Medicine of the Future in America

The Paradox of High-Tech Health Care: Delivery of High-Tech Health Care

The Paradox of High-Tech Health Care: Delivery of High-Tech Health CareDelivery of High-Tech Health Care
In addition to ethics and cost concerns, a problem in the delivery of high-tech health care is now a major public issue. As more patients require critical care, the shortage of critical care nursing personnel grows. As we expand further into artificial hearts, LVADs, R\ADs, BI\ADs, etc, requiring more highly trained skilled personnel to monitor and manage these patients, we have a smaller available personnel pool for this purpose. Thus, at the same time the public expects a higher, more efficient performance level, we are in the position of having to reduce services in some instances. canada health and care mall

The etiology of this problem is obvious even to the amateur sociologist. The nursing profession is primarily composed of women, and although men are entering the field in increasing numbers, they do not yet have a highly visible administrative role. Women, conversely, are entering other fields at an accelerated rate, so that a third to half of most medical and law school student bodies are composed of women, and women are also finding attractive careers in banking and industry. In addition, most hospital diploma schools of nursing have closed, as the educational requirements for nursing have been raised. As the United States faces a nursing shortage, the nursing profession, by raising standards of education, has actually contributed to the decrease in the numbers of trained nursing personnel. While this has been taking place, tertiary referral centers have experienced an increase in absolute and relative percentages of critical care cases in pulmonology, cardiology, cardiac surgery, infectious disease, and organ transplantation.
Obviously there are no quick “fixes” to this problem, but all involved, from the hospital president to the newest staff nurse, realize that correction of critical care personnel deficiencies is an urgent problem. One suggestion is that more men be attracted to nursing. Many qualified men would go into nursing if the financial and career advancement incentives were attractive. The nursing profession should assimulate its male counterparts and provide career incentives for both men and women similar to the well-deserved gains women physicians and lawyers are achieving in the medical and the legal professions. Second, there must be a look at training perhaps a different kind of critical care worker. This licensed practical nurse, diploma school nurse, or “paramedical intensivist” could be trained to care for the “routine” high-technology patients, allowing the fewer highly skilled nursing personnel to care for the unstable or the truly critical patients and to supervise this new class of health care worker. Third, compensation for critical care nurses must be improved to make it commensurate with many other career opportunities. The work is hard, both intellectually and physically, and deserves an improved pay scale (Fig 2). Fourth, there could be funding for nurses’ education by hospitals in exchange for a certain number of years of duty in the hospital after graduation, similar to the armed services educational programs. Fifth, there might be consideration to reopen some diploma schools for nurses to be trained for staffing less intensive care areas. Sixth, to attract excellent nurses from other professions and married nurses from home, day care centers and other meaningful “perks” should be made available in major hospitals to provide logistic support. Finally, and possibly most elusive, there should be increasing collegiality between doctors and nurses in the high-tech care area, a qualitative change that is difficult to achieve but should be a goal for all.

Figure 2. Hospital-nurse vacancy rates per 100 budgeted positions and ratio of nurses’ incomes to those of teachers. (Reproduced with permission from N Engl J Med 317:643, 1987.)

Figure 2. Hospital-nurse vacancy rates per 100 budgeted positions and ratio of nurses’ incomes to those of teachers. (Reproduced with permission from N Engl J Med 317:643, 1987.)

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