Part One Troublemaker - Advocate

Ron Panzer
November 2, 2013
Part One of Two
Reproduced with Permission
Hospice Patients Alliance

"He that is faithful in that which is least is faithful also in much: and he that is unjust in the least is unjust also in much." - Luke 16:10

In an ethical and moral society, the troublemaker repeatedly violates the rules, the standards, and if he's a criminal, the law itself. He's the student that drives the teacher crazy, the kid that's always getting in trouble with the police, the child who disobeys his parents, the one who chooses to never do things right. He ends badly.

He becomes an evil man: a liar, bully, betrayer, manipulator, schemer, deceiver, con-man, criminal, sociopath, psychopath, rapist, or even murderer.

History is filled with accounts of the suffering inflicted by such. Strife, destruction and disorder follow wherever they go and society's leaders do their best to rein in such destructive individuals.

In an ethical, moral society, the police, courts, judges, leaders, parents and government officials strive to follow the highest ethical standards of honesty, fairness, and justice in order to protect those they serve. This is part of the culture of life. This is the way it's supposed to be, at least according to God and His divine law, and those who are blessed to recognize the goodness in His law and follow Him.

In a culture of death society, however, corruption rules. People generally rebel against God and His law. Often, they even deny that He exists, which makes following His law a moot point in their mind.

That's what they want: to do whatever they want to do without worrying that there might be an ultimate Authority who judges them for what they do. They don't want to be judged at all. They don't wish to be accountable for their actions.

In a culture of death society, the police, courts, judges and government officials bend the laws to favor their friends and family or whoever pays them the most. They care only for the appearance of doing the right and violate the laws when they wish to while ignoring any pangs of conscience that they have not yet completely suppressed. They turned a deaf ear to that voice long ago, and where their lives end up is truly sad and tragic.

In culture of death healthcare, administrators are unjust and cruel. Throughout history, there has been a constant interplay between individuals who promote the culture of death in what they do and those who participate in the culture of life, but even though this struggle goes on all around us, so many have such a deep misperception of what it means to be pro-life and part of the culture of life.

You see, this is not a question of subscribing to one view or the other, like changing one's mind about whether you wish to wear one hat or another or join one political party or another. "Convincing" someone intellectually about being pro-life or caring for the patients is not enough to make a real difference in the world.

We can't sign up and become a member of the culture of life. We can only wait patiently for the dear Lord's grace, serving those in need with great love, and hope that we will find our way into that culture of life (Luke 12:33-40). Only when He opens our eyes will we truly see (John 9:35-41).

A fundamental change in how someone is is required. We must open to the spirit of life in order to participate in the culture of life. We must open our hearts to the King of Love to be pro-life, because only then can the culture of life flow through us as a stream of living water (John 7:38).

Each of us, the individual members of society, create some aspects of our own world and interact with what others create through their actions. The overall trend of our choices and actions becomes our habitual way of being, whether that is virtuous or not.[1]

We must remember that there is such a thing as "the society" that has its own characteristics within the world. The sum total of all the individual members' choices and actions determine the overall trend within the society, just as the staff and administrators determine the trend in any particular organization or healthcare agency.

A society or organization whose members have truly deep love for each other and for God, and whose choices and actions are inspired by the virtue of life-affirming mercy, is pro-life and demonstrates the blessed community intended by the dear Lord. The actions of its members are life-nourishing for the other members, each providing not only goods and services but loving interactions with the others as well.

A society whose members use each other and treat each other as objects on a chess board in an effort to do whatever they have decided to do is pro-death even though its members pride themselves as being the elite. They may go to church and cry out, "Lord, lord" all day long, but they do not understand that because there is no sacrificial love within their hearts and no sincere concern for others that they have disqualified themselves from the culture of life (Matthew 7:21-22, 25:11-12; Luke 6:44-49).

Those who promote the culture of death in what they choose to do and how they choose to be do not really even see other people as being just as important or valid as themselves. They act as if the world revolves around themselves and manipulate anyone around in order to further their own agenda. Rather than working with others, they command them if they can. They don't really see others at all.

Those who participate in the culture of life love. They love their mother, father, brothers and sisters and all around them. They love those they work with (whether they express it verbally or not). In loving, they see the other and interact in a way that communicates that love.

