quezen

I am not a fan of either one of the two 'reigning' Political Parties in the US either. (I used to be, but experience is the BEST teacher.) I am trying to get away from 'knee jerk' reactions when an issue is brought up for discussion. I can see that your 'knee jerk' reaction is the cost of insurance in your new position as CRNA (congratulations, by the way, that is quite an accomplishment, !) and actually I can see why, when you objectively told us what your Insurance Burden will be to practice and obtain well deserved fruits of your labors. Now, maybe the ANA is stirring from an (induced) slumber, and we will see this organization rouse itself and provide some actual personal HELP for some REAL Nursing problems. Something tangible, besides 'position statements'. I would LOVE to see that. Now, with the 'Reform' on the horizon, lets see what REAL benefits the ANA can get put into any final program for Nurses. And just tell us 'up front', ANA, "we can only help you if you pay up and join our 'Nurses Union'", and then tell us EXACTALLY what goodies you will get for us Nurses in this up coming 'Reform'. Wow, I have 'almost' talked myself into rejoining! Can we start a list for the 'goody bag'? #1 Mandatory Patient Ratios #2 Tort Reform Any other ideas, Nurses? (As one of my favorite fellow nurses used to tell me, "we Nurses have no one but ourselves to blame for the predicament we are in. Nurses have made up the rules for Nursing". Then she would ask, "when Nurses were making up all these rules, why didn't they say that the DOCTORS should be out on the floor taking care of the patients, and the NURSE would be sleeping in the Call Room, and if they needed a Nurse they could call us to come out to help them". HA, HA, I just loved it when she told me that, talk about a paradigm shift! )

:typing Tencat says that "turning healthcare into a business was a mistake", and while I agree wholeheartedly with the sentiment behind this remark, Woodenpug has a point, Health Care is not in the Bill of Rights. Neither was Woman's Suffrage, or the End to Slavery. An amendment to the Constitution was required to obtain both of these goals. Other than these Constitutionally guaranteed rights, I guess it is true that the US accomplishes its goals using the 'profit' model, 'the unseen hand' of Adam Smith, and all that stuff. The US has, after all, a 'Capitalist Economy', (I mean,subjective, emotional arguments about what the word 'Capitalist', may or may not imply, that is the economic system that the US runs on). It just seems so crude and inhumane to apply this kind of standard to Health Care. I mean, were talking about the lives and health of our own precious family members, not to mention ourselves. With that in mind, Woodenpug, thanks for the link to the OMB's outline of the Health Care plan. I glanced at it, I guess it would behoove me to read it carefully if I want to discuss the topic with youall. I guess that after the 'Reform' is passed the discussion can move past where we are at now, e.g., "should we have Health Care Reform", to, "we now have Health Care Reform, look at this or that specific problem with it", and so start fine tuning from that point. I am a fan, theoretically, of the Health Care plans of Australia, Canada, the Scandinavian and other European countries. I am an actual user, through my husband, of the German Health Care system. And, just like many others who chime in on these sites about their experience with other systems of Health Care, I am satisfied with the care in German system, (hey, it beats nothing, which is what I get here-except for the VA, which is not so easy to access if one does not live around a VA care center.) With that in mind, when Ocankhe refers to the "dynamic conflict for profit vs non profit health care going on for well over a century" here in the US, I guess I can see what Ocankhe is trying to say, but I would have to disagree because, the little bit of historical knowledge I have of Health Care in the US seems to indicate that the 'business' of Health Care, like we are talking about in terms of gulps of over 15% of the GNP of the largest economy in the world, only started after Medicare/Medicaid was instituted in the 60es. This took 'dispensing Health Care' out of whatever it was before the 60es in the US, which seems to have been a quasi-business/religious -'dispense alms to the poor' model, to an actual business. The 'business' of Health Care has picked up speed, I can verify from my own observations since working as a nurse since mid 1980es, with the advent of new procedures and medicines. This 'business model' of Health Care has then been filtered through the particular 'Cultural Lenses' of different sections of American Society (which can be REALLY different, from section to section of the US, as opposed to to the 'Linguistic' and, for want of a better word, 'Tribal', type of homogeneity found in European Countries, and, to a certain extent, expected of immigrants to these countries) to give the types of spending results that Soyrizo's link to the NewYorker story "The Cost Conundum" showed exist in Health Care spending in the US. After thinking about what Woodenpug said, I guess that since this IS the US, for those of us (like Me) who would like to see a more encompassing "European" type model of Health Care reform in place it may be time to 'get over it' and get familiar with the possibilities being worked on, hopefully in good faith, by the congress and the President. What has finally become crystal clear to everyone is that SOMETHING must be done.

