In anticipation of the Affordable Care Act, hospitals and insurance companies nationwide have begun to cut back services. In California, Kaiser nurses recently reported that "over the last year, Kaiser has been making it harder for patients to be admitted for hospital care when sick or injured, and is sending patients home when they should still be under hospital care" (National Nurses United, Oct. 2013).

Another key local example is Sutter's new Santa Rosa hospital, which will have reduced inpatient capacity from its current level. Now we learn that our hospital, Palm Drive, is following suit by reducing the number of beds from 37 to 14 (Press Democrat, Nov. 24). As West County nurses, we wish to express concern over these decisions and ask you to question what a hospital is for?

Considering our growing population with its aging demographics, it is vital to reflect on the effects of hospital restructuring. Healthcare experts and hospital officials alike cite many factors in this "national trend": further drops in Medicare and insurer reimbursements, declining inpatient admissions with increasing outpatient services, and "competition." They also acknowledge "uncertainty" surrounding Obamacare, so it appears restructuring plans are evolving around unknowns.

We question whether the restructuring may be precipitous and how it may impact patient safety. With beds and services reduced, where will we bed the acutely ill? Will decisions in hospital stays be guided by sound clinical judgment over profit? What care can properly be managed in outpatient settings? If beds are pre-scheduled for surgical patients, what criteria will be used for admissions in remaining beds? Who or what will determine who gets admitted vs. transported, possibly great distances? What exactly do insurers mean when they speak of "more choices" and what do hospitals mean when proclaiming "excellent patient care"?

Hoping to raise awareness and promote discourse, we encourage all to ask these same questions. Our choice to work at Palm Drive is driven by our commitment to community, and as community nurses, we are first and foremost patient advocates. We believe equal access to health care is the right of every individual.

Debra Hurst, John Finnigan and Andrea Baker are RNs at Palm Drive Hospital in Sebastopol.

Open Mic is a weekly op/ed feature in the Bohemian. To have your topical essay of 350 words considered for print, write openmic@bohemian.com.

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