Nursing, it seems, is a numbers game. We take our patient’s blood pressure and convert a handful of numerals into a clinical condition. We decipher a body temperature to establish the presence or absence of infection. We utilize the height and weight of a human being to properly dose medications that, without meticulous calculations and crosschecks, could easily prove to be lethal. Our numbers game is one where the winners and losers face the highest of stakes, yet despite the importance of these facts and figures, we at the bedside are pummeled with numbers of a very different variety.

Patient satisfaction scores. Nursing sensitive indicators. Measures and metrics and series of statistics are thrust upon us thanks to a healthcare system that seems to have shifted from patient-centric to metric-derived. Deep down at the bedside, one mustn’t only be familiar with the quantity of fluid that is removed from a patient’s continuous dialysis machine: we must also be certain to make family members feel welcomed and comfortable – not because that is the decent and humane thing to do, but because scoring a nine out of ten points will earn an institution the desperately sought-after reimbursement it hopes to secure. I cannot blame the hospital systems and healthcare powerhouses who wish to grow and expand in the name of a medical pay-for-performance structure: if left without a means for financial stability, they will be bought out, shut down, or reorganized by the neighboring system nearby. A hospital is a business, and business is all about the bottom line. At what point, however, do we draw the line?

So while we make every effort to toss caution to the wind and save lives come hell or high water, we nurses must think twice about our capacity to care. We mustn’t make the excuse that our patient is too unstable to be turned or repositioned – foolish be the nurse that fails to document this cardinal sin of the profession! Rather, we lower the head of our open-chest patient’s hospital bed and ever so gently tilt their torsos to avoid getting a slap on the wrist or a note in our file. Better dead than bedsore? Not quite, but some moments it feels this way. We remove the dreaded urinary catheters in patients who damn well may need one, if for no other reason than to prove the point that it will eventually go back in anyway. We scrub the hubs on our central lines like they’re grimy grout on a bathroom tile, hawking others to blame should the patient develop an infection. We back-prime and we buddy system and we desperately stick for any vein we might hit to keep the germs at bay. And instead of risking that our patients should fall, on those especially busy days, we keep them tucked away in bed – rigged with alarms and running with fright, like Pavlov’s dogs, when that bed trigger sounds.

It’s a numbers game, this nursing life, even when things don’t quite add up. Some days we are spinning, running in circles and muttering a prayer that we’ve done all we can for our patients while appeasing the system. Some days we are tempted to leave that stupid freaking catheter in for just one more hour, so we ourselves can have a moment to scarf down a snack and take a bathroom break in peace. Some shifts we feel the guilt that creeps up from the pit of our stomach when we know that we pushed an emergency drug without wiping down a line, because we fear the wrath of consequence despite saving a life. Some days, we just don’t give a damn whether our patient’s husband’s brother-in-law is a doctor, because him flaunting medical knowledge and spewing out jargon won’t change how we deliver care. Truth be told, some people will never be satisfied anyway: so we can “yes ma’am” and “no sir” and apologize for inconveniences while offering grievances all the live long day and it still won’t help our monthly averages or our quarterly scores or our annual totals that someone reports.

Nurses don’t do our jobs for the numbers. We don’t work through lunches and cry with patients and code until our hands bleed because of our scores. In fact, we do all of these things – and so much more – in spite of them. Nursing has always been a numbers game: one life saved; one last breath; one moment to see a patient hug his or her family again. I love my job, and I go to work every day hoping to give, learn, and grow in some capacity through the work that I do: but some days, I can’t seem to make sense of the calculated risks. Today, it seems that the mathematics have become more complex, yet what we need in this profession doesn’t need to feel like calculus. It’s a matter of simple addition: more staff; more stuff; and more time for direct patient care. Nursing is a numbers game: when you subtract competent and effective nursing care from the equation, the end result is always zero. A business cannot be a business without a profit, but a hospital will never be a hospital without its nurses.

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