For all of those on Medicaid

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I honest to GOD do not know, nor care, what insurance my patients have when I am taking care of them. I really don't. (FYI)

Specializes in LTC, med/surg, hospice.

I don't care about what type of insurance patients have. Many of them have none. I have noticed the entitlement and demanding attitudes of some of those with medicaid. It's not a myth.

I give everyone the best care that I can. My paycheck is not affected by how many syringes of morphine you receive or if you get 5 extra blankets. I don't ignore you and walk super slow to your room because you have medicaid.

Of all the things I have going on during a shift, your insurance or lack of is not that serious to me nor are the reasons behind it.

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

Is your Medicaid like our Medicare (public hospital patients)?

I treat everyone the same. Most Medicare patients are grateful for their care, but the ones in a public hospital with private care do honestly think their health insurance entitles them to more care from one nurse. I have patiently explained this to all my patients, & when they say 'I am paying your salary' or 'my insurance is paying your salary', I again patiently explain that the government or my agency has seen fit to pay my salary - I don't get into arguments about that, it is not worth it.

I had one patient complain no end a few weeks ago about everything. I gave him extra attention, talked more to him, etc to calm him down (he could be abusive which I didn't know at the time). He said he wasn't getting good nursing care, had private cover, etc, etc and I almost burst out: 'Well why don't you hire a private nurse at home, or go to a private hospital!) but of course he wouldn't to save money! What a pain in the behind!

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

As to the question of giving this pregnant teenager on Medicaid the pg test, here is my true story.

Had a psych patient not long ago admitted with a psychiatric diagnosis (can't reveal it here). She was on her 8th pregnancy, had lost one baby, and had 6 young uns at home being cared for by her Mum/relatives (as far as I could ascertain), and was about 8 weeks pg. Doesn't work - hasn't worked for years 'cos of her kids' (her words not mine). Didn't use contraception. Had various kids to various fathers - I couldn't keep up with the list. Didn't seem to think any of this was her fault/her concern. Not interested in working or having a career. Smokes, drinks, goes out, etc, etc.

She did not believe she had a mental illness (she did though not severe). Had abdominal pains, demanded a scan 2 know if baby was OK (which would not have showed baby's heartbeat etc I was told), was checked out in the ED/ER b4 coming to the ward. Demanded to see doc right away. After doc sees her she demanded to be let out of psych unit to march over to midwifery to 'get the nice midwives to do a scan; they were really nice last time I was here' (in other words, we were not). CN said no, then she demanded midwife comes to see her. M/wife comes over, counsels her & patient finally stops demanding a scan (only cos it got late & she was in bed). Says Dr doesn't know what he is doing - and this is the short version of this story.

Now, I challenge ANYONE on here to say this girl (she was fairly young) - even though she had a mental illness - was not taking any responsibility whatsoever for her actions. Mum & relatives had not had a stern talk to her re contraception, or being responsible (there are generations of people in some towns who have been on welfare). No-one apparently had ever talked to her re risks of being promiscuous, etc not even doctors tell people stuff like that now. They are too scared of being sued for telling someone their behaviour is irresponsible & reckless. Everybody molly coddled her to the point where she just used the system - and yes, with mental illness they DO know better in MOST cases.

Any arguments to this I would love to hear about.

And yes, we do all consciously or subconsciously judge patients whether people say they do or not. I for one am so tired of these girls getting knocked up to different people year after year, and they could not care less re these kids proper welfare. Half the time the kids are taken off them and raised by family/strangers, & they grow up with a myriad of problems. It is very sad. And yes they DO drive newer cars than me, all have iPods, new mobiles (mine is old), some are paying off houses cos they get so much child support they qualify as having a stable income! whereas suckers like me are just renting, as casual work is all that is available at the mo.

I KNOW I am the sucker, and I am stupid, and they are laughing at all of us behind our backs.

I think if they have more than 2 children, they get a one off payment for each subsequent child, then they are on their own, or make the Dad pay for them.

Enough is enough.

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Specializes in Med/Surg, Geriatrics.

