --> 00:40:34.999
you feel like you\'re trying to get blood from a stone.
And it wouldn\'t be so bad if today was the only day

00:40:35.000 --> 00:40:39.999
I say, \"Jodi, could you stay for a couple of hours?\"
People would be very willing to stay. But when I ask

00:40:40.000 --> 00:40:44.999
for a couple of times a week to stay, that\'s where
the frustration level and the anxiety really peaks,

00:40:45.000 --> 00:40:49.999
and then they get angry. Six North, Margie.
Hi, Jeff. Um, let me tell

00:40:50.000 --> 00:40:54.999
you what the situation is. We\'ve been able to
discharge a patient, OK, who is going mo-,

00:40:55.000 --> 00:40:59.999
a whole patient. Um, who is,
who has just left. We will

00:41:00.000 --> 00:41:04.999
clean that bed. And how about if we take our
(crosstalk) On Easter weekend, four of my

00:41:05.000 --> 00:41:09.999
staff refused to stay when a critical staffing
situation was called. There were three

00:41:10.000 --> 00:41:14.999
nurses scheduled. There were 24 patients.
The evening staff came on and didn\'t feel,

00:41:15.000 --> 00:41:19.999
uh, based on the recommended staffing for the evening,
which was five nurses, that they could handle with

00:41:20.000 --> 00:41:24.999
three nurses. And the day nurses were so
exhausted and so tired, felt that they couldn\'t

00:41:25.000 --> 00:41:29.999
put in one more minute, and knew that their job
would be on the line and said that they were

00:41:30.000 --> 00:41:34.999
leaving. You know, this, for the staff, from the
staff nurses\' view, they are making a statement.

00:41:35.000 --> 00:41:39.999
\"We can\'t do this. We need help. We need your,
we need your support.\" And as a manager

00:41:40.000 --> 00:41:44.999
being caught, understanding where they were at but
knowing in terms of their peers and the patients

00:41:45.000 --> 00:41:49.999
they, they were doing, doing something
that was really jeopardizing

00:41:50.000 --> 00:41:54.999
care. And that part was hard, probably one
of the hardest things I\'ve had to deal with.

00:41:55.000 --> 00:41:59.999
Can I have you lean forward? I just wanna listen
to your lungs for a minute. Someone will ask you

00:42:00.000 --> 00:42:04.999
if you can wash their feet. Well, do you have
time to get a basin of water to soak their feet?

00:42:05.000 --> 00:42:09.999
Um, or help them down the hallway so that
they can take a shower instead of a sponge

00:42:10.000 --> 00:42:14.999
bath? Those kind of things. Or even walking
someone to the bathroom and having

00:42:15.000 --> 00:42:19.999
to stay with them if there is other things
going on and you don\'t have that kind of time.

00:42:20.000 --> 00:42:24.999
Maybe you have to give them a bed pan, and they don\'t really
wanna use one. And you don\'t really wanna have to give one

00:42:25.000 --> 00:42:29.999
to them, but you don\'t have time to
unrestrain them, walk them to the bathroom,

00:42:30.000 --> 00:42:34.999
stay with them, get them back to bed.
The extra back rub, um,

00:42:35.000 --> 00:42:39.999
the extra special time of sitting at the
end of the bed and talking to someone,

00:42:40.000 --> 00:42:44.999
uh, being able to stay with them a little extra longer if
they are having a problem, that\'s what\'s not being done.

00:42:45.000 --> 00:42:49.999
It\'s part of the reason that,
uh, you have trouble with

00:42:50.000 --> 00:42:54.999
job satisfaction \'cause those are the things
that make you feel really good at the end of the

00:42:55.000 --> 00:42:59.999
day, that you, um, were able to
either sit and talk to a paces,

00:43:00.000 --> 00:43:04.999
patient that was going
through a crisis, or to, um,

00:43:05.000 --> 00:43:09.999
lend moral support to someone who may
be going to surgery, or to sit and talk

00:43:10.000 --> 00:43:14.999
to a patient whose family
member is dying of cancer.

00:43:15.000 --> 00:43:19.999
Um, that\'s part of what we do everyday
and what we\'re expected to do everyday.

