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Dialogues@RU is published annually
by the
Writing Program at
Rutgers, The State
University of New Jersey
Volume One
Spring 2002
The Routinization
of Health Care and the Professional Calling -
Page 2
by Megan H. Johnson
The influence of the HMO in health care and the current nursing shortage have greatly impacted the health care provider-patient relationship on a variety of levels, usually dimming the connection between the two. In "Finding Oneself," Robert Bellah stresses the importance of a person's work connecting him or her to the greater community, stating that a calling (the optimum plateau of work, in Bellah's view) is "a crucial link between the individual and the public world" (66). In Robert Bellah's terms, doctors' and nurses' connection with the "public world" is embodied by interactions with their patients, and therefore, the better the relationship between health care provider and patient, the closer their work is to Bellah's view of a calling. In her article "Systems of Health Care Delivery: Their Diversification and Decentralization," nurse and author Connie Curran discusses some of the current pressures that are weakening the link between health care professionals and the greater community. Curran notes that in many hospital settings, nurses' responsibilities have increased in recent years in response to what she calls the "diversification and decentralization" of the health care system. Curran writes:
Prospective reimbursement and increased regulation by insurers have created greater financial pressures for health care delivery systems. Because nursing is usually one of the larger expenses within the hospital, nurse managers and executives must have sophisticated financial management skills. Titles have changed from "director of nursing" to "vice president for nursing" and today, many nurse executives hold the title "executive administrator of patient services."(362-363)
The very language Curran uses to describe these prevalent trends in the nursing field hints at the direction in which health care is moving: away from a service-based orientation and nearer to that of a business concerned with the bottom line. The jargon suggests an industry full of "managers," "executives" and "vice presidents," and downplays the humanistic aspect of the field, in which patients would prefer concerned caregivers to disconnected "administrators" who have to juggle patient care and financial bureaucracy. The "greater financial pressures" that these health care "executives" must consider only weaken their ability to genuinely experience their work as a "crucial link between the individual and the public world" (Bellah 66). Marie Cowart expands upon the negative impact of the nursing shortage on the larger community in Nurses in the Workplace, discussing the results of a major 1985 study founded by the Robert Wood Johnson Foundation, whereby nurse staffing shortages in fifteen nationwide general hospitals were gauged. Cowart writes:
Working short" (i.e. where there are too few or the wrong kind of staff to adequately care for the number or type of patients) changed the way nurses did their jobs. They were more rushed, had to set work priorities between jobs, and even had to decide whether or not to do certain parts of their work. Also, when units were understaffed, monitoring of patients conditions decreased. As a result, many physicians were not notified soon enough about patients who were experiencing problems. In addition, patients did not receive treatments on time or as often as ordered. (11)
Marie Cowart's observations reflect the various manifestations of the impact of the nursing shortage. This account suggests that not only does patient care suffer, but communication between physicians and nurses in the workplace is negatively affected. Expanded responsibilities add stress to nurses and doctors, who in turn cannot give the highest quality of care to the "greater community" they serve. An unfortunate consequence of the nursing shortage is this necessity for currently employed nurses to take on projects beyond patient care. When nurses are "rushed" and forced to decide "whether or not to do certain parts of their work" due to new responsibilities, their ability to connect with their patients is tarnished, and they can no longer view their work as a "crucial link" between themselves and the "public world" they serve. These added responsibilities only diminish the nurse-patient relationship, and evidently lead to a lower quality of care for the community.