I am a new grad RN and I feel I work in one of the best hospitals in my city. I have mostly seen equal tx of all pt's and a good majority of our pt's do not have insurance- I believe we were told about 40% of our pt's do not have insurance. Although, there have been a few situations that have really peeved me off. I would like your opinions on the following.
1) A homeless pt was subjected to a new med student putting in an IJ when a PICC was actually called for. The doc wanted her to get the experience. The student finally got it inserted on her FOURTH try and after causing a significant deal of pain for the pt and not to mention, a seizure during the third attempt.
2) Pt's that come in with illegal substances in their system do not get adequate pain control. We have many many of these pt's. We were taught over and over again in school that addicts may have built up tolerance to opiods and we should advocate for them appropriately. Doesn't seem to work with the doc's at all. I've had so many pt's that were writhing in pain and probably withrawling at the same time and only have prescriptions for a lortab or even one pt with a children's dose of pain relief. Grrrr.
3) Pt came in w/seizure and fell on rocks face first. He had a CT and urinalysis and once those were cleared he was let go with ABX and 10 tylenol 3's. This was his first seizure ever, he had a suspected broken nose, an injured shoulder from the fall... no xrays ordered, and the blood was not cleaned off his face enough before discharge to even see that a rock had pierced through his lip completely. Grrr.
So, if these pt's were known to have insurance and/or did not have illegal drugs in their systems... would they have recieved this same tx? I know I am new and don't know a lot, but come on, even I can see there is something wrong here. My offering of a warm blanket or an ice pack is not going be enough for any of these mistreated pt's.
Thanks for letting me vent and I look forward to any and all comments.
Specializes in ER, ICU, Infusion, peds, informatics.
isn't xigris pretty expensive?
horrendously so.
however, it is an inpatient-only med.
inpatient meds generally aren't the issue. the hospital is obligated to provide what the patient needs. (i'm not saying it doesn't become an issue at some hospitals, but it isn't usually the big issue).
discharge meds are the issue. once the patient is discharged, they frequently don't get their meds unless they can pay.
there are three types of lies: lies, darn lies, and statistics.
data can and is manipulated to make whatever point the writer desires...
i don't disagree that you have to investigate the stats that you read but there are reputable sources that can be trusted. are the statistics related to our outcomes in america made up? or are you one of those that believe because its in america it must be the best. the sources for the numbers that i was referencing come from the institute of medicine, the world health organization, the commonwealth fund and the us census bureau all very fly by night organizations.
i don't disagree that you have to investigate the stats that you read but there are reputable sources that can be trusted. are the statistics related to our outcomes in america made up? or are you one of those that believe because its in america it must be the best. the sources for the numbers that i was referencing come from the institute of medicine, the world health organization, the commonwealth fund and the us census bureau all very fly by night organizations.
it's not the raw data, its the interpretation, which is why statisitics should be a mandatory course.
additionally, the enourmous size and lack of homogeny in the us population makes comparisons to small european nations as useful as an udder on a bull.
1) Difference in care between poor/rich. Of course there is a difference, but its almost always the outpatient side, not hte inpatient side. If I was a doc running a cardiology clinic, why would I want to take patients that dont have insurance? Screw that. Docs are not under obligation to take whomever comes in the door, thats only for the ER/hospital.
2) Students (nursing, med, PA, NP, etc) doing procedures. Whomever is precepting that student has the final say. If its a med student, then its the attending who decides. If its a nursing student, then the RN in charge can decide. As for the # of tries, it depends on the patient. Always give a minimum of 2 tries, but sometimes I would give more tries. If its a crashing patient, then you only get 2 attempts. However, if its a very stable patient and its not a critical procedure, then I would give more attempts, maybe up to 4 or 5. For example, if its a patient anesthetized in the OR, and they need a line or an intubation, I would be perfectly happy giving them 4 or 5 tries to get it as long as their vitals are stable.