If you were to show me someone who did not know love and the pervading meaningfulness of life in that love, then you would be showing me one who only appears alive, but is actually dead to true life. The philosophy that arises out of such deadened, unloving hearts speaks of the meaningless of life - simply demonstrating how lost those philosophers truly are to the way of life.

These are the ones who use words and phrases such as "justice," "for the good of society," and "patient self-determination," to argue that individuals should be able to kill themselves - when they actually seek to justify killing defenseless individuals who they determine to be unworthy of life.

Show me someone who has never loved so much that they would give their life for the other, and again, you would be showing me one who only seems to be alive. Their "compassion" and the choices they make are perverted and evil. To have never loved deeply is to have never lived.

If we have never known or have forgotten what it is to lose ourselves in the beauty of His Creation or in the one we love, if we do not now experience this love within us, then in this moment we have fallen away and know little of the culture of life. It is our task to remember the dear Lord always and to open continually to His all-consuming love.

If we do not treat others with respect and really hear them, how can we have His love within our hearts? Then again, who among us has never been unkind, cruel or wrong? It is possible for any one of us to fall into old habits of vice that harm others and also possible for us to be lifted into habits of virtue that are a blessing to others as well as ourselves.

Each of us must choose to participate either in the culture of life or the culture of death, and this is an ongoing, moment by moment, never-ending process of choosing that goes on till the day we die. Those who choose to participate in the culture of life know that shining like the sun above each of us, and above all of us together as a society, is the unifying Light and presence of God, showering His love upon each and every one of us, whether we are the caregiver or patient, or the able or disabled.

If we are present with our patients, partners and others with the same degree of love and respect we show to our own family and loved ones, that is participating in the culture of life. If the work of our hands and minds displays that love, that is participating in the culture of life. If what we share with others inspires them to have reverence for life and for God, to know without a doubt that we care, to know that they themselves are valuable and that their lives have great worth - then that is participating in the culture of life (Luke 6:44).

With this in mind, we can understand that there may be many who say they are pro-life or believe in God, but who may not honor others and God in what they do or how they do it. It is not a mere matter of taking one side or another but a matter of being one way or another in our relationship with God and in our relationship with others around us. This is the way that we can understand how the troublemaker within a culture of death arises to bring light into an often cold-hearted world.

One who participates in the culture of life sees others, including the patients she serves, as her fellow human beings, to love with everything she has, to care for in the best way possible. Imagine the horror she feels seeing the patient she loves being abused, neglected or harmed. Like a mother who suddenly becomes aware of her own child being attacked, she will act to protect that vulnerable patient who is being mistreated. Imagine how perplexed she is when managers do not care about the patient or the mission.

In the culture of death setting, the troublemaker is a relatively good man or woman, more or less as imperfectly good as any can really succeed in being. She sees the widespread corruption and exploitation of those who are defenseless and tries to put an end to it. Her anguish is palpable and does not leave her. Her only comfort in such a difficult setting is the dear Lord and His grace.

In this terrible situation, the troublemaker is an advocate for the vulnerable, a dedicated physician, nurse, therapist, counselor, dentist, or any other caregiver and protector. She sees how innocent people are made to suffer so horribly, or even be killed, at the hands of the powerful. She speaks up against the abuses of the powerful even if it means she herself has to suffer. Some think her too stupid to know when to be quiet.

Wherever there is a government, corporation, business or any other formal project managed by people, there is a self-protective, self-maintaining power structure. Wherever there are people, there is inevitably the opportunity for error and harm to arise. Because of mankind's imperfection, selfishness and pride, actions that are harmful to many are continually chosen, causing the unnecessary suffering in the world.

In the culture of death setting, administrators everywhere despise the troublemaker. When looking for employees or candidates to join in the work, they weed out any they think will cause trouble later. If they find they've missed a troublemaker and inadvertently have hired one, they fire her as soon as possible, trumping up false charges if they are able to do so.

Because such administrators manipulate those around them, using them to achieve their goals, the troublemaker, who cares so deeply about the patient and the mission, presents a problem. She cannot be manipulated or turned away from her concerns. She exists as an island of love within an uncaring and sometimes hostile world.