Good points. To me Health Care Reform is about answering the question; "Is Health Care a right, or is Health Care a privilege"?

Your welcome. My spouse is the SAME way! Us gals gotta stick together in the "mutual appreciation society!" :wink2:

Soyrizo; Thank you so, so much for the link to the article in the New Yorker "The Cost Conundrum". It is THE most interesting article I have ever read about the subject of regional differences in costs in American Health Care. I think I will read it every night for a week, just to burn that information into my brain It is such a pleasure to be exposed to the thoughts of a really well educated, smart person, who is not out to make a buck, but rather to thoughtfully examine and report on the "Battle for the Soul of the American Healthcare System", as he so eloquently puts it. I never heard of some of these theories that he relates to the current economics of health care, such as the: Anchor Tenant Theory of Economic Development, or, the Accountable-Care Organization of Grand Junction, Colorado. but they make so much sense. The example he gives, if "instead of paying a contractor to pull a team together, you paid an electrician for every outlet he connected....plumber for every sink...carpenter for every cabinet, would you be surprised if you got a house with 1000 outlets, sinks and cabinets, and the whole thing fell apart in a few years?", is right on the mark. I live close to El Paso, and sometimes even drive down there and work a shift. I have to comment on what you said about "illegal immigrants do not qualify for Medicare." I would assume they don't, I don't know exactly how that law is worded, but I have seen some of them get it, somehow. My guess would be that they use someone elses SS#, and get other ID documents to match made up in Juarez. Some 'illegals' also get Medicaid, and get their parents on Medicare. Why should the hospitals making money off them care? If employers legally do not have to do anything more than visually ascertain that a person has the ( "a") necessary SS ID in their possession, then I don't know why a hospital, which stands to make money off the transaction, could be expected to do more. Believe me, it is more than just a little annoying to a person like myself, with NO health care, except the VA, to drive an hour and work a 13 to 14 hour shift caring for people who seem to get all the health care they want, and many of whom, I know darn well, are NOT citizens of the US. Lucky for me I can get by in my broken Spanish, because often report is in English and the rest of the shift is in Spanish down in 'Chuco' (Mexican slang for El Paso). And please don't get me wrong, many of these Mexican Citizens receiving Health Care in the US are lovely people, especially the older, old fashioned, ones. I certainly DO NOT wish any ill fortune on them. However, Universal Health Care for the world is a topic for a different forum, also, I cannot say that we are helping the country (of Mexico) live up to its obligations to its own citizens by doing their job for them. After all, Mexico is a rich country, when one looks at it's mineral, oil, and agricultural wealth. I am very sorry for what is happening in that once lovely country. I don't know what the solution will be but BeeSupporter, I agree with you so much when you say; "if congress and the senate lets insurers ...write the "reform" law the way big Pharm wrote the Medicare drug bill, we're sunk,....a good pitch and then just more of the same...for the benefit of corporate big-money donors instead of for the good of our country as a whole and working, middle class Americans." I hope America has not sold itself out to such an extent that "working, middle class Americans" will not be taken into any equation in the future. I read a Post on this site (sorry, I don't remember which one), that said something like "if Canadians, Brits, and Australians are supposed to be so unhappy with their health care, like so many of these Radio Talk Shows go on about all the time, why doesn't someone ask THEM their opinion." Well, someone did. The Poll result? Over 75% of the citizens of these countries WERE happy with their health care, as opposed to around 55% of US Citizens. (If any of you know the link I am referring to perhaps you could post it here.) I would LOVE to see a 'Reform" of the US Health Care system, but a 'Reform' that would lead to something better, NOT just 'Reform' for the sake of "Reform'.