You don't care but lot's of your colleagues do, just read some of the comments on this thread. If your Medicaid patients are hypersensitive or defensive, you have your answer why. Let's not be disingenous and act like we have no idea why they think they are treated differently by the nursing staff; it's because they ARE.

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Specializes in Med/Surg, Geriatrics.
it burns me when Medicaid covers services like this and then I turn around and explain to the 93 year old lady with hemiplegia that her insurance will only authorize 6 nursing visits (at a $15/visit copay) and cover aide services for 2 days a week for 3 weeks and then hey, she's on her own. Or I explain to the woman with the gaping diabetic ulcer that her out of pocket cost for a wound vac is >$100/day- and applying to Medicaid isn't an option because her husband is still working- you know, so they have a roof over their heads.

The system is broken. :down:

Well we tried healthcare reform and the whole country went whacky. Everyone had different ideas of "reform". Some of us meant to fix the system so that the 93 year old lady and the diabetic lady would get the services they need. It turns out that some of us meant to fix the system so that the lady living alone and unable to administer her insulin would not get the services she needed.

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Specializes in ICU, ER, EP,.
You don't care but lot's of your colleagues do, just read some of the comments on this thread. If your Medicaid patients are hypersensitive or defensive, you have your answer why. Let's not be disingenous and act like we have no idea why they think they are treated differently by the nursing staff; it's because they ARE.

NOPE med/surg/geriatrics.... you lack the ER experience to make that statement, we're not talking about general inpatient care with those who need/require it, you're off base. I have worked many years in an ER and have real experience, so let me explain:

I have no idea who has what insurance, no time in the ER... the ambulance pulls up with a 26 year old woman with 4 kids in tow, with full blown hair done, fake nails, cell phone to the max with the designer purse and tells me her baby is dying, it won't "shut up" and she's sick of it.

baby is stable, they all get off the ambulance and go to the waiting room, three other kids run wild, disturbing the true sick in the peds waiting room. I try to get them back, all others more urgent, no rooms.... 26 yr old mom does the sashay up to me, head wandering in every direction and tells me she'll have me fired in 10 minutes if not seen, her kids haven't had dinner, get them meals and where can she plug in her cell phone?

now, we're not KFC and in fact I can't get a meal without an admission order so I offer crackers and juice..."You gonna do me like this, you wanna TAKE ME ON... just cuz I got the card... you starve the babies?"

(see where this goes... this is every night.. several times a night... and it ends up with someone with "a card" firing me to get seen quicker because they need their motrin/tylenol script and a taxi voucher back home).

This is what goes on in the ER... I suggest everyone work and volunteer several shifts before they waste another once of band-with and type another word.

This is not predjudice,I never ever had a second to look at insurance, treating others poorly is done by the patients and family... it is nurses being treated as dogs who are fed up with the treatment and abuse of the system....

while the acute 40 yr old MI without insurance rolls in who gets the same care... only is the one that needs it and will loose everything from that need.

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I think we are all talking about the ones on Medicaid/government insurance whatever who abuse the system; not the genuine ones.

Oh and yes I forgot about the mobile phones! They ALWAYS bring them in (as everyone has them) and ask to get them charged. I can't tell you how many hours I have wasted showing people how to charge a phone, how to send a text message, how to retrieve messages and so on.

It's a huge PITA!

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I can't believe my eyes as I read these posts... Because you have six kids, you must have medicaid???? Amazingly cell phones are sometimes cheaper than house phones, so is it THAT strange that they would have one? No one should be excused for the attitude or self entitlement, but come on, you and I both know less than 1% of Medicaid patients act like this and it has nothing to do with the medicaid and everythng to do with ther raising!!!

If you really think about it, you also have patients that are rich and have insurance that feel this entitlement. I guess it doesn't bother you as much because they are actually paying your check?

I'm very sad to see the way that some of you guys think...

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Specializes in ICU, ER, EP,.
I can't believe my eyes as I read these posts... Because you have six kids, you must have medicaid???? Amazingly cell phones are sometimes cheaper than house phones, so is it THAT strange that they would have one? No one should be excused for the attitude or self entitlement, but come on, you and I both know less than 1% of Medicaid patients act like this and it has nothing to do with the medicaid and everythng to do with ther raising!!!

