Health Care Reform Will Not Work Without Strengthening Nursing

I agree completely!
As regards contracting our services-I thought you had some instances of that in the US?
When I worked as a clinical Nurse Spec in anticoag we managed all in patient dosing plus 3,000 patients in the community.
The family physicians paid only £30 (about $50) per year for each patient we managed! But it was paid to the hospital.
Some patients had to be seem weekly as they were always unstable due to lack of concordance or ongoing medical problems.
We managed pts through pregnancy and chemotherapy.
Haematologist was rarely involved and left us to get on with it!

When someone was first started on warfarin (coumadin) we would see them at our new patient clinic, but because thes appointments weren't on the patient admin system no one was ever charged for them.
Sometimes we spent an hour educating pts or sorting out probs with wards and community nurses to ensure that pts were safely monitored and treated.

This is an ideal example of how nurses could contract services to community physicians and perhaps hospitals.
We did near patient testing so would have needed minimal lab support, maybe for the house bound pts who had IV samples.

To quote: 2. Medicine ultimately controls nursing

I can't disagree with that statement.

My opinion- if we "reform" healthcare so that daddy government does it, I see a negative impact on nursing.
-We will be paid by the government, and I see lower wages with that
-Our patient ratio will INCREASE, therefore putting pts at risk because we cannot be everywhere at once..and even MORE burnout on nurses. Hospitals will have little incentive to compete for patients ("clients"). Our unit just added another pt to our ratio. :-(
-People will die waiting for treatment because there simply isn't enough doctors.
-Possibly more paperwork..it's the government!
-the quality of healthcare will be at the bottom. When has the government done something that worked wonderfully and quality knocked your socks off.
-more taxes out of my paycheck for people that refuse to work. The government cannot give something without FIRST TAKING IT AWAY FOR SOMEONE ELSE. And quite honestly, I know the drug addict may have personal problems, but I'd have a very bitter taste in my mouth if he/she can't get their act together and mooches off the system whilst my grandparents are denied help. There HAS to be something to qualify people.
-where will these doctors come from to care for these people? Really.

Healthcare reform will never work without TORT REFORM.

Maybe with Tort reform there wouldn't be a need for healthcare reform?
Although I am not sure that the justification for excessive investigations seen in the US is just about fear of being sued.
The one thing that IMO we have in the UK that seems to be absent in the US are national evidence based guidelines.
Care, including screening and investigations, should be effective and demonstrate significant improvements in diagnosis treatment or quality of life ie be cost effective, rather than being about MDs being scared of being sued and just doing every investigation going.

Interesting reading, but each point of view demonstates why nursing cannot be a "band of brothers". Let's face it, nursing has never been respected the way that other healthcare providers have been. Is it because most of us are women? Only a small part of that is true. All of us see nursing differently, basically due to age and experience. To band together, we would have to agree and fight the insurance world--and we would lose. Insurance--Medicare, Medicaid, Blue Cross et al--they provide the funds that keep hospitals, clinics, LTC and everywhere else going. They must be pleased. They will never be pleased by nurses--why? They do not respect us. We are chatel merchandise. They own us and thus they control us. Why? Because we need our paychecks! If we quit or walk out, they just hire more. I had a supervisor once say that RNs are a dime a dozen. If we quit, she would just hire others. There was a walk-out in NJ a couple of years ago. Over 120 nurses left the hospital over poor care and working conditions. Were they right--sure--it was a lousy place to work and the patient care was the lowest I have ever seen. But what did the hospital do--it hired travelers and others. After awhile, many returned, with their tail between their legs. I was traveling then--they lured us out there paying $45.00 per hour with benefits. I was there a week before I knew what had happened. If nursing is to band together we need our state organizations to become stronger and support us. Show us the respect that we do not get anywhere else. With stronger state organizations, all the states could band together and be a force to be reckoned with, but our states do not have support from us. I was a proud member of the ISNA (Illinois State Nurses Association) after graduation and for many years, but I found it to be a social club. It was not for changing policy or helping nurses. It became a reason to sound important and feel important until we adjorned and nothing more ever got accomplished. There are too many of us, with too many varied opinions, to band together in one group. If you want to strenghthen nurses we need to strenghten our state organizations. Then each state has a voice and then elect lobbists to go to Washington. The AMA has a strong lobby in Wasington. The ANA does not. The ANA depends upon our state organizations and our state organizations have become useless in having any real authority or power. Why, probably because of why I quit the ISNA--nothing was being accomplished and it became a waste of money and time. Nurses do not count in healthcare anymore because no one knows that we exist. We are only chatel workers who do whatever our owner says--otherwise we do not get paid, our kids suffer and we cannot pay our bills if we do not do as our owners say. Many years ago the ANA tried to strengthen their position, but did not have the support of its members nor the money from dues to make it work. The AMA has money and mandatory membership--it is known in Washington and basically, doctors benefit from our hard work-they get the credit for what we do. Obama's plan is flawed because a workforce that diligently works behind the scenes is not known to him nor our congressmen. Can we ever be known by them--only if they need care! Obama's plan is a loser anyway, its model is archaic and based loosy on the VA system. Anyone out there ever work with the VA? I have, and may GOD help us all if it passes!

