CAN "TECHNICIANS" TAKE THE PLACE OF NURSES?'

By ALEX TRESNIOWSKI

Florence Nightingale overcame a disapproving mother, jealous colleagues and skeptical surgeons to become the founder of modern nursing, but she never had to duke it out with cost-cutting HMO executives. If she had, she might have sounded as angry and alarmed as the 47 nurses who wrote in response to our report "The New Hands-Off Nursing" [SOCIETY, Sept. 30].

James Kunen's article on the trend toward replacing nurses with unlicensed patient-care technicians led Clare Kranstover, an R.N. and caseworker with Kemper National Services in Park City, Utah, to issue this blunt warning: "Patients, beware! You will be at risk when hospitals put you in the hands of a technician. If the person caring for you does not have R.N. after his or her name, leave that hospital immediately!" Kranstover, 41, has been a nurse for 11 years, and was a cardiac nurse at a San Diego hospital the night a technician allowed a patient who had just suffered a heart attack to get out of bed and smoke a cigarette. "All of a sudden the patient's heart monitor showed ventricular fibrillation, a life-threatening condition in which you can die within minutes," says Kranstover. "I rushed in to resuscitate him. He almost didn't make it."

Stephen Dohl, now a nursing supervisor at a Charlotte, North Carolina, skilled-nursing facility, wrote of the stressful night in a local hospital when he was the only nurse--working with two assistant nurses and one technician--in charge of 37 patients. Downsizing, explains Dohl, 43, is the reason he no longer works in a hospital. "The more experienced nurses tend to be the ones let go," he says. "Then they are replaced with people fresh out of school who are cheaper. I left hospital nursing because I couldn't give patients the time I felt they needed." Such ruthless budget slashing disillusioned Susan M. Heffernan, a 34-year-old New York City nurse. "It is an atrocity that an annual salary of $71,250 for an R.N. with 20 years' experience is not considered cost efficient," she wrote. "To hospital administrators who want to replace R.N.s with unlicensed workers, I say, 'Someday you will be in the hospital! And then there won't be any time to rethink your decision.' "

One of 20 non-nurses who wrote us about the report, Linda Emery Evans respects the skill of nurses even though she had a narrow escape while under an R.N.'s care. "Within hours of the birth of my daughter last spring, I was in unspeakable pain," wrote Evans, 34. "I was unable to convince the nurse that I was experiencing something more than postpartum pain." After hours of pleading, Evans was operated on for internal bleeding. "I think the nurse was not really listening to what I was telling her," she says. "She may have been overworked. But I can only imagine the outcome if a technician had been dealing with me instead of an experienced R.N. What if the nurse had heard about my symptoms secondhand from a technician speaking in vague and nonmedical terms? What would the damage have been then?"

For Maureen Dever-Bumba, a nurse-practitioner and director of the Kutztown Student Health Center in Pennsylvania, the harsh truth about nursing today hit close to home. After her 72-year-old grandfather was admitted to a hospital with terminal cancer, a technician carelessly gave him medicine that caused disorientation. "He was confused and imagined that he saw bugs on people," says Dever-Bumba, who has been in the nursing profession for 18 years. She remarks, "The care was so bad my entire family had to become nurses for my grandfather because no one else was around to help. The public takes it for granted that if you're wearing white, you must be a nurse. These days, the person in white could be anyone."

Hearing horror stories like Dever-Bumba's is all in a day's work for Norma M. Lang, dean of the School of Nursing at the University of Pennsylvania in Philadelphia and a veteran of 35 years in nursing. "People don't trust that someone is going to take care of them," says Lang, 56. "I've heard that around the country." She cited research from her university indicating hospitals that place a high priority on nurses have a 7.7% lower mortality rate than hospitals with no such priority. "Really experienced nurses know when they walk into the room if something is wrong with a patient," explains Lang. "Nurses are the glue that holds the whole hospital system together."

Valerie Van Valkenburg, an R.N. from Great Falls, Montana, also emphasizes the value of the individual's skills. "Nursing is an art. When I go to a patient's bedside to answer a call light or get vital signs," she notes, "I am collecting all sorts of information to help me assess that person. My critical evaluation and intervention could prevent a costly complication or even death."

A note of optimism was sounded by Lynn Werdal, an R.N. since 1956 and now the vice president of patient-care services at Griffin Hospital in Derby, Connecticut. "There are models of patient-focused care, such as the Planetree model, that make patients the priority," she wrote. At Griffin, "patients are able to read--and write on--their medical charts," explained Lang. "There is a piano in each unit and a kitchen where families can cook meals. Griffin has round-the-clock visiting hours and care-partner rooms where family members can stay with patients." Technicians, stressed Werdal, can--and should--be trained and regarded as caregivers who can work alongside nurses. "We teach kindness," she says, "and improved communication with the patient." Sounds just like what Florence Nightingale had in mind.

--By Alex Tresniowski