Tuesday, October 28, 2008

N.J. Hospitals Crisis: Cullen Was Not The Problem, He Was A Symptom

Charles Cullen is every hospital's nightmare: A deranged nurse who methodically murders patients by giving them hard-to-detect overdoses of medications.

Cullen, who was arrested in 2004 after a 16-year crime spree made considerably easier because a severe nursing shortage enabled him to go undetected as he moved from hospital to hospital, told authorities that he murdered as many as 45 patients at hospitals in New Jersey and Pennsylvania.

As a result of Cullen cooperating with authorities in a plea bargain that will keep him behind bars for life, hospital procedures were tightened with his input and the New Jersey legislature passed the Nurse Cullen Act. This requires nurses to be fingerprinted and established a system whereby the New Jersey Board of Nursing is notified if a nurse has any kind of brush with the law, no matter how minor.

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The Nurse Cullen Act would seem to be a good thing on its face, but it is a safe bet that New Jersey hospitals have killed many more patients than Charles Cullen did as its health-care system has imploded.

The most densely populated and second wealthiest state, New Jersey had 112 hospitals 20 years ago. Today it has 74 and six have closed in the last 18 months alone. Meanwhile, four others have announced plans to close and five have filed for bankruptcy protection, with about half of the other hospitals losing money like an emergency room patient hemorrhaging blood because of gunshot wounds.

The state authorities who rushed to crack down on nurses in the wake of the Cullen scandal, have showed no such urgency in:

* Stanching the very nursing crisis that this psychopath used to his homicidal ends.

* Cutting hospital-bred infection rates.

* Pushing back against rapacious insurance companies that limit access to care.

* Cracking down on the kind of mismanagement that has resulted in the collapse of several hospitals.

This is not to say that beyond the Cullen Act there has been total inertia.

A so-called health reform package signed into law by Governor Jon Corzine in August is supposed to bring more accountability and transparency to hospitals, but the new regulations do not deal with the roots of the crisis, only the symptoms.

They are the equivalent of holding back a flood with a spoon because the core issue remains the degradation of nursing care and the flight of precious registered nurses from New Jersey's remaining hospitals, and the package doesn't even presume to deal with that.
Some of the blame for this lies with the New Jersey Hospital Association, which claims to merely be a trade association but in reality is the health-care equivalent of OPEC, the petroleum cartel.
While the NJHA was a supporter of the reform package, it has worked assiduously to advance the agendas of the executives who run hospitals -- often with a plantation mentality. It has engaged in what, like OPEC with the price of crude oil, would seem to be a pretty fair imitation of coordinating wage fixing at member hospitals.
Nurses themselves must share some of the blame.
Registered nurses trace their lineage to Florence Nightingale-like figures and it is hammered home from nursing school on that no sacrifice is too small. As a result, and as vital as their roles are, nurses keep taking it on the chin. Exacerbating the problem is that the New Jersey State Nurses Association and the few nursing unions have no clout.
The nurses association seems to be especially at sea.
Member nurses were invited (at $75 a pop) to attend a Lobbying Day at the State Capitol in Trenton earlier this month where they could hear Governor Corzine address the legislature and hob nob with professional and industry big shots.
But the event was disorganized and further hammered home that Garden State nurses are pretty much on their own when it comes to the issues that really matter.
Nurses were not allowed to hear the governor speak. The executive director of the state Board of Nursing did not like being asked challenging questions and left early. The CEO of the New Jersey Health Care Quality Institute, who was supposed to speak on reform efforts, was a no-show. And a director of the state Department of Human Services noted with a practiced blaséness that "nothing has changed" since she became an emergency room nurse 30 years ago.
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The nursing crisis in New Jersey is playing out one nurse and one hospital at a time, a kind of slow-motion Hurricane Katrina as older and more experienced nurses leave the profession and are not replaced.

A study by the Collaborative Center for Nursing paints a frightening portrait of a profession under siege: The average age of a registered nurse in New Jersey is 52, while the general population is living longer and its fastest growing segment is those over the age of 85. RNs are quitting in droves because of poor or nonexistent retirement benefits, inadequate salaries, lack of job opportunities, those oppressive plantation-mentality work environments -- as well as good old burnout.
More than 50 percent of the RNs interviewed for the study said there were too few RNs and support staff for them to properly do their jobs. Almost 40 percent said that because of their workloads, their ability to identify important changes in patients' conditions was diminished. And when this happens, patients can and do die.
The shortage is exacerbated by the inability of New Jersey's schools of nursing to meet the growing demand, and the number of new graduates would have to triple to prevent the shortage from taking on massive proportions by 2020.
Talking all of this into account, the Cullen Act seems more like a state version of the USA Patriot Act, a draconian overreaction to the 9/11 attacks, in that it almost certainly is unconstitutional and violates personal privacy. Worse yet, the state Board of Nursing has been so slipshod in protecting nurses' privacy while busily treating them as potential criminals that it's easy for anyone to access their home addresses -- say if they want to pay an off-duty call and harm them.
So while there is a Cullen Act, there is no Nurse Empowerment Act or any other effort that goes beyond merely treating the symptoms of a gravely ill system. I somehow think that Charles Cullen would appreciate the irony of that.


Anonymous said...

I congratulate you on not saying "male nurse."

Anonymous said...

There are no nursing jobs available today. Hospitals have placed a hiring freeze.

Lyall said...

Thanks for writing about the issues confronting my profession.

Lyall RN (Western Australia)

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