Obamacare and Nursing.. what do you think?

Nurses Activism

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I know that I am possibly opening up a can of ugly worms. I hope that in spite of differing opinions, that this thread can remain friendly and a simple exchange of ideas and opinions.

As a beginning nursing student, I am being told that there is this looming nursing shortage and that there is great job security. A little research on my own shows me that in my particular state, there definitely is a decent population of still practicing nurses who are 60 years and older who will be retiring soon, which would open up the way for us who are just getting started. More and more emphasis is also being put on the new healthcare law and how it will open the doors for more people to access medical care which again will increase the need for staffing.

I grew up in a country with a socialistic government, which also includes healthcare for everyone. I have seen how the hospitals are understaffed, and you are lucky if you get to spend 5 minutes with your physician, and you are not in control over which healthcare facility you can go to. I know that the new bill isn't necessarily socialistic, but there are socialistic principles in it.

As a nursing student, I can't help but wonder how this is going to affect my future as a nurse. I know that nurses talk among themselves and things trickle down from above onto the floors. Nothing is going to keep me from becoming a nurse. I am not in it for the money, but rather I feel somehow "called." However, I believe that it's good to be prepared for times ahead so that I can adjust accordingly.

How do you think that Obamacare is going to affect how care is delivered?

By the way, this is NOT a homework assignment of any kind. I am merely looking for for a friendly exchange of ideas and opinions.

Specializes in PICU, NICU, L&D, Public Health, Hospice.
I think of it more along the lines of letting them live the life that they're choosing for themselves. If they want to continue shooting meth, I have a hard time seeing why the collective "we" should feel compelled to enable that choice.

There is too much morbidity and mortality due to lack of access among people who are trying to work the program. Until someone hits rock bottom and is ready to make changes and actively work toward their own well-being, I think it's justified to move others to the head of their line.

Is it OK in some grand sense? No, not really. However, scarce resources must be allocated in some fashion or another, and this seems reasonable to me given the limitations that we have.

So will this involve some sort of "death panel" to determine who it is reasonable to treat and who is not treated and allowed to die?

Specializes in being a Credible Source.

I don't see it as any different than making an alcoholic ineligible for liver transplant if they're not clean and dry.

It's also no different than a PMD 'firing' somebody from their practice because they are noncompliant.

Specializes in FNP, ONP.

What people don't realize is that this already exists/is already being done, only by insurance companies. I just spent the better part of a month arguing with as forcefully as I could for a MRI for a very vibrant 72 year old patient. I can't give details of course, except to say, historically, this patient has risk factors that raise the index of suspicion for a metastatic lesion, and presently has pain that makes me suspect same. They will. not. authorize. it. WILL NOT. I appealed, the specialist appealed, NADA. The rationale of the medical director who finally called me and personally told me to stop appealing because they simply were not going to allow it, the pt's QALY score is too low. Pt is too old, even if we found it, pt is not likely to survive 5 years anyway, so what is the point? Conservative care, save the money. Period. The ins co doesn't care that this is a pt who does all kinds of extraordinary things which privacy demands I do not detail. 72 means pt doesn't get an MRI because an MRI would yield two possible results: no cancer, ergo waste of money; cancer which pt would not likely survive for 5 years, so probably waste money. Ins co answer: wait and see what happens, treat pt symptomatically. Medical director actually says to me: "Yea, it kind sucks to be the pt, but this is business, and we make objective, pragmatic decisions based on empirical data. We don't have the luxury of feeling sorry for people we like."

End of story, see ya later, stop calling, stop creating additional paperwork, have a nice day.

Now, would you rather live with this kind of reality because we are providing basic health care to all people, so therefore some people will not get "Cadillac care" in some circumstances such as this. Or would you rather live with this kind of reality because we have a responsibility to the profit margin and to stockholders? Because that is the bottom line. We already have rationed health care in this country, only now it is being rationed for the sake of profit as opposed to being rationed for the sake of providing basic services to all citizens.

