Nurses as active healthcare consumers

[Sharon]

Whenever I see a discussion about short staffing by nurses, I always wonder how many nurses act as informed consumers? Nurses I have spoken to directly about consumerism, usually deny acting as an informed consumer.

When electing your health care benefits or assisting a friend or family member with an election, do you investigate the official and unofficial staffing ratio's at the plans designated health care facilities?

Have you ever sought care from a hospital or health care facility further away because the staffing ratios were better? Or because the facility would not disclose the ratios?

Since 1982 this has been the practice in my family. In my family, during the 1990's, development of permanent disability from inadequate care in health care facilities has disappeared from a high in the 1980's of 5 individuals (1 child and four adults).

My belief is that as a nurse I am an expert on the amount of staff required for safe and effective patient care in any health care facility. And if a facility does not to me as an expert, I can use my consumer dollars and those of my family and friends in locations that listen to me and other nurses.

To utilize my purchase power, I elect the more costly health care benefits and pay more out of pocket.

[barton]

Sharon,

If I understand your post correctly, you are telling us that we, as nurses, are informed enough to know what questions to ask and how to obtain the best care/insurance available for ourselves and our families.

I think this has a "ring" of truth to it. However, even if consumers buy the best insurance they can afford, and ask all the "right" questions, I think that the concerns of nurses on this and other BB's reflects the probability that understaffing is a NATIONAL problem that will be experienced by all but the most wealthy of patients.

I will say though, that if every family member/loved one of a patient was to speak to administration on every day that they felt the unit was understaffed, that hospitals might start to listen.

As a nurse, I feel like an informed consumer, and many times I visit doctors who do not participate in my insurance plan, and I pay full price, out-of-pocket. I have to do without other things in my life to do this, but thank God I can. I don't think most people, especially those with kids, could afford to----and when you think about it, WHY SHOULD ANY OF US HAVE TO??!! The whole CONCEPT of purchasing health insurance, in my opinion, is to provide ourselves with the care we need, when and if we need it. Your post, to me, sounds like the PATIENT is at fault instead of the health care system! Certainly, it's wise for consumers to be informed, but no one can know everything about everything. Don't you think that patients should be allowed a certain degree of "blind trust"? Shouldn't they be allowed to know and believe that when they enter a health care facility that their best interests come first?!

Yes, I sometimes question the treatment I've been offered, and yes, I think I know what questions to ask because I'm a nurse, BUT, a couple of years ago I had surgery, and my husband and family visited, but they have jobs and lives and no one could be with me ALL the time. I was "asleep" most of the 4 days I was there, so what good did my nursing knowledge do me? I needed that blind trust.

barton

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[Sharon]

Well Barton,

One thing I did not do is blame anyone. My point is a large group of informed consumers with purchase power can make a bigger and quicker change then legislation. And I still believe that very little of the purchase power that nurses have is being utilized.

I agree with you that some constraints exist with what options are available due to location and finances, but most people do at least two have options.

I still hear many informed health care consumers go to the closest facility and not the better one. I have worked in many rural and urban areas in the U.S. and still there has been choices. I learned as a young adult when I had guardianship of 2 frail elderly and three children that many emergencies could be transported to the better facility. After many health care crises only one, a cardiac arrest, required transport to the closest facility.

When you have received bad care just like any other situation were you receive bad service, you not only have the right to complain but you do have the right to change or leave as well. I do not think the public is aware that in most situations care can be transferred and it will not jeopardize the patient's health. I do agree that poor care is a national problem and that staffing levels play a major part.

I do know that the first time you walk out of an ED AMA or request a transfer out of a facility for poor care it is hard. Like many other behaviors, once you demand and make a change, it does becomes less stressful.

It would be nice if we could have blind trust in all aspects of health care. Unfortunately, it has evolved to a point were it would be deadly to have blind trust. Many other industries, like housing and automotive, have evolved to the point were you can not have blind trust despite legislation and regulation. Like any other big event or purchase, my family prepares and plans for health care.

Recently two infants contracted the pneumonia that is circulating on the East Coast. Between the first sign, a runny nose, and respiratory distress was only 6 hours. When the illness began in the first one, we went through a mental check list comparing local facilities. We concluded better care would be received at a community hospital despite being in the vicinity of two children's hospitals. Previous episodes of poor care related to under staffing at the children's hospitals made us add to our health care plan for at least two adults to discuss the rational for where to seek care.

Because of the better staffing both in the ED and on the floor at the community hospital, the first infant received excellent care. When the second infant developed respiratory distress, she went to the community hospital as well and received excellent care as well. Since then I have recommended the hospital to both adults and children with and without the insurance or ability to pay. All have received excellent care and have not experienced any problems due to short staffing.

I am in the position to guide 27,000 people through health care and I do recommend facilities as well as providers. Always quality of care is tied into nursing staffing levels and education levels. I have never come across a facility I have recommended in its entirety. I recommend and refer to specific components based on what type of health care the individual needs. When I become aware of a problem at a health care facility, I counsel the individual: to complain verbally and in writing, get a second opinion from a provider at another health care facility, and then to transfer to a different facility if the situation has not been corrected quickly.

All nurses have the opportunity to educate others about the selection of health care facilities. For instance, how many will have children going away to college for the first time and won't be there to assist them with seeking urgent and emergency care? Most college health clinics do not accept PPO or HMO insurances. The college clinics are convenient but they are no longer free. What has been taught to an adolescent on their way to college about evaluating health care?