Nurses working at two New York City hospitals went on strike last week. They were offered considerably more money and assurances that their working conditions would improve, but they demanded something the hospitals probably could not deliver: more help. They argued that the ratio of nurses to patients was dangerous. There are simply too few nurses assigned to direct patient care to provide safe and adequate patient management. The hospitals argue that they cannot fulfill their current recruitment goals and would be misleading their staff if they assured them that they would or could hire more nurses. Both sides in this dispute are correct. More nurses are needed but are unavailable for the foreseeable future.
The resolution of this strike is predictable. The hospitals will promise what they cannot deliver, and the nurses will return to the perilous conditions that have existed for years. Nurses will get credited with sounding an alarm, and the hospitals will be applauded for acknowledging the dangers that exist. Little will change aside from patient mortality and morbidity (deaths and complications), which will increase in the years ahead.
The Covid epidemic demonstrated the inadequacy of America’s healthcare. It overwhelmed existing facilities but did not prompt the expansion of or additions to those facilities. Elective procedures were cancelled, and space never intended for patient care was hastily converted to house the critically ill. People who ordinarily would have been deemed candidates for emergency admissions were turned away or held in tents near the hospital in case they suddenly deteriorated. Nursing shifts were extended from 8 hours to 12 hours or 16 hours, and staff with inadequate training were obliged to help manage rapidly deteriorating patients.
Covid is still with us. RSV (respiratory syncytial virus) is lurking in the wings, and the flu is threatening a resurgence. Compounding the already dire situation is the complexity of care demanded by these epidemic diseases. Sitting by the bedside and checking a pulse every hour or so was acceptable medical care two centuries ago, but today’s healthcare provider needs training in pharmaceuticals, test interpretation, crisis recognition, and even equipment operation. This applies to nurses, nurse practitioners, technicians, physical therapists, and physicians’ assistants, as well as to physicians. We have considerably more equipment to help in the management of patients than was available just two decades ago, but that equipment has not made patient care simpler. On the contrary, healthcare professionals need training to operate the machines and to understand the information provided by those machines.
The obvious question that needs to be addressed is, “Where can we get health professionals who have been trained or can be quickly trained to address the shortage we face?” Our country has repeatedly faced similar challenges in healthcare and numerous other professions since it was founded and has invariably found the solution outside its borders.When its army needed instruction in modern combat techniques and engineering, it relied on German, Polish, and French military professionals, including von Steuben, Pulaski, Kosciusko, and Lafayette. To advance its electrical industry and infrastructure, it relied on Tesla, Steinmetz, and dozens of other European immigrants. To develop nuclear weapons, it harnessed the genius of a virtual army of Hungarian, Polish, and Italian physicists, including Szilard, Teller, Ulam, and Fermi. After World War II, our military brought as many of the engineers working on German rockets as they could find to the U.S. to deal with the imminent threat from the Soviet Union. Faced with crises, the U.S. has repeatedly turned to foreign sources of talent and manpower (or womanpower) to avert disaster.
And so, friends and neighbors, where can we turn for help? Where can we find thousands of healthcare professionals, desperate for work, eager to relocate to the United States, already trained to some extent in techniques and technologies adopted by the U.S.? The obvious answer is to rely on “…your tired, your poor, Your huddled masses yearning to breathe free.” Tens of thousands of people looking for work and safety are literally banging on the walls erected at the southern border, and many of these are precisely the individuals we need to improve our overwhelmed healthcare system. Integrating the nurses and doctors driven out of their homelands by the chaos of drug and human trafficking or by the instability of their governments may literally save our lives.
Even before the United States evolved from a British colony to a democratic nation, Americans have resisted the arrival of immigrants. The famously liberal Benjamin Franklin objected to the arrival of the “swarthy” Europeans from Italy, Spain, Germany, and Sweden (yes, Sweden) and asked, “Why should Pennsylvania, founded by the English, become a Colony of Aliens, who will shortly be so numerous as to Germanize us instead of our Anglifying them, and will never adopt our Language or Customs, any more than they can acquire our Complexion.” Necessity changes attitudes. A former President asked why we do not get more immigrants from Sweden, rather than from “shithole countries.” Perhaps the Swedes are still upset by Benjamin Franklin’s disdain of them.
The American government must change the structure and financing of American hospitals to avoid more Covid-era-type collapses. Recruiting doctors and nurses from the throngs of people at our borders is only one of many steps that must be adopted to assure adequate healthcare for us and our children. Eliminating price gouging by pharmaceutical and medical device manufacturers is an inevitable next step, and there are many additional measures that need to be taken to keep our healthcare system from permanently deteriorating. The remedies are within our reach. Perhaps our twenty-first century needs will motivate us to grasp them and to leave our eighteenth century prejudices behind.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.
