[imenid37]

If they want nursing and medicine to document out the wazoo and do all of the preventatory interventions, then they better start the cloning process. The RN's in med-surg at my hospital have 10, yes 10, 10!!! patients to whom they are assigned. Often they have an LPN to help with meds, but not always. How do these two nurses get to know all TEN patients and prevent every possible complication when they are assigned to TEN high acuity patients? Where are we supposed to get more nurses in a timely mannner where we could reasonably address some of these directives as they take effect? I am afraid that these govt. providers and private insurers (who always follow Medicare) will bankrupt us when they refuse to reimburse and cripple the system even further. What about complications in patients who refuse to co-operate with their tx plan or those who by virtue of their extreme obesity, substance abuse, etc. are naturally at a high risk for complications? What these directives ask for is difficult to comlpy with if there is optimal staffing. With the typically poor staffing in many facilities, it is nearly impossible. We should let elves or garden gnomes run the govt. They couldn't do a worse job than what we have now.

[CountyRat]

Complications are the result of the patient being sick. The sicker the patient is, the more likely he or she will suffer complications. This has been a known truth in medicine since before Hippocrates first sharpened a pencil. The solution is to treat the complication, not stigmatize the provider who is rendering care.

Let's reason this out together. You receive an elderly, obese female with Type 1 DM; poorly controled. She is dying. She needs surgery. NOW! She is a lousy surgical candidate, but, oh gee, there is that "she is dying" thing so, hi-ho and away we go, off to the OR. Guess what? The physiological stress of disease, plus the added stress of surgery (surgery is, after all, controlled trauma) makes hyperglycemia a virtual inevitability. Control with insulin will be initiated, but will be achieved slowly, and with great difficulty, and yes, some danger to the patient. Doctor's fault? Nurse's fault? No. Diabetes' fault. That's one of the reasons its such a crummy disease, but I digress.

A week has passed. You have achieved marginal glucose control. Happy days ahead? Hell no! Hyperglycemia bungles the immune system. Doctor's fault? Nurse's fault? No, no one's fault. Just a fact of mamilian physiology that we are stuck with (unless CMS crafts a regulation changing mamilian physiology. Oh, sorry, another digression.) Now incissional sepsis is a virtual certainty. Gosh! There are two, yes TWO "never events" one hard upon the other! This is an outrage! What is the answer? Punish someone, or treat the infection? Medical tradition says, "treat the infection." CMS says, "punish someone." And in the process, create a disincentive to treat the patients who need the care of doctors and nurses the most!

It is not possible to regulate the laws of physiology away. The sickest people tend to get sicker before they get well (if they get well.) I am just a dumb nurse, but I do know stupid when I see it. This is stupid. This will hurt patients. START TELLING PEOPLE THAT CMS IS AN ASS THAT WILL GET THEM KILLED UNLESS THEY FIGHT BACK NOW!

On our next show, we will discuss JCAHO, and how their intrusions into clinical medicine and nursing (about which they know nothing) ensure that patients receive care that is significantly below the capabilities of providers. Stay tuned.

[interleukin]

Damn Well Said, Man!

[Ginger45]

Oh geezzz....this is getting out of control. I agree with RN 1980. What we are going to end up with is noone to take care of the pts. They need to focus more on increasing staffing ratios then fewer nurses would leave the hospital because they just can't deal with the stress. Infections happen, there is no perfect world. We are all human and running around like chickens with our heads cut off to get everything done.

Alot of these things are a risk that pt's are warned about prior to the procedures. This is nuts.

[Nurse4years]

Originally Posted by TiredMD

There's a saying among surgeons: if you're not having complications, you're not operating enough.

Complications are a reality of medical practice. Bad things sometimes happen despite our best efforts. That's why complications are not, in and of themselves, grounds for malpractice suits. That's why we warn patients of potential complications during informed consent.

Pretending like an iatrogenic pneumo or line sepsis should never happen is ridiculous.

This is just a bunch more reasons I won't be accepting Medicare/Medicaid patients once I'm in private practice.

Respectfully, would you list the other reasons?

[TiredMD]

Originally Posted by Nurse4years

Respectfully, would you list the other reasons?

Sure, although I can feel the flames rising as I write this

1) Reimbursement is terrible. Depending on your location, many medicaid patients are now money-losers, meaning it costs the physician more to see them in the office than they get back from the insurance company. I'm all about providing charity care, but not full time.

2) I don't want to deal with the paperwork.

3) The patients tend to be sicker and less pleasant to deal with.

4) Setting up your practice to file insurance claims is something you don't want to do unless you have to.

I recognize that, depending on my circumstances come private practice, I will likely have to take these patients initially. Once my base is settled though, I will stop taking them and strip them out of my practice as quickly as possible.

I think that cash-only practices are not only feasible, but also the way of the future. For a patient with private insurance, you can send them a bill, get your money, and let them deal with filing reimbursement. For Medicare/Medicaid, you cannot bill the patient in excess of what insurance will pay. What the hell kind of system is that? It's blackmail.

[Kelly_the_Great]

CountyRat, I LOVE YOUR MIND!!!

TiredMD, no flames from me! You're only verbalizing the reasons why government intrusion is limiting patients' access to quality care IMHO.

[mystcnurse]

Except doesn't medicare and medicaid lead the way for private insurance companies to do the same?

[TiredMD]

Originally Posted by mystcnurse

Except doesn't medicare and medicaid lead the way for private insurance companies to do the same?

Typically, yes. But the fact that physicians still make money off private insurance, while going broke on government insurance, means that there are still differences.

[mystcnurse]

I swere I'm not making a political statement here, at all. But, have you seen the movie "Sicko"? I just watched it, and I am very confused. Just want some other thoughts. Our system is severely messed up, I know, but can it ever be fixed?