How much waste do you see?

[PiPhi2004]

So after the MM 'sicko' thread, me and some of my co-workers got to talking last night about the whole univ health care issue and what's best. We all agreed that, on our unit esp, we see a lot of dollars that could go elsewhere and we see a lot of wasteful spending in our system. We basically take patients that are dead or near death. We save patients that are homeless and leave them on vents for months at a time where we know we will never get that money back when they die. We also see the same with illegals. About 1/2 of our patients do not have any form of insurance (so they wont be paying) and they still get to sit on the vent and rot until they die for thousands of dollars a day. This is a huge waste to me. In other units perspectively, how much wasting of healthcare dollars do you see?

[TopazLover, BSN, RN]

I totally agree we need to find solutions.

My first list of suggestions:

1.Better communications on unit. Are others feeling the same way? Apparently so. Then discuss it rationally at a meeting. Have a special meeting called if necessary.

2.Better education to the nurses about cultural differences. There are cultures that believe one must do everything to prevent death. We need to respect that.

3.Teach families gently that vents on some people just prolong the dying process, they are not preventing death. A chaplain may be better than some of us at that.

4.Conserve our supplies.

5.Be respectful of other employees that are impacted by our wastefulness. Places like laundry, whoever does your bio-haz disposal, supplies your unit.

6.Support positive communications amongst co-workers. How you say it is just as important as what you say.

Thank you for letting me have my soapbox.:typing

[leslie :-D]

I mean look at how much $$ is spent on end of life care!! Studies have shown that the last 6 months of patient's lives cost the most as far as medical care than any other. Many people have chronic diseases that can not be cured or even helped, yet we stick em in hospital beds on vents because its the "right" thing to do. When a month goes by were still doing basically nothing new for these patients, just waiting for them to get septic so we can spend more money helping with that. Do you think of how that money could have been spent on research and development of better drugs and treatments for those who had a chance? Either way, insured or not, someone is paying. I am sorry but that, to me, is rediculous and an extremely poor use of resources.

sadder than being so wasteful with $$, is that these cases are truly a waste of life.

had some doctors or families agreed that care was futile, they could have been placed on hospice, where their remaining time could be lived in comfort and in dignity.

don't even get me started on these end of life rescues.

it's so darned costly...

but more from the perspective of what the pt loses in any remaining quality of life...

and hundreds of thousands of $$$ spent, is or should be, an afterthought.

leslie

[cardiacRN2006, ADN, RN]

Speaking of waste...has anybody noticed that when some people clean pts that they throw the dirty washcloths in the trash? What's up with that? I'm sure that's lots of money wasted...

[nessajune21]

Well no one needs to be calling me "disgusting to the nursing profession"

I said the POST was disgusting and an embarrassment to the profession- not YOU.

I am sorry if you mistook my offense to your words as a blow to you as a person. I did not ever say YOU were disgusting. I just thought that the post was in poor taste- however- you are entitled to your opinion.

[haleysmum]

I'm gonna rant girls...so pull up a chair. What is this "waste of life" stuff? To US is it may seem time consuming to have people who have 0 chance of recovery, to keep people alive when we know are just prolonging the inevitable. I see pts everyday, who are 96 yo demented, loaded with CA, couldn't tell you their own name, can't walk can't feed themselves and don't know their own kids and are full codes! But they are someones mother father, grandmother,grandfather, sister, brother. THEY don't think they are a waste, no matter the physical/mental condition. It IS OUR JOB, to give them care to the best of our abilities, end of story. God forbid, if it was my mother on a vent, I know as a nurse what should be done. As a daughter, I want to keep her as long as possible no matter the prognosis.

[leslie :-D]

I see pts everyday, who are 96 yo demented, loaded with CA, couldn't tell you their own name, can't walk can't feed themselves and don't know their own kids and are full codes! But they are someones mother father, grandmother,grandfather, sister, brother. THEY don't think they are a waste, no matter the physical/mental condition. It IS OUR JOB, to give them care to the best of our abilities, end of story. God forbid, if it was my mother on a vent, I know as a nurse what should be done. As a daughter, I want to keep her as long as possible no matter the prognosis.

sorry, but it's not about you or any other family member.

it is only about the pt.

and it goes far beyond sustaining them.

these folks suffer.

and when i hear about families who insist on doing everything possible (even in spite of pt wishes), i want to whack them on the upside.

haleysmum, as a daughter, you want to keep your mom as long as possible, no matter how she suffers?

that's the real question here.

leslie

[cardiacRN2006, ADN, RN]

sorry, but it's not about you or any other family member.

it is only about the pt.

and it goes far beyond sustaining them.

these folks suffer.

and when i hear about families who insist on doing everything possible (even in spite of pt wishes), i want to whack them on the upside.

haleysmum, as a daughter, you want to keep your mom as long as possible, no matter how she suffers?

that's the real question here.

leslie

Leslie,

Thank you for this post. I wanted to say the same thing, but I knew it wouldn't come across as well as how you've posted it.

How sad...My mother knows that I would never do such a thing. Sometimes letting someone go so that they don't suffer is the most loving thing a family can do.

[leslie :-D]

Leslie,

Thank you for this post. I wanted to say the same thing, but I knew it wouldn't come across as well as how you've posted it.