If you really think about it, you also have patients that are rich and have insurance that feel this entitlement. I guess it doesn't bother you as much because they are actually paying your check?

I'm very sad to see the way that some of you guys think...

As I've said, when you actually work in an ER and SEE, SEE this for real, you'll post differently. Without that real life experience, it's just anecdotal. This is not OUR thinking as nurses, it's about how we are treated by a percent of the ER patient population. which it seems, you may need to and please volunteer for.

You're mistaking my post for an uncaring something it's not, without reading, understanding and living it. That in itself makes the difference in our posts, real world exp. These are the people that claim their ability to fire us because they have "so and so insurance"..as I STATED I had no way to know until it was thrown in my face. Please read the posts thoroughly before making incorrect assumptions.

I look forward to your reply, and thank you for a different point of view, but I ask you to read carefully through the posts, prior to posting. Debate soon!

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Specializes in Clinical Research, Outpt Women's Health.

1% ha ha ha!:smokin::smokin::smokin::smokin::smokin:

Seriously though. I worked office Ob/Gyn for a decade so we had a huge Medicaid population. In that population it was more like 70%. These were almost all people physically and mentally capable of working...... I still cared for them all with genuine respect and empathy and we all got along great. The important goal was a healthy mom and baby and i would do anything it took including making their appointments a positive experience to achieve the goal of a good outcome.

However, that does not blind one to the facts that are right in front of your face. The girls are pretty up front about it because they knew I was on their side, but also that I was not naive to "working the system". However, they also know I cared about them and their pregnancy.

The saddest thing was to have 3 generations all at the same visit. All on Medicaid. Talk about the learned norm. 14 year old pregnant, mom also a patient & with a young baby, and "grandma" all of 47 who was still raising her other kids kids..........

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1% ha ha ha!:smokin::smokin::smokin::smokin::smokin:

Seriously though. I worked office Ob/Gyn for a decade so we had a huge Medicaid population. In that population it was more like 70%. These were almost all people physically and mentally capable of working...... I still cared for them all with genuine respect and empathy and we all got along great. The important goal was a healthy mom and baby and i would do anything it took including making their appointments a positive experience to achieve the goal of a good outcome.

However, that does not blind one to the facts that are right in front of your face. The girls are pretty up front about it because they knew I was on their side, but also that I was not naive to "working the system". However, they also know I cared about them and their pregnancy.

The saddest thing was to have 3 generations all at the same visit. All on Medicaid. Talk about the learned norm. 14 year old pregnant, mom also a patient & with a young baby, and "grandma" all of 47 who was still raising her other kids kids..........

When I was working on my bachelor's degree my minor was in sociology. In our courses we talked a lot about these "learned norms". What is really sad is that these people don't want any better for themselves and what's even worse, their parents don't even want better. I know a girl who every single time she mentions getting a job, her mothers freaks, saying "Oh, you can't get a job! You'll lose your medicaid, your food stamps, you'll have to start paying rent!" Well, God forbid anyone should try to support themselves for a change!

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Specializes in WOC, Hospice, Home Health.
When I was working on my bachelor's degree my minor was in sociology. In our courses we talked a lot about these "learned norms". What is really sad is that these people don't want any better for themselves and what's even worse, their parents don't even want better. I know a girl who every single time she mentions getting a job, her mothers freaks, saying "Oh, you can't get a job! You'll lose your medicaid, your food stamps, you'll have to start paying rent!" Well, God forbid anyone should try to support themselves for a change!

I had a patient who was a young man in his 20s with 2 kids explain to me that his Medicaid was not active because his mother had his paperwork. He had no idea who his caseworker was, no idea how to get the the social services building downtown, and honestly, no idea how to take care of himself/ his future. How are you raising children if your mother is still responsible for your Medicaid? I bite my tongue and try to help but taking some responsibility for your own affairs would be nice.

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