sunnyd_83 1,449 Views
Joined Aug 29, '11.
Posts: 64 (14% Liked)
This whole thread is bizarre.
I feel the need to add another perspective to "obamacare." My youngest son has a severe disability through no wrong doing on my part. He has lots of health problems, general health issues, has had lots of surgeries etc... Obamacare will help my son, we make too much money for Medicaid and I know his healthcare is into millions of dollars at this point, yet we no longer will have to worry about being denied insurance due to his pre-existing condition or meeting the lifetime cap of benefits many ins companies have. My son is on several medications but his Growth hormone alone is over $1400 for a 28 day supply! That's the generic brand... As I said, his surgeries are countless, he has scoliosis and wears a boston brace. I could go on and on... For my family obamacare is a good thing, for those it's not I'm very sorry but I am great flu to know no ins company can say they have paid enough money out for my son and that they will not pay anymore! If you think this does not really happen, it does... Talk to parents of special needs kids and you'll be surprised what ins companies have been putting us through. I did not post this to start a debate, it's just a look into the life of someone obamacare has helped.
Why should healthcare be a God given right? That's the problem with America, everyone thinks they are entitled to everything. No, your not. You need to work for what you have.
I work in a state that elected to provide medicaid expansion as part of the ACA. We were closed yesterday for New Year's, so today was when "obamacare" implementation really took effect for my clinic.
Instead of seeing <5% patients with insurance, more than half the patients I saw today had medicaid.
My schedule for the next 3 weeks is booked entirely with established patients who need new referrals placed to the medicaid system. I am trying to clear a 2-year backlog of orders for echo's, ultrasounds, CTs, MRIs, physical therapy, and any specialty referral to rheumatology, urology, sports medicine, orthopedics, pain management, etc.
.... Yes, our patients previously waited, on average, more than 12 months for any of the above referrals. Without insurance we can only refer to the horrendously overbooked safety net county system. It was hopeless. Usually they never got any appointment at all. The alternative is a 24+ hour ER wait which rarely gets them the evaluation needed (an angry resident once returned a patient to me with WE DONT DO MRIs IN THE ER scrawled on the referral I gave her.)
I was finally able to order diabetic shoes and a wheelchair. Tomorrow I will see 2 asthmatics who need prescriptions for neb machines.
I will complete prior auth's for cellcept (SLE) and rebif (MS). Both patients are currently off meds due to cost and not doing well.
For patients with no insurance we have a very small dispensary with limited stock of meds. With medicaid coverage, I can now prescribe:
combined BP pills, januvia, finasteride, flomax, epipens, advair, imitrex, fioricet, insulin pens, namenda, aricept, lexapro, lipitor, lovenox, verapamil, zyrtec, olmesartan, atropine nasal, levaquin, and valtrex to name a few. I have missed lexapro and verapamil the most.
My experience with obamacare is that it has made me feel like SUPER NP!!! because I can finally deliver care to high-risk patients. These are not bad people, or freeloaders, or "welfare queens." The majority of my patients are the working poor, who put in more hours/week than I do, feed more mouths, have more chronic diseases, and make a fraction of my salary. They keep my city running.
Has anyone else seen a dramatic change in their practice with ACA implementation?
Went to the doctors office today from having stabbing pain where my gallbladder was (taken out 07/13). Did a assessment and suspected appendicitis. Rushed me up to lakeside in Omaha NE. Had a CAT scan and confirmed. So They got in touch with my dr and Admited me. Surgery at 8 pm awake by 10.
The hospitalist was very kind, good bedside manor. The surgeon was you know.....a surgeon.
My point is the nurses. All new grads within the last 2 Years (one graduated in May!!). They are so caring and bedside manor is understanding and very caring. I will never again in my life be weary of a new grad again!! They are so confident and ontop of things!
I think it looks really unprofessional. Germs and bodily fluids aside - think about how it looks to see a nurse with a bottle of Corona in his/her hand tearing up the dance floor. I certainly don't want that person taking care of my grandma! Think about how it would look in other professions: Police officer sitting at a bar in full uniform, or sous chef swilling back margaritas in their toque and white coat, lab worker getting down on the dance floor in their white lab coat. Nope - none of it sounds very appealing to me and seems like a cry for attention. If you're going out after work bring a danged change of clothes!
There is absolutely no reason for hiring managers to choose new grads who never worked in healthcare over those who have.
This will be our 4th Caption Contest. Similar to prior Caption Contests the winner will get $100.
Good afternoon nurses your mission, should you choose to accept it, involves coming up with a caption to this About A Nurse cartoon. You may submit as many captions as you wish. You have 1 week to achieve your objective. Follow the easy rules below.
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UPDATE: We have chosen 8 entries. Vote for your favorite - Top 8 Captions - Help select winner in 4th Nursing Caption Contest
I love what everyone's including. I didn't think about black out curtains!! Great idea!
1. Show a little compassion for a patient who is legitimately ill
2. Show a little respect for the patient rather than treating the patient like a nuisance
3. Pay attention to the PERSON in front of you with an illness and not just focus on average numbers
Most of the time, patients just want to feel as if someone is listening and taking them seriously.
Ok, so your normal temperature is 97 and now it's a raging 98.9.
Here is my question for you: What do you want me to do?
Your geri patients will not have high temps even if their urine is pure pus. Believe me. I once thought a patient had a severe stroke with a simple UTI. Pos. Babinski, somnolent, etc. No temp elevation.
Hopefully you were taught that these norms were "ranges". Not facts. The general public does not know that. They think in absolutes. One number for each parameter. Most don't have a clue what that means. Some of you recall that your vitals may have some relationship with that thing called the Krebs Cycle. Would you rather explain that cycle or just be polite when people say slightly off the wall things.? You don't have to seed or feed the drama. Just don't do or say something that will cause them to escalate. That takes time to deal with, expertise to settle, and puts you in a position where the next thing yhou know there is a script for such events.
Many elderly patients run a low normal temp - of around 97. So - if they have a temp of 99, they could be very seriously ill. Normal isn't always "normal"
Many times patients aren't trying to be annoying, they really don't know any better. They may truly believe that 99 is a fever or whatever. But it really sucks to be the patient trying to tell a nurse something and get blown off. The last time I was in the hospital, the nurse started my IV exactly where I asked her not to--in my left wrist. It was uncomfortable at first, as most IVs are, but it flushed fine, so I tried to ignore it. Over the next hour, it went from being uncomfortable to causing writhing pain. I tried to tell the nurse that it was developing phlebitis, she flushed it, went in fine, so she upped the drip rate of the fluids. Ten minutes later, I tried agin with the neuro tech who told them same nurse and--within my hearing--told the tech that the site was fine, that I was a PIA know-it-all. (No one knew I was a nurse at that point.) By the time the CRNA came around, it was just starting to get red and I was in worse pain from the IV than from the ruptured disk I was there to get repaired. The CRNA recognized the phlebitis and pulled the IV. Another nurse came to start the new IV, thankfully and I didn't have to see the mouthy one again. By the time I was discharged the next day, I was black-and-blue from thumb joint to halfway up my forearm. It took three weeks for it to go away. Sometimes patients really do know what they're talking about. Not always, but sometimes.
And, of course, there's the temp. Perfectly normal, patient states there's a fever. Well, you don't have one now...? "Oh, I took Tylenol before coming, but I definitely have a fever."
You can't fix stupid.
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