It's 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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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.