3) Teaching hospitals vs nonteaching. Every hospital should have a sign out front that says they are a teaching hospital, and therefore you WILL be cared for by med students, nursing students, PA students, NP students, etc. For patients who dont like that, they can go elsewhere. Teaching hospitals are essential for training future generations of healthcare workers. I've seen surgeons refuse to operate for elective cases because the patient demanded no residents/students. They always explain that its a package deal--if you want the famous surgeons at the academic medical centers then you have to take the med students and residents that come along with him. If you want the solo surgeon with no students, go to the community hospital where they dont do as many cases, usually dont do research, arent as caught up on the latest evidence based medicine, havent seen as many unusual/atypical cases, and where they usually dont participate in advance the field. I was always proud of my surgeons who did that.
4) Patients who cant afford meds. Universally I find that when this happens, its because the patient didnt tell the nurse/doc that htey cant afford the prescriptions. Its the patients responsibility to let us know that they cant afford it, we arent mindreaders here. If we discharge someone on expensive scripts and they cant afford it, then they need to call back and tell us and we'll have the doc change it to a generic (usually the pharmacy does this automatically anyways). Its unacceptable for patients to just not fill meds, not see any of their outpatient clinics, and then blame us for their misfortune. Like I said, we dont know what people's financial status is--the onus is on the patient to tell us if they cant afford stuff.
5) Pain control. I think its fairly obvious who the drug seekers are. They have multiple admits with negative workups, strong history of drug abuse, and on physical exam its easy to tell. Poke their belly while you are talking about something else and watch their reaction--drug seekers will conveniently forget that they are supposed to be in pain whereas patients who are really hurting will wince/moan regardless of what they are talking about. Docs usually feel uncomfortable treating vague pain complaints with narcotics when there's no source and I think thats understandable. If a person has severe belly pain, but is eating/drinking like a horse, has no physical signs (abdominal guarding, rebound, withdrawal), has a negative abd U/S, negative CT, neg pancreatic enzymes, neg x-ray, neg GI scope then what are they treating?
The only reason I asked is because I have given that to patients at the hospital where I work. I still think that the treatment of poor patients varies from hospital to hospital. The majority of the patient population where I work is poor. So poor patients getting poor treatment is not necessarily true.
In relation to treating the pain of those that have a prior history of drug use...
Keep in mind that when you have opioid habituation it is very difficult to kill one's pain, and some times there is a fine line between killing the pain and killing the person.
Part of this is natural consequences not punishment. Just like eating too many Twinkies and getting fat brings on knee pain (for example). I always tell anyone that I work with that to become habituated will be a big problem when they have an acute pain episode.
This includes people on prescription medications for chronic pain. And anyone that smokes lots of pot or drinks lots of ETOH, many of these substances work on similiar receptors in the brain. So the person with RA and is on lots of meds (narcs) for chronic pain, gets in a car crash and they will have more pain than another person that is not narcotic habituated. Its not fair, its not right, is should not be that way....but it is what it is.
If you try to give enough narcotics to kill the pain, you may have a pt that is so obtunded that a bit of sleep apnea may put him over the edge and you find a dead person next time you go in to check him.
You still need to advocate for your pts, but this may be the reason that the pt was still in pain and no more meds were ordered. That is where my favorite nursing intructor comes in...nursing interventions, what can you do to make the pt more comfortable that is non-medicine? Labor and delivery nurses have it going on for moms that want to go med free. Check out some fo the things they do for the next time you have a pt in pain that can not have more meds.
I was told that a full treatment course of Xigris for one patient can cost around $100,000. This was from an ED doc that I work with.
Thats incorrect it cost about 3,600 a bag and runs for 96 hours with a total cost of about 15k give ortake because patient weight does determine rate. Second course is usually not done but is not unheard of.
