My monthly semi-coherent rant on the state of healthcare

[rngreenhorn]

Healthcare is screwed. The new CMS regulations that are cutting funding to hospitals, added to the general bad state of the economy, are causing staffing cuts. The new rules that base reimbursement on patient satisfaction mean more staffing cuts, worse CMS scores, more decreased payments, and even more staffing cuts. Add to that, cuts to Medicaid, and the fact that no one knows what is going to happen with private insurance once the PPACA is fully implemented, and the future is pretty bleak. Pretty soon, in hospitals across the nation, there is going to be one nurse taking care of 10 agitated and /or mad patients on each unit.

Before you all respond with the question, "Well what are you doing about it?" I'll tell you: 1) I'm getting angry, 2) I have completed my employee satisfaction survey with a 3 page essay of "the problem, and ways to fix it" (and everyone knows surveys fix everything), 3) I've caused my unit manager to quit (with all my complaints and the fact that her hands are tied by the unreasonable demand of administration), it's no damn wonder she quit, 4) I've talked to: my boss, her boss, the staffing office, the house sup, the COO of the unit, the "head in her a** of nurse theory" CNO of the hospital, doctors, and I have even discussed it with by dog, and 5) I've done some soul searching to see if it possible just my problem, including having my hormone level checked by my PCP. But after another horrendous day, being stuck in one of my patient's rooms, and being punched by said head injured patient (because there is no budget to staff a 1:1), that lead to really pi** poor nursing for the rest of my patients, I'm beyond frustrated. The impossible rules and regulations of those in power are completely detached from reality.

And let me "pre-respond" to the new nurses, nurse manager, nurse administrators, nurse educators and such, before you say "well if you hate it so much, then you should quit, you clearly don't have the temperament and warm fussy approach to be a compassionate nurse. Didn't you study theory?" I'll say, you are right, I don't. This profession sucks. I will be looking for another career. The sad thing is, I believe in the nursing philosophy, I think people are basically good. It's just that the leaders and regulators in healthcare are suffering from some serious group think.

You may say, "Well healthcare in the U.S. is too expensive." I agree, yes it is. But is it going to be one heck of a road to equilibrium. I once loved my job, but I am beaten down, dishearten, and afraid for what's to come... Also, I am not a martyr, I will help people (it is in all our natures), but I will not condone stupidity.

PS. Yes, the grammar in this rant sucks. Sue me.

[anniv91106]

Very well written. Yes, we don't care any more about the patients- because we have so many things to work on beside the patient: hourly rounds, belonging sheets fill up, tickets to ride ( each time pt leaves the unit), safety sheet to be signed by the patient, and zillion other things to document. Forget the patient, he/she can lie in poop, wait for pain medication etc.- I'm busy charting everything.

Well, nursing is pathetic especially in the hospital. Coworkers are leaving in droves our hospital.

Don't forget that we must watch out for the surveillance cameras. The facility where I work is investing in more cameras.

[itsmejuli]

Healthcare is screwed.

Before you all respond with the question, "Well what are you doing about it?"

I whole heartedly agree. So much so that after spending almost 20 years in the US, I decided it was time to return to Canada.

I worked for 2 American private insurers then worked a year in LTC in Florida. I'm so glad I could relocate back to Canada and work in socialized medicine.

[VICEDRN, BSN, RN]

I concur. I love taking care of sick people but after closing in on two years of nursing, I wish I had chosen a different path and I am aggressively reviewing my options for leaving acute care nursing as quickly as possible.

Customer service is just an opportunity for the patients to abuse us and bully us into giving them everything they want regardless of what our assessment indicates.

Our inequitable distribution of healthcare forces me to watch people die in the er because they can't access the system while others visit and revisit because they are either very poor or very rich. (This is my testimony: I WATCH people die from lack of access and I swear I want to write a book about it and its why I work in an inner city charity hospital HELLHOLE of a place to work.)

I have lost my faith in management because the NMs office is just a revolving door of upper management patsies who just want us nurses "more under control" cost wise and schedule wise. Otherwise, we have so many freakin admino-nurses who make life miserable for people who actually work as nurses without actually enriching or improving my practice that I actively avoid working days and weekday nights so I don't have to see their budget sucking faces when I go to work.

I am sick of reading about new rules that limit nursing practice into a series of automated mindless tasks. Limiting PRN medications so nurses don't have to choose medications? I didn't get a bachelors degree to avoid thinking. Seriously.

