Planning our future and outsourcing

[Mudwoman]

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??????

[ZASHAGALKA, RN]

My huge concern is that nursing is going to end up exactly like IT. You're going to get a bunch of MBAs that have never spent a single day doing anything remotely nurse-like, essentially making the field a living hell. Added to the fact that many jobs are cut due to funding (it's a little hard to outsource nursing per se...)

Going to end up this way? This has been the case since the '80's and the MBAs making the changes to nursing without any heed to reality of how things are done?

Hospital Admins call them 'consultants'.

~faith,

Timothy.

[Mudwoman]

Some more thought. Went on the Bureau of Labor Statistics that the Govt puts out. For RN's the number of nurses leaving the occupation from ages 60-64 is nearly 60% of the number of nurses working in the 55-59 age bracket. Not surprising that after age 59, we find the work too physically demanding.

But, what if there is no Social Security, no retirement benefits, no way to quit working for many of us? I could not live on the proposed Social Security wage of $800 that I might get at age 62 and my full retirement age is now 67.

Some more info.

There are approx 2,500,000 RN's. Avg pay is $27.35 hr. 1,400,000 approx work in hospitals.

States with the highest concentration and largest percent of state employment are: Mass. (avg $32), S. Dakota (avg $23), MS (avg $23), W. Virg. (avg $23), and Maine (avg $25)

Top paying states: CA(avg $34), Maryland (avg $32), Mass (avg $32), Hawaii (avg $32), N. Jersey (avg $30)

There are approx 725,000 LPN/LVN's Avg pay is $17.41. The number employed in Nursing Hms and Hospitals is about even.

States with the highest concentration and largest percent of state employment are: Arkansas, LA, W. Virg, OK, MS (salaries avg $13.50)

Top paying states: Conn, D. C., N Jersey, Mass, RI (sal avg $22)

APN/NP. There are approx 58,000. Avg wage $42.13 hr. Most all work in Hospitals and Dr Offices.

States with highest concentration: MO (avg $43) RI (avg $38) IL (avg $18) AZ (avg $63) ID (avg $27)

Highest paying states: MT (avg $85) AR (avg $78) NV (avg $76) SC (avg $70) W. Virg (avg $67)

In the avg's above I have rounded to the nearest $$ for simplicity.

Best Metro area to work for an RN: San-Jose/Sunnyvale/Santa Clara, CA with avg of $42.28 hr.

Best Metro area for LPN/LVN: San Francisco/San Mateo/Redwood City, CA with avg of $25.05

Best place for NP/APN: Clarksville, TN/KY with an avg of $94 hr. Close behind is Kingsport/Bristol TN/VA and Prescott, AZ with $93 hr.

In doing all this, I have to admit that living in the Hot Springs, AR area and it being one of the worst places for LPN's, this probably gives me a different paradigm of the future. But, a lot of the nursing "shortage" has to do with older nurses leaving the profession in their 50's and baby boomers getting socialized medicine called Medicare. I don't think the boomers can afford to retire. They will work till they drop and there won't be much money for medical care for them. Lots of people will be hoping they drop soon.

[Mudwoman]

That figure for a NP/APN in Illinois of average pay $18 per hour is for real!!!! 10% of all NP/APN's are in Illinois. Shows what happens when there is a glut.

[mvanz9999, RN]

That figure for a NP/APN in Illinois of average pay $18 per hour is for real!!!! 10% of all NP/APN's are in Illinois. Shows what happens when there is a glut.

Ugh. Look where I'm at. So basically I would make MORE as an RN than an NP in Illinois?

I've talked with quite a few people my age, and no one believes this generation will be able to fully retire...ever. There simply is no way to live on the tiny amount of benefits from federal sources.

If these numbers hold true in Illinois, it's only going to get worse. This makes me think seriously about dropping the whole NP idea. I'm not going to spend a lot of $$$ to make less money. That would be beyond stupid.

[Mudwoman]

Ugh. Look where I'm at. So basically I would make MORE as an RN than an NP in Illinois?

