Much furor abounds on Twitter today about the plight of the Vanderbilt nurses, who now are expected to assume janitorial roles as well. Three main issues concern me about this decision.
The first is that nurses have become the dumping ground for any extra activity or responsibility. It is as if management casts around and in desperation says "well, let's make that the primary nurse's responsibility." I often say darkly that very few things are NOT the primary nurse's responsibility. We are charged with ensuring that everyone from housekeepers up to the physicians does their jobs correctly; no one but us ultimately has the ultimate responsibility. Why? Because I am the primary nurse, every single thing involving my patient's care should fall on my shoulders? No. People are hired to do a job, and it should be done with or without my double-checking, because ain't nobody got time for that. I really do not have time to be double-checking physicians' orders and making sure the secretaries do their jobs. I'm busy saving lives and shit. But I'm guessing, and it's an educated guess, that these well-educated (to the point of total impracticality) managers cast about for ways to save money and their tired little minds went down the well-worn path of "let it be the primary nurse's responsibility." Come on, people. Learn a new song. You'll be scrubbing poo off the walls yourselves when your educated, professional medical professionals leave your hospital hamstrung, because administrators seem to be forgetting these days that the only reason people are in the hospital to begin with is that they need nursing care.
The second is the assumption that nurses fall in the category of janitors. There's nothing wrong with being a janitor. But until I see administrators, physicians, the CEO, and secretaries all pitching in to mop urine and scrub poop stains, I'm going to have to assume that the designation of nurses for these activities is a clear slight to the profession. Vanderbilt does not respect its nurses' training, expertise, or contributions. "Here, girl. You they-ah. Empty this bedpan and sweep this floor." We are not a servile profession here to have our backs and spirits broken. No, we are sharp cookies who need to be spending our time looking for the beginnings of pressure ulcers, crackling lungs, and CAUTIs to save hospitals from huge financial penalties and patients from bad outcomes. Find me a janitor or a manager who can walk in a room and know in 10 seconds whether a patient is decompensating plus fix the problem, and I'll change my mind. And even if you just look at the bottom line, which is cheaper? A housekeeper's salary or a bunch of hits from Medicare nonreimbursement because your nurses have either quit or been too occupied polishing mirrors to save sick patients?
The third is the (what should be) obvious nightmare of nurses swilling about in toilets and dirty mop buckets before they put things like IVs and urinary catheters in patients, much less simply distributing medications. This is a cross-contamination nightmare, and Vanderbilt can tout adherence to precautions as much as they want. It's still a nightmare. It is also a public relations nightmare in the making. Bad surgical outcome? "I think I got an infection because my nurse was cleaning the bathroom before she changed my dressing." Bang. That legal bill right there---just one---will make this hospital reconsider. I wonder how many patients will need to be killed before the cost-benefit ratio favors reinstituting janitorial staff? It is chilling. Aside from infection control, it just looks bad. If I or my family were admitted to this hospital and saw the nursing staff with even more responsibilities that included janitorial tasks, I would take steps to be admitted elsewhere. Why? Because I would assume my nurse would have even less time to spend on patients, thus putting them at risk, and because I would assume the hospital is cutting corners so drastically that they were putting patients at risk---which, I argue, Vanderbilt is.
This decision needs to be reversed.