00:43:20.000 --> 00:43:24.999
Um, it\'s part of being a nurse. If it

00:43:25.000 --> 00:43:29.999
gets to the point where someone is
really acutely ill and you just can\'t

00:43:30.000 --> 00:43:34.999
stretch yourself far enough to get everything
done, if it gets to the point where I feel

00:43:35.000 --> 00:43:39.999
like I can\'t concentrate enough
finally to get that done safely,

00:43:40.000 --> 00:43:44.999
to just squeak through anymore, then I think I would
really seriously have to think about doing something

00:43:45.000 --> 00:43:49.999
different. Maybe I would go into a private duty
position where I\'d only have to worry about

00:43:50.000 --> 00:43:54.999
being able to pamper one whole
person to do everything for them.

00:43:55.000 --> 00:43:59.999
Not everybody is gonna be able to afford that though.
And then it\'s not just happening here. It\'s happening

00:44:00.000 --> 00:44:04.999
all over. Uh, when people come in the hospital,
they are sicker because of the whole,

00:44:05.000 --> 00:44:09.999
uh, diagnostic-related group. People
are tra-, people are sent home earlier

00:44:10.000 --> 00:44:14.999
s-, so they\'re tr-, and you, we try to keep them out
of the hospital. So when they finally do come in,

00:44:15.000 --> 00:44:19.999
they are sicker, and that increases our load.
We have a graying population in the state of

00:44:20.000 --> 00:44:24.999
Massachusetts. Certainly in our catchment area of
Newton-Wellesley, there is a higher percentage of elderly

00:44:25.000 --> 00:44:29.999
people. Elderly people get sick more
than young people. That\'s a fact. So we

00:44:30.000 --> 00:44:34.999
see, so we\'re seeing sicker and sicker
people, uh, even though people\'s stays are

00:44:35.000 --> 00:44:39.999
shorter and shorter, which makes them sicker and sicker.
So there is, there is a lot of forces that are going on.

00:44:40.000 --> 00:44:44.999
Uh, add a, a projected
spread of AIDS, uh, in the

00:44:45.000 --> 00:44:49.999
population, and uh, we\'re gonna be
working even harder. And it\'s a terrible

00:44:50.000 --> 00:44:54.999
position to have to be in as the coordinator. And
it\'s a terrible position to have to be in as a nurse.

00:44:55.000 --> 00:44:59.999
And very scary for a patient who knows
they\'re probably, you know, number

00:45:00.000 --> 00:45:04.999
10 on the list and, um, is the nurse gonna tell
them that they are number 10 on the list and

00:45:05.000 --> 00:45:09.999
\"I can\'t get to you. I\'m sorry. You\'ll have to wait
an hour.\" It will take me a while. I\'ll go home

00:45:10.000 --> 00:45:14.999
and I\'ll tell my husband everything that happened
for the day. And then usually, I\'ll just kinda

00:45:15.000 --> 00:45:19.999
put it to rest hopefully. I\'ll worry.
I worry about them,

00:45:20.000 --> 00:45:24.999
you know, because I can\'t help it. I
feel that I would like to stay tonight.

00:45:25.000 --> 00:45:29.999
I would like to come in tomorrow and work for them.
But in reality, I can\'t do that. And to cover

00:45:30.000 --> 00:45:34.999
one sick call for the nurse manager is OK, but you
can\'t cover every hole that you have in your schedule.

00:45:35.000 --> 00:45:39.999
You know what I mean? And we\'d be burned out three
seconds flat if we did that. I can\'t do it. So I

00:45:40.000 --> 00:45:44.999
need to draw the line and say, \"I\'ve done my
job. I\'ve done the best I can\" and leave it.

00:45:45.000 --> 00:45:50.000
[music]

00:46:20.000 --> 00:46:24.999
[music] Unlike nursing
shortages of the past,

00:46:25.000 --> 00:46:29.999
today\'s crisis is coupled with a sharp decline
in the number of people going into nursing.

00:46:30.000 --> 00:46:34.999
Like many community hospitals,
Newton-Wellesley had relied on its own school

00:46:35.000 --> 00:46:39.999
of nursing for much of its staffing. The
decision to close the school was made

00:46:40.000 --> 00:46:44.999
very painfully. Each year,
the number of enrollment,

00:46:45.000 --> 00:46:49.999
enrollees was decreasing. But also even the
number of inquiries, people asking for catalogs

00:46:50.000 --> 00:46:54.999
to be sent, uh, had been decreasing.
By 1988, Boston University

00:46:55.000 --> 00:46:59.999
had closed its nursing school. And nearby Boston
College was also facing a drop in enrollments.

