The late Dr Lois Malasanos, RN, PhD, had a novel concept for health care. She believed hospitals should be run by nurses, with physicians being contracted for their skills as needed.
Lois, whom I knew both professionally and socially in the beginning of my legal career, was a member of the Florida Board of Nursing. I was a new attorney for the State agency that regulated professional Boards. She was the Dean of the University of Florida College of nursing, and the author of one of the standard texts for nursing students nationwide.
Dr Malasanos believed the purpose of a hospital stay was for patients to receive skilled nursing care. She is right. If you have ever spent time as a hospital in-patient, you know it’s the nurses who are providing the care you need. After whatever medical procedure you underwent, the only time you see the doctors is if they stop by to check how you are doing. It’s the nurses who are there 24/7.
My recent three-week hospitalization, following a heart attack and open-heart surgery, was the first time I’d ever spent more than 24 hours in a hospital as a patient. The experience convinced me that Dr Malasanos was on to something.
On Saturday, May 29, I was feeling an unusual sensation in my solar plexus. Not pain, or pressure, or any of the “classic” signs of a heart attack. It was more like indigestion. I had no cardiac history, ate right and regularly exercised. In the words of a doctor who subsequently treated me, I’m “the guy this was not supposed to happen to.”
But as a former Air Force independent duty medic, I instinctively knew it wasn’t something I should ignore. So I drove to the nearest hospital emergency room.
Though my EKG in the ER did not raise any concerns, my troponin level was elevated — which can be an early warning sign of a heart attack. So I was admitted for overnight observation. That saved my life.
Around 0500 the next morning I awoke unable to get comfortable in bed, so I got up into the bedside chair. Within minutes two thing happened almost simultaneously. The team monitoring my EKG came into the room to check on me — and I felt the first stabbing pain in my chest. The team wanted to check my vital signs, but I told them to get me back onto the bed because I knew I was “going bad”. They did so, and the nurse called a “Rapid Response”.
I was quickly surrounded by what I knew to be a cardiac emergency team. Many times I’d been on the other side of that scenario, so I suspected I was having a heart attack. When the doctor confirmed it, I responded that I couldn’t think of a better place to have one.
I remained conscious and the “medic” part of my brain took over. I kept asking what “my numbers” were – meaning my vital signs, etc. Throughout the attack a nurse held my hand, looked in my eyes and kept telling me my vitals. It helped to distract me from the pain, and reassured me I wasn’t dying.
After 6 mg of morphine, 4 hits of nitroglycerine, and a dose of atropine, the pain subsided. I was stabilized. I don’t know that nurse’s name, but she was my “angel of mercy” during the ordeal.
The attending physician saved my life. But that nurse talked me through it, which at one point kept me from passing out. That wouldn’t have been good. She was the first of the incredible nurses who helped me over the next three weeks.
During my tenure prosecuting for the nursing Board, I saw the difference between good and bad nurses. The members of the Board were tasked with keeping the public safe from the bad ones — and took that responsibility seriously. Nurses either conformed to the standards of practice set by the Board, or they were disciplined — which could include loss of their license. The Board members weren’t interested in excuses, or whining. That experience taught me a lot about the nursing profession.
I’ve also learned a lot from being married to a RN for the past 35 years. We met when we were college students. I was in law school, she was in nursing. Her subsequent career included being a clinical instructor in a community college nursing program, and as a consultant to the State Board on standards of nursing practice.
Like the Board, she holds nurses to a very high standard. The nurses who cared for me following my heart attack met those standards.
Four days after my heart attack, I underwent open-heart surgery to correct the problem which caused it. The cardiac surgeon gave me, in effect, a new heart that will probably out last the rest of me. I can’t say enough good things about him, and his partner who regularly saw me before and after surgery. As a medic, I was trained by, and worked with, some good doctors. Those guys are two of the best I’ve ever known.
But it was after I was wheeled, still unconscious, out of the operating room to cardiac ICU that my healing really began. And I owe it to the nurses.
The day after surgery I was greeted by the nurse I nicknamed “the drill instructor”. One of the most important parts of her job was to get me “up and walking”. With the chest tubes and IVs still attached, it was the hardest thing I’ve ever done. But the drill instructor didn’t want to hear any excuses from me. I was going to walk. End of discussion.
That went on all four days I spent in ICU, with longer walks each day. You could put her in a Smokey Bear hat, and she’d fit right in at basic training. But she was doing what had to be done to facilitate my recovery. I can’t thank her enough.
Over the next two weeks I was cared for by a series of nurses on the cardiac floor, all of whom possessed the combination of technical competence, and compassion, required of good nurses. Unfortunately, the realities of working in contemporary hospitals drives off too many of the good ones.
The economics, and administrative structure, of corporate health care has always taken a toll on good nurses. My wife was one of them. She retired early, and vowed never to work in a hospital again. And apparently the explosion of regulations under Obamacare has made it even worse. So I have the utmost respect for those nurses who cared for me.
Which brings us back to Dr Malasanos’ idea to have hospitals run (and even owned) by nurses. Sure it was the doctors who saved my life, and gave me a new heart. They stopped by to see me every day, and spent far more time answering my questions than I expected. I couldn’t be more pleased with what they did, and their bedside manners. But when the doctors were gone, it was the nurses who were there 24/7.
It was nurses who answered the call button when I needed help at all hours. It was nurses who encouraged me to get up and walk every day to speed my recovery. It was the nurses who made sure I got my medications on schedule, and monitored how those meds were effecting me. In short, the reason for being in the hospital was so I could get the skilled nursing care necessary for my recovery. So why shouldn’t hospitals be run by nurses?
Before Florence Nightingale, hospitals in the Crimean War were death traps for wounded soldiers. She fought the medical establishment to change that.
Less than a decade later American Civil War hospitals were little better, until nurses — primarily Clara Barton and Mary Ann “Mother” Bickerdyke — also took on the medical establishment to change things. Those pioneering nurses established the ethos that nurses are not only skilled care givers but also the “advocates for the welfare of the patient”, even against doctors if necessary.
But just like those hospitals of old, modern corporate hospitals are bastions of the medical profession, with nurses serving as skilled employees to facilitate the work of the doctors. Dr Malasanos thought that was backwards, and following my recent hospital stay I agree with her.
The doctors deserve the credit for saving my life and fixing my heart. This is not meant to take anything away from them. I’m alive because of them. But it was the nurses who got me back on my feet afterward, both figuratively and literally, and set me on the path to be “the poster-boy for open heart surgery recovery.”
So why shouldn’t the nurses be running the hospitals rather than corporate administrators? Dr Malasanos thought so, and now, so do I!