How sad...My mother knows that I would never do such a thing. Sometimes letting someone go so that they don't suffer is the most loving thing a family can do.

thanks cardiac.

i extended the same courtesy towards my own mom, when she got cancer in 2004.

and it's interesting.

even though my family (siblings and stepdad) were on board with my wish to disconnect all supports, it was the 2 oncologists that gave us a run for our money...

that aggressive treatment could buy her a few more weeks.

on top of this, they wouldn't give her morphine.

and this was at john hopkins.

even though she was unconscious, vented, a zillion invasive lines, blown up like a balloon, sev'l bedsores, i could see how uncomfortable she was.

her eyebrows were knitted and her face was tense.

when she finally became cmo, the mso4 gtt worked within a minute.

her face totally relaxed.

working in a palliative care and hospice unit, i have dealt with many pts receiving palliative care, full codes and knocking on death's door.

families insisting to continue on with chemo and radiation.

the med'l director now knows to stand back when he sees me getting riled up.

thankfully, we're on the same page and he supports me.

often i have given my families a piece of my mind.

the only reason it's allowed/supported is because my bosses think i say it best.

my point being, i truly have no patience or compassion for those who refuse to let their loved ones just be comfortable.

clearly, it strikes a nerve with me.

leslie

[texas2007, BSN, RN]

If my unit subscribed to the OP's school of thought, we'd be out of business. It seems like the majority of parents wanting "everything done" for months and months are the ones with medicaid. I mean, why not...it's free, right?

[BelleKat, BSN, RN]

thanks cardiac.

i extended the same courtesy towards my own mom, when she got cancer in 2004.

and it's interesting.

even though my family (siblings and stepdad) were on board with my wish to disconnect all supports, it was the 2 oncologists that gave us a run for our money...

that aggressive treatment could buy her a few more weeks.

on top of this, they wouldn't give her morphine.

and this was at john hopkins.

even though she was unconscious, vented, a zillion invasive lines, blown up like a balloon, sev'l bedsores, i could see how uncomfortable she was.

her eyebrows were knitted and her face was tense.

when she finally became cmo, the mso4 gtt worked within a minute.

her face totally relaxed.

working in a palliative care and hospice unit, i have dealt with many pts receiving palliative care, full codes and knocking on death's door.

families insisting to continue on with chemo and radiation.

the med'l director now knows to stand back when he sees me getting riled up.

thankfully, we're on the same page and he supports me.

often i have given my families a piece of my mind.

the only reason it's allowed/supported is because my bosses think i say it best.

my point being, i truly have no patience or compassion for those who refuse to let their loved ones just be comfortable.

clearly, it strikes a nerve with me.

leslie

Thanks for saying this Leslie.

I've mostly worked in a large teaching hospital where there were mostly young trauma victims who had a chance no matter what and some made it despite the odds being against them. If they have a disease like ca or end stage organ failure and there just is nothing that we are doing except prolonging the agony without even making them comfortable I would have a real problem with that. I probably would not be able to work in a place like that where the docs don't level with the familes about the futility of continued treatment and continue to give them false hope.

[leslie :-D]

Thanks for saying this Leslie.

I've mostly worked in a large teaching hospital where there were mostly young trauma victims who had a chance no matter what and some made it despite the odds being against them. If they have a disease like ca or end stage organ failure and there just is nothing that we are doing except prolonging the agony without even making them comfortable I would have a real problem with that. I probably would not be able to work in a place like that where the docs don't level with the familes about the futility of continued treatment and continue to give them false hope.

belle, you bring up a great point about teaching hospitals...

that too often, what these hospitals lack in ethics, make up for in teaching opportunities.

and i so agree with you about trauma victims.

everyone deserves a chance, especially the young with bodies that can and do bounce back.

but when cancer is aggressively eating through your organs and we have all sorts of meds to prolong the inevitable pain/suffering, we have clearly overstepped our bounds.

these people are no longer living life.

they are merely and miserably existing.

leslie

[oncnursemsn]

I'm glad this posting is getting back to the heart of the discussion: prolonging, usually in agony, the lives of patients for whom there is absolutely no chance of recovery. End stage cancer is not curable- and on our bone marrow transplant floor, I have seen some terrible suffering and unrealistic expectations because our docs don't "give it to them straight." Somehow working with adults is more difficult than children- most parents don't sit by and watch as their kids suffer. Not the same with adults- if the doc says "oh, we'll try something else," the patient and family members often say Ok. Denial is a huge defense mechanism.

The cost of sending our "train wrecks" to the intensive care unit is enormous. I think OP wrote of the cost of the last 6 months of life in this country is astounding.

Another poster wrote of supplies- over use, wasted, thrown away etc. It's a 2 part problem. I'm trying to educate my students to be careful with resources. The gastric contents sucked out via NGT- don't have to go into biohazard. They're gastric contents- pour down toilet or hopper and toss the plastic thingy away. Stuff like that. We are spoiled and careless. I cringe and say something when the doc tosses the yellow isolation (cloth) gown into the trash. "Hey Doc, you gonna pay for that gown?"

Thanks for the forum to vent. :angryfire