00:47:00.000 --> 00:47:04.999
The classes that we used to have
would be approximately 180.

00:47:05.000 --> 00:47:09.999
And this year\'s freshman, freshman class
was 61. So the numbers have really

00:47:10.000 --> 00:47:14.999
decreased. Um, we are hoping
that this will be the bottom.

00:47:15.000 --> 00:47:19.999
Well, if it continued to drop dramatically, there would have
to be a serious question as to whether a program can survive

00:47:20.000 --> 00:47:24.999
depending on how small the numbers get.
The only thing that worries me about

00:47:25.000 --> 00:47:29.999
nursing is, like, the weekends and holidays. Once you
have a family, you\'re not gonna wanna be away from

00:47:30.000 --> 00:47:34.999
your family for holidays. It\'s just something
you\'re gonna have to accept. Yeah. Especially

00:47:35.000 --> 00:47:39.999
if the shortage continues. So
I mean it\'s, we\'ll have to

00:47:40.000 --> 00:47:44.999
deal with it because this is our choice.
So I called him and,

00:47:45.000 --> 00:47:49.999
uh, I said, you know, I told him what the story was. He
said, \"Oh.\" He said, \"We\'re gonna stop that Heparin.\"

00:47:50.000 --> 00:47:54.999
In addition to low salaries, job stress,
and unpredictable working hours, nurses

00:47:55.000 --> 00:47:59.999
often feel that they are treated with a lack
of respect, not only by the public, but by the

00:48:00.000 --> 00:48:04.999
physicians they work with as well. DCd. No sooner
that I do that that he comes up on the floor.

00:48:05.000 --> 00:48:09.999
\"We\'re gonna change.\" \"Erm, I had done
this.\" You will get the medical students

00:48:10.000 --> 00:48:14.999
and then the interns and then the medical residents.
But when they come on the clinical unit, they turn

00:48:15.000 --> 00:48:19.999
to the nurse. And all the theory that they have
learned in the classroom then, they come and apply it

00:48:20.000 --> 00:48:24.999
on the unit. And I think that the nurses are the ones that
carry them through. The nurses are the ones who pick up on

00:48:25.000 --> 00:48:29.999
their bad judgments or their bad orders.
Or things that just aren\'t quite kosher

00:48:30.000 --> 00:48:34.999
enough at the time, we\'ll point it out to them and say, \"Do
your really wanna order that? Because so and so has this

00:48:35.000 --> 00:48:39.999
kind of a diagnosis, and I don\'t really think that,
you know, is appropriate.\" And it\'s interesting that

00:48:40.000 --> 00:48:44.999
we really do kind of help them grow through
their profession. And then all of a sudden,

00:48:45.000 --> 00:48:49.999
they\'re attending physicians and the
role changes. June 30th, they\'re medical

00:48:50.000 --> 00:48:54.999
students. July 1st, they\'re physicians. They
are supposed to come in and know what to do.

00:48:55.000 --> 00:48:59.999
They\'re brand new. We\'ve been doing this for years. We
know what to do. But somehow, sometimes you have to play

00:49:00.000 --> 00:49:04.999
this game where you\'re actually telling them
what to do but trying not to make it look like

00:49:05.000 --> 00:49:09.999
you\'re telling them what to do. Uh, I mean,
you, if you\'re in nursing, you become adept

00:49:10.000 --> 00:49:14.999
to that very quickly. But I guess what I was saying is that
we shouldn\'t have to be. We shouldn\'t have to be doing that.

00:49:15.000 --> 00:49:19.999
You know, I get very, uh, upset with, when a physician says,
\"I don\'t understand why a nurse has to go to college,

00:49:20.000 --> 00:49:24.999
you know, to learn to give baths and bed
pans and, and to give injections. Anyone can

00:49:25.000 --> 00:49:29.999
be trained to do that.\" Uh,
nursing, nursing education is an

00:49:30.000 --> 00:49:34.999
education, and it isn\'t a training. Uh, we
look at a wide breadth. A good distinction.

