Nurses, not agents

Yoel Donchin, Haaretz, February 28, 2006

The area surrounding very important people who are protected by very young people, security guards, is called a "sterile zone" in professional lingo. I, who come from the operating room, look at sterile zones in a totally different way. Until recently, I never came in close proximity with those people who are in the apple of the state's eye and must be protected from all harm. However, in the last few weeks, they penetrated my sterile zone in the hospital, and I see them doing their wonderful work.

I am sure that experts on personal protection and experienced security officials know exactly how many people are needed to protect a senior figure, what the risks are and for which situations they must be prepared. I am convinced that without the communication devices affixed to the ear, weapons, fast cars, metal detectors and a suitable salary, it would be impossible to maintain a proper democracy.

I cannot specify how many people are generating a sterile field around the figure they are now protecting inside the hospital, since I do not want to damage, heaven forbid, the security of the person, the security of the state or the stability of the government.

Nonetheless, the number of nurses who treat patients in the intensive-care unit is not confidential, and neither is the number of nurses found at all times on the morning shift in the operating room, the number of nurses in the internal medicine ward in my hospital, or the ratio of nurses who keep premature babies alive in other hospitals compared with the patients they have. And these numbers need to be significantly increased.

I don't presume to determine the needs involved in protecting public figures, but I can say with certainty that the number of nurses in the intensive-care units who work alongside the security guards and are responsible for the lives of more than six patients is far smaller than the number of guards.

A series of significant articles has recently shown that the mortality and morbidity rates in a hospital are an outcome of the number of nurses on shift. The more nurses there are, the better the patients will be treated and the more the number of mistakes and the rate of complications will diminish. Statistics show that adding a single nurse to a ward is more valuable than adding sophisticated equipment. Due to budget constraints, which apparently do not affect our friends the security guards, who also protect the patients, nurses are forced to cope with tasks that are not normally part of the nursing field, such as answering telephones, cleaning, and serving as messengers when there is a need to bring medication.

It has been found that nurses are interrupted between five and 10 times while carrying out a single action, such as preparing medication for distribution. In addition, stringent safety requirements demand that two nurses sign off on calculations of medication dosages and approve giving a unit of blood before the transfusion begins. Instead of increasing safety, however, these requirements decrease it by providing additional distractions. Nurses in hospitals have a very heavy workload, and many of them burn out and leave for less demanding jobs.

Despite my lack of knowledge about protecting public figures, I am not so certain that the large number of people surrounding the figure in question indicates an ability to protect him. One can deduce from history and from successful assassinations of heads of state (including the murder of a prime minister by a security guard) that leaders who espoused peace paid with their lives, even when they were surrounded by a sterile, clean and unrestricted zone. But who dares to say that the emperor has no clothes?

The large number of security guards and small number of nurses, the means available to the authorities and those unavailable to the wearers of white coats, indicate more than anything else what the priorities are of those who allot enormous resources on one hand, and prepare reduced health baskets on the other. But personal security and democracy are the outcome, not of the number of security guards, but of the number of nurses.

The writer is an anesthesiology expert at Hadassah University Hospital.

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