I've talked with quite a few people my age, and no one believes this generation will be able to fully retire...ever. There simply is no way to live on the tiny amount of benefits from federal sources.

If these numbers hold true in Illinois, it's only going to get worse. This makes me think seriously about dropping the whole NP idea. I'm not going to spend a lot of $$$ to make less money. That would be beyond stupid.

Don't give up yet. Here is a better web site I found today.

http://nurse-practitioners.advanceweb.com

Has better information and more up to date info.

[HARRN2b]

Mvan,

you are exactly right in saying that this generation will not be able to retire--ever. We are loosing seniors already. I have been researching this for some time. There is a very large settlement of retiree's near Guadalahara sp? Mexico. The reason they live their is cost. They can afford to pay out of pocket for most of their medical costs. You can check the sight yourself or ask questions, but I believe an EKG is around $30US. Now, I looked into that price over a year ago and prices have started to escalate, due to numbers of Americans and Canadians moving there.

People that I know are looking into all kinds of ways to live out their "golden years". I just do not think it will be in the United States, sadly, for some of us. The website by the way is www.chapala.com .

[mvanz9999, RN]

This is what I was talking about earlier. "If you don't like it get out and vote". Vote for what? I've got one bad candidate and another worse candidate. How is this democracy? I cannot stand candidate A or B. So I'm left to throw away my vote on a 3rd party that cannot possibly win, or vote for someone I do not support.

From today's paper:

"Illinois voters are unhappy with Democratic Gov. Rod Blagojevich, but they like Republican challenger Judy Baar Topinka even less, giving the incumbent the advantage less than a month before the election, a new Tribune/WGN-TV poll shows.

The poll reveals widespread voter disillusionment even before the latest allegations of corruption, setting the stage for a lackluster turnout in the Nov. 7 election. And as the election moves closer, voters are becoming increasingly unsure about where to turn."

Will all of this unrest about the future of nursing, I feel more and more powerless as the government and the candidates seems less and less viable choices. And if you do not like the choices, the entire system fails.

[ZASHAGALKA, RN]

This is what I was talking about earlier. "If you don't like it get out and vote". Vote for what? I've got one bad candidate and another worse candidate. How is this democracy? I cannot stand candidate A or B. So I'm left to throw away my vote on a 3rd party that cannot possibly win, or vote for someone I do not support.

From today's paper:

"Illinois voters are unhappy with Democratic Gov. Rod Blagojevich, but they like Republican challenger Judy Baar Topinka even less, giving the incumbent the advantage less than a month before the election, a new Tribune/WGN-TV poll shows.

The poll reveals widespread voter disillusionment even before the latest allegations of corruption, setting the stage for a lackluster turnout in the Nov. 7 election. And as the election moves closer, voters are becoming increasingly unsure about where to turn."

Will all of this unrest about the future of nursing, I feel more and more powerless as the government and the candidates seems less and less viable choices. And if you do not like the choices, the entire system fails.

You have more options than this.

You are complaining about end-user options - the vote, but you have the ability to be the designer of the system. Get involved and you can be in a position to influence a party's candidate.

Or, run for office yourself.

We get exactly the system we deserve. If you don't like the system: change it.

If you limit your options to that of an end user, it is YOU, by default, that allow the choices that are made for you to choose from.

You suggest that it is futile to say, "If you don't like it, get out and vote." Fine, so back it further up the chain of command: "If you don't like it, get out and influence who the candidates will be." And believe me, in 3 weeks, on the Wed AFTER the election: that is EXACTLY the time to be influencing who the candidates will be in 2008.

~faith,

Timothy.

[RunningWithScissors]

Let's face it, this country is going to gell in a hand basket and health care is just another symptom of a much larger problem.

We don't need to worry about what's going to happen 10-15 years from now, though, because, if you believe the multi-cultural prophecies, :

The world as we know it will cease to exist in 2012.

.......................

[ZASHAGALKA, RN]

Let's face it, this country is going to gell in a hand basket and health care is just another symptom of a much larger problem.