00:49:35.000 --> 00:49:39.999
Of education. And if we want someone to be
professional, then they need that education to be able

00:49:40.000 --> 00:49:44.999
to interact with other professionals.
A lot of physicians respect nurses,

00:49:45.000 --> 00:49:49.999
uh, and they think what we do
is very important. But some

00:49:50.000 --> 00:49:54.999
don\'t. And it\'s the ones who
don\'t who really need to be

00:49:55.000 --> 00:49:59.999
reeducated, rehabilitated, if you will. Uh,

00:50:00.000 --> 00:50:04.999
although, you know, somebody, somebody might say,
\"Well, they are not gonna change.\" Well, they may

00:50:05.000 --> 00:50:09.999
have to change. Uh, because what we do
is important and we wanna be recognized

00:50:10.000 --> 00:50:14.999
for that. It takes two parties here.
Mm-hmm. And I think sometimes, doctors are

00:50:15.000 --> 00:50:19.999
negligent in their willingness to, to wanna
discuss things with us. But I think nurses are

00:50:20.000 --> 00:50:24.999
sometimes too because they still carry over the, \"This
doctor is never gonna listen to me. He ordered it.

00:50:25.000 --> 00:50:29.999
Therefore, I have to follow it even though I don\'t
agree with it.\" I think we have to be more open and

00:50:30.000 --> 00:50:34.999
more assertive and look at the knowledge and what we
have to offer in this situation and say, \"Hey, you know,

00:50:35.000 --> 00:50:39.999
we need to look at this total picture.\"
Mm-hmm. Now is a time when we can

00:50:40.000 --> 00:50:44.999
offer more to patients than we ever could
before. But most of the things we have to

00:50:45.000 --> 00:50:49.999
offer have to be offered in a hospital. That the
day of the country doctor who holds your hand

00:50:50.000 --> 00:50:54.999
be-, uh, to make you better because
he had little else to offer is gone.

00:50:55.000 --> 00:50:59.999
And today, in the day of scientific medicine,
we need other health care professionals

00:51:00.000 --> 00:51:04.999
who, who, to round out the team.
The things that nurses do,

00:51:05.000 --> 00:51:09.999
doctors can\'t do. A nurse is not a, is not a
half a doctor. A nurse is a nurse professional

00:51:10.000 --> 00:51:14.999
who does what nurses do, and doctors can\'t do
that, just as nurses don\'t do what doctors do.

00:51:15.000 --> 00:51:19.999
And neither of us can do what we
do unless we work with the other.

00:51:20.000 --> 00:51:24.999
[music] People who will, who
may ultimately be patients

00:51:25.000 --> 00:51:29.999
in a hospital need to
know that things will be

00:51:30.000 --> 00:51:34.999
different, that what they experience in
a hospital may well be different if,

00:51:35.000 --> 00:51:39.999
if we can\'t have enough nurses
to care for them. Maybe the only

00:51:40.000 --> 00:51:44.999
way you change the values
of a society, uh, back to

00:51:45.000 --> 00:51:49.999
taking care of each other is, um, for people
to be scared, for people, for there to be a

00:51:50.000 --> 00:51:54.999
generation of people who don\'t get the care they
need when they are sick. Maybe it will take

00:51:55.000 --> 00:51:59.999
that. And though, and, and the, the young
people saying, \"Holy mackerel! My mother

00:52:00.000 --> 00:52:04.999
died because there was nobody to
take care of her. This isn\'t right,\"

00:52:05.000 --> 00:52:09.999
may-, maybe, maybe it will take that. In
one way or another, we are beginning to

00:52:10.000 --> 00:52:14.999
ration care. Whether or not we like to
admit it or not, care to the patients

00:52:15.000 --> 00:52:19.999
are being rationed. Uh, and
it is in accordance with,

00:52:20.000 --> 00:52:24.999
uh, severity of illness. It\'s
in accordance with disease.

00:52:25.000 --> 00:52:29.999
Uh, so that in the long run, the
patient is the one that suffers.

