Planning our future and outsourcing

  1. First it was manufacturing, then IT jobs and next it may be us, and so this post is my attempt to make us think about our futures and brainstorm and maybe think outside the box to come up with new ideas.

    The US health care system is in shambles. We now lag behind 36 countries in overall health system performance ranging from infant mortality to adult mortality to life expectancy. The maternal death rate in NYC is over 20%. Smaller companies like Blue Ridge Paper Co in North Carolina that are essentially self insured for their 2000 employees is sending employees to India and Thailand for medical proceedures. Open Heart in New Delhi, India at the world class Apollo Hospital is $6500 plus airfare that can be found for as little as $700 if booked in advance. The cost in the US is an average of $60K. The patient/nurse ratio in India is 1 to 1 and they only employ RN's.

    This is all new thinking, but what happens when a large company like General Motors or Citibank hops on this bandwagon? 350,000 Americans are now going out of the country for surgical proceedures. 44 million Americans are without healthcare insurance, and Congress has passed laws that you can no longer file bankruptcy to get rid of your medical expenses. 70% of medical expenses are incurred the last decade of life. The oldest of 77 million Babyboomers just turned 60.

    So, if this trend continues, where does that leave us and what can we do to make ourselves more marketable? How do we redefine nursing employment? Obviously, there will still be a demand for emergency care and emergency surgery and chronic care to some extent. But what about caps on medicare spending for chronic care---then what will people do.

    I wish I had a crystal ball, but alas I don't. I'm seeing more and more part-time and seasonal contract work in the paper. I'm seeing less and less "benefits" Will we first be outsourced to a nursing agency the way payroll services were outsourced----so we won't work for Healthy Hospital or Old Age Home, but rather ABC Nursing Agency. Will we all become contract labor? Will we bid jobs?

    This will be a time of great turmoil and also great opportunities. I want to concentrate on the opportunities. What are your ideas??????
  2. Visit Mudwoman profile page

    About Mudwoman

    Joined: May '04; Posts: 375; Likes: 173
    RN BSN CDE; from US
    Specialty: 20 year(s) of experience in Certified Diabetes Educator

    56 Comments

  3. by   mvanz9999
    I don't have any ideas to resolved this dilemna. Here's a brief background of me. In 1996, everyone (including myself) was flocking to IT. That's where I went. Things were booming until 2000 and 9/11 after which things stopped. There was a glut of IT people, because Y2K was over. Then jobs started being outsourced to foreign countries.

    Now I'm stuck with an 80 mile a day commute because in 2 years I haven't been able to find a different job. Not to mention that I never recovered my income after my 2002 layoff. I don't get to choose where or for whom I work. I have to take anything I can get. Even if I don't really want it.

    So my biggest concern is repeating this mess. Right now nursing is the hot job. But what happens in 10 or 15 years when this mass of baby boomers starts dying? When the boom is gone? Where are all the nurses going to go?

    I have seen the IT world turn essentially into contract only work. There are very few jobs with benefits. I was recently contacted about a job which was a 7-year contract, with an option to go longer. Which means the person with this job will NEVER get benefits.

    So my concern is that everyone is flocking to nursing...there's going to be a serious drop-off after baby boomers start reaching the end of life, and then there will be a glut of nurses. I don't want to be in that glut.

    I'm not really sure what the answer is. The way to stop it would be to simply protest by NOT taking jobs without benefits, not accepting patient overload, and not working unreasonable numbers of hours. Unfortunately the US is not capable of working together. We are one of the most polarized countries when it comes to this.

    Remember a short time ago when France decided to make it EASIER to fire employees by extending their probationary period, and giving larger leeway to companies? The entire working class protested by marching in the streets. The law was quickly repealed because of the mass protest. If Americans weren't so selfish and concerned only with themselves, we could accomplish the same thing.

    The way things are now, I don't see this happening. So our jobs will continue to go overseas, we will get less pay and less benefits. I think that's just the way it is. We are just too selfish and interested only in "Me, Me and Me".
  4. by   Indy
    This mass of baby boomers has already started dying. They've got diabetes, cardio problems galore, and cancer. Assisted living is everywhere and some of them are looking into it. It won't be long before today's assisted living is tomorrow's nursing home.

    We don't have enough nurses to take care of them now, when they're gone it'll be close to my time for retirement and/or disability, death, etc. So I can only hope that when my time comes there might be a few more nurses around. After that, I can't predict swings in the demographics. I just know my generation has been following the baby boomers in everything; they're my parents. So even if I don't like nursing homes much, there's still a good chance I could work in one before all is said and done.
  5. by   Mudwoman
    This is great to have some posts.

    Fed Chairman Ben Bernanke announced to Congress last week that there is no choice but to revamp social security and medicare/medicaid for the 77 million baby boomers. The US simply doesn't have the funds and will not have the funds to provide for them.