Trial and error, that's the way to do it. But it is interesting that you are thinking about this. To me that shows a meticulous person, I mean, how many people even THINK about socks, before they start working, and I agree, they are important. I like short terry lined socks for summer, and higher terry lined socks for winter. I like a little bit of cushy feeling, but not too much. If you really want some good socks, check out Thorlos (spelling?), these are the socks marathoners wear. They come in 'sports' versions. They also come in a long 'anti fatigue' version which a lot of military personnel like to wear with the boots, they are sold in Military Clothing Stores, but they are probably available online. May be 'too much' sock for working a hospital floor, but boy, are they comfortable. Good Luck in your career. may you find wonderful places to work, wonderful colleagues to work with, and may you always get patients that appreciate you, and that need just the nursing touch that you provide!

The Army is not for you, OK. Just a suggestion, the pay checks don't bounce, and many, many people who needed a 'new start' and needed a way to get out of financial 'dire straits' have gone this route, when their back was against the wall, so to speak. Getting up at 0 dark thirty, and running PT, and trying to keep up with training and new experiences, can bring a sort of 'Zen like' clarity to a mind, that was previously focused on keeping up car payments and being able to afford to go to the movies eat at a nice restaurant with friends. I just have to say a small comment about Army Medics. These guys, and gals, can be awesome. Their skills range from beginning CNA, with a little field training thrown in, for newbies, to advanced Paramedic. They know a lot and can do a lot, please don't say 'just' a Medic. Many enlisted working in an LPN type status are actually two year RN grads, and they hold a license as an RN, they just choose, for various reasons, not to pursue that BSN. They first are trained as 'Medics', then they get an additional skill identifier to work in the Nursing, Lab, Pharmacy, X-ray, or what have you field, in which some are already fully qualified. All these people are 'Medics'. Also, the Reserves do allow two year grads to come in Commissioned. They just must have a BSN to move past the rank of Captain. I have worked with enlisted soldiers in the Army medical field who are doctors in their home countries in Africa, or Eastern Europe, or whatever poor, faraway place they are originally from. In the US Army they are Medics or Pharmacy techs, or Lab personnel. So please don't say 'just', about these people. You know, when I started posting on 'allnurses' I was taken aback also by some of the negative responses to some of my (brilliant, I personally thought) comments. It has taken me a awhile, but you know, I think that I have figured out that this give and take on 'allnurses', both the positive and the negative, is a good 'surrogate' way to learn to deal with the negativity runs like a river through Nursing. You know all those things about your jobs and about Nursing that bother you. They bother most other people also. No one like to feel 'unfulfilled', or that the potential they know they possess will forever go unexpressed, but they have the bills also, just like you, and a lot have families they have to support and have 'other personal' reasons why they cannot leave and find a job that might suit them better. So they stay. Year, after year. These are not happy people, and you can be sure that they are not just waiting for some 'hotshot' new grad to come along and tell them how things could be done better. So they get a little negative sometimes, or make a negative comment. Of course some are just rotten, conniving, scheming, evil backstabbers. It really does behoove a person to know the difference! This instance of negativity may be an expression of how they feel about some comment that 'pushed their button', or it may be a way to try to make themselves feel better about what they have put up with for years, by saying something like "suck it up, I had to put up with this kind of BS for years, if you want a paycheck you will have to put up with it to." So I think the point that the person was trying to make that reviewed your 'history' was that by looking at the 'history' of a persons posts, it is possible to get more of 'take' on the 'whole person', and not just make a judgment about one person by one or two comments or posts. Maybe she was trying to say, go out and do something, and tell us something interesting about the experience, why it was positive, or why it was negative. Don't just whine that you would like to have a 'better' job (better than most of us who have been doing this for years), with plenty of money to pay off a heavy debt load (been there, done that!), and then ask us our opinion, but tell us, like our moms used to "if you can't say anything nice, don't say any thing at all!"

I do have a suggestion. If you ever were to consider attending a BSN program, it would be good practice to practice communicating in a clear, standard English fashion. I know that if you graduated Valedictorian, you know how to do this. I know that Twitter and 'shorthand' spellings are in vogue, in some settings, and I am not saying I am against them, even congresspersons use this method of communication these days! However, in this day and age of the ipod, forcing others to listen to your taste in music, whatever it may be, is just egotistical and bad manners. In the same fashion, on this 'allnurses' site, with it's 'Preview Post', and spell check, communicating your opinions, whatever they may be, in a clear, standard English ( or Spanish, or German or what ever language you are educated in and choose to write in), is just good manners and shows respect for your audience. Also, should you choose to further your education, do it to further your education, not to push off the inevitable day of financial reckoning by living it up on some more Student Loans. One more suggestion. There is an organization that is hiring, that will forgive Student Loans, will give you free money for future Education, will give you free food, free housing, and will pay your way to get there. Pick up the phone and call the Army. They build upon the skills you have, but train you to do things their way. The Army has a great deal of experience training people, and they do it well. Also, there is the added advantage, especially for 'undecided' youth. You can't quit. You MUST finish.

