Let the controversy begin.

tonchitoRN · Nov 28, 2003

i was once a poor soul with no health insurance and barely enough money to keep my head above water. now i have money but i will not forget what it was like to be poor. it is not a good feeling to know what hunger is. always remember you too are one step away from being in the poor house. imagine being maimed in an accident and being unable to work. then try looking for empathy. only when you walk in the shoes of someone less fortunate then you will know what it is like. the original poster did not seem to have too much empathy for the person she turned back to the street. maybe one day you will be in need and the person you turn to puts you back into the street. then you can see what it feels like. especially during the holidays i hope you all can open your hearts and give some time and money to the charities who do their part to help those less fortunate.

iliel · Nov 28, 2003

Originally posted by LeesieBug
The reason people with no insurance line up at the ER for minor health issues is because otherwise they get NO health care.

Don't I know this! I am currently uninsured since I don't work, I had a sinus infection for almost a YEAR! My DR. wasn't too sure how to treat it since other attemps had failed and she wanted me to go to a ENT. She see's me no prob without insurance....It took me 2 months to find a DR in this damn town who would see me without insurance. They had no reason to think I wouldn't pay. They judged me from the begining..assuming that if I had no job, no insurance then I couldn't pay. I found a wonderful ENT who took me, and gave me a ton of free meds since I had no insurance and I'm fine.

It's so hard to get in to see a DR here because of the high cost of malpractice insurance, 60% of our OBGYN's left town. It's sad really....a little off topic...

NursePerson · Nov 28, 2003

"NursePerson, I'm not sure the ER nurses role is "when someone was cold i took them in, When they were hungry i feed them, when they were in prison i come to visit, when they were lonely i comforted them...........". It is very noble and honorable that's what it is to you. I'm going to disagree. The emergency room is not a homeless shelter."

The statement i made was not meant to be taken literally of course. You can not do all of the things i said in an ER but you can be the one who does not judge your fellow human being. As a nurse i am there to care for all that pass my way without prejudice, judgment, or disgust. Remember any of us can be in their place at any given time due to circumstances that we can not control. As for me i will always to treat my fellow human being with care keeping in mind how i want to be treated. There are so many sad experiences that people in this world have why add even one more by treating someone with dishonor. Yes there are problems with healthcare take it out on the legislators not on the innocent people caught in the middle. As a voting block nurses could make a difference, Something to think about?

fergus51 · Nov 28, 2003

Tweety, you would be surprised. They did a study a while ago and found that the ER "abuser" is more myth than reality. Most people there did have a valid reason for going, and even those who didn't require emergency care could only know that after the fact. They also found that a lot of them could have been treated by an NP rather than a doctor and are trying to increase the number of NPs for that reason.

My problem when I was younger in Washington was that a doctor (GP) didn't have to accept patients without insurance, but the emergency room did. So.... when you don't have insurance, where are you gonna go? To the emergency room, which is much more expensive than a GP visit would be. There are certainly abusers everywhere (even with "universal health care"), but the way the system is set up only encourages it. I want more NPs, more walk in clinics, less CYA medicine (and so better lawsuit laws), more autonomy for triage nurses, and more common sense from people. And if all that fails, I think emergency nurses should have the right to kick patients out whenever they want;)

webbiedebbie · Nov 28, 2003

We have a few "Medac" and "Urgent Care Centers" where I live. They keep medical records on you and advertise that no appointment is needed. I have used them a few times. However, they are operating from only 8 a.m. to 8 p.m. It is much easier to go there and be treated than try to get into your physician's office!

I have often thought that if they were open 24/7, the emergency departments could be used for true emergencies. What a concept!

hmccartn · Nov 28, 2003

On the flip side of this issue, in the U.S. there are people who really require health care but do not seek treatment because of the financial burden they will incur if they do.

Peppermint · Nov 28, 2003

lovewhatIdo · Nov 29, 2003

Just a little different angle-

In the L&D that I work, almost 50% of our births are DSHS. Most of these women and men are young and healthy. A small minority are immigrants and migrant workers. But most are not.

I have to admit, it "tips" me a little when I see these young healthy people having there kids "on the state". Especiall repetedly. I try to keep open minded and remeber there are all kinds of circumstances-but

it is very frustrating. Why are these young people not working??? We are also a border state and have people from across the border come over, have their babies on the state, and they do it so their kids can have dual citazinship (sic). It is hard sometimes not to get cynical or resentful.

