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Re: VBAC dying art>From: vnellsch (vnellsch@eastex.net)Tue Mar 31 13:12:25 2009
amen, doctorjoe, amen. i could not agree more. verner nellsch, md
> ----- Original Message ----- In a message dated 3/30/09 7:32:36 PM, vnellsch@eastex.net writes: i am in a small community hospital about an hour north of houston, texas. i have been quietly doing vbacs here for the last ten years. no troubles from doing them, but here recently, the hospital, spurred on by some of the labor and delivery nurses, have promulgated a policy that may keep me from doing many. This is a BiG pet peeve of mine! When I was certified as a Nursing Assistant (aka nurse's aid, or currently a CNA), there was a clear three-legged heirarchy in medicine. There was (1) Administration, who ran the hospital business; (2) Nursing staff, who cared for the patients and basically advocated for them; and finally (3) medical staff, who swooped in, did their best medicine, and swooped out. Now there are only TWO forces in play: (1) Hospital -- holding the money -- represented by Administration, which INCLUDES the Nurse Administrators (or Nurse Supervisors, or whatever you call them -- often M.S.N. or D.N.S. level nurses who may (not always) have very little clinical experience and very little patient sympathy; and (2) the Medical Staff, many of whom are hired by the Hospital and so are in effect part of (1). The long and short of it, Hospital bottom lines predominate in any discussion of clinical care. There is very little support for the best treatment/care of patients UNLESS it's somehow tied to the bottom line. Joe P.
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