I have worked with nurses who did this, use the I Pod/Phone to pull up lab values and ect. I see that more physicians are doing this also. Seems to work for them, and it certainly impressed me! The idea about videos streams of infrequently preformed procedures is really good. Better than running back to the look at a picture in a book, or read a dry, featureless SOP. You are obviously one of the 'early adapters' high tech.

Don't waste any more of your time getting a BSN the way you are feeling now. If you want to change careers, and have the family support and wherewithal to do it then do it. Keep your nursing license up to date, and keep working, if only PRN, or part time. Nursing is just like you described it, and it is not going to change. When I was in school in the 80es, students had bumper stickers that read, "down with paperwork, back to the patient". The same subjects were the 'hot topics'. Overwork, no patient contact, no respect, glorified pill pusher, ect. This is the unfortunate reality of this field. NO ONE is going to PAY you $20-$30 an hour to sit at the side of some sick patient and hold their hand, despite what the public thinks and is led to believe. If a patient wants that kind of care, they better have family members like like you to take care of them, or enough money to hire private duty. The 'art' to Nursing these days is to be so over worked, and stressed out, and constantly insulted, and STILL go into a room and smile and ask "how are you doing", and get done what you need to get done as efficiently as possible, and get the heck out of the room, especially if the 'family members' are sitting around expecting you to fluff pillows, coo, and croon, and ask if anyone would like tea. You, the nurse, are wondering if the blood is finished in the next room and whether or not the dying patient is dead yet, whether the EKG got done on so and so having chest pain, and you are doing a mental calculation at that very moment to decide how exactly to extract yourself from the family members, without them 'writing you up' because you did not live up their expectations of a nurse who would 'sacrifice your own life' for the good of their loved one. That is the way it is, it is not going to change, it is only going to get worse. Maybe we will get Universal Health Care, and some of the consumers will have to give up the ideas they have about how they should be treated like guests in hotel, instead of consumers of an overburdened health care system, but that is an IF, and is a long way off. Be happy you figured it out now. Just think, a lot of nurses just kept hanging in there, thinking maybe it was something THEY were doing, and that they would learn and things would get better. The years went by and all of a sudden it is TOO LATE to retrain. BUT keep your licence active AND continue to work. It is not so easy to get a job these days, you may just have to suck it up and work with what you have. That is exactly why a lot of us 'novices' who became 'experts', are still working in this field. We would like to have a life also, but it takes money to live.

Yes, you are getting the shaft. Just look at how much $ all your hard work is making that 'Big Corporation'. I'll bet when you bring up your issues you get thrown a bone with a little meat on it, because you are making $$ for them. Look at it like this, in countries where 'bargaining' in the norm, rather than fixed prices, no one ever pays what the asking price is, but everyone know, more or less, what the price of an item is going to be. Same thing in the real estate market. The seller says $xx amount, and you say, "on no", I can only go $xx amount. The savvy, person with experience will not go TOO low, because one must consider feeling and not insult the other party. The minute you open your mouth about how you feel like you are not being fairly compensated, the experienced hawk for this 'Big Corporation', will do mental math calculations that would make an MIT computer look slow, and will offer you something to keep you doing all that hard work and making them all that juicy $$$. They will present this offer to you in a way that will make it look like they are really making a sacrifice, but 'for you' ('para Usted'), they will do it. You will take the deal, because you are a little intimidated anyway, and only later will you figure out that you are STILL doing all the work and getting the shaft. Then, after you get a little more experience, you too, will go PRN, and some yahoo will be the supervisor/manager at the job you have now, and you, with your obvious abilities, will come to work there, or somewhere else for PRN pay, and learn to never even open your mouth when you see idiots making important management decisions, because you know that the system does not want to be 'good' or 'right', whatever those terms may mean, but it does want to be 'rich' (.-an objective criteria and easy to measure.) I guess I sound a little cynical, because I have 'been there and done that', and maybe, hopefully, I am wrong. I am wishing 'good luck' to you today, and in your entire career. You sound like an honest, organized, motivated person. I would be proud to work for you-as a PRN! Let us know how it goes.