I don't buy into the fact that it (system abuse) is a symptom of a deeper illness as posted earlier. Yes some people are down on their luck, etc. But there is alot of, "I don't want to, and I don't have to" There seems to be a prevailing attitude of, "the world owes me". I don't think so.

Anyway,my two cents:)

sabRN2b05, BSN, RN · Nov 29, 2003

Ok, I've read all the posts on this subject. I am working as an Admit Rep in an ER in Louisiana while I am in nursing school. I agree with the various points that have been made. Of course, I don't know all the answers, either.

Some of you were talking about turning people away - well, in Louisiana, as far as I understand it, people cannot be turned away (anyone heard of EMTALA?) EVERYONE who comes in complaining of something has to be triaged. We get our fair share of emergencies (chest pain, SOB, MVA's), but we get more of runny noses/congestion/cold symptoms, "back pain" (most of the time, in my opinion, this complaint is from "drug seekers"), broken/sprained limbs, etc.

What pisses me off is that those who are waiting to be seen for minor stuff (like the aforementioned runny noses, etc.) get pissed at us because of the "wait" to see an MD. This happens when we have a lot of ambulances come in with REAL emergencies, or we have a couple of patients who come in with SOB or chest pain. A few weekends ago, we had a 3 year old who had been found in a pool, not breathing, mom screaming at the top of her lungs, running in the ER, screaming "someone help me". The whole lobby hears her, sees the triage nurse jump into action, run the child back to the trauma room to start CPR, etc. Of course, this child became top priority to be treated (as well he/she should have). Of course this type of emergency (along with MVA's, chest pains, SOB, etc) are going to get treated before "back pain", flu symptoms, etc. But I swear that the people with flu, runny nose, etc. (not real emergencies) will be the first ones to ***** because "they got seen before me" or "I was registered an hour ago and haven't been seen yet"

Just makes you want to say "You have a runny nose, this child just came in not breathing - it's not rocket science! Sit down, shut up, and wait your turn!"

But to change the subject a bit, we have a good many patients who have private insurance, a lot have LA Medicaid or MS Medicaid (the hospital is not far from the MS/LA state line). We also have our fair share of self pay patients. Regardless, everyone has to be seen by an MD (of course, unless a person decided to leave AMA). We cannot even ASK for insurance (before triaging or during registration) until a person is seen by an MD. People who have insurance are always trying to give us their card BEFORE they're even triaged. We then have to try to explain WHY we can't take it, which usually goes in one ear and out the other because all they are thinking about is getting triaged/seeing an MD.

I understand the rationale - it assures that everyone is treated fairly without regard to whether they can pay. I understand that there are those who can't afford insurance or are not eligible for Medicaid. But, I also understand that there are those who use the ER (especially on the weekends) when they could wait to see their PCP.

This really places a burden on us because as if we are not busy enough some nights when I feel like I register someone every 10-15 minutes for 12 hours, we have to check with the nurses to see if the MD has "seen" them yet, then either go to the patient's room while they are in the hospital gown, get them to get up off the bed, find their wallet/purse, and give us their card. The other way to get their insurance info is we catch them leaving (if we're not busy registering someone and ACTUALLY see them leave), then try to get their attention through the glassed-in cubicles we're in (sometimes taking our attention off the patient we are currently registering). We look like idiots yelling "ma'am (or "sir") - can you check out with us - we need to get your insurance information." Of course, most will turn around and gladly come back so that we can copy their card. Others don't hear us, or we don't see them. Then, we have to update the chart as "self pay", the patient gets this huge bill in, calls the business office wondering while their insurance hasn't been filed, only to be told that no insurance information was obtained (and the notes logged on the acct show that the admit clerk didn't see them leave to gain that info) Further, they get pissed because they'll say that they tried to show the admit clerks their insurance card in the first place!! Something is wrong with the whole process!

Tweety, BSN, RN · Nov 29, 2003

Originally posted by NursePerson
The statement i made was not meant to be taken literally of course. You can not do all of the things i said in an ER but you can be the one who does not judge your fellow human being. As a nurse i am there to care for all that pass my way without prejudice, judgment, or disgust. Remember any of us can be in their place at any given time due to circumstances that we can not control. As for me i will always to treat my fellow human being with care keeping in mind how i want to be treated. There are so many sad experiences that people in this world have why add even one more by treating someone with dishonor. Yes there are problems with healthcare take it out on the legislators not on the innocent people caught in the middle. As a voting block nurses could make a difference, Something to think about?