Every healthcare professional knows of abuses and violations within the care setting. But most do nothing at all about them. Their silence allows the abuses to continue. They are easily manipulated and intimidated by those in authority. But what about that one, the troublemaker? She lives as a stranger in a bizarre, uncaring world.

In the evolution of the advocate, from a simple healthcare professional into troublemaker, there is always a moment of truth. Because He Who Is has blessed her and opened her heart (Exodus 3:14) and called her to serve the people, she cares and loves her patients. She is impelled to act.

This is the movement, or emanation, of the Holy Spirit from God through a person that causes them to act in the spirit of mercy in the world (whether they realize this at the moment or not).[2] This spirit is the spirit of love, something quite foreign to the culture of death and most central to the culture of life.

Like oil in water, she stands out from those who do not care and instruct her not to care. She brings a light into the dark world created by those who act without seeing, feeling or knowing what they really do. If the advocate didn't care, why would she bother to act? It is because she cares so much and is moved by the Spirit of real love that she gives everything she can. It is God's unchangeable love that radiates from her.

While she realizes that there are many aspects of the work that can be done in different ways, the spirit of how things are done must never be compromised. Why? She knows that if one compromises the spirit of how things are done, the entire work will be corrupted and go astray and that people will be harmed in so many ways. She knows that her patients can be harmed, so she stands up to policies that betray her patient's needs.

One of the most famous examples of a troublemaker is St. Francis who was called to restore the purity and authenticity of the Christian Church in his time. Most do not think of Francis as a troublemaker, but the purity of his example (made possible through God's grace) exposed those arrogant, dishonest, hypocritical religious leaders who sought to impress and then exploit the people. Francis was authentically devoted to God and was not fooled by those who were pretenders, just as Jesus was not fooled by the Pharisees.

Francis inspired many to repent and live a life in obedience to the spiritual rules revealed to him and formed the Friars Minor, the order of Franciscan monks who were to spread God's love, serving all in need. He instructed his followers to rely completely upon God and His grace for their needs just as the disciples of Jesus were instructed to do. One of the simple rules they were to follow was the rule of poverty.

While Francis was away, leaders arose who urged that the rule of poverty be relaxed, thinking this change to be practical. They were sure that the changes they were proposing were absolutely necessary.

After returning from travels to the Holy Land to bring the message of the Lord to all those who were fighting, Francis was shocked and dismayed to see that these followers had betrayed his vision. He urged them to return to the true way, but found they would not listen to him at all.

Although the Order was extremely important to him, Francis let it go, remaining true to his vow of poverty, not possessing anything, even control over the Order or its members who wished to go another way.

He realized that each of us must make our own choices, and though these leaders were betraying what he knew to be good, he allowed them to go their own way. The culture of life does not impose its will upon those who reject it. Francis then retired from the Order and lived a solitary, holy life dedicated to prayer and communion with God.

His act of resigning from the Order was a great gesture that should have evoked shame in those who had betrayed him, but they were not ashamed at all. They did not really care and definitely did not value his input. They were excited to follow their new direction. They thought they knew better.

While so many know this story about St. Francis, most never ask the obvious question: What would have happened if the followers in the Order had sincerely repented and apologized? What would have happened if they had returned to the way Francis showed and lived a life in harmony with the spirit of his vision and the prompting of the Holy Spirit? Francis would have been able to remain with them and continue to work with them. He would not have stayed away.

Of course, they were completely unresponsive, refused to listen, and insisted on following the new direction they said must be taken. Only after Francis saw that these leaders chose not to listen to him did he leave them, preferring to live his life in obedience to the mission he was given to follow.

These followers were just like the many powerful leaders in the Church in Francis' time who felt threatened by Francis's call to live lives authentically true to the dear Lord's teaching. They were not willing to relinquish their misguided ideas of what a religious life really meant. Some of them had acquired power, wealth, and prestige; they would not let go of these.

These "blind guides" were not receptive, just as administrators today in many organizations and in healthcare especially are not receptive to listen to the sincere pleas of dedicated, loving staff who call for improvements in patient care.

