Socialized Medicine/Nursing - page 3

Hi everyone. I am especially interested in how nurses are treated in the UK and Canada. I feel the US is moving more and more toward socialism, more taxes, more regulations, more government... Read More

  1. by   PPL
    Well, we all agree on something, and that seems to be that we all just want to practice nursing the way we believe it should be practiced; and for the reasons we all went into it in the first place. I am very curious though as to why the shift toward private health care is happening in your country, LRM. Enough people must be dissatisfied with the public system to want a private system, or what is the rationale? Thanks for joining the discussion.
  2. by   LRM
    Thanks PPL, good Q about the changes but it is very complex and I guess really just a factor of modern economic and society changes happening all round the world. There has been a trend for several years towards private health cover, especially as bunky said the resources available can be limited dependant on gov. funding & economic climate so the public system has had hard times. Also, capatalism has impacted on society, as everywhere, and the division of rich & poor is increasing with the better off wanting "better" health care options.

    However, only small Nos of people opted for private hence premiums are high & many folk refused to contibute as they already had medicare cover (manditory tax deductions). But now, the gov. has offered 30% rebates on health insurance premiums & other incentives which has encouraged more people to join. One incentive is that if you are under 30 years old and join by 30th June you will receive lower premiums for life so people are panicking and signing up in droves beleiving if they don't they will miss the "cheaper" premiums.

    The values of people have changed and its every person for themselves, which is no different from other Western societies. This is far too deep to get into (this is taking me back to the sociology subject we did for the nursing degree at uni) and unless we all opt to run off to Utopia, put our heads in the sand and join a commune (no offence to those in communes who probably don't possess computers anyway!)then we will have to live with these changes and strive to reduce hardships that arise between the haves & the have-nots.

    There is nothing wrong with making money & being successful, and having choices regarding health insurance. I believe that those that have more should help support those that don't but what I fear is that those that can't afford insurance will eventually be left in the cold because so much more money will be going towards the private health insurance companies and Medicare will be given less priority and suffer.

    Hopefully this won't happen in oz as mandatory tax deductions still exist but who knows what will happen down the line, will people evntually demand a tax refund because they have private insurance & don't "need" the public system. The USA system is also creeping in where private health companies deal with certain hospitals & may start to have some control over your health care, deciding what treatment you can & can't have for certain diagnosis. And ofcourse share holder profits will eventually take precedence to health care, so you see it is very complex & my brain hurts now, think I'll have a coffee break.
  3. by   snickers
    And now from a Canadian perspective....
    Bunky, you must have been in Canada a few years ago.....
    The healthcare situation has deteriorated also to the point of collapse here in B.C., and the situation is no better all across Canada.
    The federal government has cut transfer payments to the provinces all across the board. It used to be 50/50, back in the late 80,s and early 90's, now for instance in New Brunswick, the federal portion is 18cents and the province all the rest.
    All of the provinces are having trouble maintaining healthcare. Many hospitals have been closed all across the country, waiting lists are getting longer and longer, people are lined up, and spending days on stretchers in emergency departments.
    In the past couple of years, nurses all across the country have been out on strike, for money and conditions'
    The situation in B.C. is such that.....there are 26,000 R.N.s, the mean age of those nuses is 47 years old, there are 5000 nurses who,if they wished could exercise their retirement. Of the nurses, there are only 500 nurses, under the age of 25.!!!
    Alberta has brought in Bill 11, which is the implementation of private clinics, which will do surgical cases,and there has been such an uproar all across Canada, strangely enough the federal government has remained silent....
    All of the hospitals have now been amalgamated ito regional health boards all across the country, which in my view has created another layer of beuroracy(sp,)
    Ive been nusing in Canada for 25 years and I,ve never seen it as bad as this.
    In the city where I live (80.000 population) a place with 1 hospital....all the surgeons, anesthesiologists, internists have resigned their hospital priviledges, with the Gps set to go out this Thursday, hence, there is nothing but "life and limb" cases happening. This is the regional referral centre for the whole north of British Columbia. The docs are stiking cause they want better recruitment packages for the doctors.
    There are 10.000 people here with no physician......social medicine doesn"t work if there aren"t any docs.
    I'll save the bedside story for another post.
    I think you should savor the way it was when you were here Bunky.......
    .....it's that way no more.

    sj.
  4. by   bunky
    But snickers, what's the deal then in Ontario right now with London getting funding for doubling one of it's (many of them for 300,000 population)hospitals and the RN $7000 sign on bonuses going on in Toronto and Ottawa? And what about the Ontario gov't now putting a lot of money into their healthcare system?

