Planning our future and outsourcing

[Mudwoman]

First it was manufacturing, then IT jobs and next it may be us, and so this post is my attempt to make us think about our futures and brainstorm and maybe think outside the box to come up with new ideas.

The US health care system is in shambles. We now lag behind 36 countries in overall health system performance ranging from infant mortality to adult mortality to life expectancy. The maternal death rate in NYC is over 20%. Smaller companies like Blue Ridge Paper Co in North Carolina that are essentially self insured for their 2000 employees is sending employees to India and Thailand for medical proceedures. Open Heart in New Delhi, India at the world class Apollo Hospital is $6500 plus airfare that can be found for as little as $700 if booked in advance. The cost in the US is an average of $60K. The patient/nurse ratio in India is 1 to 1 and they only employ RN's.

This is all new thinking, but what happens when a large company like General Motors or Citibank hops on this bandwagon? 350,000 Americans are now going out of the country for surgical proceedures. 44 million Americans are without healthcare insurance, and Congress has passed laws that you can no longer file bankruptcy to get rid of your medical expenses. 70% of medical expenses are incurred the last decade of life. The oldest of 77 million Babyboomers just turned 60.

So, if this trend continues, where does that leave us and what can we do to make ourselves more marketable? How do we redefine nursing employment? Obviously, there will still be a demand for emergency care and emergency surgery and chronic care to some extent. But what about caps on medicare spending for chronic care---then what will people do.

I wish I had a crystal ball, but alas I don't. I'm seeing more and more part-time and seasonal contract work in the paper. I'm seeing less and less "benefits" Will we first be outsourced to a nursing agency the way payroll services were outsourced----so we won't work for Healthy Hospital or Old Age Home, but rather ABC Nursing Agency. Will we all become contract labor? Will we bid jobs?

This will be a time of great turmoil and also great opportunities. I want to concentrate on the opportunities. What are your ideas??????

[nerdtonurse?, BSN, RN]

Like some of the other posters, I'm coming from an IT background. IT used to be a fun, challenging field, and I've been trying to determine why that changed. When it was still fun, nerds like me were managed by other nerds, and we had, if not respect, at least the attention of mangement. When we told them what would work, they would take that into account. They might say no, but they'd treat us like we knew what we were talking about...

Then the MBAs came....

I have sat in meetings where we've done 3 solid months of testing to determine the best way to accomplish something, down to software, hardware, telcom, everything, only to have an MBA who can't spell IT say, "well, I was reading in an article that you could do it THIS way...." And yup, we'd be trying to implement something that we knew from the start would never work because the database physically couldn't pass the instructions as fast as the requirements called for, or we couldn't get a 10BaseT nic to handle the thruput of a GBnic card....:trout:

I'm just really, really hoping that the day to day supervision of nurses stays in the hands of other nurses. If they change the rules so that LPNs, RNs, etc. can report to MBAs, then that's it, and nursing is doomed....

[mvanz9999, RN]

Like some of the other posters, I'm coming from an IT background. IT used to be a fun, challenging field, and I've been trying to determine why that changed. .....

Then the MBAs came....

I have sat in meetings where we've done 3 solid months of testing to determine the best way to accomplish something, down to software, hardware, telcom, everything, only to have an MBA who can't spell IT say, "well, I was reading in an article that you could do it THIS way...." And yup, we'd be trying to implement something that we knew from the start would never work ......

Wow. This is a well constructed statement. It's EXACTLY what happened. MBA's come in and say "NO, we're doing it this way" and we are left to clean up the mess that we knew would occur if it was done this way to begin with.

My huge concern is that nursing is going to end up exactly like IT. You're going to get a bunch of MBAs that have never spent a single day doing anything remotely nurse-like, essentially making the field a living hell. Added to the fact that many jobs are cut due to funding (it's a little hard to outsource nursing per se...).

So how are you dealing with the though that there may, one day in the non-too distant future, a glut of nurses, and a lack of well-paying jobs (with benefits)? I don't want to repeat this whole fiasco again.

[Mudwoman]

In the late 1990's no one would have thought that IT would be outsourced the way it was. There are lots of people on this board that may read this thread and think we are all crazy and this could never happen, but I truly believe that in 10-15 years we will have HALF the hospitals in operation as we do today. Congress passed laws that went into effect January 2006 that elderly can no longer put assets into their children's names to avoid liquidating those assets to go to a nursing home. Given possible economic scenarios in this country in the future, the kids may decide to take care of dear old mom or dad to keep the assets from going to the government piggy bank. Law suits may be another demise of the nursing homes as we know them.

