One of my most memorable experiences was more than a decade ago while working for a level one trauma center on the East Coast. I was sitting in a hospital break room during one of my breaks as an inventory coordinator when a nurse walked in. I simply asked how her day was going, and she fell into the chair next to me crying.

Surprised by her reaction, I asked, “What’s going on?” She replied, “I just lost my third patient today.”

The impact of her personal experience stuck with me. Even now, looking back, I can’t help but think how difficult a day it must have been for her. Until that moment, my only experience with nursing had been as a patient.

Seriously injured while serving on active duty it was a nurse who saw me first, and it was a nurse who discharged me from the hospital. It was a nurse who was responsible for all of my care. Like an air traffic controller, it was a nurse who coordinated my care as well as the care of many others.

What I didn’t know at the time, but more than a decade later I would learn: the most overwhelming parts of nursing are the constant system failures. More than 30 percent of nursing time is spent hunting, fetching and clarifying work not patient care. This is not the cause of any one person or processes patient care has just evolved this way over time.

Fast forward more than decade and those experiences of stress and disappointment still exist for nurses. The reality here is that health care organizations/hospitals (HCOs) function in a way that requires nurses to focus more of their limited time and attention diagnosing systems needs rather than focusing on patients care. Nurses scrambling for linen, supplies, equipment or waiting to clarify a medication prescription are just a few examples. It’s all the unrelated system needs and its failures, not patient care, that adds real cost.

Overburdened, a single nurse could be caring for as many as five to six patients struggling in a system that’s failing him/her. In recent years, the cost of health care has gotten a great deal of attention and with good reason. Between 2000 and 2007 health care spending grew at nearly six percent per year, a much steadier growth rate than inflation or wage growth.

Future health care costs have even been a security concern — increases in health care spending are and will increasingly take money away from military readiness. Many scandalous stories about the costs of health care have been told. And while we share Americans’ outrage at the cost of health care, there is some good news on the cost front: health care spending has been leveling off in recent years.

Progress on the cost of health care notwithstanding, there is a serious scandal in health care — the toll that health care takes on the people who deliver it. The burdens of regulation, cost reductions, and quality initiatives piled onto nurses and other clinicians are undeniable. The biggest current and future risk to health care is shortages of nurses and doctors.

Especially in nursing, there is growing evidence that the job people are asked to do is unreasonable and consequently moving people out of the profession; emerging shortages are weighing down further the workload and feasibility of already overworked doctors and nurses. In a recent study of forty hospital units, more than one-third of nurses reported they intended to leave their position within the next year; citing emotional exhaustion and lack of personal accomplishment, two key indicators of nurse burnout.

And as growing evidence has shown, nurse burnout dramatically influences how satisfied patients are with their care. The performance of nurses and their impact on quality is determined by many factors. In the end, though, all research on the quality of nursing care either concludes the absolute necessity of support departments providing nurses with what they need, or assumes that these departments will do so.

Put another way, treating nurses as customers is at the heart of all work on the quality of patient care by nurses. Efficiency — how hospitals must operate — will loom large as the Affordable Care Act is rolled out and sequestration cuts continue. Efficiency will equal profitability; without it continued financial pressures will mount. Leaving only two choices for hospitals: open or closed.

Colin Baird is the author of The Scandal of Healthcare: Nurses, Waste & Customer Service.

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