Thursday, March 29, 2007

The Army, Nursing, and a Crisis of Care

The recent developments highlighting the broken healthcare system which cares for American military personnel comes as no surpise. This crisis is, to a large extent, a distillation of the problems pervading the nationwide healthcare system in general. While I would not venture to say that the military medical infrastructure is a microcosm of the larger country's system of care and insurance---it is far too large an animal to be classified a microcosm---it stands to reason that challenges faced by the country as a whole vis-a-vis healthcare would be reflected in the care of injured soldiers and veterans.

A nationwide---or worldwide---nursing shortage is impacting every level of healthcare, from schools and community health centers to hospitals and dialysis units. With precious little financial incentive from the federal government to ease the economic burden of attending nursing school, the relative cost of college has put nursing out of reach for many otherwise qualified candidates. Government subsidies of student loans seem to be mostly a thing of the past, with most students going into greater and greater debt as they juggle family, school, and work responsibilities. As gas, food, and housing prices soar, many are driven to simply make ends meet rather than pursue higher degrees. With fewer Masters-prepared nurses, the number of nursing professors decreases as well, thus limiting the number of new students schools can accept each year. With competition more severe, perhaps many potential nurses are being turned away from new careers in healthcare, opting for other more promising and lucrative careers in business or technology. For myself, graduate school would mean at least an additional $40,000 in debt, not to mention the fact that my earning potential would not increase dramatically from that extra education.

According to some reports, nursing within the armed forces is also in a crisis. As more and more military nurses are shifted to serve in high-need areas, wounded veterans and those in various states of rehabilitation languish in understaffed VA facilities or are lost in the maze of VA outpatient care. As a Nurse Care Manager, I understand how a trained and knowledgable nurse advocate can make all the difference to a confused and ill patient as he or she tries to make sense of an unrelenting bureaucracy. It appears that even brain injured vets are left to navigate the labyrinth of veteran healthcare without professional case management by a nurse, and it's no wonder that so many have fallen through the cracks, essentially stymied by a system seemingly contructed to thwart their timely recovery and deny desperately needed benefits.

I am certain that the nurses who work in these VA facilities work long hours, with large patient loads, often butting heads with a bureaucratic machine which works hard only to slow their patients' progress towards the positive end of the health continuum. It must be a frustrating place to be, and I wonder to myself if the stressors far outweigh the benefits.

Major General Gale Pollock, the chief of the Army Nurse Corps, testified before Congress this week that there is no money in the military budget to hire more nurses to care for the soldiers returning from Iraq and Afghanistan. Nurses appear to be leaving the Armed Forces at rates double that of other officers, and crucial areas of nursing speciality seem to be suffering the lion's share of that hemorrhage of personnel. My blogging colleague over at Universal Health has written an eloquent series of posts which detail and explain the way that nursing shortages (and nurses' silence) has exacerbated the crisis within the VA healthcare system.

As I and my colleagues continue to burn to a crisp within a healthcare environment which squeezes us dry while offering fewer incentives to continue giving our all---other than the satisfaction of a job well done under great duress---our brethren in the nursing corps of the Armed Services suffer the same deprivations and low morale. Even as I have encouraged friends and students to pursue careers in nursing, I hope aginst the odds that these fresh faces will bring perspective and passion to an ailing industry, perhaps serving to assist in the transformation of American healthcare as a whole. Just as our national economy would collapse overnight if our investors in China and Saudi Arabia were to suddenly withdraw their underwriting of the once mighty American Dollar, our healthcare system and the vulnerable populations which it serves would also implode if attrition rates continued to climb faster than our medical and nursing schools can churn out new victims---er, I mean, recruits.

For many of us, we are nurses in order to vocationally express our desire to contribute to the health and well-being of our fellow human beings in a way which feels intellectually stimulating, economically feasible and emotionally satisfying. Caring for patients and serving to improve their overall health outcomes is a large part of what nurses do, and we strive for the same goals within the civilian and non-civilian healthcare systems. Sadly, we are all universally affected by a government which preaches care and compassion yet simultaneously invests its riches in arms, war, and corporate welfare. Poor planning and rosy visions of an easy victory in the Middle East by ignorant military strategists has only served to exacerbate the crisis faced by returning soldiers in need of adequate medical care for which no funds exist. Meanwhile, the national healthcare system self-destructs, Medicare Part D limps along, the numbers of uninsured Americans rises, and homelessness becomes more pervasive. As the working poor struggle to make ends meet, often choosing food over preventive healthcare, corporate CEOs walk away with their subordinates' IRA funds in order to underwrite lavish lifestyles that only their hard-working employees truly deserve. Perhaps Kenneth Lay now regrets his malfeasance as he slow roasts in his special CEO Purgatory, but Donald Rumsfeld is probably at this moment playing golf and travelling the well-paid lecture circuit as a retired (and generously pensioned) civilian leader of a miltary which he decimated with his ignorance and hubris.

The personal is indeed political, and when one chooses to serve his or her fellow citizens within the healthcare industry, one's politics can only inform one's view of the powers which hinder or buoy one's efforts to provide that care. There is much to be angry about as one gropes blindly for a foothold in this country which seems destined for self-destruction. Here on the front lines of healthcare, we dig in our heels, bow our heads, and continue to provide the optimal care that we are able, even as the Powers That Be seem hell-bent on our failure.