Editor’s note: This article was initially published in The Daily Gazette, Swarthmore’s online, daily newspaper founded in Fall 1996. As of Fall 2018, the DG has merged with The Phoenix. See the about page to read more about the DG.
Director of Worth Health Center Beth Kotarski caused some panic among RAs when she announced at RA training that from now on, there will be only two students allowed in Worth overnight. In an interview with the Gazette, Kotarski clarified her meaning: “it’s a medical protocol… the RN will make an individual judgment on each case and keep only those students that fit the criteria for one RN to care for.”
In an interview with the Gazette, Kotarski clarified that “this is no change from what the nurses have always done,” the only difference being that the policy is now written down and formalized. “There was a sense that Worth was a big place that could envelop all the students who might need help… it was expected that whoever was in the building could keep an eye on everyone… but one nurse and three people in critical condition, how do you do that safely? You can’t.”
This means that if students who are “medically unstable” come in, “we have to send them to the emergency room.” Although students may be concerned that the police will get involved in an emergency room visit, Kotarski stressed that “people don’t realize the danger of alcohol poisoning… the student’s responsibility needs to be getting a student here in a safe manner. Leave the medical assessment to the nurses.” She added that “peer schools don’t even handle the problem… with nobody in health services overnight, everyone gets sent to the emergency room no matter what their condition.”
The policy of allowing nurses to make the judgment about how many students they can safely care for is about protecting students but also about protecting nurses. “The first weekend I worked here there was an incident… there were three students overnight, but one nurse in the building with two hands and two eyes. She told me the next day that she wouldn’t work weekends anymore… if something happened, she could have lost her license, and this was her livelihood.” Kotarski continued, “It’s impossible and incredibly unfair to put all the responsibility on one weekend nurse… now that this is formalized, it’s OK for a nurse to say ‘I can’t handle this.'”
In the past, sometimes nurses who felt that they weren’t allowed to send students to the hospital would “deputize students to be RNs and watch over their friends… I’m not comfortable with using students to be nursing staff.”
Kotarski also wanted to stress that this policy will probably rarely be put into use. “Even the biggest party night at this school, there is rarely more than one medically unstable student admitted.” Over the past academic year, there were a total of 40 admissions overnight. When students do enter critical condition, it’s almost always because of binge drinking, said Kotarski.
“Alcohol is not something to fool around with,” Kotarski stated. “It’s a serious problem, and the binge drinking is one problem that the incredibly smart and committed students of Swarthmore should take on and try to solve for the good of the whole community.”
Since I was at the RA training meeting with Beth Kotarski, I’d like to add a little bit more clarification about her viewpoint as I saw it at the meeting. When she talks about how dangerous alcohol poisoning is, she’s talking about not wanting students to die. If one person has serious alcohol poisoning, or if things get so busy that not everyone can be taken care of properly, Worth calls the ER so that people don’t die.
In my opinion and in my personal experiences, one of the downright best things about Worth Health Center was precisely that notion of, “whatever happens, we’re here for you 24/7.” Although I realize that such a notion needs to be formalized for precisely the reasons mentioned in the article above, I believe it would be terrible if in the process the student body also lost that sense of assurance.
There’s something quite distinctive between, “whatever happens, we’re here for you,” and, “whatever happens, the ER/hospital is there for you.” Psychologically speaking, it’s far more comforting and relaxing, and it makes you feel more a member of a community rather than just ‘another patient’. I hope that, however the policy is worded, the College and Health Center will not lose that ‘human touch’.
Lastly, I’d like to voice my opinion that I don’t believe the fact that “peer schools” immediately send their students to the ER should really affect how our policies are designed here: when I heard from my old high school friends about how their Health Centers are run, it made me value Worth Health Center and the “we’re there for you” feeling even more. Of course, this is said acknowledging that sometimes the ER is without a doubt the right choice.
Just my two cents.
-S
While I understand the concern in having students watch over their sick (extremely drunk) friends and essentially acting as nurses, I have been in this role and I felt that it was a very good way of handling the situation. A good friend of mine was extremely inebriated, my friends and I called public safety and were escorted to Worth, and upon seeing the state that my friend was in the nurse (who was calm, professional, and very effective) decided that as long as I could stay with her for about an hour and she stabilized and fell asleep safely, that she could stay the night; otherwise the nurse alone couldn’t look after her and the other students. I was able to provide that constant supervision necessary while the nurse took care of other things in Worth and she knew that if anything were to happen I would alert her immediately. While this would clearly not be a viable option in cases of alcohol poisoning, it is a much better alternative for students who have – for whatever reason – consumed too much alcohol and need increased supervision overnight but that do not need to go to the emergency room.
Blood alcohol levels can keep rising, and even if a friend is asleep, the level may still be going up, leading to respiratory failure. The advantage of a hospital is that blood levels can be followed, and treament such as IV fluids and oxygen can be initiated, along with cardiac, respiratory and pulseoximeter monitoring.
Just watching another student, as comforting as that may be, cannot substitute for this type of care. It is ultimately the responsibility of the student to not reach that level of intoxication that can potentially do such harm to the body and mind.
Requesting that a health service nurse with rudimentary monitoring equipment become a substitute for a hospital is a lot to ask a health care professonal, as this is a medical problem, akin to drug overdoses.
Too much intake of alcohol or drugs obviously can do much damage and require immediate resusitative measures. This is best provided in an ER setting, which is why most college facilities would send students there for evaluation, observation and treatment as needed.