The ER is the ER is the ER ...

by Pixie.RN Asst. Admin

Itís a military healthcare free-for-all! Imagine a world in which all your ER visits were free, your doctor appointments cost nothing, all your prescription medicines were yours for the asking, and there were no copays or annual deductibles. Does it sound like Utopia, a fantasy land? Actually, it exists today! Welcome to Army Healthcare. The price for this plan is service, 24 hours a day, seven days a week.

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    The ER is the ER is the ER ...

    I really had no idea what to expect from working in an Army ER, but I suspected it wouldn't be much different than any other ER. I knew just from my experience with various ERs in the northern and northwestern Virginia area that most ERs had similar patient demographics and similar ... patient "challenges," shall we say?

    One thing that is markedly different from my old ER: the average age of my patients in the Army ER has dropped dramatically. One would also assume that because of the younger age range, these are healthy people, but that is not always the case. I have stopped in the middle of several shifts and thought to myself, "Wow, we see some really sick people here!" Though I am thankful for the younger demographic, because I can recall shifts during which the average age of my patients was about 95, and they were all very sick or trying to climb out of bed.

    We also see some extraordinary numbers in our small Army ER. When I was first in contact with the head nurse and started asking typical questions about the ER (number of beds, nurse to patient ratio, number of daily visits, etc.), I thought her answer for the number of patients seen daily was a typographical error. We average more than 100 visits daily in our few beds -- we have 11 beds in the main ER, then 4 beds/rooms in our urgent care/fast track area that are only open for about 12 hours a day, so for the most part, we're pushing big numbers through the main 11 beds. I am still scratching my head over this, after coming from an ER of 15 beds where seeing 75 patients in a day felt like the seventh level of hell. The only thing I can figure is that maybe it's because we don't really slow down at night, and we are usually running the entire shift. But I adore my night shift people! My RN coworkers and medics rock, and I am grateful to work with such a team. When I left my ER in Virginia, my biggest regret was leaving my fabulous team -- these were the people that raised me as a nurse over the years, as it were; they even gave me an beer stein as a farewell gift that has "Raised By [Facility Name]" engraved in the glass. I thought I'd never find such a great group of coworkers again, and I'm happy to say that I was wrong. Not to say I don't miss my Virginia peeps, but the sadness is lessened by the awesomeness of my new peeps.

    And Army healthcare in the ER ... well, it's free. Really. No money exchanges hands anywhere in our ER, no copay, nada. People who are eligible for care (active duty and their family members, eligible retirees and family members, reservists or national guard on orders, etc.) don't pay a dime to come to the ER. It's like a frequent flyer's dream! It also leads to abuse of the ER, for sure, but often these patients aren't able to get in to see their primary care managers (PCMs), or it's the middle of the night and they're having acute symptoms. I get it. And you know what? I'm fine with it. I joined the Army Nurse Corps to care for soldiers and their family members, and I am getting what I asked for, and then some! We see a lot of pediatric patients, and with the post-deployment baby boom, a ton of OB patients as well. Greater than 20 weeks and they go right upstairs to L&D if they have a pregnancy-related complaint, but we keep the less than 20-weekers, and there are a lot of them. Military people seem to like making large families!

    And this is interesting -- we can turn away civilian patients who are not eligible for care, as long as they aren't presenting with a life threat. That was weird for me one night in triage to tell a patient that we weren't going to see him for his minor complaint. He was on post with a group of contractors for some kind of conference, and his coworkers told him he needed to go to the ER for this minor issue. He was prior service, but was not eligible for care in a military treatment facility. I learned that even though he has insurance, he would still get an enormous bill that his insurance would not likely cover. Once he heard that, he thanked me for my time and beat feet out the door. Granted, if that same guy showed up with chest pain, we wouldn't even have had the conversation; we'd see him, no question.

    The military system has its flaws, but overall I have to say my experience as both a nurse and a patient has been good. No, I have not been a patient in my own ER, but I was able to get in to see my PCM for my periodic health assessment in a timely manner. Also, the pharmacy is great -- a patient can pick up prescriptions almost as soon as the doctor enters the order in the computer, and guess how much prescriptions cost? That's right -- nothing! Medications are free. The first time my husband and I went to pick up a 90-day supply of one of his regular medications, I kept waiting for someone to ask us for money. Pretty strange!

