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Changes in Hospital Nursing

July 07, 1996

* Re "Hospital Nurses Feel Pain of Health System's Restructuring," July 1: Before I became a sociologist, I was a practicing registered nurse for 18 years in Southern California. The current phenomenon of health system restructuring is resurrecting a system of nursing care delivery that dates back to the '60s and '70s. A few registered nurses were responsible (in theory) for 25 to 50 patients, while a cadre of what were then called nurses' aides (now euphemistically referred to as "care partners" or "patient liaisons"), unlicensed caregivers, were assigned to a specific function (one person took all the blood pressures, another passed all the meal trays, etc). This system was abandoned in the 1980s as an inefficient, disjointed and sometimes dangerous way of administering patient care.

One benefit of the RN delivering all the care to a smaller number of patients was that he or she was able to make frequent "informal" assessments of the patient's condition as she fed, bathed and administered medications. Now the nurse can no longer make these frequent assessments, which oftentimes caught subtle signs of deterioration in the patient. As hard-working as the nursing assistants are, I wouldn't want them to be the ones with whom my loved one had the most frequent interactions. I would want that relationship to be with a well-trained registered nurse.

JUDI KESSLER

Santa Barbara

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