    God don't tell me I'm wrong to come back to this as the hospitals I've spoken to in Ontario are telling me that they're spending a lot now to catch up.
  5. by   snickers
    Bunky;
    I can't speak to what is happening specifically in London or in some of the Toronto hospitals. I do know that the Premier of Ontario had made severe financial cuts to both education and health care. Maybe money is now being funnelled into Ontario healthcare.
    I would be inclined to get in touch with the college of nurses , or the union to find out more details.The hospital I work at is offering a 2000 dollar incentive to nurses to come and work. The money is amortized over 12 months, so it wouldn't surprise me if a place is offering 5000 dollars.
    I read in one of my magazines that nurses in Ontario are now making 30.00 dollars/hr.....after 9 years fulltime hours. That is the highest in Canada, I make 26.50 , maximum after 6years, here in B.C.
    There are no more diploma programs anywhere in Canada. All of the registered nursing associations want nurses to have their degrees, hence a 4 year university course to become a nurse, Most provinces have cut back on education funding so there are many less seats being put aside for nurses.Of course, the majority of nurses are diploma nurses, and do not have their degrees. Imagine 4 years university education, a 40,000 dollar student loan, to work shift work work and slug in out on the front lines of our floundering healthcare system!!!!!
    manitoba's premier is talking about vetoeing their rn association mandate for 4 year programme, and fast tracking nursing students.
    That is another problem that I see. In the 80's and the early 90's, there were nursing students everywhere. It was the students, whether they were 1-2-3-year nursing students who were everywhere within the hospital, taking care of a large number of the patients,.Those students of course are gone because we don't have many going in to nursing.
    I could go on and on......
    Bunky; do you know any nurses that work in Ontario, so you could get more relevant info? on the nursing situation in Ontario?
    I don't think that the hospital human resouces in London would be dishonest for the job offer. And....the rnao and ontario nurses union are there for you aswell...
    sj.
  6. by   PPL
    Gosh Bunky, Snickers post painted a bleak picture. Also, LRM is correct in mentioning just how complex this issue is; meanwhile, we're JUST TRYING TO DO THE JOB!!! I worked my ever lovin' butt off last night, but then made it all better by going for breakfast at Cracker Barrel with some co-workers. I have been following everybody's posts, and it is so interesting. I do not know how much worse it can get in the States, and feel strongly that for the dollars we're spending, we ought to be getting more bang for our buck, and more quality care for the patients. Snickers, please DO talk about the bedside aspect. What are you experiencing currently? Bunky believes there to be less paperwork and more opportunity to practice quality patient care in the Canadian system, but your post is frightening! Thanks to all!
  7. by   LRM
    Thanks PPL, at the end of the day we just have to work within the society & culture that we live in and do the best we can keeping our focus as pt advocate no matter our system. No one system is better or worse than the other, both have advantages & disadvantages but if all were the same wouldn't life be boring!

    When you say "you do not know how much worse it can get in the States" you can understand our fears down under where the USA system is encroaching. Corporations are arguing for a more efficient health care system whilst many fear the take over of profit margins. Why can't we learn from each other and take the best of both worlds?

    Again, this is a complex sociological problem and maybe we'll leave it to the sociologists to argue in depth. But if we stick to our own values & ethics we can make our patch for liveable.
  8. by   bunky
    Snickers yes there are diploma programs going on in Ontario! Sir Sanford Fleming College in Peterborough Ontario to name but one. I do keep in contact with former teachers there so I get a fairly accurate idea of what is going on. I am also aware that as of 2005 there will be no more hiring of diploma nurses in Canada. That is currently happening in some US States like North Dakota where there is a big push toward BSN.

    No one here makes $30/hr Snickers unless they work for an agency. I started in a hospital here at $13/hr here which is a joke! I now make a base pay of just over $16/hr so to me $30/hr or even your salary of $26+ sounds pretty good, even with the higher cost of living in Canada. I also get just over $100 off of each check every two weeks for health insurance where THEY tell me what doctor I can go to and I pay a co-pay for going to the doctor, and a drug plan that I pay $15 per prescription after I meet my $100 deductable, and if I or my children were to have a pre-existing condition that would cost them some money they may have refused me coverage!