Oh come on, she probably wasn't actually dead when whoever it was was feeding her. I am not trying to vindicate the stuff that is discussed here, I have seen most of it, or a similar version myself. A lot of you nurses are going to be like me, you won't last, whereas these you are complaining about will be home sucking up on a nice retirement someday. A large part of the problem, the way I see it, is the belief that the modern health care system can cure anything, even death. A LOT of patients, or their families, should take a realistic look at their conditions and make themselves DNR, (and yes I know that does not mean 'don't treat'), and when the time to go on to whatever comes next is coming , there should be some way to address that in a humane manner. After all, even a dying animal has enough instinctual 'smarts' to stop eating. In the LTC you have to go through the motions, even if it against all good sense. The patient was probably fed by some CNA who tried to do what they were told they must do in order to get their paycheck. The 'savy' CNA would have done what the 'savy' nurses who are sitting at the desk or out smoking are doing. Let nature take it's course, and hang in there so they can make a couple of bucks to support themselves and their families. Just playing Devils Advocate, but say the truth, sometimes preforming, or not preforming nursing care is just another way of saying 'look at me, I work so much harder than so and so". If no one had fed this patient then the battle cry would have been, she was lethargic and no one even fed her so she got so weak she died.

What is a 'Daytime TV College'? What does it mean to 'push the lay person to RN in 10 shifts'? Just wondering. The poster above does have a point. There are a lot of colleges in the US that charge 40 grand a year. After I posted about the demise of the Diploma Schools I got to thinking, I studied Nursing about the time of the change over from Diploma based education to college biased education for the Nursing profession. Part of our 'brain washing' process in the University was to be taught that we were somehow 'better', or 'superior', to those Diploma grads. I was clueless about the reality of the world of Nursing, so I believed this 'ego stroking'. Until I got out and got to work and saw the difference between my knowledge, skills and abilities, and those of Nurses who had actually worked doing nursing work of every kind for three years while they were being educated. The diploma Nurses were just a different breed, they knew what they were doing, from the get-go, after graduation. When we university grads hit the floor it was just common knowledge that we would have to undergo a long 'rehab' process if we were to be made into 'working' nurses. The Diploma nurses used to complain about our performance level. We University grads were taught to complain about the performance level of the Associate Degree Nurses. I have since learned what nonsense this was. The Associate Grads are just like us University grads, some worthless, some OK, some really good. The difference MAY be that you cannot discuss esoteric issues with them, when you have a free moment. I say MAY, because a lot of Nurses who went back and got an Associate Degree in Nursing have a degree, or even an advanced degree, in another, non marketable, skill. Nursing has always been confused about what it is, a 'Profession', or a 'Trade'. Now the 'established' Nursing schools are crying foul because they have been usurped by upstarts who are producing THEIR product, and making a nice tidy financial profit doing so. Sounds like a lament for a Country and Western song to me. Guess what. You guys stuck it to the Diploma Programs, and now these 'upstarts' are sticking it to you. Could we get to the 'core' issue here. WHY is EVERYTHING related to health care in the US about MONEY?

The most knowledgeable all around nurses I ever worked with were 'Diploma' School graduates. What did nursing do in it's infinite wisdom? Get rid of most of the Diploma Schools and insisted that Nurses be trained in Colleges. This sort of silliness is just rewards for this elitist path that nursing went down all those years ago. I loved College, and,as I get older my education gives me comfort and allows me to make my own individual sense of the world. I don't think I learned all that much about nursing in the University, however. I didn't get 'clinicals' until the last 1 & 1/2 years of a four year program. I learned most by doing, after I got out and started working, and by being shown how by the 'old timers'. I think the best training I had for the actual 'work' of nursing was the waitress work I did to put myself through college. That job gave me the skills to create pathways in my brain to remember who ordered what, and the time management skills to get the order to the right person in a timely, and friendly, manner. The same skills, I would wager, that 'Diploma' nurses learned from day 1 when they started working in hospitals half the day and taking classes the other half. You know that old saying "those who can do, those who can't, teach". Well, just substitute 'manage' for 'teach', add the two phrases together and you have a pretty good picture of the world of Nursing today. Health Care, in the US today, is about the money. The most money spent on health care in this country is spent in the last two weeks of a persons life. "Dead men tell no tails". I will bet that a lot of these grads that 'can't' will end up in management for some corporation managing an extended care facility, or some such entity, that would scare the be jeasus out of the old timers. This seems to be what the Health Care system in the US today wants. Let's just wait and see if any of the organizations of foxes, who are supposedly 'watching the hen house', (JACHO, the United States Public Health Service, and so on), move in to take any action on this state of affairs.