It is clear that a faithful but naive employee, soldier, citizen, family member, or other may be most dedicated to the well-being of those in need, but when she finds something that is just not right - something that will cause harm, administrators do not listen to her. When she dares to speak up, at risk to herself, she believes that because the problem is so obvious and the truth of the matter is clear, that those higher up in the chain of command or management will immediately act on her suggestions and correct the problem.

If those with greater authority are receptive and respond to correct the problem, then all is as it should be. The responsive administrator or manager is a blessing to the entire work.

However, when there is no receptivity, when decisions are made without even consulting those in the field who might have great insight into determining what is best-suited to the needs of the mission or the patient, when those with authority deny the obvious, when they say things that are certainly untrue and inaccurate, when they refuse to do what is clearly necessary to correct the problem, a terrible red flag is raised.

When those in authority do not answer questions at all or answer nonsensically, when they remain unbending, there is something terribly wrong. Even though it is natural that in any organization some have authority and some follow, it is not right for those in authority to misuse that authority, to speak untruth, to ignore the problems that exist, or to refuse to hear the words of those with wisdom before acting.

In such situations, advocates for the patient or mission become extremely distressed. Why? Not only are the needs of the patients or defenseless not being met, but often, actual harm to the patient or mission is occurring. What should be done is not being done and what should not be done is being done. This reversal of what should or should not be done results from the dominance of the culture of death way of functioning. Respect for the lives of the patients, staff and others does not really exist any more.

At first, the employee (or other advocate) becomes extremely confused and troubled. She does not understand why the logical and right thing to do is not immediately done. It just doesn't make sense! She naively believes that those administrators share her deep reverence for the mission.

Over time, after respectfully communicating repeatedly with those in authority, after carefully explaining why changes are needed, the inescapable conclusion arises: They do know the truth about the problem, but are actually intentionally creating that situation for one reason or another, whether due to a power-play, a misunderstanding of the mission, pride, greed, or for some other agenda.

It becomes clear that the inspired mission the employee had been called to serve is not the same mission or goal that those in authority are serving. This shocks the employee. It becomes clear that although she had been encouraged repeatedly to see herself as a "partner" in the work, those in authority are "pulling rank" and imposing their way forcefully upon all. The actions of those in authority that violate the merciful spirit of the mission at hand speak for themselves.

Anyone who has worked for long within healthcare and many other industries has found himself or herself in this type of situation at one point or another. What is to be done then? If you've seen this type of situation, what did you do?

Certainly, those administrators who are honestly striving to protect the patients and assure their well-being will act to do so. When they do not, it's because they have chosen not to. The naive employee begins to see the reality of the situation as it truly is. Her eyes are opened to the realities within healthcare and in society.

The dishonesty of administrators who betray the mission (and the patients with it) is exposed, and they are known for what they are. When out of their mouths come that which we know to be a lie and not the whole truth as well as nothing but the truth, their misleading statements fail to reassure. Something within feels as if it had died - the disappointment in those who were once trusted is terrible to experience. We understand what Jesus meant when He said:

"It is not that which goes into the mouth that makes a man unclean;
but that which comes out of the mouth,
this makes a man unclean." - Matthew 15:11

Those administrators' actions directly reveal what their goals are, and in a patient care setting, their goals are often revenue for the agency first, order second, and patient welfare third, fourth or last on the list. Decade after decade, numerous investigations have revealed actual neglect, abuse and direct harm to patients in healthcare settings, yet these continue to occur without being corrected. How is that possible?

We must realize that what is true is true. What we see being done is the policy of those in authority. When those in authority deny the obvious about what they are causing to occur, when they treat others without respect, they have wed themselves to the culture of death, however unbelievable that may be to those who believed them to be good, dedicated men and women.

However good they may be, and however good the work they have done before, none is truly good other than God, Himself (Luke 18:19). Any one of us may go astray, and tragically, these administrators have gone astray. When the advocate approaches them, questioning their actions, they should feel ashamed at what they have done, but these do not feel ashamed at all.

Let me share a few examples with you about administrators who say one thing and do another, who impose policies on the staff without even consulting them, and what the consequences can be: In 1985 when I worked in an adult foster care home serving the developmentally disabled men, the owners set policies that violated infection control standards.

