IN TEXAS. Currently.
I like to lurk around the periphery of subjects and get perspectives from people I consider to be an original source. I suspect this behavior stems from a deeply seeded distrust in politics and media. Little did I know that I might one day become one of those sources so I figured I would hop in here and donate my perspective to others who might want to know what is happening in hospitals all across America.
A brief explanation of hospital culture In order to understand this- one must take note of the divide between the three branches of a hospital. Most hospitals in America are run by health networks today but even if they were not- they would still share a lot of the same people/employees. The three branches are Medical, Administration, Service. We don’t need to discuss service personnel as they are, pretty much, what you might expect. Housekeepers, grounds keepers, security guards, a lot of temps and/or volunteers. These people are typically not that invested in the process and have a habit of just going with the flow.
Medical personnel are the core of the organization (although they are the least seen). These include physicians, specialists, technologists, therapists, nurses. They are public facing but they rarely make statements (or policies) FOR the organization. The reason they are so important is because they are the ones who generate money for the organization. A hospital’s budget is primarily determined by the amount of medical personnel they are able to attract. This creates a reverse power dynamic with administration. Although administration signs the checks, the medical personnel are the ones who make that possible. During layoffs these people are never touched. Medical personnel are typically self governed from department to department. Like miniature kingdoms. They often report to a department medical director who is often a physician and they take no orders from anyone else, even ignoring other departments. These people are very career minded and they understand that their reputation to their peers is a thousand times more important than employment status with a hospital/health network. A person who is highly credentialed and holds licenses can move from hospital to hospital and their reputation will easily follow them.
Administration plays an important role in the health network as they are in charge of facilities, scheduling patients, reporting paperwork, handling insurance (god knows I don’t want to do that), payroll, security, etc. These are good people and they do serve an important role in the hospital but I want to stress the difference in the power dynamic. If a health network loses the VP of operations, as well as 3/4ths of the IT department- the hospital will still be open for business the following day. But if you lose a neurologist than his entire clinic is simply gone forever. All of those patients will have to be turned away until such time as that person can be replaced.
When the virus started it was on no one’s radar. We deal with viral infections all the time. We have facilities and personnel ready to intervene and treat pathologies of all shapes and sizes. Isolation rooms and positive pressure rooms ready to go. The media began screaming about this however you need to understand that most medical personnel tend to avoid politics and religion. We see thousands of patients, sometimes tens of thousands (depending on your department) so we try to keep very shallow relationships and avoid certain interactions. But we were aware of it. The alarmism had filtered through every media outlet.
Administration became aware of the virus from these sources as well, however they, as was previously mentioned, have very little contact with medical personnel and could do nothing besides engage in planning activities in case the worst happened.
Politics became involved and it was not long before Governors and Senators began contacting health networks (administration) to plan “an enhanced’ response. This is where things start to go sideways. Government, effectively, ran away with administration. A good example are ICU rooms. The ICU is set up to hold thirty patients. If they have fifteen patients and you call up the Nurse Super and ask her how many ICU beds they have left she will tell you “We have thirty rooms, we have fifteen left” but this is misleading. Once the ICU becomes full, they will open the adjoining hallway and activate the “Overflow rooms” while calling in additional medical personnel to staff it. And they can continue to do this. The 30 room ICU becomes a 60 room ICU. This process is called a level 1 emergency. This is important because it is what allows a hospital to scale to the situation. If the worst were to happen (for example a plane crash) then the hospital can prepare itself to receive any number of patients. The 60 room ICU becomes a 120 room ICU. At the final levels, hospitals can construct tent cities in the parking lot if they need to. It never gets that far however because of medivac helicopters. Rather than paying medical personnel top dollar to come in on their days off or fly in from other states- they can simply offload additional patients to other hospitals in other states. But the option is there (in case the worst happens). So you can imagine everyone’s surprise when the media begins talking about how “Hospital ICU rooms are NEARLY full” and “What are we going to do when it is full?” An RN associate of mine who heard this question laughed and pointed at the double doors at the end of the hallway. She said “It’s that easy. Page everyone and open the overflow rooms, whats the big deal?” but that is not how the media presented it. They presented it as if we only had fifteen beds and when they were full then we would lock the doors and put a no vacancy sign on the front.
