While driving, I listen to “talk radio,” since I generally find talk more informative than music. The other day, I heard an ad for one of those get-rich-without-working schemes, complete with phony testimonials, on how to make big money on the Internet selling products that you never see, feel, touch, smell, store, pack, ship, or even own. “You can quit your regular job … make $100K the first month … the computer does everything … make money even as you sleep … let the professionals teach you their secrets … sign up for the course … created by a team of professionals … call now!”
Ah so, I said to myself, now even scam artists consider themselves professionals.
On second thought, I reflected, why not? Why can’t scam artists call themselves professionals, when so many professionals are also scam artists? There are, after all, doctors who ping-pong consults; who run Medicaid mills; who do unnecessary tests and procedures; who sell false testimony as expert witnesses; who run up charges for injured plaintiffs; who justify claims rejections for insurance companies; who take kickbacks. There are lawyers who suborn perjury; who abet class-action suits for self-enrichment; who use junk science to win liability claims; who sue frivolously; who prosecute despite extenuating evidence; who impanel grand juries for political payback; who pad their bills with exorbitant hourly fees; who accept referral fees which are nothing but kickbacks. There are clergy who preach politics and racism from the pulpit; who extort donations from corporations; who sexually abuse altar boys; who teach the killing of innocents and unbelievers; who run massive businesses supported by donations from the poor and gullible; who give lip service to poverty while adopting lifestyles of the rich and famous.
Being a professional doesn’t prevent one from going to the dark side.
In the beginning, there were only three professions: medicine, law, and the clergy. What these prototypical professions had in common was arcane knowledge, long and rigorous training, restricted entry, high ethical and performance standards, autonomy, self governance, self policing, and dedication to the service of others. Being a professional—a doctor, lawyer, or priest/minister/rabbi—brought prestige, respect, trust, and financial security but not wealth.
Eventually, the term professional came to include others such as teachers, nurses, social workers, accountants, dentists, pharmacists, architects, engineers, and the military. These professions shared many of the characteristics of the prototypical three.
Today, we have professional shoppers, models, landscapers, musicians, gamblers, and wrestlers. We have professional golf, tennis, baseball, football, basketball, and hockey; in fact, almost any sport you can name has its professional version. Obviously, the meaning of the term has changed with time, and the distinction between profession and occupation has blurred. In a way, if calling oneself a professional promotes pride in one’s work, higher standards, and better performance, it may be for the good.
Most young people who go into medicine, nursing, or social service don’t do it for the money. Find out more on this website. They do it for altruistic reasons, such as to heal the sick or to help those in need. If they eventually work in long term care, they will find that there is often a conflict between the primary service goal of their professions, and the primary profit goal of the long term care business. Nonprofits are no better than for-profits in this regard. They may not show operating profits and losses on their balance sheets; they show operating gains and deficits. It’s just a matter of semantics. In fact, nonprofits are more profitable than for-profits. They have the competitive advantage of being tax exempt and, as charitable organizations, they may raise funds through affiliated foundations and ladies’ auxiliaries, solicit bequests, and use the labor of volunteers at the lower than minimum wage of $0.00/hour. Since they cannot show a profit, any potential gains after operating costs go to executive compensation and the fees of consultants and attorneys.
A former director of nursing I know—she is now out of long term care and working again as a hospital nurse—once worked as the DON for a large long term care facility that was a short distance from an esteemed medical center. This LTC facility was new and modern, owned by a real estate developer, and had relatively few long term residents. It was effectively one big subacute unit. Its subacute patients all came from the nearby medical center, which prided itself on its short length of stay, perhaps the shortest in the state. The medical center achieved this dubious statistic by discharging patients to home or to subacute units “too quick, too sick.”
The director of nursing found herself, with the staff and support services of a nursing home, responsible for the care of medically unstable patients. Many had to be sent back to the hospital shortly after admission. Pre-admission screening of photocopied records did not help; the patients were more stable on paper than they were in reality. She complained first to the administrator of the nursing home, and then to the owner, and was ordered to continue accepting those patients, whatever their condition. She felt that her professional standards and her nursing license were in jeopardy, and she resigned.
Admittedly, this is an extreme example. Very few hospitals are so relentless in their pursuit of the short length of stay, or so flagrant in their disregard of patient welfare. Most long term care facilities have around 10-20% subacute patients, and are not subacute factories with 80-90% subacutes like this facility. When there are several nursing homes competing for the same pool of subacute patients, however, even those with smaller subacute units will be tempted to admit patients who are sicker than they can adequately handle.
Whenever staffing or admission policies compromise patient care, directors of nursing face serious professional challenges. Most will rationalize by telling themselves that it would be no different elsewhere. Given the high turnover rate of RNs and DONs, it is likely that they have already worked in other facilities as staff nurses, supervisors, or DONs; they know from previous experience that this is sadly true .