They placed the residents at risk of acquiring a very serious and permanent infection (spreading a chronic infection in one to all the rest). When asked to modify their policies for infection control, they refused to comply with the standards. They told me, "Trust us, we know what we're doing." The inspectors who were brought in disagreed and forced them to make changes.

Another case? In the early 1990s I was thrilled to begin work at the local rehabilitation hospital, reputed to be a very fine center for treating newly injured patients. I was hired to work almost exclusively on the spinal-cord injury unit, but at the hospital we not only provided complete bedside care for newly-injured quadriplegics and paraplegics with spinal cord injuries, we also cared for amputees, brain-injured patients, stroke and pediatric patients.

All the staff worked together to care for and teach the patients and families how to live as independently as possible. This was very demanding but also very rewarding work. However, I soon learned that although the hospital provided excellent care to the patients, the staff were mistreated in many ways, sometimes causing serious injury. This, too, is part of the culture of death way of functioning within healthcare settings - something known to most who work within the healthcare industry today.

One example was what happened in an isolation room, a "quiet room," that the administration had constructed by its own maintenance workers who converted a room to function like something you might imagine existing in a psychiatric hospital. They took a room and padded every wall and every other surface from the inside, including the doorknob. It was made to be soundproof so almost no noise escaped from within it.

However, contrary to the most basic standards and common sense, in order to save a few thousand dollars, they chose not to set in place standard protective measures for patients and staff. In a psychiatric hospital there are all sorts of protective measures taken to assure the safety of patients and staff. This "quiet room" had none of these.

There was no call light or buzzer system from within, no way of phoning out (this was before cellphones), the door could not be unlocked or even opened from within at all. There was no video-surveillance from the nursing desk. The only way to open it was from outside. They told the staff, who had no input into the decision to make that quiet room, "Don't worry, trust us! This is how it's going to be!"

My friend, Karen, (a single-mother with two teenage children at home) and another female nurse led a brain-injured, unstable and violent patient into the quiet room to calm him down. They were doing so according to the criteria set out in the official care plan for that patient when the door accidentally swung shut on all three of them.

This patient was a very strong, young man who attacked Karen by grabbing her hair from behind and dragged her around the room, swinging her from side-to-side forcefully. The two nurses screamed for quite a while before someone heard some faint noises and eventually realized they were in trouble inside the virtually soundproof room.

Karen was injured permanently. She suffered with severe pain, "pinched nerves," and numbness going down her arm. She could not move her head side-to-side at all and wore a neck brace for more than a year. Management let her take a while off from work, but then assigned her to work in an office position, a secretarial position that she was not qualified to do. Her neck pain was so severe that she could not even do that work.

Meanwhile, once the short-term disability checks stopped, they pushed Karen to the ends of her abilities. This hospital was self-insured for worker's compensation claims and had tremendous financial incentives to settle Karen's claims for much less than her eventual, actual medical costs. The workers' compensation physicians they hired to evaluate Karen failed to find what was wrong with Karen, and the hospital administrators decided not to give Karen her weekly paychecks.

After this had gone on for a few months, I spoke to the CEO of the hospital on Karen's behalf. He told me, "Ron, Trust me! We will pay her. We want to settle with her!" And what did they offer Karen? An immediate payment of $20,000 if she would sign away all rights to any further claims against the hospital.

How did the administrators think they could set Karen up so that she would be pressured into signing away her rights to compensation for her severe injuries on the job? They continued to fail to pay her the required worker's compensation checks that she and her children depended upon for food and housing. They kept promising her, to her face, "Oh, we will pay you!"

Karen eventually received a notice that she and her children would be evicted if she did not pay the rent on her apartment. They were about to be put out on the street when she went down to the hospital to pick up the check that management again promised to give her - yet, even though they had just told her they had the check and to come down and pick it up, the hospital administrators again refused to pay her!

She was still suffering from her injuries and was so distraught that she collapsed that day at the rehab hospital. She knew she and her children were to be evicted and was sent to the emergency room with angina chest pain so terrible she thought she was dying, but it was a panic attack brought about by the treatment she received at the hand of these well-respected hospital administrators. These were the actions of prominent leaders in our city! But they acted abominably! The very few of us who knew what they had done to Karen were outraged.