Then the incentives arrived. It was flu season and we were visited by the usual suspects. COPD, Emphysema, CHF. Patients who are already “circling the drain” often have a rough time during flue season. But this season was different because the government had announced financial assistance for hospitals. It works like this… if you have a patient who contracts the flu and has to spend a few days in the ICU then you could stand to make (after haggling with insurance) around $7k. However if your patient contracted corona virus, then the government would reimburse some where in the range of $47k. Administration began speaking to physicians and attempting to ‘educate them’ on this new lucrative virus. There was a bit of tension during that time because administration had to proceed in a manner which would not appear that they were pressuring physicians… while at the same time… pressure those physicians. Ultimately, they won. Over the course of a few months it became difficult to find a diagnosis of influenza. If you were going to diagnose some one with any form of respiratory failure, what did it really matter whether or not you called it influenza or covid? Well, it mattered to the tune of $40k. Outside physicians were even brought in to posthumously diagnose patients with covid based entirely on reviewing their chart. The CDC guidance had made it so easy to diagnose anyone with covid for any reason and the reward for doing so was immense. When the tests eventually arrived they appeared to help with this. They produced so many false positives it was incredible. It became a windfall for hospitals. A real cash cow. Meanwhile nothing had really changed. Patient numbers were the same as the previous year and nothing extra was required. Many of these hospitals had expected to implement bonuses for additional personnel as well as hiring incentives and overtime but all of that eventually lapsed as it became clear it would not be needed. Influenza had disappeared and everything was covid.
Mask mandates were all the rage and I may have difficulty explaining the confusion involving this. Where as I am sure you have heard about all of the failings of masks in recent months- you need to imagine what it was like to use these things professionally (as a temporary device, part of a larger procedure, for specific purposes) to using them unprofessionally “Just wear them when patients are watching”. However this was not an order from administration. As I explained, administration does not give us orders. It was also not something which was born from the medical community (if there is such a thing) we have completely different procedures for dealing with viruses. This was an order from THE GOVERNOR. “Everyone needs to wear a mask when entering the hospital. It doesn’t matter what kind and it doesn’t matter how it is worn. Even if it doesn’t work it is still better than nothing.” Actually no, no it’s not. It is not better than nothing. If we are dealing with a real virus then we should treat it like a real virus. Doing something for no reason is not better than doing nothing. It technically IS doing nothing.
Physician protests began but they were not protesting administration. Administration was wise enough to play the part of the neutral party. In large part these physician groups began protesting government mandates by way of “Speaking out” to the media. These protests were largely expected and silenced. Youtube channels were deleted, doctors were villainized and twitter began to sanitize these testimonials. I began to collect a lot of these videos and store them away as it became apparent they they were being actively washed from the internet by parties unknown. Although there are many who would privately agree with those voices, few are brave enough (or foolish enough) to risk making an enemy out of these external threats.
Vaccine rollout began and this is probably where things hit the fan. When the vaccine released, administration put out a memo to everyone. In partnership with the government they had agreed to pay for all staff to be vaccinated. As a result they wanted to find out how many doses they should order. This was a huge mistake on their part because they very quickly found out that most of administration were happy to receive the vaccine and nearly none of the medical personnel would receive one. This was very bad optics. Not just for the CDC but for administration as well. The media narrative had, so far, been that this was an initiative put forward by “The medical community”. In order to get the population to trust the vaccine, they desperately needed medical personnel to get it first. I’m sure you all saw that video of the alaska RN who collapsed after receiving the vaccine. What was significant for many people was the fact that she collapsed but I was more curious about why they were trying to publicly show medical personnel receiving the vaccine and then advocating for it. This was a cornerstone of their narrative. It wasn’t long before the federal government began talking about mandating a requirement for all medical personnel to be vaccinated. Yet at the same time they were not discussing WHY medical personnel had refused to get it. Nor where they addressing the elephant in the room which was “If medical personnel were not trusting the vaccine then why should anyone else?”.
For over a year the media presented this narrative that this was the product of science. While conspiring with politicians, media personalities and hospital administrations all across the country they are only now realizing that they never had the approval of the actual people they needed. So they put pressure on administration to implement a ‘Vaccine requirement for employment policy’ however administration (so far at least) has largely refused. Administration can not run a hospital with no medical staff and they know that. That is called ‘A hotel’. This is not a state wide phenomenon. This (so far as I can tell by way of Maryland, Virginia, Colorado, Texas, Arkansas, New Mexico) is a nation wide issue. The president can make everyone in the military get the vaccine. He can order all military hospitals to do it. Yet he can not order all private hospitals to commit financial suicide. This is currently playing out in every state of the union and everyone has run out of options. If the media makes too much of a fuss about hospitals refusing vaccination, it is going to pull down the narrative that hospitals are the ones who WANT people to get vaccinated.
What strange times we live in.