I very much agree that unions can be important to protecting the rights of the worker. I also agree with the statement that a union is only as good as the members participation and support of the particular union in question.

And I am totally in agreement to the concept of the nurse as an independent contractor. I do believe we are already in somewhat of an "independent contractor" position. I know from recent personal experience that the job market is far more open (but still very tight) to an experienced nurse. I was forced to leave my last job due largely to lack of support from my nurse manager and in particular the company's "human" resources department. It took me a month and a half to get a new job. I need icontinuing insurance benefits due to some "pre-existing conditions" or otherwise I believe I would do per diem work. I do not like being beholden to employers at all, but as long as we are going to have no public option to coverage (due to political tomfoolery) jobs = insurance coverage and that is the way it is for any non-wealthy working person.

Bad times employment-wise will continue for quite a bit longer, however we should all be very thankful we are working in a profession that for better or worse, will NEVER be outsourced and will ALWAYS be worthwhile!

Senator Barbara Boxer has introduced a nurse patient ratio bill to the Senate (S1031). The bill would mandate that the ratios need to be maintained @ all times (this means actually having a break relief nurse) & would include only RN's. Some of the ratios include: ICU- 1:2, tele & step down- 1:3, med-surg- 1:5, ER -1:3. If more nurses actuall;y had a reasonable workload, maybe we would have enough energy to stand up for ourselves, & organize.

My Kudos to you for writing this analogy, as you make a great point. While looking through the federal government website, I see funding programs for training physicians and physicians assistants, while the funding for training nurses does not even come close to paralleling such programs.

Ever notice on a hospital ward, there are numerous nurses and CNAs, while the ratio of doctors is maybe one doctor on the floor doing rounds. That is because doctors admit numerous patients for stays in the hospital to resolve acute and immediate health matters enough to merely stabalize the patient while moving them out to produce an empty bed for the next awaiting patient. In the meantime, a typical nurse may be having to care for 8 post-op patients after working an 11-day stint of 12+ hour shifts. She/he may be pleading with her peers to "help watch out for me because I don't know if I'm coming or going" and praying to make it safely through the shift without any errors.

Hearing all the horror stories from my fellows graduates who went to work on the medical floors made me afraid to even seek hospital nursing. I felt their fear and was afraid to put myself at the risk they expressed to me they experienced on a daily basis.

Eventually I went into acute inpatient psychiatric nursing. My first night on the unit I had 14 patients and had to share a Mental Health Worker, who was paid a modest standard of, and carried out the duties of a CNA, while possessing a BS degree in psychology. I worked 11 nights straight, and was afraid to even answer my phone...I might be put on the spot, made to feel obligated to go in to work. In the meantime, my child had a breakdown and cried to her teacher that all she wanted was her mother. I saw her, while I drug her in and out of bed for 3 days in a row during her sleep, to pass her to her sitter; while she didn't see me much at all, if any because she might be asleep, as a result of the demands of my nursing profession. I witnessed the roster of 20 or so prn nurses whom were available when I'd first begun working at the hospital become extinct or slim to none after about 10 months of working there. These were mainly retired nurses, or nurses who'd been in the field so long it didn't take much for them to become disenchanted, from years of experience in the field.

After going through this, I eventually drifted out of the field while trying to work, and complete an advanced degree in nursing. Now, I'm trying to get into a refresher course. It takes alot of encouragement within my own self to muster up the courage to try returning to the field after being out so long. Technology has moved fast and it seems scarey thinking about trying to cram all this catch up knowledge into mind. Also, while there is such a shortage of nurses, the facilities seem to want nurses who can readily handle any crisis, with or without the proper tools to handle any situation, and without any guarantee of adequate support on the job.

It is a matter of need that strides be taken to implement better provisions for former, present, and future nurses who can be a valuable asset to the health care field, as they are the front runner of the link between patient and care.

I agree with you LIndaRN!!

Now I hear that President Obama is going to "make" health care workers join unions as part of his solution to the health care crisis. Not sure what the union will do for us! But it will pay back the unions for supporting him.