It was only through the assistance of two friends who paid the $1,200 overdue back rent payment for her that she was able to stay in her apartment and wait out the administration, which was then forced to pay her what they were required to do by law. Over the next few years she finally managed to see good physicians who properly diagnosed her condition and determined she had four vertebrae in her neck that were damaged.

After undergoing a few neck surgeries, she ended up having those four vertebrae in her neck fused together. Her medical bills added up to hundreds of thousands of dollars. My good friend Karen never worked as a nurse again. That was over twenty years ago.

The Occupational Safety & Health Administration inspectors forced the hospital to close down that "quiet room" completely, and the hospital was fined $1,000. Apparently, the employees who were told to just "trust" the judgment of the administration did have good reason to question what the managers did. The staff knew better but their input was discounted out-of-hand.

Another example? In healthcare, we often need to transfer heavy, immobile patients from bed to wheelchair or a moving "stretcher." If we can move and lift them by ourselves, we will do so, but if not, we use a mechanical device, often one called a "hoyer lift." This involves placing a pad under the patient and attaching that strong pad to the lift so that we can then move the patient by moving the lift (like a crane moves a heavy piece of equipment).

Of course, such devices and the pads used to support the patient's weight must be in good condition for the patient to safely be moved. Back in 1990, while working at the rehab hospital, I noticed that the heavy canvas cloth pad being used was old and dangerously frayed at the edges where the chains from the hoyer lift hold the pad. As we are supposed to do, I reported this to the supervisor, asking that a replacement be ordered before the pad broke and a patient fell.

Well, in a culture of life setting, they would have done exactly what was asked, but they did not. They refused to order the pad saying, "Trust us." "It'll be ok!" "Don't worry, Ron!" And they must have said to themselves, "He's raising a fuss about nothing!" About four months later, a very heavy quadriplegic patient was being transferred from bed to wheelchair using the hoyer lift and pad.

The pad broke exactly where the chains connected with the pad: it was frayed, just as I had warned the administrators, and the patient fell to the ground. Luckily, the charge nurse and I were there to prevent him from falling too hard and protected his head. This is one example of hundreds and thousands of times that those in authority do not listen to staff and endanger the mission at hand, which is serving those in need well and assuring their safety.

There were more problems for the staff at this fine hospital. Nurses, like soldiers in the military, are extremely dedicated to their mission. They do incredible work, sometimes beyond their ability and become injured on the job. When policemen are injured on the job, the entire force takes up collections and tries to help out in some way. When military are injured, they receive benefits of some sort and healthcare for life through the Veterans Administration. When nurses are injured, there is often nothing for them.

Nurses and nurse aides have the highest rate of back injury of just about all professions. When nurses are injured, healthcare agencies often do everything possible to quietly move that nurse out of view, outside the awareness of almost all other staff. They use many administrative tricks to avoid paying benefits to the injured employee. Many nurses are left disabled, without benefits and financially ruined.

Like many agencies today, with an eye to increase the hospital revenue, the administration manipulated the staffing levels so that they would not have to pay for a full staff - a full staff that met the staffing requirements required by the standards of care and the law. Troubled by the injuries occurring, and finding no information forthcoming from the administrators, I decided to research the issue and found out what the industry staffing requirements actually were. I realized what the administrators were doing.

The hospital had a north and south end with two patient-care units on each end. They were short-staffing the units on one end while properly staffing the units on the other end. Every two months, they rotated the short-staffing so that one end would be complaining bitterly while the other nurses from the other end of the hospital were breathing a sigh of relief, saying that everything was "just fine" now. It was a case of "divide and conquer" as well as deliberately confusing the staff so that the nurses were kept divided on the problem. The administrators realized that it was vital that the entire staff not realize what the administrators were doing.

Because we were lifting and transferring very heavy patients who either could not support their own weight reliably or could not do so at all, patients were evaluated by therapists to determine if a patient required two nurses in order to transfer him. This is standard procedure.

Because we each had our own patient care assignments, and because of short-staffing by the administration, there often was no other nurse to help move a patient, even if there were orders that the patient should only be moved with two or more staff to assist.

