High-Value and Low-Value Patients - page 5

A handful of readers might have had knee-jerk reactions after reading the title of this piece. Some of you were probably frowning as you muttered to yourselves, “High-value patients? Low-value patients? Who in the hell does the... Read More

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    I do think that many nurses -- and I've been guilty of this as well -- may have less sympathy for health disorders that could be deemed "life style induced" such as ETOH, drugs, etc. It's one of the things that I like about working with the little ones (although then the judgment is often passed on to the parents and families). I have also worked all over my hospital as a float RN and there are huge differences in staffing among the different departments. The RNs on the adult medicine and chronic units are expected to practically work like dogs with 5-8 patients and few CNAs, whereas other areas have a 1:1 or 1:2 nurse/patient ratios. That's not fair to the nurses, or the patients on the poorly staffed units, who are equally valuable and deserving of attentive care. It's a big problem and I think the nurses on those floors need to vote with their feet if they can't get the appropriate staffing, supplies and amenities for their units. I was disappointed when appropriate staffing legislation did not get far in our state because it is sorely needed.

    I can say that for me personally, what makes a patient "high value" is my ability to find a way to work with the patient and/or their family successfully regardless of the reason they are in the hospital. Being amenable to teaching, to the plan of care, to the interventions we need to do (IV starts, lab draws, etc.) that may cause discomfort in the short run, but are needed to get their child well and back home. I'm all for advocating for your loved one -- I do it too -- but parents who interfere with my doing my job (such as saying "you only get one try" to put in the IV for a dehydrated infant) or are needlessly distrustful or hostile to me are just a giant pain. (Honestly, I would never dream of treating nurses or doctors the way I've sometimes been treated!) Another problem we see is when the child has a chronic condition (DM I, seizures, etc.) and the family does not want to accept that their child has this illness and needs ongoing meds and care. The parents then do not give the medsproperly, and they end up back in the ER, at which time they tell us the problem, or the decline in their child's functioning, is due to the treatment and not the underlying disorder! Many of these types of folks seem to think their loved one will receive better care by taking an adversarial attitude with the healthcare team, but I believe the opposite is true. These folks are the "low value" ones to me.
    Last edit by rnfostermom on Dec 4, '13
    0.adamantite likes this.

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    I've seen the pink ribbon on a six-pack of an alcoholic limeade beverage. Weird, especially since ETOH consumption linked to breast CA risk.
    pseudomonas, Nola009, SHGR, and 1 other like this.
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    Quote from Don Gloves
    I've seen the pink ribbon on a six-pack of an alcoholic limeade beverage. Weird, especially since ETOH consumption linked to breast CA risk.
    That's a really good flavor!
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    Male Breast Cancer info:
    What is breast cancer in men?

    American Cancer Society estimates for breast cancer in men in the United States for 2013 are:
    • About 2,240 new cases of invasive breast cancer will be diagnosed
    • About 410 men will die from breast cancer
    pseudomonas and SoldierNurse22 like this.
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    I've been an Oncology nurse for 6 years and have definitely noticed that hierarchy. The low end: rectal ca, head and neck, colon, lung. The high end: leukemia, lymphoma, breast. Strange.
    pseudomonas, SHGR, OhioTry, and 1 other like this.
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    Quote from 0.adamantite
    This describes the patient population of where I work. We are often poorly stocked, with broken equipment, missing medications, and they under staff us. What we do and who we care for are not valued. Also, I was told that these patients are not "money-makers" for the hospital because many of them are under or un-insured. So while the specialty units get the best of everything, we are just scraping by.
    We are an Onc unit with a lot of broken equipment, etc. One patient's family complained that they'd been transferred to our unit because it "looked like it was from the 80s" from a very posh hospital across town with nice new furnishings, equipment, computer installed in every room etc. So, not always the case.
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    You know what frosts my buns? The whole breast cancer pink thing goes after cure, fine and dandy. But what would happen if they put a quarter of that money and political capital into prevention-- looking at the carcinogens in our lives? No, we can't do that, the polluters and the food-additives and the like, they spend money on politicians. You know what they say: An ounce of prevention is worth a pound of pink ribbons.
    pseudomonas, Nola009, SHGR, and 1 other like this.
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    I just had this discussion over Christmas dinner with my family the other day. I recounted the story I told earlier on this thread and my little sister told me how she lit into a young, male cashier who was wearing a "check them or I'll check them for you" lanyard. After probably 20 minutes of talking about pink ribbons, Susan G. Komen and the hype and popularity of female breast cancer, my Dad topped off the night with, "As a man, I really hope I never get breast cancer."
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    Thanks for putting this into words. Like many others have said, I see evidence of this attitude all the time but have never heard or seen it expressed like this. Crystal clear and so true.

    Oncology in general is high-value. When I worked in that area it was very obvious. I don't think cancer patients are any more brave than any other patients. It's just that somehow we as a society have decided that cancer patients are brave, perhaps because that is a way of staving off the fear that "the C-word" gives us.

    Now that I work with the population that you have so accurately described as having a low perceived value, I personalize the comments people make about my patients. That they are noncompliant and therefore bad people. My coworkers even go so far as to make fun of them and criticize them. Yes, I do take it personally and yes, I do call my coworkers out on it.
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    Wow. This is an amazing thread. It's something I've noticed without noticing many times and now it has words. Had a beautiful, funny lady of about 65 in the other day. She has non-Hodgkins lymphoma. Where I've watched other patients whispered about: "drug seeker." "He just wants his drugs." "She'll be calling for pain meds all day!" For this lady everyone bent over backwards to try to get her pain down. They should have. But non-cancer patients probably have hard to control pain, too. Hopefully as a nurse I will see all my patients as high value.
    vintagemother, ~PedsRN~, SHGR, and 1 other like this.

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