I am the nurse with some of the horror stories about the Commissioned Corps that I have posted on this site. In fairness (I am a Libra, after all), I have to add that for some people, for at least a three year period, don't take everything I have said and as a 'roadmap' for the experence you might have with the Commissioned Corps. I keep reading the 'horror stories' in general about a lot of civilian nursing experences and I guess in their own way they are just as bad to the people who experenced them as what happen to me. Sometimes 'systems' are rotten, I guess it has always been this way. Get rid of the 'rotten' system and since nature abhors a vacumn another system will just rise up to take it's place and with time that system may get rotten too (I guess a 'concept analyses of 'rotten' would be in order here, but I'll spare you!) It's how a person uses these systems to get through life that matters, and I guess, and in some cases the Commissioned Corps would be a good place to start a career. The problems start with thinking that you can make a 20 year carreer, just like some of the people with an 'in' of an ethnic qualification, or a personal relationship with the 'brass' do. You get in, you get addicted to the money and the benifits, and you see others with a lot less smarts than you have effortlesly get a retirement and you want that too. Well as a Nurse, you probably won't get it! However, that said, I believe you can get some student loans forgiven by 36 months of service with these people, you can get the GI bill, and you can qualify for a VA loan after 36 months of service, plus, I know for all you imortal youngesters this does't count, but eventually the governmnet will pick up your burial costs, just the VA system does. All for only 36 months of your life! I realize that a lot of these things are important to young people starting out, so I think I should be fair and give both sides of the picture. If you are smart, and can duck and dive and are flexible and willing transfere to stay ahead of the "BS" for a 36 month tour, it may be for you. Also, YOU CAN ITER-SERVICE TRANSFERE. You may not have the nerve, right out of Nursing school to go to an Armed Forces recruter. You are pretty beat up from surviving Nursing school and your first job. However, 36 months of a decent salery, government benefits, meeting new people and dealing with 'different' systems, and you may change your mind and call that Army, Navy, or Airforce Recruiter. The important thing then would be that the 36 months Commissioned Corps service transfere as direct active service time, and you have a head start in the next service. You would not be such a 'newby'. Now, for someone like the former Navy person, it may be that they would expect a personnel system with clear performance objectives and a well designated chain of command. This is not to be found in the Commissioned Corps, but then this is not to be found in a lot of civilian jobs, either. Also, former soldiers, and sailors ane smart and cagey, because they have absorbed, sort of by osmosis, survival skills from the experences they dealt with in their 'former' life in the service. Who knows, maybe they can 'fly under the radar' and get that 20 years with the USPHS. Everyone has their own experience, in whatever service you could name. I don't want to dissuade someone from an experence that may be dificult, but that in the end they may profit from just because I, myself, had a bad time of it. NO, the USPHS is NOT paying me to say some positive things about them. I still have not gotten anywhere with solving my problem with them, and I still think some of these people are names that I can't use on this site. HOWEVER, the new Chief Nurse of the Commissioned Corps gives me the impression that she is a graceful, honest person. If a system is ever to change, it changes with people, one 'good' person at a time. This lady, Admiral Romano, does not come from the Indian Health Service but rather the National Instutes of Health. Maybe she will be a 'new' wind blowing some good into this organization. I know that just like they say with Washington DC scene, 'its the nature of the system there, it will not change and it will eventually wear down anyone who trys to change it'. But I believe in a basic something in people and maybe, this new Chief Nurse, with some good nurses watching her back, could make a difference for the better. I hope I am not wrong in my impression of her, I have been fooled before, but something is just telling me to tell both sides of the Commissioned Corps experence. So if think the Commissioned Corps is for you, try it, keep your head down, and keep us 'has beens' updated on what your experence was like.