The whole world watched the saga unfold during the height of the pandemic: Nurses bending over intubated patients, sleeping in hallways after days of work with no break, holding hands and phones as dying patients said their final good-byes to loved ones.
I saw the saga myself, as my son, an emergency room nurse, shared stories from the back porch because he — and countless others — chose to quarantine outdoors during the worst of the COVID-19 surges, living in his truck to protect his family. The relentless grind took a physical and emotional toll on nurses, who are now leaving their jobs in historic numbers.
As a result, America is experiencing an unprecedented crisis in health care delivery. It’s a crisis we can solve.
Some nurses have left their hospital jobs for better pay through lucrative travel nursing assignments. That’s led to charges that nurses and the agencies they work for are exploiting a bad situation to cash in at the expense of desperate hospital systems.
But here’s the real problem: Our “health” care system is, in reality, a “sick” care system, in which underpaid nurses work under extreme conditions, with workloads and patient acuity (a measure of the severity of a person’s illness or medical condition) increasing while staffing decreases.
Our current “sick care” system was constructed to react to illness, with hospitals vying for the business (and insurance payments) of those who suffer from acute and chronic conditions. People with insurance and proximity have access to the best care and thus the highest likelihood of recovery and survival.
But in 2020, 28 million Americans — nearly 9% — did not have insurance coverage and thus, no access to care. Without access, people ignore or neglect health issues. Conditions worsen and become more difficult to treat. People entering hospitals are sicker and need more advanced nursing care and more costly hospital stays.
The result: poor outcomes.
Partners in Health
A better system — one that Chicago can replicate — has already proven powerfully successful in developing areas of the world for over 30 years.
It was created by the late Paul Farmer, who believed that health care is a universal human right and founded the international nonprofit Partners in Health. His approach emphasizes primary care provided by a workforce of nurses and local community health workers, in partnerships with local government agencies, philanthropic leaders, and businesses.
Nurses, trained in primary care and health promotion, are perfectly prepared to change this paradigm. Sheila Davis, the current CEO of Partners in Health, is a nurse. And health outcomes improve when nurses use their primary-care skills to their full potential.
Chicago can replicate this model, in communities that are in real need of better access to true health care.
The infrastructure is already available, in some of the 50 schools that still remain vacant after being closed in 2013 by then-Mayor Rahm Emanuel, most on the South and West Side. This past June, Planning and Development Commissioner Maurice Cox said that repurposing the closed schools was “one of the biggest opportunities yet to be tapped”...to revive these predominantly Black neighborhoods.
Imagine a true health care system that uses this available infrastructure, becoming a place where residents can access primary care in their own neighborhoods. A place where the closed schools can be used for education again — for health education, and to teach cohorts of community health workers who can then go out into their communities to support their friends, neighbors and families with health information and care.
Imagine a place where residents can have access to healthy food, through farmer’s markets, and safe places to exercise. Imagine all of the social determinants of health that could be addressed by repurposing these schools into hubs for health.
The stark health disparities revealed once again by the COVID-19 pandemic clearly show that there are gaps in our “sick care” system. We can do better, and we need to do better.
With modest economic investments and a new dedication to primary, community care, skilled nursing professionals can recreate a system that allows access for all and transforms “sick care” back into health care.
Yasmin Cavenagh, DNP, MPH, RN is an assistant professor in the department of Women, Children and Family Nursing at Rush University and holds a faculty practice role in Family Connects, an international program that provides community-based care to postpartum mothers and their babies. Cavenagh is a Public Voices Fellow of the OpEd Project.
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