Are we a culture that takes care of the smallest and weakest among us, or are we a culture that enriches the strongest at the expense of the small and weak? Unfortunately, the ACA doesn't even begin to address that fundamental question. All it does is begin to force people to take some responsibility for themselves. I'm surprised conservatives don't love it, actually, since it is a big business insurance company windfall and forces people to be accountable, and "pull themselves up by their boot straps," which conservatives also generally like. As far as the whole "limiting freedom crap" it has been my observation that both liberals and conservatives love to pass all kinds of laws that limit all kinds of freedoms so long as they are freedoms they don't like (flag burning anyone?). There isn't really anything "socialist" or liberal about the ACA. I think had it been proposed by Romney, ala the Massachusetts plan, even Limbaugh would love it, lol.

Specializes in ER, ICU, Administration (briefly).

You know, we keep debating unique cases but are missing a bigger point.

Most of what we spend on healthcare now is due to preventable diseases.

65% on obesity related issues.

If we could just go back to 1980 obesity levels, we would save 1 trillion dollars in healthcare. Medicare problem solved!

How much education on obesity do you do with your patients?

How are you doing?

Specializes in being a Credible Source.
How much education on obesity do you do with your patients?
Regularly... I doubt it does a lick of good, though.

How are you doing?
If you mean causing changes in patient behavior, not well, I'd guess.

If you mean personally, I'm 35 lbs off my maximum and have my kid choosing exercise and a healthy diet for herself.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

It will be difficult for RNs in the acute care setting to provide the type of ongoing education and advocacy that our "at risk" patients require. The relative absence of RNs in the primary and ambulatory settings negatively affects health outcomes of the population.

Specializes in ER, ICU, Administration (briefly).

With the exception of ARNP's of course.

That said, I strongly agree. There is a lack of "nursing" in primary care, and an ounce of prevention, as they say, is worth a pound of cure.

I read an article recently that said that many primary care physicians had stopped talking to their patients openly and frankly about obesity because patients would simply go to another PCP who didn't.

Specializes in being a Credible Source.

In this day and age, obesity is not primarily from lack of information. Most people know how destructive it is, they just can't summon the various resources needed to combat the problem.

The primary energy should be in prevention rather than educating those already afflicted.

Specializes in critical care, ER, health policy.

How???

How can we prevent obesity?

Specializes in PICU, NICU, L&D, Public Health, Hospice.

I do believe that there is a knowledge deficit for many Americans relative to nutrition and dietary habits and how they relate to obesity and overall health.

When I was young we were taught the basics of nutrition in HS in home economics. We were run through the basics of preparing meals from scratch, shopping, meal planning, etc. Not so much anymore...AND...fast food restaurants are now EVERYWHERE with their high fat, high carb offerings.

Not all citizens are as knowledgeable about nutrition as nurses and other educated health professionals. Given that, even many of us in our improved understanding of these matters are morbidly obese.

Indeed it is more than just a knowledge deficit, but that is a place to start.

Specializes in Pediatrics, Emergency, Trauma.
I do believe that there is a knowledge deficit for many Americans relative to nutrition and dietary habits and how they relate to obesity and overall health.

When I was young we were taught the basics of nutrition in HS in home economics. We were run through the basics of preparing meals from scratch, shopping, meal planning, etc. Not so much anymore...AND...fast food restaurants are now EVERYWHERE with their high fat, high carb offerings.

Not all citizens are as knowledgeable about nutrition as nurses and other educated health professionals. Given that, even many of us in our improved understanding of these matters are morbidly obese.

Indeed it is more than just a knowledge deficit, but that is a place to start.

^Or access and income to nutritious food...

There are several sections in my metro area that do not have an adequate supermarket...one section of this city did not have a supermarket in FORTY years.

Not everyone can afford stellar food from like a Whole Foods or even Trader Joes...fresh food should be available to ALL.

There is a myth that people who are obese are excessively eating...there are an increasing percentage of overweight and obese persons who are low income and can't afford nutritious food, plus the stress of access to healthcare, affording medication, in addition to not making ends meet.

Specializes in retired from healthcare.

Why can't Obama Care cost the same amount as auto insurance or home insurance

instead of the outrageous amounts people are talking about?

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