00:52:30.000 --> 00:52:34.999
The nursing shortage is ongoing, and it\'s not
gonna be gone next summer. And I think we need to

00:52:35.000 --> 00:52:39.999
be looking ahead to, to what\'s coming down
the road and, you know, what things that

00:52:40.000 --> 00:52:44.999
we\'d done in the past that were positive,
what things got a good response, and,

00:52:45.000 --> 00:52:49.999
I don\'t know. Can we clone nurses at this meeting?
We have the nurse machine outside. In an effort

00:52:50.000 --> 00:52:54.999
to confront the crisis, the hospital has
focused not only on recruitment but also on

00:52:55.000 --> 00:52:59.999
ways to keep the nurses who are already
on staff. Despite its present problems,

00:53:00.000 --> 00:53:04.999
Newton-Wellesley is considered to be a good
place for nurses to work. We are able to

00:53:05.000 --> 00:53:09.999
provide a setting in which
an, an individual nurse can

00:53:10.000 --> 00:53:14.999
use some amount of creativity
and have some sense of autonomy

00:53:15.000 --> 00:53:19.999
around decision-making, uh, on
treatment planning for patients. Uh,

00:53:20.000 --> 00:53:24.999
opportunities for learning, uh,
location, and ease of access

00:53:25.000 --> 00:53:29.999
are very important to people. The
existence of a daycare center is very

00:53:30.000 --> 00:53:34.999
important. Um, certainly, we have recruited

00:53:35.000 --> 00:53:39.999
many people, um, with, with that, with
all those being equal between two

00:53:40.000 --> 00:53:44.999
institutions, with that being certainly
the, the drawing card for coming here.

00:53:45.000 --> 00:53:49.999
Faced with growing staff dissatisfaction,
the hospital decided to reduce its reliance

00:53:50.000 --> 00:53:54.999
on mandatory overtime and to introduce
a variety of flexible new staffing

00:53:55.000 --> 00:53:59.999
arrangements. Following union
negotiations, it also significantly

00:54:00.000 --> 00:54:04.999
increased nursing salaries. As a result
of these changes, the hospital was able

00:54:05.000 --> 00:54:09.999
to fill many of its nursing positions,
bringing at least some short-term relief.

00:54:10.000 --> 00:54:14.999
Both locally and nationally, however, the
number of nurses available remains far

00:54:15.000 --> 00:54:19.999
below the expected need. The, the
shortage definitely is not over.

00:54:20.000 --> 00:54:24.999
We at, at this hospital are
feeling some respite from it now.

00:54:25.000 --> 00:54:29.999
Some other hospitals are as well.
Yet there are hospitals beyond that

00:54:30.000 --> 00:54:34.999
who are still struggling to recruit nurses.

00:54:35.000 --> 00:54:39.999
It\'s not over. You could certainly
make an argument for this being

00:54:40.000 --> 00:54:44.999
the, really the most opportune time to go into
nursing. There is gonna be a lot of changes. Uh,

00:54:45.000 --> 00:54:49.999
it\'s gonna be very exciting. I think the
prof-, I think our profession is going to,

00:54:50.000 --> 00:54:54.999
uh, undergo a, a metamorphosis. Into what?
I\'m not sure. But I think

00:54:55.000 --> 00:54:59.999
in the end, I think we\'ll have a much more
exciting, attractive, vibrant, and challenging

00:55:00.000 --> 00:55:04.999
profession. Unfortunately, I think it\'s gonna
be, there\'ll be some stress and some pain

00:55:05.000 --> 00:55:09.999
getting to the next stage. But we\'re
definitely moving towards that.

00:55:10.000 --> 00:55:14.999
When everything goes right, especially when
people are really sick and they don\'t feel good

00:55:15.000 --> 00:55:19.999
and they can\'t see beyond this
hour, when you can help them

00:55:20.000 --> 00:55:24.999
get better, get moving, get motivated,

00:55:25.000 --> 00:55:29.999
not everybody gets cured,
but when you can really

00:55:30.000 --> 00:55:34.999
have an impact and in working
as a team with the therapy

00:55:35.000 --> 00:55:39.999
people, physical therapy, the doctors,
when everything works and you

00:55:40.000 --> 00:55:44.999
really have someone walk out of here
that\'s better because of their experience

00:55:45.000 --> 00:55:49.999
and the care that they had received, then
you can take a lot of pride in that.

00:55:50.000 --> 00:55:54.999
And that\'s what keeps us going.

00:55:55.000 --> 00:56:00.000
[music]