I am a new grad RN and I feel I work in one of the best hospitals in my city. I have mostly seen equal tx of all pt's and a good majority of our pt's do not have insurance- I believe we were told about 40% of our pt's do not have insurance. Although, there have been a few situations that have really peeved me off. I would like your opinions on the following.
1) A homeless pt was subjected to a new med student putting in an IJ when a PICC was actually called for. The doc wanted her to get the experience. The student finally got it inserted on her FOURTH try and after causing a significant deal of pain for the pt and not to mention, a seizure during the third attempt.
2) Pt's that come in with illegal substances in their system do not get adequate pain control. We have many many of these pt's. We were taught over and over again in school that addicts may have built up tolerance to opiods and we should advocate for them appropriately. Doesn't seem to work with the doc's at all. I've had so many pt's that were writhing in pain and probably withrawling at the same time and only have prescriptions for a lortab or even one pt with a children's dose of pain relief. Grrrr.
3) Pt came in w/seizure and fell on rocks face first. He had a CT and urinalysis and once those were cleared he was let go with ABX and 10 tylenol 3's. This was his first seizure ever, he had a suspected broken nose, an injured shoulder from the fall... no xrays ordered, and the blood was not cleaned off his face enough before discharge to even see that a rock had pierced through his lip completely. Grrr.
So, if these pt's were known to have insurance and/or did not have illegal drugs in their systems... would they have recieved this same tx? I know I am new and don't know a lot, but come on, even I can see there is something wrong here. My offering of a warm blanket or an ice pack is not going be enough for any of these mistreated pt's.
Thanks for letting me vent and I look forward to any and all comments.
I know, sad isn't it? And before anyone dare disputes me, I have experienced this firsthand as a patient. The other weekend, I had to go to he ER due to rapid heart rate/anxiety. Being that I just started a new job, I am in between insurance coverage. I know I could have the COBRA coverage, but we all know that's too expensive for anyone to afford (what a joke).
Well, to make a long story short, I was dismissed without my psychosocial needs even being addressed. They did an EKG, which showed a "slight abnormality" (probably respiratory sinus arrhythmia, I suspect), but the doctor said it wasn't anything to worry about.
Thank God for that, but, I still felt that I could've had assessed my psychosocial status since that was one of my chief complaints. So, to this day, I am still dealing with unresolved anxiety. I guess, since I didn't have insurance, they didn't want to go too deep.
You know, it is awful that just because doesn't have insurance they are not thoroughly treated. When a person gets sick, all they need to worry about is getting well. They don't need to hesitate to go get checked out just because they don't have insurance. And they definitely do not need to be worried about all of their assets being seized just because they got sick. Why, in this "great" country, are we still mistreating our citizens?
"Well, to make a long story short, I was dismissed without my psychosocial needs even being addressed. They did an EKG, which showed a "slight abnormality" (probably respiratory sinus arrhythmia, I suspect), but the doctor said it wasn't anything to worry about.
Thank God for that, but, I still felt that I could've had assessed my psychosocial status since that was one of my chief complaints. So, to this day, I am still dealing with unresolved anxiety. I guess, since I didn't have insurance, they didn't want to go too deep."
This may upset you but it may have had nothing to do with you being insured or not. Many people including those in health care don't really understand what an ER is for. It is to find and fix things that may risk life or limb. When you came in they determined that you were not having a cardiac issue that would harm you at that time. ERs are not meant to treat psychosocial issues unless you are suicidal. And having worked with some great ER docs, you would not want them treating your psychosocial unresolved anxiety. They are in emergency medicine because they like blood, guts, adrenaline, and so on. A primary care provider is who you need to deal with things that may take a long time to truly adress is more appropriate.
For people that come in with what turns out to be anxiety (and yes lots of people come in for that because it is very scary and sometimes hard to determine if it is cardiac, etc.) they are lucky to get an ativan and told to see thier PCP in the am.
ERs are not for primary care, even if many people use it that way.
RN1982
3,362 Posts
Isn't Xigris pretty expensive?