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Having worked in health care in one aspect or another for nearly half of my life, I lament the forces that have shaped health care as we know it. All of us are adversely affected in one way or another, from rising health insurance premiums to a reduction in the number of nursing schools in Western New York.

I first went to work as a registered nurse in 1982, having learned from "old school" instructors who put as much emphasis on patient comfort via back rubs and the holding of a hand as they did on the base of knowledge we acquired in our textbooks. Working at a Catholic hospital in Batavia, I saw our nuns working the halls as nurses and supervisors. Our nursing skills were sharp and plentiful.

But 20 years of HMO-driven changes, many of them out of the control of hospital administrators, have left the system a shambles. Ask any nurse who works at a hospital or nursing home what the R.N.-patient ratio is now versus what it was 20 years ago. Horror stories abound about units being short-staffed, mistakes being made and injuries incurred simply because there wasn't enough help available.

A dangerous gap in patient care has been created as institutions hire nursing assistants in lieu of nurses, gambling to save a few bucks. God loves nursing assistants, but they aren't trained -- and certainly aren't paid -- to pick up on subtle yet important changes in a patient's condition. These subtleties can lead to death or injuries.

Just once I'd like to see a team of politicians announce a plan to hire "100,000 nurses nationwide" in an effort to curtail medical mistakes and improve patient care.



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