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??????

[mvanz9999, RN]

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

I'm not really sure what this means. You mean to say with all this disillusion, the population (of German) found a strong leader (in Hitler) and blindly followed him, despite the horrors for which he was responsible?

So are you saying a horrible person could come along to lead the country (George W.) and we would blindly follow him into a disastrous reign of terror?

I don't think George W. is the same as Hitler, but I'd like to know why there is a war in Iraq that the majority of the country DOES NOT SUPPORT. How does this happen, in a democracy?

[Mudwoman]

Before he was elected, Hitler was charismatic and had all the answers. Germany loved him. I don't think GWB is a Hitler, I'm just saying that when a country is so fed up with the leaders in government, someone comes along that is suave and says the right things and you never know when that person will turn out to be worse than all the others combined.

I was simply pointing out that Germany was looking for a change. They got it. It wasn't the change they thought they would get or wanted, but change they did get.

[klgann]

I know that this discussion is about outsourcing, but have to correct the statement about maternal mortality. The actual rate is 22 out of 100,000, or

.022%. See the below quote from United Press International.

Obesity and other health conditions may help explain why women in New York City are more than twice as likely to die in childbirth.

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Not at all - 1 2 3 4 5 - Highly A study by a medical group detailed in an advance copy of Crain's New York Business says in 2002 New York City's maternal mortality rate of 22 deaths per 100,000 births was 2 1/2 times the national average, the New York Post reported Monday.

The figure was compiled by the state chapter of the American College of Obstetricians and Gynecologists as part of an effort to lower maternal mortality rates to three deaths per 100,000.

"Eight-point-nine is still above where we want to go, so to be higher than that is not getting us in the right direction," said Dr. Howard Minkoff, a spokesman for the medical group.

He cited poverty, obesity and other health conditions as possible reasons for the higher death rate.

According to the Crain's report, more recent figures indicate the problem is equally serious statewide with a rate of 21.2 deaths per 100,000 births in 2004.

Copyright 2006 by United Press International

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??????

[Wuzabeth]

so at the age of 37, almost 38, should one bother going to Nursing School????

[MQ Edna]

Ok...let me get this straight. The field of nursing now is in jeopardy? It's not the high-paying job that we all strived to get after all? I mean, after all aint we all in it for the money?? I hate to be sarcastic here, but come now. The picture isn't as bleak as all are making it out to look like....!

[mvanz9999, RN]

so at the age of 37, almost 38, should one bother going to Nursing School????

I am. .

Why not? You've still got a LOT of years to work.

[Mudwoman]

If you decide to go to nursing school, don't stop at the LPN/LVN or the ADN. Go for at least the BSN and preferably the MSN.

Healthcare as we know it is going to change. Exactly what that change is, we will only know when we get there as no one can see into the future for sure. However, you can look around at what is happening right now before our eyes and start putting part of the puzzle together.

People can go anywhere in the world and get great healthcare. The US is no longer THE place to get good healthcare.

Healthcare is not only great in other places of the world, it is a lot cheaper. Open heart in the US $60K Open heart in India with airfare $10K.

Insurance companies are moving towards Health Savings Accounts with high deductables and catastrophic coverage only. As more and more Americans have to pay the majority of the bill, they will look at ways to save money. Just like we started shopping at Walmart, we will start shopping for healthcare and won't care if we take a vacation to do it.

Social Security and Medicare will be revamped. We don't know what that revamping will look like, but with 77 million baby boomers hitting retirement, it won't be what it is today. 85% of all hospital revenue comes from Medicare and medicaid. If those funds are reduced or cut, many hospitals will not survive. That means fewer nurses working in hospitals.

Already, Congress has changed the rules on payment for nursing homes. A person must now liquidate all their estate and use that money before medicare will start paying. People can no longer put assets into their kid's names to avoid this. I see the kids taking care of mom and dad to keep the assets.

Now, 23 states allow nurse practitioners to work independently without a doctor over their practice. I see more and more states going to this in order to save on healthcare costs. In the future, you will see a nurse practitioner who will then refer you to a primary physician who will refer you to a specialist if necessary.

Baby Boomers will work till they drop dead. Much of the "Nursing Shortage" is hypothetical in that it assumes most of the nurses in the 45-60 age group now working, will soon retire. They won't.

So, if you have a huge influx of elderly requiring care with no insurance or limited benefits through medicare. If nurses who would normally retire continue working. If people start refusing to stay in this country for healthcare when they can go somewhere else cheaper and get better care, where does that leave 2.5 million RN's, 800,000 LPN's and 150,000 nurse practitioners? Imagine if the 41,000 applicants to nursing school that did NOT get in DID get in.

More and more, I see short term contract jobs available for nurses. Will we eventually all work for an agency and move around from hospital to hospital or nursing home on an "as needed" basis? How about our benefits? None? Are we to become contract labor?

Things, they are a changing, and the purpose of this thread was to get you thinking about how you are not going to be one of the nurses that can't find a job.

[mvanz9999, RN]

If you decide to go to nursing school, don't stop at the LPN/LVN or the ADN. Go for at least the BSN and preferably the MSN.

......

For all the reasons in your post, this is why I've ruled out the ADN/BSN programs. I've decided to pursue only a Masters. If I don't get in, so be it. Anything less is asking for trouble in the near future. It happened in IT, I won't let it happen again.

[AfloydRN, BSN, RN]

Education is the key. You can never have too much and the more you have the more marketable you will become. Noone I know has ever been turned down for a nursing job because they have too many degrees.

[kadokin, ASN, RN]

Like some of the other posters, I'm coming from an IT background. IT used to be a fun, challenging field, and I've been trying to determine why that changed. When it was still fun, nerds like me were managed by other nerds, and we had, if not respect, at least the attention of mangement. When we told them what would work, they would take that into account. They might say no, but they'd treat us like we knew what we were talking about...

Then the MBAs came....

I have sat in meetings where we've done 3 solid months of testing to determine the best way to accomplish something, down to software, hardware, telcom, everything, only to have an MBA who can't spell IT say, "well, I was reading in an article that you could do it THIS way...." And yup, we'd be trying to implement something that we knew from the start would never work because the database physically couldn't pass the instructions as fast as the requirements called for, or we couldn't get a 10BaseT nic to handle the thruput of a GBnic card....:trout:

I'm just really, really hoping that the day to day supervision of nurses stays in the hands of other nurses. If they change the rules so that LPNs, RNs, etc. can report to MBAs, then that's it, and nursing is doomed....

Guess what my friend, we are already headed in that direction and I don't mean maybe. Sorry to be the one to break the news to you.

[Mudwoman]

One of the nurses at our facility is going to work for an agency. This agency supplies nurses for 2 large nursing homes/rehab centers. The nursing homes/rehab centers do not employ nurses direct. This agency is hiring like crazy and you let them know what you can work. Schedule is made out for 2 weeks at a time and you commit to working your scheduled days once the schedule is made out. Any nurse can work up to 48 hours and as little as 0 hours. NO BENEFITS. Pay is $18 per hour for LPN's and $25-$28 for RN's in an area that pays on average $13.50 hour/$20 hour.

This is the next wave of the future. Look for Hospitals and Doctor's offices to create separate "companies" that will handle the employment end. Then those "companies" will be sold or merged. You will work for an agency and basically be float pool.

[felixfelix]

...or you'll have to incorporate yourself and hire your "company" out...yea, this working world is getting crazy. Maybe this is how you'll differentiate yourself to your employers...another layer of risk management instead of skill level.