I can certainly wholeheartedly agree with what you are saying.. I hope that I abide by that. I care for people unconditionally, regardless of their finances, sex, race and I would like to think that most of us do. This is one of the main reasons I've only worked in not-for-profits.

But is pointing out that a homeless person uses the ER for a bed for the night being judgemental? Is pointing out that this is an inappropriate use of our resources judgemental? Is it dishonorable? I have no answers. But I'm trying to separate the caring of the person and whether or not they need to be there in the first place. Perhaps as you suggest that is a waste of energy. Especially since ER abuse is really not that big of a problem. I know our ER has it's fair share of drunks on any given night sleeping on a gurney in the corner sleeping it off until the morning when they wake him up and send him on his way.

If someone says they are sick and/or in pain, then I care for them regardless, without judgement.

bluesky, BSN, RN · Nov 29, 2003

In the ideal society, people who have medical problems that aren't emergencies would have other, better resources to turn to. Unfortunately, many don't and the ER is the only place they have left. I for one endure the occasional verbal abuse and understand it to be what it is, the pain of those who have been judged, neglected and abandoned by us. To blame them, to blame the victim just because she doesn't wear her victimhood in an obsequious way that caresses your ego, well that's just dandy.

The ER is the only place I would ever work because I feel proud that I take care of every single human being that walks through those doors, regardless.

I sincerely hope that your contempt for the patients that you view as unworthy doesn't get in the way of the quality of care they receive while in your care.

Dayray, RN · Nov 29, 2003

I personally don't pay any attention to who is self pay vs private insurance vs Medicaid. I really don't care as I strongly believe my role is to care for them regardless and not judge them.

I have heard some very mean things said by care providers about patients. I used to work with a doc who would ask what insurance the patient had before making orders (not because he wanted to make sure the item was covered but because he wouldn't order anything but essentials for Medicaid patients).

To get back to the original post:

I can see how you might be upset by people "bottle necking" the ER with scraps and fevers when there are people with more serious conditions waiting to be seen. I also have rolled my eyes at some of the people who come into my OB unit for silly reasons but I also realize that they do come in for a reason. Some are truthfully scared and no matter how stupid the reason my seem they really believed they needed to come in. others are just anxious personalities and while I don't think we can change that or make them feel better they come in because thats the only thing they can think of to do.

There are other reasons that may be hidden as well. I once had a 17 year old 36 week pregnant girl come in by ambulance. She said she came in because she was having contractions but there were none on the monitor and her story didn't add up. The charge nurse was complaining about "spending our money on her" As it turned out the patient admitted to me that her own father was also the father of her baby and she called the ambulance because he threatened to kill her and the baby. She came in because it was the only thing she could do to be safe and I told her to do it again if she needed too. Some think thats a waste of tax dollars and maybe it is but it isn't her fault.

As for the uninsured coming in: yeah thats a problem across the country but ask your self what you would do if you were uninsured and were sick. Would you lye down and die in the street or swallow your pride and go into the ER for treatment?

I know what your thinking "they should get a job and pay" well maybe there is some truth to that but there are allot of things that stop people from being productive.

Regardless of you moral views on poverty and welfare they are a reality in this country and are not simply answered by "go get a job" Our country is different from any other in that we are the product of the mixing in of different social and economical ideal. In many countries people who couldn't or don't work would simply die. In our country this isn't the case but those people become a surf like population and we offer them few options on how to get out of that lifestyle. If you really are bothered by it or want to change it you have 3 options.

#1 change the system so these people have no access to medical care and watch most of them die while the rest become criminals in order to pay for or steal medicine/treatment.

#2 use the nursing process to assess, plan, intervene and evaluate social problems, help a little bit a little at a time. holistic (including social) care is imo what makes nurses more then just medical technicians and can really make a difference.

#3 choose to do nothing and continue to resent "abuse of the system". It will effect your care and it will make you bitter but will do nothing to solve the problem.

before the flames roll in please keep in mind that without the benefit of face to face communication and voice inflections, it is easy to misconstrue the tone of a post. I didn't mean any of this as an attack on anyone and am not at all upset with anyone or there views.