    Please, for all of us, talk about the patient ratios you have, and PLEASE go into detail about the protocols on your unit for things like charting, and vital signs, how often they HAVE to be done, and discuss how your lab work is done, like are you having to get out the glucometer and check all of your diabetics, and how often they are checked. Tell us how many times in a day you have to transcribe new orders on a patient, and how many doctors on average are writing orders on one patient. How often are you printing new MARS and checking them? How many times do you have to drop everything and draw labs? And as for the actual working conditions, how many times do you go without a lunch break there or even your two fifteen minute breaks? How many of those do you actually have to skip? What happens if you do miss one of them? This is the meat and potatoes aspect of the working conditions that I want to get at. What are your benefits like there Snickers? How much do YOU have to pay for a prescription and how much do you pay for your drug benefit coverage? What about your dental benefits, and your vision benefits, how much do they cost you and how much do they cover?

    And let's talk about the patients themselves too, and how much time you spend actually in the room with them as opposed to writing about them, and transcribing orders, and following up on other departments making sure that RT, and PT, are following through on their part too? How many times do you have to leave the floor to run to the lab with specimens? Please tell all of us how many G-tube feeders you have on average each day? How many of your patients are basically corpses? How much time in your shift do you have to spend charting on each patient who has no changes, who isn't really going to have any changes, but is in an acute care bed anyway? What about the families attitudes in general? Keep in mind that there are those who you just can't please no matter what you do, but how do the families treat you there? How do the patients treat you overall?

    This is the area where I feel Canada has it hands down! Here in the US we try to simulate ICU units on a first aid stand budget and the nurses get pushed to the max to comply with standards set out by people who have never actually done this for a living, and demand that it all looks good on paper without any thought as to HOW it's done.

    I am most interested to hear your factual take on these issues Snickers. After we get your response, I am fairly certain PPL and others will compare it to working conditions, expectations, standards, and benefits here. PPL do you feel that they set unmeetable standards of care here, sometimes unnecessary standards of care here based more on fear of law suits than on need? Like they are used more as a documentation of proof rather than a diagnostic tool?

    Fire away guys! This is fascinating to me!
  9. by   PPL
    Yes Bunky! It is bordering on the ridiculous, the way we have to chart. I work in rehab, so we have CARF as well as the other bulls--t standards to meet. Our patients are not "near corpses" or whatever you called them that made me LOL, and they must make progress, or they don't meet rehab criteria, so it's bye-bye to nursing home. I just got a couple demerits for not charting my teaching, etc. I work the night shift, so I'm not waking people up to teach, but during toileting, am care, etc., we're doing teaching re mobility, safety measures, keytones, meds, pain scale/pain management, etc., and on and on. We have special teaching sheets, plus the regular charting, graphics, patient log and/or memory books, accu check controls, refrig book for 5 frigging refrigerators/freezers, plus get everyone up in AM that PT/OT is not dressing, and of course, they NEVER toilet, 'cause that's the nurse's job! On weekends, PT/OT never dresses/grooms, so it's all left to the nurses, since they won't get their asses outta bed and get into the hosp early enough. When you have two night nurses and an aid if you're lucky that comes in at 0600, a few TBI'S, several strokes, total hips and knees with CPM'S, several diabetics, you get the picture; BUT I HAVE TO BE SURE AND REMEMBER TO CHART MY TEACHING; IT'S NOT GOOD ENOUGH THAT I AM DOING IT WITH EVERY BREATH I TAKE AND EVERY MOVE I MAKE! The other night when I worked, I charted every single thing I taught, no matter how mundane, of course, this made me work an hour over, so overtime will be the next demerit. CAN YOU DIG IT? LRM is right, we just have to make the most of our little patch of the world, but in another post I said they set us up in an impossible situation, expect us to perform magic, then penalize us when it can't be done! Then they wonder about poor patient satisfaction survey. By the way, I had supper with my son, "The Real Bunky" as he calls himself now, since I told him about you. He is an engineer at a small plant, and of course is known as Bunky only to the family, and close friends, NOT at work. I hope Snickers and LRM will tell us a little about their bedside experiences in their systems. Nighty-night!
  10. by   bunky
    The other thing that I want Snickers to describe is the paperwork involved with an admission, and exactly what the nursing care plan entails on an admit, and the data base. See, the thing that I am getting at here is that while staffing may seem just as short there as it is here, the overall focus of the work is far different because the paperwork here that is CYA is insane. The standards of care guidlelines no matter what the prognosis is are unreasonable. This is what I am hoping that Snickers can shed some light on to illustrate what I am saying.

