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Journalist’s Tradewhelmed. With so manypatients who are so veryill, how many places canI be at once? Severalmonths later, when Iread the cancerpatient’s obituary, Iknow her need for mycare was as great as therespiratory patient’s. Iam grateful that I wasable to help her sortthrough the tangle ofemotions and fears thatprevented her fromresting that night. Yet Ialso know that if I hadevaluated the other patientsooner, he mighthave been stabilizedwithout the necessity ofintensive care.I recall the sinkingfeeling of finding a patient,weakened by illness,on the floor nextto his bed. He has fallen while trying toget to the bathroom unassisted—hedid not want to bother me, knowingthat I am very busy. As I carefully lifthim back to bed and evaluate for possiblehead injury or hip fracture, I realizethat it has been over 30 minutessince I last passed here—how long agodid he fall? While I am bathing him andchanging his soiled hospital gown priorto sending him for emergency x-rays, Irealize that a diabetic patient’s eveninginsulin dose will now be at least 45minutes late, and wonder if yet anotherpatient’s pain medication hasworn off. I know that it will beanother 20 minutes before Ican check in on him.Nowhere does the povertyof access to nursing care becomemore evident than whenI am attempting to prepare afamily to take home a frail parent.There is always a lot ofteaching and preparation to bedone, a lot for a family to learn:how to manage the medications;how to help with walking,balancing, bathing; howto tell when the disease is gettingworse, and whom to call56 Nieman Reports / Fall 1999Today, fewer nurses are available to meet patients’ many needs. Reproducedfrom originals in the Center for the Study of the History of Nursing,School of Nursing, University of Pennsylvania.in an emergency. The visiting nursesfrom the home care agency will be in tosee and evaluate the patient, and homehealth assistants will come in severaltimes weekly, but the brunt of the responsibilitywill rest on the shouldersof sons, daughters, nieces, nephewsand grandchildren—anyone who canpitch in and help.Now, even as I assure the family thatthe home care nurse will be out tomorrowto evaluate the situation, I wonderhow many visits will be allowed? Withthe latest cutbacks in reimbursementfor the care of our sickest and frailestHere are some Web sites to help reporters:American Association of Colleges of Nursinghttp://www.aacn.nche.edu/mediaAmerican Nurses Associationhttp://www.nursingworld.org/rnrealnewsNational Institute of Nursing Researchhttp://www.nih.gov/ninr/InTheNews.htmUniversity of Pennsylvania School of Nursinghttp://www.nursing.upenn.edu/newspatients, ongoing professionalevaluationand support that hasenabled families tocare for their elders athome is being terminatedsoon after dischargefrom the hospital.As I read an articlein my local paper aboutpatient deaths, it seemsto me that inadequatestaffing may be a factor.I am frustrated toonce again see thatobvious questions arenot being addressed:How many nurses wereon the unit that night?How many patientswere they caring for?How sick were thosepatients? How muchnecessary care, monitoring,surveillance,could not be attended to despite thebest efforts of nurses who probably didnot sit down once all night?The article zeroed in on automatedalarm systems, questioning whetherthey were they functioning or adequate.It makes me wonder how the reporterscan fail to realize that an alarm can onlytrigger a prompt assessment. If thenurse is not available to respond, thenthe alarm is useless. Why did theseinvestigative journalists fail to asknurses what might have happened toresult in these patients’ deaths?The fiscal realities that drive theimpoverishment of care are veryreal. But our citizens have neverdeclared that the professionalnurses whose care provides comfort,dignity, education and safetyare luxuries that we can no longerafford. It’s just happening, andnobody—least of all journalists—seems to be paying attention. ■Jean Chaisson has 19 years ofexperience as a registered nursein hospital care. Since 1984 shehas been a clinical nurse andnurse specialist at a majorBoston teaching hospital.