    Am I still glad I joined the Army Nurse Corps? Absolutely. I am loving it! At the tail end of a shift spent in the "penalty box," AKA triage, I am not quite as cheerful, but no regrets ... proud to wear the uniform! I just kinda wish I could wear scrubs in the ER, though.
    Last edit by Joe V on Nov 28, '11
    pmabraham, w2cross2blue, kalevra, and 30 others like this.
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  4. About Pixie.RN

    LunahRN: a short green-eyed redhead, very tattooed, a volunteer Paramedic, ER RN, new-ish 1LT/66HM5. Avid reader, addicted to good shoes, allnurses, and her Android smartphone.

    Pixie.RN joined Aug '05 - from 'everywhere and nowhere - global nomad'. Age: 41 Pixie.RN has 'NREMT-P: 11, RN: 6' year(s) of experience and specializes in 'ED/Trauma, 66HM5 (Army)'. Posts: 11,846 Likes: 6,392; Learn more about Pixie.RN by visiting their allnursesPage

    14 Comments so far...

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    One of the other cool things re: military health care - after 20 years of active service (with some new qualifiers), the military member and their spouse have Tricare for Life which is the military's answer to medical insurance.
    Pixie.RN and VickyRN like this.
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    It really only seems fair. If you are willing to give your life for our country, and essentially protect me along with everyone else, then you deserve to have your health protected indefinitely. That is the least we can do.

    (I am not implying that no one else deserves health care at affordable prices)

    I only wish I could serve my country in such an amazing way , but I am unable to due to my asthma, genetic HTN, and bi polar disorder. *joy*
    arbor-vitae, x4livin, and VickyRN like this.
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    I wish now that I had followed my original career path and joined. Now the closest I can get is to work as a civilian nurse in a military hospital. Unfortunately though I need a year's acute care experience to do so :-(

    Qualifying disabled dependents of military members, like my sister can also keep Tricare. It's a wonderful benefit earned through great service.
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    If you can't serve, supporting our Soldiers is also very appreciated!!
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    It would be great for all Americans to enjoy the benefits of *free* healthcare. I feel blessed as a military spouse that my children's medications, which would cost $900 per month, are available at no charge. I use the term "free" loosely, as it is my husband and so many others who have dedicated their lives to this country. For that, I am proud.
    Last edit by Pixie.RN on Dec 6, '11 : Reason: TOS: removed link
    Zombi RN likes this.
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    "The price for this plan is service, 24 hours a day, seven days a week."

    Freedom isn't free, and neither is our military's healthcare! We do lose a bit of self-determination and autonomy as patients in the system, but that is also our choice. We are not required to use Tricare, after all. That said, I do not think our health benefits can be beat, but rest assured, Civilian Reader, that our healthcare is NOT free. It comes at a great price, albeit a price that we have chosen to pay of our own free will.

    Thanks, Lunah, for your service! WACH/FS-HAAF is lucky to have you! Rock of the Marne!
    midinphx and Pixie.RN like this.
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    Quote from TerraRN
    Rock of the Marne!
    Top of the Rock!!!
  12. 3
    And the floor is the floor: The conversations are so normal it's unremarkable: "How are you?"... "How was school?"... "Really?! You won your game?! Way to go!!!" "What are your plans for tomorrow?"... "Hey! I'll be home soon!"..."I miss you!"... "I love you too!"... Everything you would expect when separated families talk. Until you stop and think that this is the first time they have talked in days, possibly weeks, and one of them is lying in a hospital bed in a knitter's nightmare of tubes, hoses, and assorted bandages. The physical injuries vary from missing appendages to simple flesh wounds. The emotional trauma runs the spectrum also: "I gotta get back to my guys" through "I just want to go home". Every one is in the pipeline, getting treated and stabilized en route to somewhere else. Just pausing here for a couple of days, maybe a week, then back in motion to some final destination. Just another night at work somewhere outside the US.
    Back home Peds is similar. Mom juggling a new place, a kid in the hospital and two more staying with someone she just met. It's ok, Mom. We've got him. Take care of your toddlers and come back when you can. She was gone for three hours making arrangements. The new friends brought the toddlers up later that afternoon to visit.: Phone calls that sound as distant as they are. "How is she doing?" We have answers. Most good, all honest.: A parent showing up at 0300, travel worn and dirty, no problem, we'll find a shower and can find a place to sit and/or sleep.: There are idiots/jerks/social services cases also, but far fewer than most civilian communities. All in all I know I make a difference here, at least some of the time.
    And yes, there is a price, and its paid by the entire family, but there's a price to everything in life, this one I know is worthwhile.
    happydrunkcat, Pixie.RN, and jnndub like this.
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    Any advice to an ARMY spouse? As an RN, is it better to apply at base ER or go to trauma center? Thanks.


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