Wish it was different for us. Really I do. All I can say is keep it moving. Get a new job. Go PRN in two places. Work day surgery or urgent care for Kaiser.

Worse part is that you worry...after everyone with even 3-5 years experience leaves, the hospital is left with nothing but floors full of newbies and how is that good for patients?

[Zen123]

All i can say is this mess right now is making a good nurse into a bad nurse. I'll go in..do what i can and some just can't be done.

[nursetobows]

I know many people don't agree with universal health care and I am not here to debate that with anyone........

With that being said...........my husband and I have already agreed that if anything was neglected to any member of our family we are on the first plane back to the UK for care. I am an American citizen but lived overseas for 3 years and both of my children are British citizens and my husband and I feel blessed that we have that option.

One thing many people don't know is that as a UK citizen if the care you receive in the UK is not working for you you are allowed to show proof of a country that can provide you life saving care and it is covered by the NHS.

[rngreenhorn]

Thank you all for your funny and insightful comments. Guess I'm going to have to pop a handful of Metoprolol before heading to work, so my arteries don't blow up. Yes, the prospect of growing old today is terrifying. And I agree there is no single answer.

Socialized medicine worked for Italy, and Greece... and the UN says their system is faaaabulous, but it's not looking so hot for them right now. Also, in that paradise of a system, it is NOT all "free," the people pay 21% out of packet (twice as much as the US and France). Good luck getting our people to agree that we, in fact, should pay something. Employer provided (but heavily governmental regulated) insurance is working for France, but 92% of their citizens also buy additional private insurance in order to get the "good stuff" and their system is the 3rd most expensive in the world and going broke (just like us). Add to that the fact that France and other EU members will be bailing out Italy and Greece (and it's a bit dodgy over there right now). Insurance mandates work for the Swiss, but their citizenry is pretty dang homogenous, and it is a small rich country that looks nothing like the U.S.

I don't think a not-for-profit industry is the answer because without individual motivation, there is no reason to achieve, and subsidies aren't exactly working out for other industry right now. However I did hear a convincing argument on NPR that either a single payer socialized system OR a balls-to-the-wall (I don't think NPR used that particular colloquialism) market driven system would be better than the current hybrid. For me, it doesn't make sense to work your butt off only to provide for everyone else. There is no collective, only a bunch of individuals, (except for the Borg in Star Trek) and that existence sucked for Jean Luc Picard (just like it will suck for us). At the same time, the CEO's and leaders of giant corporations don't deserve huge paychecks and bonuses if said organization is failing and being bailed out by us. The giant divide between the wealthy and the poor is a bad thing, for sure, but complete equality is neither possible nor desirable. And it is not particularly healthy that 50% of the nation pays no taxes. The leaders on the left and right who have done this to us should hang their heads shame. Crony capitalism AND unjust unfettered redistribution are both immoral. There is not a finite amount of money in the world (economies expand and contract). It is not true that if my neighbor has a bunch of money, then there is no money left for me. Nor is it true that there should be no safety net, bad things happen to good people, and we as a moral society are obligated to help. But we are NOT obligated to help the incorrigible slackers and unmotivated.

Anyway, that is my 1 cent (only 1 cent instead of 2 because I can't afford 2 right now) ;0). I expect some will disagree, that's OK, we all want the same thing, to take care of each other, we just disagree about how to go about doing that... A least the goal is worthy.

[AJPV]

"Balls to the wall" - that would be a great presidential campaign platform

[rngreenhorn]

Very well written. Yes, we don't care any more about the patients- because we have so many things to work on beside the patient: hourly rounds, belonging sheets fill up, tickets to ride ( each time pt leaves the unit), safety sheet to be signed by the patient, and zillion other things to document. Forget the patient, he/she can lie in poop, wait for pain medication etc.- I'm busy charting everything.

Well, nursing is pathetic especially in the hospital. Coworkers are leaving in droves our hospital.

Haven't you heard hourly rounding et al is evidence-based! Sheesh, what is wrong with you? It worked wonders for some 5 bed hospital in Outer Mongolia. Plus the research is peer reviewed--- so of course it is practical to implement it in every unit, in every hospital in the world.... nay, the universe. What? You say hourly rounding is not possible? Well I can't believe that, it's evidence-based dangit!

[GHGoonette, BSN, RN]

Nationalized health care is a good thing provided that the populace understands that there are chains attached, in the form of heavier taxation. We're staring it in the face in South Africa, and given the levels of tax that we already pay, it's scary.

