Twenty-five years ago, Donald Daien graduated summa cum laude from ASU's nursing college. With diploma in hand, the idealistic student ventured into the world to comfort sick people.
"People are most important to me so I decided to do something to help others...and chose nursing because it afforded the most direct and continuous patient contact," Daien said. "I felt that I could really make a difference as a nurse."
At first things went well. Daien worked at Arizona State Hospital, Phoenix Camelback Hospital, Maricopa Medical Center and St. Luke's Hospital, among others.
As America's health care industry shifted its focus from patients to profit, Daien began burning out. Now, he is 57 years old and unemployed. He left the profession he loved because he felt that a focus on profits in the health care industry resulted in poor working conditions for nurses and diminished care for sick people. His disillusionment is shared by nurses across the country.
But some nurses have stayed on. Thirteen years ago, Daien married a nurse named Judy Mahoney. Today, Mahoney is petite, gray haired and 60 years old. She has worked in hospitals in Maryland, New York and Oregon. She cannot leave nursing. Mahoney said she stayed because she loves the patients and because she believes her job at St. Luke's Hospital provides one of the rare, better than average, work situations.
And yet she said she believes that in general, "Arizona has always been in the dark ages when it comes to health care of any kind. It's a very bad place to be sick or old."
Deadly burnout
Daien's story is emblematic of a nationwide burn out among nurses who leave their profession because they say they are exhausted and unable to deliver quality care to patients. They claim they are overworked by health care corporations that care more about return on their investments than on patient health.
In October 2002, the Journal of the American Medical Association reported on a study that found job dissatisfaction among hospital nurses was four times greater than the average for all U.S. workers. The study also revealed that higher patient-to-nurse ratios, the number of patients assigned to one nurse, correlated with high emotional exhaustion and greater job dissatisfaction.
Patients die as a result of overworked nurses. The study reported patient deaths increased by 7 percent for each additional patient added to the average nurse's workload.
Daien and Mahoney represent two sides of the American nurse story. Daien, frustrated, left the profession. Mahoney toughed it out. Yet both agree that big corporations force nurses to work long hours and take on too many patients. The result? Burnout and compromised patient care.
Efforts to unionize
Arizona is not taking the proper steps to improve working conditions for nurses, according to Jane Black, coordinator for Southern Arizona Nurses Coalition an affiliate of the California Nurses Association, the largest professional association and union for registered nurses in America.
"The nursing shortage persists due to the issues that go on in the workplace, making it not a very attractive profession," Black said.
"When you do nothing for the working conditions, improving nursing ratios so the nurses are not chronically over worked then there's not going to be any improvement in the nursing shortage," Black said.
Black says CNA is currently campaigning to unionize St. Joseph's Hospital in Phoenix, and contends that despite an agreement with CNA, the hospital hired a union buster. She said St. Joseph's has 54 counts against them for firing nurses who tried to organize.
"There's a lot more going on than people think," Black said.
CNA had a similar campaign to unionize the hospital a couple years ago, Black said, but lost by two votes, because nurses feared they would lose their jobs if they joined the organization.
Sarah Padilla, public relations specialist for St. Joseph's Hospital, said that the hospital has a number of programs set up for employees to voice their opinions and that the hospital doesn't need a union.
"We prefer to keep a direct relationship with our nurses. It eliminates the middle man and we feel it's just a more efficient way to work," Padilla said.
In May, the hospital was charged with illegally firing a veteran nurse for her effort to unionize the health care facility, according to news reports.
According to Padilla, the firing of the veteran nurse went through arbitration and found St. Joseph's Hospital did nothing illegal. She added that CNA canceled their election last week, the day before it was scheduled.
Padilla says that there have been improvements, such as technological advances, but they have not noticed a decline in the quality of health care at all. In fact, she says, satisfaction levels among patients and nurses have gone up.
"We're constantly monitoring patient and employee satisfaction and we're seeing a rise," Padilla said.
The numbers game
In 2001, Valley nurses wrote the Arizona Department of Health Services during a comment period of the DHS's rulemaking for Valley hospitals. But these rules went into effect for Arizona hospitals in 2002 with no changes addressing the nurses' concerns, including the prohibition of mandatory overtime. The department responded that there was no evidence that showed that mandatory overtime was a health and safety issue in Arizona.
Another concern, the patient-to-nurse ratio in intensive care units, which requested be changed from 1:3 to 1:2, was also declined. The department said it is up to the individual hospitals to determine the level of nursing care needed. In other words, the way many nurses saw it, hospitals got what they wanted and nurses were set up for abuse one again.
Kathy McCanna, program manager for medical facilities licensing in Arizona, does not see it that way. McCanna said DHS cares about the "heath and safety" of the patients.
"We're going to take safety of patients over benefits of nurses," McCanna said.
McCanna said concerns are addressed as they relate to each rule package and ultimately the department is responsible for the rules.
"In some cases the position of the department may weigh more heavily," McCanna said.
She added that the department tries to listen to all sides including nurses, the public and hospital owners. But DHS holds task force meetings that give hospital owners a chance to weigh in on the final decision, McCanna said.
Not just 'bolting fenders'
Daien sipped a café mocha at a table outside a Scottsdale bagel shop. The sun shone on his gold and gray buzz cut. His blue eyes seemed sad behind his gold rimmed glasses as he talked about his lost career. Reaching into his jeans pocket, he pulled out a pack of Pall Malls and a blue lighter to match. He flicked his cigarette with his thumbnail, discarding the ashes into a small terra cotta pot.
Hospitals are all about profit, Daien said.
Patients and nurses are victims of Wall Street greed, Daien said. Health care institutions have to answer to private investors.
"The health care industry is just that, an industry," Daien said. "It views nurses as labor and it views labor as an expense. More precisely, it views nurses as a variable as opposed to a fixed expense."
Daien said he believes that health care companies can't alter many costs for operating hospitals, like energy expenses, so they continue cutting nursing costs. When the hospital decreases money spent on nursing expenses the number of patients allotted to one nurse increases and nurses often find themselves working double shifts.
There is no nursing shortage, Daien said. There is instead a shortage of nurses who are willing to work in abusive conditions.
Daien said he experienced first hand the direct effects hospital spending has had on nurses and patients, he says. He often worked 12 hour night shifts, and says he had just ended one of these stints at a local hospital when his manager asked him to stay for day shift.
"I said 'I'm too tired,' and part of the reason I was too tired was because they short staffed me," Daien said.
Shortly after this incident, Daien received a letter from the State Board of Nursing saying the director of nurses had filed a complaint against his license. "It became clear to me at that point that this was a tactic being used not just on me, but nationwide," he said.
He wrote a letter back to the state board that expressed the idea that nurses feared complaints against their licenses if they didn't take the extra shift when asked. He said he finally received a response that no action had been taken against his license.
The nursing board has no complaints listed on Daien's file. It is clean.
"If you're honest about that and say 'I'm too tired and I tried setting up these meds and I'm making mistakes,' that may not be honored," Daien said.
Such a system, he said, works fine "if you're bolting fenders onto Fords.
"It's not OK if you're taking care of people."
Patients have to take a stand, but they don't know what their rights are when it comes to health care, Daien said. "I fault my own profession for that. I think it's incumbent upon the nurses to go out there and educate the public on what they should be getting in terms of care."
"The fact is that health care employers want to increase profits for themselves even if it kills you, the patient," Daien said.
"You simply become collateral damage."
Reach the reporter at beth.cochran@asu.edu.