    So, suppose that Medicare says we will pay a lifetime benefit of $5000 for any diabetic care from the time you are 65 to your death. What happens when the benefit is up? If a person has some money, they will probably go where they can get cheaper care----maybe that is India or Mexico. If they don't have any money, then they will do the best they can and die an earlier death than the current aged population. No heroic measures.

    Big companies are no longer "US" companies, they are "International" companies. Look for them to eventually get on the International Health Care wagon for their employees. If you can get on a plane to go to a meeting, you can get on a plane to go have your gallbladder removed.

    Smaller companies will also look for savings. If you can have Cardiac Bypass at a local hospital for $60K and you can have the same surgery with airfare in New Delhi for $10K and your chances of survival are better in New Delhi, then you are going to New Delhi, or you are going to pay the difference yourself.

    I think this leaves lots of nurses without jobs and other nurses in great demand. I think more and more Advance Practice Nurses and Nurse Practitioners are going to be needed. I see Not For Profit clinics opening staffed with just NP's and APN's to take care of colds/flu and chronic care patients. Already in 18 states, NP's and APN's can work without being under a Doctor. They are independent. I see more and more states doing this. For the patient that has little money, no insurance, I see a demand for Nursing Diagnosis/Nursing Protocols to help these people deal with their disease process in the best way possible. That means that nurses are going to have to step up and get that BSN at least. You will see a sign on someone's home stating "Nursing Here".

    The state of Arkansas already approved unlicensed people to give meds---called a medication aide. Nursing homes have jumped on that one. Just a matter of time before most LPN jobs are phased out. There will still be seasonal work for immunizations etc, and Doctor offices will still use them, but if the docs are closing down for lack of business, just how many nurses will they need? As RN's vie for what is left, the more education and experience you have the more marketable you will be.
  6. by   mvanz9999
    Interesting view Mudwoman. I'm a career changer, and for the reasons you've stated above, I basically have decided to go the NP route. There are many direct entry MSN programs, which I've heard the pros and cons of. But basically when you get down to it, I neither want to work under the standard RN/LPN conditions, nor be out of a job in 10 years. So I'm totally on your side. For me it's either Masters or nothing.

    It's a shame that the US is continually driving work to other countries, requiring more and more education from people that are less and less able to afford it.
  7. by   Mudwoman
    The hospital that I nursed at before coming to the job I have now, kept telling us that health care in this country is consumer driven and that people will more and more start choosing where they go. Magnet Status hospitals are the wave of the future and to get that certification, requires primary care by RNs only.

    Also, got my new employee insurance packet for next year. Our insurance is being changed to plan where we put into a health savings account and the company contributes $300 for each family member up to $900 to the account each year. Has a $5000 deductible for each family member and then the plan pays 80%. There will be more of this too.

    Can't afford to be sick. Working on that RN and hope to graduate in March, then it is the BSN and then NP. I'm 53 and don't have a lot of time, but looks like retirement may not be an option if I want to eat. Have to stay at it and stay healthy.
  8. by   RN007
    This is a great, thought-provoking post. Thanks for starting it. I, too, am an 'older' student entering my second career May '07 as an RN and will continue to become an NP or CNS. Eventually, when I'm too gray to work in a hospital, I hope to teach. I don't see an appreciable glut of nurses entering the field in the near future. I talked to a recruiter today at our children's hospital, and she can't take anymore nursing students. She's filled to the brim with us: days, evenings, nights, weekends. Even if nursing schools open up, I'm not sure hospitals will be able to train new nurses any faster.
  9. by   nurse4theplanet
    Quote from Mudwoman
    Fed Chairman Ben Bernanke announced to Congress last week that there is no choice but to revamp social security and medicare/medicaid for the 77 million baby boomers. The US simply doesn't have the funds and will not have the funds to provide for them.

    I am curious to see how this will affect the healthcare system. Recently, I attended an inservice at my hospital in which we were told that the company had entered into a CIA agreement with the Federal Government in order to keep our Medicare Eligibility. They stressed that without Medicare payments, our hospital could not exist...its the bane of our existence. If the SS system collapses and Medicare is severely reduced or obsolete...what will happen to hospitals like mine?
    Last edit by nurse4theplanet on Oct 10, '06
  10. by   barbyann
    An important and thought provoking thread! If history is a predictor of the future, nursing will include CHANGE. I'm 43yo, my plan includes remaining flexible and watching national and international trends in healthcare.
  11. by   mvanz9999
    Quote from Mudwoman
    Also, got my new employee insurance packet for next year. Our insurance is being changed to plan where we put into a health savings account and the company contributes $300 for each family member up to $900 to the account each year. Has a $5000 deductible for each family member and then the plan pays 80%. There will be more of this too.

    Can't afford to be sick. Working on that RN and hope to graduate in March, then it is the BSN and then NP. I'm 53 and don't have a lot of time, but looks like retirement may not be an option if I want to eat. Have to stay at it and stay healthy.
    I assume this is a change (for the worse) from previous years. This happened to me as well. My deductible went from an affordable and reasonable $500.00 per year to $2000, my premiums doubled and coverage is only 90% maximum after deductible is met (formerly was 100%).

