ARTS & FARCES internet

When I started dialysis in 2000 the patient-to-staff ratio was three-to-one and there was always at least one—and usually two or three—registered nurse on the floor. Those nurses had more than one hundred years of dialysis experience between them. But by 2002 the patient-to-staff ratio was four-to-one and the main charge nurse had less than one year of experience in dialysis.

Yesterday the ratio was five-to-one for the last hour or so of my treatment. And here’s a sampling of what I saw during that hour because of the lack of staff:

• A patient’s visitor, likely a family member, was taping her access after treatment. The wound broke open and the visitor was seen wiping up blood from the immediate area and re-taping the patient.
• A patient’s prescribed treatment was cut short because too many patients were ending their treatments at the same time.
• The charge nurse began my rinseback at the end of my treatment by violating the current protocol; there wasn’t time to perform my rinseback properly. To make matters worse, the nurse pointed to a clamp and explained, “when the line gets to the right color, clamp it.”
• I waited close to 30 minutes to be taped. That doesn’t sound like much, I know, but after a four-plus hour procedure, it makes a difference.

And that’s just what I saw in my immediate surroundings. It’s a 16-chair dialysis unit and I have no idea what else went on.

I spent that hour going over in my mind how I could phrase a question that wouldn’t be taken as confrontational. These are, after all, good people and only contributory factors in the problems with the current state of dialysis care. The problem, frankly stated, is that corporations are allowed to profit on the misfortune of the patients they serve.

I’m not of the clearest mind at the end of my dialysis treatments so the best phrasing for the question I could come up with was, “how long can I expect DaVita to continue to run this unit under-staffed?” In hindsight, not all that bad. The charge nurse responded that there was no under-staffing. I replied, “c’mon—a five-to-one patient ratio is under-staffed.” He said that nurses had always been counted in the patient ratios. I told him that was news to me. I doubt that’s the case, but if it is, then patient ratios when I started dialysis in 2000 were two-to-one.

I went on to outline the list of dangerous events I’d witnessed. His response was terse: “I don’t have to justify my actions to you.” My final comment was that I didn’t want to argue, but that I did want the information. I also told him that I’d be taking appropriate action and that I didn’t want to be accused of filing a complaint without first talking to the center’s staff, straight-up and head-on.

Of all of this, the thing that bothers me the most is a charge nurse’s statement that he doesn’t have to justify his actions. As long as my health and safety are directly related to that nurse’s actions—as long as I’m a stakeholder with a lot of skin in this game—I say he damn well does have to justify his actions. If not to me, then to the appropriate regulatory agencies. Problem is, the regulatory agencies file a lot of paperwork but rarely take any action.

Hell, it’s a mid-term election year; let’s see how the politicians respond.