This commentary is by Vicki Ward of Barnard, who holds a master’s degree in family nursing and a post-master’s certificate in psychiatric and mental health nursing.
Vermont is a Doctor State. Like Colorado, Hawaii, with the desirable landscape and persisting regard from patients, physicians and their administrators maintain quiet control over the health care scene.
Since the corporatization of health care, nursing has repeatedly been diminished aside from the nurse practitioner role. Home health initiatives, hospice initiatives, mental health and substance abuse treatment programs were developing with new leadership strategies prior to the mid-1990s when the business of health care “took charge.”
Do you know that “dark money” in politics is funded by Realtors #2 and Doctors #3 for Republican insurrectionists/obstructionists, according to Open Secrets? Who wants to maintain the status quo?
As Julie Andrews sang in “The Sound of Music“: Nothing comes from nothing, nothing ever could, so somewhere in our youth or childhood, there must have been something. …” Only, in the case of U.S. nursing, as the domain of nursing education surged in the 1980s, guess what followed? The shutdown of nursing creativity and growth by MBAs, M.D.s, with politicians’ support, aside from the nurse practitioner role, which has filled such a deep gap in health that she has persisted.
Community health and the wide judgment we had gained for health care visits to the ill, elderly, new moms and babies, special needs kids were shut down. Hospice-like nursing homes were allowed to be privatized by non-health-care providers who make gobs of administrative money and forgo care. Public health nursing has been so diminished that one conference I attended in New Mexico five years ago was out of a 1970s bad movie. Lack of a U.S. public health system has transferred patient rage in a pandemic to hospital caregiving nurses.
Interesting to hear the acknowledgment of what nurse educators have been paid, but without comparison to other health care educators, like M.D.s and physical therapists. Sounds like a values clash, which is exactly what it is. Nursing values patient care and safety, fair remuneration with benefits and lack of drama/conflict. The latter is inflicted only in union situations when untenable solutions are proposed and to be “jammed down your throat.”
Nurses began leaving hospital work initially in the late 1980s as more educated nurses were offered leadership positions when hospital-trained nurses, who did have more hands-on hospital training in their programs than bachelor’s degree in nursing programs could offer were devalued. Education brought wider views of what nursing could offer but unfortunately, as the corporatization of hospitals and health care has occurred, this view has shrunk and its leaders made corporate copies.
Nurses used to have one unit secretary per hospital unit/floor, but now contend with masses of oft-times better-paid administrators making demands with no appreciation/respect of direct care work.
Hospitals were made to care for patients with nurses, doctors and nurses aides, not to become paperwork-driven bastions of highly paid peripheral staff. Between these money swallowers, health insurers, pharmacy middlemen, costs have exploded. Medical bankruptcies persist and uncovered, end-of-life medical costs still ravage generational wealth transfer of the lower middle and middle classes. Can you hear the sucking sound?
Some offer public funding of “primary care,” which is wellness visits. If illness is identified, especially serious illness, who will pay? Why even go for this “primary care” if you know that you can not afford the hidden and monstrous costs allowed in U.S. health care? One of the reasons Docs in a Box make money is their costs are usually more transparent. Many of us have forgone health insurance at various times in our lives to save funds, with no plan to use U.S. medical care during these times.
Violence in health care settings has greatly increased in the past decades. Where did you think mental health, and deeply intertwined substance abuse/dependence care needs, were going to go when they were defunded? Because the U.S. system denied the existence of these health care problems, they did not go away.
Deepening of these health challenges untreated brings more physical pain and actually classic health compromises (if one bothers to be interested in how untreated mental health/substance abuse ravage the body). Who wants to be hit doing their job? Smacked? Punched? Another factor is the continued escalation of violence in the U.S., including health care settings. Do you hear anyone allowed to speak of this? An emphatic no!
And, the anger of continued Covid infection has created a wave of extreme violence toward health care providers in hospitals, especially toward nurses, the 24-hour caregivers. By whom? The unvaccinated who are sick and politically angry, taking it out on nurses. What is being done? Very little.
Corporate health care has never cared about nurses/patients, only about money. Do you recall how many hospitals have been taken down over the past two decades? And now, they talk about hospital system collapse from the pandemic.
National standards for infection control, use of PPE, protecting workers symptomatic for a pandemic disease, unfortunately require national OSHA standards. The administrators don’t want to do it, and OSHA wants to waffle.
To continue to recruit nurses, the U.S. needs to choose whether to continue down the corporatization trail or transform into a sustainable health care model, providing health care rather than money care. Prepaying the most highly paid professionals, doctors, for this work is more money care in the context of $12 to $15 hourly wages in Vermont. And, yes, as the time away from pandemic relief payments waxes, many hourly wages return to their unsustainable low levels.
No wonder Vermont will need workers. Who can afford to work at this wage, unless you are a trust funder or wealthy outsider? Perhaps Vermont needs a new state department to train the wealthy to put their own groceries through the prepay machine, train them to create their own victory gardens, learn how to use a shovel, do simple landscaping, and, like home economics, teach house cleaning of your own properties.
I am not certain who will like this, but importing immigrants from untenable lives will help keep your costs low as the simmering rage of Americans left behind burns.
