silentRN 9,971 Views
Joined May 19, '08.
Posts: 644 (35% Liked)
My answer is still the same as it was a year ago when I responded to this post...nursing still sucks, and it's just gonna suck even more.
"Emerge" just frikken urks me. Stop it, child.
There is that valid argument that the DNP is just a lame attempt to somehow justify nurses as being smart enough to get a doctorate degree. But alas, nobody gives a rat's behind about that even after you've chumped out all that time and money. Your are still ...a nurse.
Chiros, Audiologists have developed a scheme to call themselves "doctor". The patients don't know they are not and assume they are MDs of some kind. It's too funny.
Nurses who go the DNP route don't want to be called doctor - they don't (excepting the goofy ones, and there are always a few of those to make the fool of us all) Nurses just keep stabbing out in the dark trying to find a way to be taken seriously and to be respected. We haven't found a way to do that so, some just figure that some more "research" and paper writing years (LOL on the research, even MDs LOL on MD research - haha) will garner some kind of respect?!
to be on the safe side of things...i'm just going to stop taking it for the next two weeks. i already quit smoking to take a hospital job, so what the hell. i will also still bring the script in.
very happy to be hired, but it feels like i live in soviet russia sometimes.
This past 2 weeks, the patients i have opened up cases for in HH speak not a work of English. They have social security numbers, Medicare benefits, and Medicaid benefits. Live in the U.S. But do not speak a word of English. Getting a family member who does or a translator at a certain time, or even to make a simple phone call and to get someone to answer the door is an utmost challenge.
I know this topic is controversial, but why am I struggling to hard to understand some Spanish so I can do my job in America?
Most are quite lovely patients. Some are just shocked that I don't speak Spanish!
My rant of the day. And these days, there are a lot of rants for me in this field, I admit it.
Honestly, Regardless of what health care plan passes where, who what what how, for better or for worse, if it is not 100% to the benefit of health insurance and pharmaceutical companies, they are going to use it as an excuse to cut access to care, raise premiums and deductibles. It is the nature of business these days. I'm not saying I am or am not in favor of the ACA, but if the government does something that might cost a mega corporation some $$$, they will pass off that cost to you. Because they can.
"Medicaid for all" will mean more, not less, inequality when it comes to healthcare. Poor people will simply be at the end of a much longer line for services. Better educated, more affluent people will always have the means to get to the front of the line. They will now have free healthcare services that in the past they would have paid for. Many of them will consume these free services, thus making the line for healthcare longer.
What we need is true health insurance in a true healthcare market. Right now, there isn't a true market or true prices for healthcare. Insurance should be for catastophic circumstances, and people should pay for routine care out of pocket. If people bought policies based on real risk against illness, trauma, etc, insurance companies would be competing for business like they do with car, home, flood, etc. insurance. When you buy car insurance, they will pay you for damages to your car in a accident. They aren't paying for your oil changes, tune-ups, new tires, car washes, etc. They also don't tell you how to repair your car. They give you the value of your damages in cash. Then you decide how the repair will be made and by who. You control your $$$, and this leads to competition, quality, and innovation in the marketplace.
Right now health insurance companies try to enroll healthier people, and try to avoid higher risk people. This is because they have to charge the same for all. This is why many with pre-existing conditions have such a hard time getting covered. If they could charge less for lower risk people, and more for higher risk people, more people would be covered. And if they were competing against each other, they would be motivated to offer the lowest premiums they could.
Insurance companies now pay for many services that many people would pay on their own. People then consume services more often. This makes insurance and healthcare services more expensive for all.
When you are sick, you often have limited choices of who and where and how you will be treated. Limited competition equals less motivation to offer a better product at a better price.
Imagine what would happen if people paid for routine care on their own (you could still use HSA's and FSA's) and when something big happened your insurance company gave you the money to be treated. Then you decided who, what, where, and how you would be treated.
A true market for health insurance and healthcare services would equal better quality and lower healthcare costs for everyone.
What you fail to realize that it really doesn't matter if you have insurance if nobody accepts it. I rarely see Medicaid patients because of the low reimbursement. Just because you add millions to the Medicaid roles doesn't mean they will have access to healthcare. To help pay for the new entitlement Obama plans to lower reimbursement for Medicare. If the reimbursement for Medicare gets lowered not only will I quit seeing all Medicaid patients but I will also quit seeing Medicare patient.
I'm a FNP but was a MBA before getting into healthcare. I run my business like a business. I fear I will only be seeing PPO and cash paying patients. Obamacare has provided a slippery slope by providing patients with insurance and few providers willing to see them because of low reimbursement rates.
I love this! " I believe in, "What goes around, comes around." So in my own little way I try to make the world a little gentler and kinder place to be"
There needs to be a complete restructuring of our health care system. The bean counters need to be put in their rightful place. They have been wrongfully given authority aka unquestionable power to run our healthcare systems by virtue of giving them the HUGE undeserved salaries they earn. The emphasis some where along the line shifted (probably back as far as the 1990's with the advent of Managed care) from competent patient care- the reason we are all there, to the finances. The financial directors and the CEO's have had their bottoms kissed, red carpet, card blanche treatment from then on - like they were the 'King of the Hill'. The entire hierarcy and ultimate decision making power distribution has to change in these systems. The job qualification for CEO/administrator has to be re examined and repurposed into a job discription whereby the CEO actually has a medical or nursing LICENSE and education and is aware of why the building exists. Yes, the finances are important but they should have never overshadowed the safety of people's lives and wellbeing. Which is exactly what has happened.