OP, you mention Greece; there's an interesting case in point. According to what I've read about that country, tax-dodging is almost a national sport! Of course, that hasn't been corroborated by any Greek citizens, but if it is true, certainly illustrates the pitfalls of a national health scheme.

[DoGoodThenGo]

Thank you all for your funny and insightful comments. Guess I'm going to have to pop a handful of Metoprolol before heading to work, so my arteries don't blow up. Yes, the prospect of growing old today is terrifying. And I agree there is no single answer.

Socialized medicine worked for Italy, and Greece... and the UN says their system is faaaabulous, but it's not looking so hot for them right now. Also, in that paradise of a system, it is NOT all "free," the people pay 21% out of packet (twice as much as the US and France). Good luck getting our people to agree that we, in fact, should pay something. Employer provided (but heavily governmental regulated) insurance is working for France, but 92% of their citizens also buy additional private insurance in order to get the "good stuff" and their system is the 3rd most expensive in the world and going broke (just like us). Add to that the fact that France and other EU members will be bailing out Italy and Greece (and it's a bit dodgy over there right now). Insurance mandates work for the Swiss, but their citizenry is pretty dang homogenous, and it is a small rich country that looks nothing like the U.S.

I don't think a not-for-profit industry is the answer because without individual motivation, there is no reason to achieve, and subsidies aren't exactly working out for other industry right now. However I did hear a convincing argument on NPR that either a single payer socialized system OR a balls-to-the-wall (I don't think NPR used that particular colloquialism) market driven system would be better than the current hybrid. For me, it doesn't make sense to work your butt off only to provide for everyone else. There is no collective, only a bunch of individuals, (except for the Borg in Star Trek) and that existence sucked for Jean Luc Picard (just like it will suck for us). At the same time, the CEO's and leaders of giant corporations don't deserve huge paychecks and bonuses if said organization is failing and being bailed out by us. The giant divide between the wealthy and the poor is a bad thing, for sure, but complete equality is neither possible nor desirable. And it is not particularly healthy that 50% of the nation pays no taxes. The leaders on the left and right who have done this to us should hang their heads shame. Crony capitalism AND unjust unfettered redistribution are both immoral. There is not a finite amount of money in the world (economies expand and contract). It is not true that if my neighbor has a bunch of money, then there is no money left for me. Nor is it true that there should be no safety net, bad things happen to good people, and we as a moral society are obligated to help. But we are NOT obligated to help the incorrigible slackers and unmotivated.

Anyway, that is my 1 cent (only 1 cent instead of 2 because I can't afford 2 right now) ;0). I expect some will disagree, that's OK, we all want the same thing, to take care of each other, we just disagree about how to go about doing that... A least the goal is worthy.

It isn't just who you think are paying zero federal taxes. Many persons and or households with incomes

By and large for most groups federal income taxes have been going down for years, it is on the state level where many get caught (try living in NYS).

As for social medical care; there isn't a country that offers such schemes that is currently not grappling with rising costs and how to deal with them. France, Denmark, et all all are trying various methods to keep costs down instead of raising already very high taxes that fund the things. France in particular has been trying to find ways to shift more of the costs onto providers and or users of the system. Of course you can imagine how this is going over (just see the strikes in Greece and France), but governments know something must be done.

For instance whilst hospitals in the United States are moving quickly to mostly private rooms where possible, such things are rare elsewhere and or aren't always covered under national health plans. You'll still find open wards along with semi-private (two, four and more) beds all over the world.

The other problem with many socialised medical schemes is that hospitals aren't always big spenders on new/modern technology and or equipment. If they aren't going to be paid (one way or another) why bother so goes the train of thought. There is a reason why so many of the world's wealthy and powerful persons seek medical care at US hospitals including recently late Saudi royalty.

[ebear, BSN, RN]

rngreenhorn, I don't know whether to laugh or cry! Your posts are right on target! It breaks my heart to see what "health care systems" have become but you have such an entertaining way of telling it like it is! I've been in this crap for 37 yrs! :hug: *wine

[student forever]

When the supplies run out, why not anonymously call the family of the pt/res and ask them to drop some off next time they are in the area? Might shake things up a bit????

Or, do like the schools do - send a list of supplies for the parents to bring, kleenex, crayons, paper. . . toilet paper, peri pads, swabs, wipes. . .

sounds revolting, no?