Those of us on the spinal cord injury unit often had to provide total bedside care for two quadriplegics, two paraplegics, a stroke patient or two and another, often up to seven patients, and have them up in their wheelchair ready for therapy, doing all this from 7:30 a.m. to 9:00 a.m. This includes at a minimum, oral care, showers, bowel programs (if needed), dressing and feeding the patient, administering medications, and transferring them up to the wheelchair.

In the three years I worked there, I saw many nurses who were permanently injured, because they ended up lifting or moving a patient all by themselves. This was a direct result of administrators' decisions to short-staff the hospital. Imagine 100-120 lb nurses moving a 200 or 300 lb patient all by themselves. Even if a nurse was larger than that, many were injured terribly. Even though they needed others to help them, they moved the patients on their own, because there was nobody else to help.

Nurses do what they have to do, because they are dedicated, because they care, because they need their job to support their families and don't wish to lose it. They do the job, but often pay a high price. Once they're injured, they lose their job anyway and are put through the same benefit-denying strategies that Karen endured. There are many difficulties for those who work in the healthcare industry, whatever area they work in.

I did learn what the staffing requirements actually were. I shared the required staffing ratios with other staff and proved that the administration was deliberately understaffing each end of the hospital regularly. I let the administration know that we knew. They were clearly very upset that the staff had learned what they were doing. They didn't care about the staff at all. It was a business to them, and if nurses were sacrificed in their race to make money, it was a "cost of doing business" that didn't really affect them.

I remember when some of us were first hired, how they listed all the benefits that came with the job. Once I saw how they acted when a staff member was actually injured, I realized that when they said, "Trust us!" that they "cared for us," it was just another lie. That nurses' lives were devastated did not matter at all to them. They did want us to trust them, but when we needed them to care for us, they treated the nurses who were injured cruelly.

Later on, I worked on a hospice's continuous care team, caring for those patients with extreme symptoms out-of-control. At one point, because the hospice corporation had been found by the U.S. Justice Department to have committed fraud, improperly billing the federal government about $1.5 million, they were ordered to repay that large amount.[3]

What did the administrators do? Aside from firing 80 employees statewide, and streamlining their expenditures for staff and operations, they ordered nurses like me to chart that we were providing continuous care when we were not providing that care. They reassured us, "Trust us, this is ok." But we knew better.

We knew that when the hospice would bill at the higher "continuous care" rate, they would be reimbursed hundreds of dollars more per patient, per day, and multiplied by many patients, this would amount to millions of dollars in extra revenue coming into the hospice. These millions of dollars in revenue would come from the same federal government that had ordered them to repay those millions fraudulently billed before. In other words, to "fix" the problem of their having defrauded the government, they would defraud the government again, but in a different way. The administrators were determined to commit healthcare fraud.

Of course, I and one other nurse (out of dozens) protested, but the Vice-President of the corporation told me privately, "Ron, you're right. What we're doing is illegal, but nothing will happen to us. We might get cited for a deficiency, but we'll keep on going."

In other words, they might have had to repay some of it, but the U.S. Justice Department would never force any healthcare corporation to pay back 100% of what is stolen through fraud. So, corporations are rewarded for their fraud and allowed to keep huge sums of money. And that's what happened in this case and in thousands of cases all across the USA.

There have been many other instances where administrators told us, "Trust us!" and then went on to do wrong, to ask us to violate our duty to our patients, to create situations where the patient's best interests were not served. So, you can see, I understand what it means when administrators say, "Trust us!" and then do what is not right, what is contrary to the basic mission, what is so obviously wrong.

It really is shocking, but many who hold positions of authority are not in it to serve, but see their position as a stepping-stone to career advancement, greater income and prestige. Even if some are really dedicated and wish to serve, they do not always have a proper understanding of the mission and interfere with what is best for the patients. They do not see the right way at all.

How many have entered the field in order to serve and how many have entered it to be served? So many administrators are there for the wrong reasons. So many have no idea how horribly wrong their decisions are.

Even those who have good intentions but who do not see what is best for the patients are not capable of even imagining what the terrible consequences of their actions will be years later. Real lives are often adversely affected by their decisions, whether they are lives of patients, staff or others.