We don't need to worry about what's going to happen 10-15 years from now, though, because, if you believe the multi-cultural prophecies, :

The world as we know it will cease to exist in 2012.

.......................

Perception is reality for many of us.

I see this nation as a great place to live, and a great time. At any time, any society is going to have 'problems'. Any time you balance how to allocate resources, some will feel left out on some things. And some things will always lack comparative attn to others.

That's the nature of politics and the pure definition of politics is the collective allocation of resourses, be they economic, legal, or otherwise. The only perfect system is a dictatorship and then, it's only perfect for one person.

btw, I'll hedge my bets that the world won't end in 2012.

~faith,

Timothy.

[mvanz9999, RN]

ZASHAGALKA, you make good points. However, I do not share your optimism.

True, one COULD run for office or maneuver into a position to affect who is in office, however that's not me. I'm interested in being a nurse and a lot of other things. I politician is not one of those things.

If I want to be a nurse, I will. If I wanted to be a politician, I'd do that instead. Not everyone has the desire to involve themselves in the horrific mess called "the government".

I don't care to get into a long discussion about who has the best government, blah, blah, blah. That similar to saying who is the best candidate, neither of which I like. We may have the "best" government, but it still sucks. What kind of choice is that?

You're correct. Technically government is about the allocation of resources. I honestly believe that most of those resources, be they economic, legal, or other, are wasted. Total nonsense. Why is Chicago, a city in dire need of many things, wasting resources by banning DUCK LIVER? Have we nothing better to worry about?

Why are $ Billions spent on the "open road tolling" project? Because the homeless shelters don't need money? Why not give all the money spent on these things to the VA hospital that is closing due to lack of funds. I have seen our VA hopsital. It's always full. Out the door and down the street full. Yes it's being closed due to lack of funds. But the state sure has a lot of money for nonsense like building big toll-road bridges featuring the governor's name. Or banning (and enforcing) the sale of Foie Gras in Chicago. But the veterans? The heck with them!!!! The welfare of ducks is more important.

In addition, the city, the county, and the state government are all under federal investigation for crimes. Past governor, guilty as charged. It's so corrupt, it's unbelievable. I do not care to get myself involved with federal criminals. Thank you.

I'm starting to not agree that the best place to live is the US. I'm thinking of moving to Canada.

[Mudwoman]

ZASHAGALKA, you make good points. However, I do not share your optimism.

True, one COULD run for office or maneuver into a position to affect who is in office, however that's not me. I'm interested in being a nurse and a lot of other things. I politician is not one of those things.

If I want to be a nurse, I will. If I wanted to be a politician, I'd do that instead. Not everyone has the desire to involve themselves in the horrific mess called "the government".

I don't care to get into a long discussion about who has the best government, blah, blah, blah. That similar to saying who is the best candidate, neither of which I like. We may have the "best" government, but it still sucks. What kind of choice is that?

You're correct. Technically government is about the allocation of resources. I honestly believe that most of those resources, be they economic, legal, or other, are wasted. Total nonsense. Why is Chicago, a city in dire need of many things, wasting resources by banning DUCK LIVER? Have we nothing better to worry about?

Why are $ Billions spent on the "open road tolling" project? Because the homeless shelters don't need money? Why not give all the money spent on these things to the VA hospital that is closing due to lack of funds. I have seen our VA hopsital. It's always full. Out the door and down the street full. Yes it's being closed due to lack of funds. But the state sure has a lot of money for nonsense like building big toll-road bridges featuring the governor's name. Or banning (and enforcing) the sale of Foie Gras in Chicago. But the veterans? The heck with them!!!! The welfare of ducks is more important.

In addition, the city, the county, and the state government are all under federal investigation for crimes. Past governor, guilty as charged. It's so corrupt, it's unbelievable. I do not care to get myself involved with federal criminals. Thank you.

I'm starting to not agree that the best place to live is the US. I'm thinking of moving to Canada.

It is this same disilllusionment that Germany experienced and then along came Hitler.