A Fractured Fairy Tale
Health care fable questions likelihood of storybook ending for nurses

By Sandra Moore, RN
January 30, 2002

Once upon a time, there was a kingdom. The kingdom had a king (naturally), his courtiers, who made regulations, and a treasurer, who paid out money.

In this kingdom, all households had a head of household, a caretaker and a lot of children of various ages. Heads of households could be of more than one household, but every household had a caretaker. If there were not a lot of children, then the household went kaput. Sometimes, a large household took over another large household, but that's for another fable.

Heads of households and caretakers were specially educated, with more years required for the former. Many years ago, caretakers had no education and came off the street. Strangely, when it first was suggested that they have special education, many heads of households were opposed.

They preferred to be known as head deities and were opposed to the education of caretakers for religious reasons, as they believed it broke the First Commandment. (You will worship no God but me and me only will you serve.)

Most caretakers were female and most heads of households were male, although it could be the other way around. More females were choosing to be heads of households than were males choosing to be caretakers, however.

Caretakers were responsible for everything going smoothly in the household and for all the children's care. The head of household was to decide on each child's care and the caretaker was to carry out these decisions.

If the caretaker didn't think a decision was good for a particular child, there might be a discussion with the head of household, but only if the head of household was open to any other opinions and this varied quite a lot. (Heads of households, on the whole, did not like discussions.)

If a decision by a head of household proved to be wrong and not good for a child, the caretaker also was held responsible by the king and courtiers for not talking the head of household out of it.

The head of household went from household to household making decisions, so all the caretaking was done by the caretaker, who was also obligated to carry out all the head of household's decisions.

For example, if the head of household decided a child should dance, the caretaker was to find a dance school, arrange lessons, provide shoes and leotards, and did not have the option to tell the head of household that it was mealtime, that the children were all crying and that it was too busy right now.

The caretaker also was responsible for recording everything that happened in the household, so that the head of household knew decisions were implemented, the courtiers knew regulations were followed and the treasurer knew if any money had to be paid out.

For instance, if a child fell and scraped a knee, the caretaker was to wash the knee, bandage it, comfort the child and record it in detail, so the head of household knew the instructions for scrapes were done, the courtiers knew the regulations for knees were followed and the treasurer could decide if a Band-Aid would be paid for.

The record-keeping made it difficult to spend any time in comforting, which made the caretakers and the children unhappy. It seemed to the caretakers that the courtiers were not as interested in the regulations being followed as they were in them being recorded nicely.

Some caretakers had more education, and they were usually in the neighborhood clubhouse having meetings to decide how the caretakers could best fulfill all their obligations and that all the regulations were followed. They were called managers.

At one time, managers spent time in households seeing how things could be best managed, but the king and court decided managers must stay in the clubhouse and have meetings and decide how the caretakers were to carry out their caretaking. It also kept them very busy keeping up with all the regulations and changes and telling the caretakers about them.

Usually, they decided that more record-keeping was the best solution. Some managers were unhappy with this arrangement, but some quite liked it this way; they didn't have to be around the children, who often were careless with body secretions.

Caretakers had other caretakers to relieve them for rest periods, but if there was no one to relieve them, they couldn't leave the house unattended. This began to happen more as many caretakers got old and not many people were going to caretaker school.

The caretakers who were still caretaking got very tired and felt that having so little say in how they did caretaking and all the record-keeping were getting pretty silly. So they left.

The end.