The bean counters should be put back down in the back offices with the IT dept where they belong. The first priorty and focus of the institution's decision making should be on competent, medically sound and safe patient care which now a days- it is not. MBA's, the business oriented CEO's are not educated in medical and nursing theory and practices. A code or life threatening illness, chronic illness, permanent life altering disability and re admission rates etc,etc are unknown territory to them. They are idots. These patient's today are way over these MBA's heads- they are out of their leagues!!
They should be handed the bills by the Chief Executive Medical Officer or Chief Executive Nursing Officer( CEMO or CENO not the CEO) and told "here, pay it", or "you figure it out, that's what you get paid to do" and "you don't have a nursing license or a medical license - I do!!"" Oh and by the way- don't forget you have a 'ribbon cutting ceremony' or a 'ceremonial shovelful' to do today with pictures- look presentable." The top Executive of any healthcare sytem should be a CLINICIAN.
If our civilan healthcare can not do this, then it's time to turn the responsibility of running of our healthcare systems and the preservation of our citizens safe health care needs over to the government. The private sector busines man sure has not done a good/competent job up to now.
I dunno. :shrugs: Seems all the "smart" folks in healthcare seem to be making a lot of errors, or know darn well the damage they're causing, yet they just don't care, because they're on the "good" end of the stick.
I literally will NOT work in med-surg, even for pay. I refuse to be treated like some sort of robot without needs and penalized for every last mistake I might make, even to the point of being punished with the revocation of my license. I refuse to cow tow to demanding family members and patients who care more about "an extra chair" for my Aunt Mabel than the lifesaving procedures we might be performing on the patient next to them. No one wants to say NO to these folks, and NO one wants to say NO to hospital administrators and bean counters -- yet the NURSE has to say YES to everything heaped upon him or her.
It's an unsustainable situation -- much like the state of healthcare today.
**VENT VENT VENT VENT **
5 months into nursing as a RN, not a student.....
1. Dumb Residents. Yes... they do exist with their idiotic order sets.
2. Management saying " Staffing will get better- we are working on it"
3.The PCNA who charts nurse notified re: crazy vitals and they never said a word, so when you check vitals half an hour later, you see a BP of 190/110.
- same PCNA who wont do a manual check.
- same who tells the POD #1 pt " 99.1 temp? oh you have an infection.we have to tell the DR"
4. Family members who come running to the front desk screaming "i need my moms nurse...she was supposed to have gingerale. its been 10 minutes. this is unacceptable"
6.Other departments that won't lift a finger, and spend 5 minutes hunting down the nurse for something idiotic like a blanket...
Where I've worked, we have saved narcs to use for the next dose, as long as it's the same nurse giving it. We label and date the vial and put it in the med cart in a lock box. We waste what's left at end of shift. We do always waste with 2 nurses. I know of some nurses who do keep it in their pocket if they are giving it frequently. Nobody I know has ever been written up for it. The narc isn't wasted every time because it's expensive. The facility trusts the nurses unless there is cause not to. It's nice to be trusted, but I think that is not the norm in this day and age.
I'm sorry, but I just don't see the problem. 10 years ago this same piece could have been written, they were saying then that there was going to be a lack of educators as well as a lack of bedside nurses. Remember all the talk about the nursing shortage which should have started 2 years ago. Well, there is no nursing shortage. We have new grads that can't find jobs, we also have experienced nurses that can't find jobs.
The economy tanked and nurses that would have retired are no staying on. I'm sure it is the same for educators, maybe before they were retiring at around 62 years old, but how many can afford to do that now. It is at least not back breaking work like working at the bedside can be. Which is where your educators are going to come from. From nurses that just can't physically lift and turn any more pt's but want to stay in nursing.
Just because a person's good at something doesn't automatically make them a good teacher -- I've worked with people that were blindingly brilliant, but couldn't "dumb it down" enough to tell you how to make toast. Most of us with some initials after our names remember certain professors with fondness -- because the truly good ones were so rare.
I personally think that the ability to teach is like the ability to lead -- you're either a leader or a teacher, or you're not. You can learn to be a boss or an instructor, but leaders and teachers are born, not made. And churning out a bunch of instructors who are going for the job because they're looking at summers, weekends and holidays off isn't going to help anybody (the equivalent of the people I went to nursing school with who wanted to be travel nurses and CRNAs, but couldn't pass A&P II).
I also think we need to seriously look at what the BSN level classwork is. We're putting in a lot of "management" stuff, at least in the programs I've seen. Let people do what they are best at. If you want to be a manager, go get at MBA or a MPH. I think we need more psych, more patho, more "stuff" that will keep the patient alive at 3 am when you can't get a MD on the phone and your patient's crashing. I'd like to see classes that revolved around labs -- seeing what set of labs means what, not just "oh, Mr. J's K is 2.5. he'll be getting some riders," but what to look for in a patient with cancer that could mean it's mets'd to the bone, or that maybe you need to back off the Diprivan a little on a person who's lipid panel looks like A, B, or C. I can't even get someone to give me a straight and consistent answer on when a person needs to be on reverse isolation -- some talk numbers, some talk ratios of numbers.
Sorry, it's been a rough week.
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