    Say HI to the "REAL BUNKY" for me!
  11. by   bunky
    The other thing that I want Snickers to describe is the paperwork involved with an admission, and exactly what the nursing care plan entails on an admit, and the data base. See, the thing that I am getting at here is that while staffing may seem just as short there as it is here, the overall focus of the work is far different because the paperwork here that is CYA is insane. The standards of care guidlelines no matter what the prognosis is are unreasonable. This is what I am hoping that Snickers can shed some light on to illustrate what I am saying.

    Say HI to the "REAL BUNKY" for me!
  12. by   LRM
    WOW, bunky & PPL you want to know a lot. My paper work experience is limited to EN work (=LPN)& student RN but we don't seem to have anywhere near the documentation you are describing in the states (abit scary!)

    On admission each pts nursing history needs to be completed (not full physical assessment, this has been done in ER or by resident MO).
    Nurses may decide to document allergies, medical & surgical Hx and basic obs, ect, & anything else that may impact on the pt's admission. The admission notes are brief. Most day-to-day documentation is completed on nursing care plan, planned & signed each shift by allocated RN & changed as needed (normally the plan continues the same from day-to-day dependent on the pt & is adjusted accordingly, eg: DAY 1: obs post-op, DAY 2: obs 4/24, DAY 3: obs TDS, this is adjusted by RNs evaluation, eg: afebrile, eating/drinking well, no Sx infection).
    Documentation in charts DOES NOT need to repeat what was done for or with the pt throughout the shift as the care plan is a legal doc & this is sufficient.
    Computer pt allocation is completed by each RN for their pt load & must correspond to care plan (for auditing) eg: if a point is given for pt education, then it must be written briefly on care plan what ed. was given for (meds, disease process, procedure).
    At least one chart entry (clinical notes)must be written per pt per 24 hr period (normally day shift as more happens) Obviously, extra notes are written if pt condition changes (eg : analgesic give, effect etc, meds changed)

    All other members of health care team use same clinical notes, so nurses, drs(residents, registrars, surgeons) plus therapists(physio, speech, occupational, dietician) all document together (gives a continuim & each can easily read what the other has written) Don't need to write "dr ordered..., or physio attended to pt.. as the drs & physiotherapists will document their visits in clinical notes for all to read.

    D/C notes are normally brief (meds given , apt times) however if a pt is going to have community nursing (eg: wound changes, hygeine assistance) or transfering to a nursing home/different hospital, more thorough D/C notes would be written for effective communication (cares required, mobility, community needs/problems)

    Basiclly I have found the documentation at ward level to be minimal, repetition is discouraged & waffle is frowned upon. Clear, precise, relevant notes are required, with nursing care plans forming the bulk of day-to-day paper work (this is usually only one page)along with med sheets & fluid charts.

    Some hospitals are using and working towards introducing Clincal Pathways for their care plans, nurses have mixed reaction to these, more paper work involved if care diverges from pathway, some need abit more refining out here. And each surgeon seems to have their "own" preferences (eg: times for R/O sutures can vary, pre-op preps vary, etc.)which throws the pathway out the window, some consitency needs to be worked out.
    Hope this info throws some light onto our 'socialised' system, does this sound similar to Canada bunky?
  13. by   leem
    Originally posted by bunky:


    As for attitudes about death and dying? I wonder about this all the time. I wonder if it isn't more of a cultural thing, at least in the region and the culture I am working with. It seems that the people who were well off and saw the doctor regularly during their life don't wind up with g-tubes, and their families seem to accept their imminent death without trying to prolong their suffering. Maybe it is lack of knowledge that makes some so unwilling to say no heroics and it may even be partly influenced by guilt at not having had their relative seen by a doctor regularly. It is something that I see all the time and often wonder about. And you do have a mini socialized system here already in the military and it seems to be working alright there.


    [This message has been edited by bunky (edited June 15, 2000).]
    Hi Bunky,

    Just a few things. The well off don't let their "loved" ones pass on more quickly because they are better educated. Its really more of a practical matter. Money. Who gets it. Them... or the doctors. Clearly, you have seen who wins that argument. As for the poor, get real. It is not stupity or guilt. It is that their value system may tend to lean more towards life -- and not its monetary valuation. Incidently, a "G"or "J" tube is not the end of the world, nor should it be the reason to end a life. As far as military medicine goes, clearly you have not experienced the "joy". I have, and thank you, but no thanks. It is a system where, in reality, the patient has essentially no rights, and medical personnel have very little accountability.

    Lee



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