The Moral Distress Driving Healthcare Professional Burnout--A Message From An ICU RN
Rarely do healthcare professionals speak out for fear of being targeted by their organization. One ICU nurse speaks out about the lack of consideration insurance companies have for the patient. Money drives the industry. But how long can this last before something breaks? The following is a message I received from a reader who dared to speak out after experiencing the death of a patient on her birthday.
Dear Allison,
Please publish this message on your blog.
I know you are a critical care nurse, and you have probably experienced much of the moral injury many nurses continue to feel each day we show up to work.
I have been practicing as a critical care registered nurse my entire career and have seen US medical care plummet from the best to the worst. It’s not because there is a lack of technology; or because the doctors and nurses don’t care. The problem is the entire healthcare system has become all about money.
Consideration of what is best for the patient has gone out the window. Instead, it’s about what insurance coverage someone has, their age, demographics, and ability to pay the bill.
It has become abundantly clear to me and so many other morally depleted and burned-out healthcare professionals that insurance companies are controlling the industry with money as a motivation rather than doing what is right for the patient.
This past weekend we had a patient who died, lying in an ICU bed for two months because her insurance company repeatedly refused to pay for her transfer to a long-term acute care (LTAC) facility where she could wean from the ventilator. The doctor working for the insurance company told our ICU doctor, “She can stay in your ICU. What’s the difference?”
The difference is that an LTAC is designed to wean patients from the ventilator, so they are not simply a long-term care facility but an acute, long-term care facility. A hospital ICU is for acutely ill patients who require intensive treatment to save their lives.
The insurance company knows her bill is capped at a certain amount if she stays in the hospital. They will pay up to a certain amount for her diagnosis. After that, she can stay in the hospital relatively free of charge, regardless of the care she receives.
If she transfers to an LTAC, the bills start from scratch, and there is no limit to what they can amount to.
Instead of going to a facility set up to take care of her needs to wean her from the ventilator and receive continuous physical therapy to get her back to her functional baseline, she died waiting for all of that to happen.
She pulled out her tracheostomy and PEG tube, went into ventricular fibrillation, and died several hours later. It was her 76th birthday.
As I write this letter to you, hoping you will publish it, we’ve had two other patients in our ICU for over six weeks waiting for their insurance company to approve them for an LTAC to wean from the ventilator. The insurance companies have repeatedly denied the transfer.
I have concluded that patients and their families have no voice. The healthcare professionals caring for patients can’t care for their patients properly. Greedy insurance companies who are making the decisions don’t send their representatives to meet with patients and their families. Instead, they look at a person on paper and make critical life decisions based solely on how they can save money.
Thank you for letting my voice be heard,
A Nurse in Moral Distress
