NORFOLK, Va. - At age 78, Murrell Werth has had seven operations and has been hospitalized many times over the years. Lately she's noticed a disturbing trend. Nurses seem so busy and overworked that they don't have time to help her with basic needs like making up the bed or getting a glass of water.
One time, she rang her call button for 2 1/2 hours to no avail.
So now, when Werth needs to stay overnight at the hospital, she tries something different:
She brings her own nurse.
Werth is one of a small but growing number of patients in Virginia's Hampton Roads region helping to fuel a resurgence in the use of private-duty nurses. These professionals were popular with wealthy clients in the 1950s and 1960s, but all but disappeared from hospitals by the early 1980s, when medicine became more sophisticated and high-tech.
Today, with hospitals across the country facing a critical shortage of nurses, patients such as Werth say they're willing to pay out-of-pocket for extra care.
"I tell all my friends, 'If you are going to the hospital for more than one night, get a private nurse,'" said Werth, a Norfolk native who recently returned to Hampton Roads after living in New York. "I would not go to the hospital again without a private nurse."
Hospitals generally prohibit private-duty nurses from performing invasive procedures such as giving intravenous fluids, said Pat Schulte, chief nurse executive for Bon Secours DePaul Medical Center in Norfolk, Va. But many do allow them to monitor vital signs such as pulse, blood pressure and breathing. They also can provide "comfort measures" like bathing and feeding patients or helping them get to the restroom.
Seeing warning signs
While a patient's loved ones can sometimes provide these services, nurses are trained to notice things that even dedicated family members might miss, said Mary Ann Letson, client services manager for Interim Healthcare, which provides nurses to hospitals and to individuals. Private-duty nurses sometimes can spot medical warning signs and seek help before problems become more serious.
"They can't give medication, but they can be proactive to make sure that patients get their medication on time," Letson said. "Their observational skills are much better. You might have a very stoic patient, for example, who won't tell you he's in pain. If you notice he's moving his right arm but he won't lift his left, that's a very small, very minute thing that gives you insight into his condition. You're not going to notice unless you're with a patient for half an hour or so."
This level of awareness means a lot to Werth.
During a recent hospital stay, she said, the staff wrapped her legs in tight nylon stockings - a common procedure intended to help prevent blood clots after surgery. The nurses apparently forgot she had told them she's highly allergic to nylon.
Werth's legs swelled and her skin peeled. She endured pain for several days before realizing that the stockings were the cause. Her private-duty nurse helped her remove them.
"The hospital nurses are overworked," Werth said. "They are too busy with too many patients.
"When I was in the hospital in New York and had a private-duty nurse, she felt so sorry for the other nurses that - if I didn't need her - she'd run and help the other nurses on the floor for a few minutes. The nurses were so scarce. It was just an impossible workload."
Indeed, many nurses today complain that hospitals ask them to cover more patients than ever. Nurses who once had to care for five patients now sometimes struggle with seven.
But nurses can only work so much overtime. Hospitals that can't find enough of their own nurses turn to temporary employment agencies that specialize in medical professionals.
'The bare minimum'
Local hospitals sometimes close off beds when they lack the nurses to cover them. Doctors delay surgeries. Patients sometimes spend the night in the emergency room because beds aren't available on regular floors upstairs.
Most nurses say they willingly stay late to handle emergencies. These days, however, they find little time to tend to less urgent needs, said Brenda Nichols, chair of the School of Nursing at Old Dominion University in Norfolk. Nichols, a registered nurse, got a glimpse of what it's like to be a patient recently when she was hospitalized for reconstructive surgery relating to a mastectomy performed several years ago.
"It's not a good time to be a patient," said Nichols, who was in intensive care after her operation. "The problem is that the nurses were doing the bare minimum, but they don't have time to think about what else needs to be done."
Nichols said she had to ask nurses three times to add moisture to her oxygen supply, which left her lips dried and cracked. Her request was finally met, almost 15 hours later.
"It's not that nurses don't want to do this stuff," she said. "But so often they don't have the right help and assistance."
Like Werth, Nichols recommends that patients hire their own nurses - if they can afford it.
Agencies charge anywhere from $12 an hour for a certified nurse aide to $25 an hour for a licensed practical nurse with more advanced training, Letson said. Some patients even request registered nurses, who have more education and command higher salaries. For a 24-hour hospital stay, that can add $300 to $600 to a patient's bill.
And health insurance plans typically don't cover the cost of private nurses.
In spite of the high cost, demand for private nurses is growing, said JoAnn Eure, a registered nurse and the administrator of Eure Professional Staffing and Medical Services in Virginia. Many of her clients are the adult children of elderly parents.
These customers often are exhausted from staying with their parents around the clock while trying to care for their own families. Sometimes they're looking for a "sitter" so that their mother or father won't be alone, said Anthony Harper, assistant agency manager at Americare Plus, an employment service.
Hospitals that might usually require restraints for patients with dementia - to prevent them from wandering or harming themselves or others - will often waive this rule if a patient is under close supervision, Harper said. Sometimes, hospitals will even pay for sitters to stay with patients who are in danger of falling out of bed.
Cathy Carter, a nurse who worked in the emergency room at Sentara Virginia Beach General Hospital before moving to Texas recently, advises patients to bring a nurse or relative with them to the hospital.
But others doubt the benefit.
Dr. Patricia Raymond, a gastroenterologist, sees private nurses as "probably just a waste of money," since they are not permitted to perform much real medical care.
Instead of suggesting a private nurse, some doctors, such as urologist Dr. Steve Schlossberg, said they ask hospitals to assign patients with extra needs to a "step-down unit," which provides more monitoring than a regular floor but less than intensive care.
Some medical professionals worry about promoting a two-tiered health care system - one for most patients and another for those affluent enough to hire private nurses.
"That will lead to quality care only for those who can afford it," said Marci Moorehead, a nurse who owns her own medical/legal consulting business and specializes in issues such as worker's compensation and medical malpractice.
She also fears the hospitals might come to rely on private nurses, instead of raising salaries and stepping up efforts to hire more staff.
"The fact that people hire their own nurses shows that staffing trends are getting worse, not better," Moorehead said. "The more people start to hire their own nurses, the less importance the hospitals will place on staffing. Nurse-patient ratio should be a No. 1 priority for a hospital."
New research shows that patients fare better when there are more nurses around.
A study released recently by the federal government found that the patients of nurses assigned to care for a small number of people leave the hospital sooner and suffer fewer medical problems. The study, conducted by the Department of Health and Human Services, examined 5 million patient discharges in 1997. Patients in units with more nurses were up to 25 percent less likely to suffer complications such as urinary tract infections, pneumonia, shock and upper gastrointestinal bleeding.