No insurance

No money

No heroic healthcare

Fewer nurses

The nurses that survive will be the cream of the crop. Well educated. Certified. Experienced.

[HARRN2b]

This all worries me as I have the same thoughts. However, I cannot imagine going to med school today and have all those loans with an unknown as to how to pay back the loans. The future of healthcare is in dire straights.

Actually, and this is only my opinion, this country is in dire straights. We are spending far more than we can ever afford in Iraq, we are still dependent on foreign oil and all of our products are outsourced. What if there were to be some world calamity and we needed medical products but the products were made overseas? What if we had used the dollars spent on the war in Iraq to help our own citizens? Americans, please wake up!!!!!

[mvanz9999, RN]

So how do we counter this? As nurses, nurses-to-be? How do we protect our jobs and maximize both opportunities and compensation?

Because I'm a victim of the IT debacle, I have no interested in making myself a second victim by spending more money to become a nurse, to have better job prospects, only to have nursing turn into today's IT.

I have no doubt that what Mudwoman is saying is not only possible, but very likely. Is there anything we can do to assure that we will have jobs?

[HARRN2b]

We need to have politicians who protect our own interests on the homefront. That is the bottom line. Do you own due diligence and vote them out if you do not like what is going on. If you are happy with the way things are then keep them in. Simple.

[mvanz9999, RN]

I don't believe it works that way, nor do I believe the US has a true democracy. Every 4 years we have an election, and it essentially comes down to voting for dumb and dumber. It's not voting for who you support, rather it's voting for who is the least evil.

I can go vote myself into a frenzie, but it doesn't seem to do much good.

[canoehead, BSN, RN]

The maternal death rate in NYC is over 20%.

I don't think so.

We have a shortage of nurses that want to work in the curent system. My priority would be to improve the system before I'd try finding new work to do.

[nurse4theplanet, RN]

The nurses that survive will be the cream of the crop. Well educated. Certified. Experienced.

Do you believe so? I would think that the nurses at 'the top' would be the cream of the crop, but your floor nurses would be 'cheap labor'...nurses willing to work for the lowest amount of money. It seems to me an oversupply would lower wages, forcing the more experienced to become frustrated and choose other avenues...just thinking outloud...

[nurse4theplanet, RN]

We need to have politicians who protect our own interests on the homefront. That is the bottom line. Do you own due diligence and vote them out if you do not like what is going on. If you are happy with the way things are then keep them in. Simple.

At a local level, this may be effective. However, at a federal level...not simple at all. Too many interests involved. If you want YOUR law passed, you have to agree to other laws being passed which you would otherwise vote against. Its a dirty business. The further up these lawmakers get, the smaller their voice becomes, and the more they are exposed to corruption. They either become part of the political Machine or are destroyed by it. Money is the driving force of federal politics and if there is no money to be made in healthcare.....you might as well hang up this pipe dream

[Mudwoman]

I don't think so.

We have a shortage of nurses that want to work in the curent system. My priority would be to improve the system before I'd try finding new work to do.

You are right that I got the % wrong. Had the 22.9 deaths in my head and just put the % on there. Still a staggering statistic.

October 2006 American Journal of Nursing. Pg 19. A Worrisome Maternal Mortality Rate in New York State.

Healthy People 2010 goal: 3.3 deaths per 100,000 live births

Avg US rate: 8.9 deaths per 100,000 live births

New York State rate: 12.8 deaths per 100,000 live births

New York City rate: 22.9 deaths per 100,000 live births.

Read the report from the Safe Motherhood Initiative

http://mail.ny.acog.org/website/SafeMotherhoodrev.pdf

[Mudwoman]

This all worries me as I have the same thoughts. However, I cannot imagine going to med school today and have all those loans with an unknown as to how to pay back the loans. The future of healthcare is in dire straights.

Actually, and this is only my opinion, this country is in dire straights. We are spending far more than we can ever afford in Iraq, we are still dependent on foreign oil and all of our products are outsourced. What if there were to be some world calamity and we needed medical products but the products were made overseas? What if we had used the dollars spent on the war in Iraq to help our own citizens? Americans, please wake up!!!!!

Interesting that you talked about medical supplies and products. I kept ordering IBU the other day from the pharmacy and couldn't get any and we were out. I called and the Pharmacist told me they were having trouble getting it. So what's up???? Drugs like Tylenol and Advil are no longer made in the good old USA. Outsourced because it is cheaper. I don't know how true this is as I have not looked into it further, but don't have reason to believe he would lie.