Obamacare and Nursing.. what do you think?

[OKNurse2be]

I know that I am possibly opening up a can of ugly worms. I hope that in spite of differing opinions, that this thread can remain friendly and a simple exchange of ideas and opinions.

As a beginning nursing student, I am being told that there is this looming nursing shortage and that there is great job security. A little research on my own shows me that in my particular state, there definitely is a decent population of still practicing nurses who are 60 years and older who will be retiring soon, which would open up the way for us who are just getting started. More and more emphasis is also being put on the new healthcare law and how it will open the doors for more people to access medical care which again will increase the need for staffing.

I grew up in a country with a socialistic government, which also includes healthcare for everyone. I have seen how the hospitals are understaffed, and you are lucky if you get to spend 5 minutes with your physician, and you are not in control over which healthcare facility you can go to. I know that the new bill isn't necessarily socialistic, but there are socialistic principles in it.

As a nursing student, I can't help but wonder how this is going to affect my future as a nurse. I know that nurses talk among themselves and things trickle down from above onto the floors. Nothing is going to keep me from becoming a nurse. I am not in it for the money, but rather I feel somehow "called." However, I believe that it's good to be prepared for times ahead so that I can adjust accordingly.

How do you think that Obamacare is going to affect how care is delivered?

By the way, this is NOT a homework assignment of any kind. I am merely looking for for a friendly exchange of ideas and opinions.

[Music in My Heart]

Everyone seems to think that they're millionaires, and will be affected by estate taxes.

Americans are nothing if not wishful thinkers.

Estate Tax and the Founding Fathers (Economist, Lexington's Notebook, 2010)

I think the term "magical thinking" is more accurate.

[Music in My Heart]

Such as? FTR, I wasn't referring to the occasional misuse of emergency services. I'm talking about situations where on a daily basis-if not multiple times per day-EMS picks up a "regular", drunk homeless person, and transports them to the nearest ED "to sleep it off". Once the booze wears off, the regular is demanding food, warm blankets, clean scrubs, bus tokens, and even medical treatment for their self-inflicted health problems. The ED has become their personal hotel. Emergency departments should be able to make abuse of their services less readily available. I'm not really sure how "more compassionate options" would help a population of people that obviously lacks the desire for self-improvement to adopt a lifestyle that embraces personal accountability.

On the extreme end of the abuse:

Pts who present for legitimate problems who then go AMA after a day or so, only to return a day or two after that for exacerbation of the very complaint for which they originally presented... which are often directly attributable to their lifestyle choices... most often related to substance abuse, specifically meth and booze.

As far as I'm concerned, if you show up and then leave... you're exempted from EMTALA regulations for the next 60 days.

Same if you're noncompliant after d/c... or if you refuse to follow the plan of care... How many diabetics and CHFers do we see who demand greasy, salty, and/or sugary foods... who refuse to be bound by I/O restrictions.

If you pee hot for meth, begone with you until you come back clean.

If you're drunk as a skunk, go sleep it off *before* you're permitted to see a doc.

If you're not going to help yourself, stop expecting the rest of us to try to pick up the pieces.

[tewdles, RN]

in other words, it is okay if they die in the streets?

[tewdles, RN]

On the extreme end of the abuse:

Pts who present for legitimate problems who then go AMA after a day or so, only to return a day or two after that for exacerbation of the very complaint for which they originally presented... which are often directly attributable to their lifestyle choices... most often related to substance abuse, specifically meth and booze.

As far as I'm concerned, if you show up and then leave... you're exempted from EMTALA regulations for the next 60 days.

Same if you're noncompliant after d/c... or if you refuse to follow the plan of care... How many diabetics and CHFers do we see who demand greasy, salty, and/or sugary foods... who refuse to be bound by I/O restrictions.

If you pee hot for meth, begone with you until you come back clean.

If you're drunk as a skunk, go sleep it off *before* you're permitted to see a doc.

If you're not going to help yourself, stop expecting the rest of us to try to pick up the pieces.

Is this the same type of sentiment that caused supporters to encourage Dr Paul to say that he would let these folks die rather than treat them...during a republican debate?

[SC_RNDude]

... verified source please...

Are you serious???

[SC_RNDude]

Is this the same type of sentiment that caused supporters to encourage Dr Paul to say that he would let these folks die rather than treat them...during a republican debate?

Dr. Paul never said any such thing.

[SC_RNDude]

That quote, of course, preceeded the reality that a public option wouldn't be included in the bill.

He has backed off the $2500 figure, but on the 2012 campaign trail he continued to claim premiums would decrease.

[tewdles, RN]

Dr. Paul never said any such thing.

You are correct, he was surprised by the shouting from his supporters to allow those to die...

but the supporters...folks like you and me apparently...they believe that we should allow those people to die without treatment.

[Music in My Heart]

@tewdles:

I personally am in favor of singe-payor, not-for-profit healthcare.

That said, if people are not going to 'work the program' then it's simply a waste of valuable resources to permit them to present to the ED, suck up resources, go AMA 24 hours later because they want another drink/smoke/hit, and then come back 2 days later just to repeat the cycle.

I can accept dying on the streets if that's what they choose for themselves by refusing to follow through with the prescribed treatment regimen.

The reality is that we can't afford to continue to subsidize habitual abusers of the system.

I used to work in a rural county with only two ambulances for 2200 square miles. It was not at all uncommon for people to use them as convenience rides for non-emergent complaints which would then leave a population of some 5,000 people with the nearest ACLS care an hour away.

[tewdles, RN]

I am glad that this is clarified.

So, basically, yes...

if the person is not capable of making appropriate choices about their health care we should allow them to die without care because to do otherwise is too expensive and difficult.

[tyvin, BSN, RN]

Obama concedes: Obamacare didn't do anything for rising health care costs

[Music in My Heart]

I think of it more along the lines of letting them live the life that they're choosing for themselves. If they want to continue shooting meth, I have a hard time seeing why the collective "we" should feel compelled to enable that choice.

There is too much morbidity and mortality due to lack of access among people who are trying to work the program. Until someone hits rock bottom and is ready to make changes and actively work toward their own well-being, I think it's justified to move others to the head of their line.

Is it OK in some grand sense? No, not really. However, scarce resources must be allocated in some fashion or another, and this seems reasonable to me given the limitations that we have.