    Not only can I not afford to be sick, I really can't afford to make sure I'm well. I literally have to pay for everything now. Which means I'm not going to be making wellness trips to the doctor, because I have to pay out of pocket for that now.

    In the long run, this is going to cost businesses far more than simply paying for wellness exams NOW.

    asoldierswife05: I have no idea what will happen. I suppose there will be drastic cuts at the hospital, many will probably close, and the only people able to afford healthcare will be the very wealthy. Hospitals will turn into for profit centers only.

    As a side note, they are closing our VA hospital here. In Chicago. As you can imagine, it's an extremely busy hospital. They claim there is not enough funding from the Fed government to keep it open. Ridiculous and filled with lies. Perhaps a few less pork barrel projects and a few more dollars to the VA?

    I have no idea what these poor soldiers, who were promised a lifetime of care, are going to do. It's obscene....
  12. by   Mudwoman
    Quote from asoldierswife05
    I am curious to see how this will affect the healthcare system. Recently, I attended an inservice at my hospital in which we were told that the company had entered into a CIA agreement with the Federal Government in order to keep our Medicare Eligibility. They stressed that without Medicare payments, our hospital could not exist...its the bane of our existence. If the SS system collapses and Medicare is severely reduced or obsolete...what will happen to hospitals like mine?


    The hospital I was working at is a non-profit catholic charity hospital. 70% of the patients are medicare/medicaid. Many hospitals will have to close or change how they do things. This hospital here closed some of the floors and leased them out to other businesses like a rehab facility and LTC facility. They are expanding the emergency room.

    15-20 years ago, everyone went to a specialist. Then Managed Care came along and said that you had to have a Family Physician as a Gate Keeper. More and more family physician offices are bringing in NP's and APN's rather than other doctors. I think it is just a matter of time before Managed Care says that you have to go to a NP and be referred to a Family Physician.

    Then look at the UK. 4 of 5 of the new graduating nurses can't find employment and the UK has taken away licenses of all foreign nurses in that country. They have cut nursing programs by 80% leaving lots of educators unemployed as well. They have a glut of nurses. Same thing could happen here. Imagine if the 41,000 applicants that did not get into nursing school had gotten in this year.

    ANA continues to yell and scream and lobby that we are in dire straights for nurses especially considering the huge numbers of elderly we will soon have. But it all comes down to the money. Without money, there is no healthcare as we know it today. So, the point of all this is to start thinking about how we will be the 1 in 5 that has a job and what will that job look like. What do we need to start doing NOW so we don't end up in the unemployment line and on welfare.

    I think we will be contract labor without any benefits.

    I think we will bid jobs and the job will go to the lowest bidder with the greatest skills and education.

    I think healthcare for the millions of elderly that will be provided by medicare will be wellness care in line with Healthy People 2010

    I think doctors that make $300K to $500K a year are a dying breed.

    Team nursing is a failure. Customers will demand primary care and low nurse/patient ratios and for a reasonable price. They will find a hospital that provides that even if they have to travel to get there. As long as the insurance companies were paying the bills, we didn't care how much it cost. When we start having to pick up the tab, we will care.
  13. by   mvanz9999
    Quote from Mudwoman
    I think we will be contract labor without any benefits.

    I think we will bid jobs and the job will go to the lowest bidder with the greatest skills and education.
    This is exactly what happened with IT people. Contract labor with no benefits. The days of contractors being paid $90.00 an hour are gone. Now you are lucky to get $20.00 an hour.

    The question is, how can we prevent being stuck in this mess as I am in IT? Is getting and advanced practice degree essential? Does that guarantee you'll still be working?

    I have no idea, but this is my greatest reservation about switching to nursing.
  14. by   nerdtonurse?
    Like some of the other posters, I'm coming from an IT background. IT used to be a fun, challenging field, and I've been trying to determine why that changed. When it was still fun, nerds like me were managed by other nerds, and we had, if not respect, at least the attention of mangement. When we told them what would work, they would take that into account. They might say no, but they'd treat us like we knew what we were talking about...

    Then the MBAs came....

    I have sat in meetings where we've done 3 solid months of testing to determine the best way to accomplish something, down to software, hardware, telcom, everything, only to have an MBA who can't spell IT say, "well, I was reading in an article that you could do it THIS way...." And yup, we'd be trying to implement something that we knew from the start would never work because the database physically couldn't pass the instructions as fast as the requirements called for, or we couldn't get a 10BaseT nic to handle the thruput of a GBnic card....:trout:

    I'm just really, really hoping that the day to day supervision of nurses stays in the hands of other nurses. If they change the rules so that LPNs, RNs, etc. can report to MBAs, then that's it, and nursing is doomed....

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