had to look at who delivers certain aspects of care to the sick. In some units, Cronenwett said, fewer registered nurses are hired, and they are expected to supervise nursing assistants, licensed practical nurses and a myriad of tech- nicians who deliver most of the hands-on patient care.Veteran nurses ay that hands-on time with a patient often reveals vital information crucial to recovery. Bathing a patient is not necessarily a job to be left to the untrained, they say, because it can be an opportunity for the nurse to assess kin color, look for rashes, check for ange of motion. Taking the skilled nurse out of this role can be detri- mental. "There is nothing potentially wrong with using more assistants if everyone is competent in their roles and the right number ofpeople are in the right roles every day," Cronenwett said. "Unfortunately, high turnover in the lesser-skilled, lower-paid positions often leaves fewer nurses with inade- quate assistance. "Should we take care ofpatients with fewer nurses, or less qualified people? This is a question society will have to answer. In the meantime, nurses have to be prepared to help atients and families within the resources available." While lower-trained staff such as LPNs are not hired often for acute-care units, managed care has had such an impact on the job pool that new graduates are filling positions in intensive care once reserved for the highly skilled, said Mary Holtschneider ' 95, clinical nurse educator at Duke University Health Systems. "There is a shortage of critical-care/higher experienced nurses. It's not that the younger nurses can't do the job; they just require dif- ferent amounts oftraining and support:'
When A Nurse Is In Charge
Nursing cutbacks haven't hap-
pened at Northeast
Medical Center, a
457-bed hospital in
Concord. As chief
operating officer at
Northeast, Dari Daves
Caldwell ' 79, often
has to look at her
hospital's cost effec-
tiveness, but because
she is a nurse, she is
more protective of
the nursing staff.
"The last place I'll cut," she said,"is at the bedside. I really feel philosophical
that the core mission of the hospital is to provide care for the patients:' Cutting
nurses, she said, conflicts with that mission.
Because professional nurses make up the majority of those employed in
hospitals,"going after nurse staffing is the lazy way to cut costs. It's easy, and it's
quick. It's much harder to cut elsewhere, to look at all departments for jobs
that don't support that core mission. We can cut nurses, but we pay a premium;
or we can do it the right way."
Caldwell recently cut her hospital's landscaping budget in half. "We were
changing out flowers all the time, but we don't have to look like the Biltmore
In a recent study of seven hospitals in the Charlotte metro area, said
Caldwell, who has her master's in nursing from Duke University, Northeast had
nurse-patient ratios equal to or better than all of the hospitals in the study.
"I think that has a lot to do with why we don't have a shortage here."
Of the 823 RN positions at Northeast, only 20 are unfilled. "If you asked the
nurses, they would tell you we are short-staffed, but compared to other hospi-
tals, we are in great shape."
Caldwell said several Charlotte hospitals cut their nursing staffs a few
years ago, and now they are giving hiring bonuses to get those nurses back.
Caldwell disagrees with the premise that the issue boils down to economics.
Although the nurse always has been integral to the health-care system, today
that is more true than ever. "The most dramatic change I've seen has been in
the nurse/physician relationship," she said. "We're just coming out of era
where nurses served as the handmaiden to the physician. Now we work
more as colleagues. The pace is so fast, it's impossible for the doctor to keep
up with what's going on with a patient without that nurse:'
More nurses, too, she says, are evolving into operations roles, as she did.
"Many of the top people in hospitals today have never laid their hands on a
patient;' she said,"and they have no knowledge of what it takes to care for
patients today. I think I bring to the [management] table an aspect that has
been missing. It's helpful when dealing with physicians, because they believe me:'
- Susan Byrum Rountree 79
C A R OLI N A A LUMN I R EV IE W