Jump to content
2019 Nursing Salary Survey Read more... ×
MunoRN

MunoRN

Critical Care
advertisement

Activity Wall

  • MunoRN last visited:
  • 5,919

    Content

  • 0

    Articles

  • 63,166

    Visitors

  • 0

    Followers

  • 5

    Likes

  • 0

    Points

  1. MunoRN

    An allnurses Fix On Healthcare

    Are you maybe confusing single payer with government-operated healthcare? Single payer doesn't mean that you go to a doctor employed by the federal government or a government run hospital, all it means is that the administration of the payment process is consolidated to a single entity, which significantly decreases these administrative costs. In the private insurance industry we pay for overhead that's about 14% of the cost, our only quasi-single payer comparison is CMS, which has an administrative overhead cost of about 4%, and lower price inflation to boot. Maybe you could expand on "how about the public schools" and "How are those regulations senior care facilities working out".
  2. Except the incidence of post-partum depression is generally lower in breastfeeding women.
  3. Measures that reduce sloppy practice and errors aren't a bad thing, Atul Gwande in The Checklist Manifesto put it more eloquently, but basically the reason why some Physicians feel "insulted" by these initiatives is that it violates their "freedom" to practice crappy medicine, not because it impairs their ability to provide quality treatment, since it doesn't. These measures are actually extremely flexible, you can give just about any reason you want as to why you aren't following the recommendations and still be compliant. Just because your GI bleeder has a Hgb of 4 which then makes them tachycardic, tachypneic, hypotensive, elevates their lactic acid level, etc in no way means that you should give them 3 liters of NS, and any physician who is evaluating the patient correctly won't order that fluid. The OP is correct that there once was a time when we under-assessed septic patients and just sent them home with a z-pack, which resulted in too many preventable deaths, which is why there's been a push to do a better job of treating these patients. There is certainly an argument that it's possible to over-screen and over treat based on unreliable or non-specific assessment, but I think the best route is to fix those instances when we're doing too much, rather than to just settle for doing too little.
  4. MunoRN

    8 Organ and Tissue Donation Myth Busters

    While it certainly shouldn't be a reason to not be an organ donor, this isn't completely true: Organ recipients is actually limited to those who can pay for it, while it's gotten much better since the ACA, prior to that about 1/3 of those who otherwise qualified for transplantation could not receive them due to lack of insurance coverage or ability to show they could pay the full costs out of pocket (typically about $500k) And you can actually game the system with enough money. While there is a single nationwide database there is not one single nationwide waiting list, someone who can afford to travel the country and be evaluated at every transplant center, and who can get to any of these centers on short notice (access to a private jet) can be on multiple or even all the waiting lists at once.
  5. MunoRN

    Nurse Satisfaction comes before Patient Satisfaction

    Maybe you could say what you actually think is incorrect. The government does not pay out less in total due to HCHAPS, hospitals that fall in a broad average range don't have any change in their reimbursement, hospitals that fall well below average see a reduction in reimbursement by as much as 2%, and an equal number of hospitals that far exceed the average see an increase in reimbursement by as much as 2%. It's possible to provide healthcare very well, and it's possible to provide it poorly, hospitals shouldn't be paid the same regardless of which of those two groups they are in, if that was the case then there would be no incentive to provide quality care or disincentive to provide bad care. I would agree that the survey could use some work, but scanning through your posts I only noticed one example that you've provided of what you disagreed with, which was the question about whether or no staff listened to concerns. It's generally agreed that ignoring patient concerns potentially hinders their safety (I feel like my breathing is getting worse, I'm worried mom's going to get up without help and fall, etc).
  6. MunoRN

    Nurse Satisfaction comes before Patient Satisfaction

    I don't think it's unreasonable to pay less for a product that falls well below average quality. What the HCAHPS survey essentially asks patients is whether or not the facility is staffing properly for their workload and providing the necessary support to provide adequate care; Did the staff have time to teach you about new medications, discharge teaching, answer call lights, etc. The way HCAHPS surveys work, is that even if your scores are "poor", you don't lose any reimbursement as long as they are about as poor as everyone else's, if a facility is doing a significantly worse job at providing patient care, then they get paid less, I don't see any reason why they should get paid the same as those providing a better, or even just average product. There's certainly some improvements that could be made, but as a basic premise I don't see a problem with payers providing financial incentive for facilities to provide more support for those providing care.
  7. MunoRN

    Do Bachelor's Degrees Save Lives? - The Facts about Earning a BSN

    While the information that appears on your website is a bit hard to believe, it does say that the "RN to BSN" program is 181 credits which would be in addition to, not including credits obtained in the students previous RN degree. The defined starting point is an RN, so according to your site, from RN degree to completion of an RN-BSN would be 4 years of full time school. 181 credits times the quoted cost of $260 per credit is $47,060. While it does appear many of these credits should be considered as already completed as part of the RN program, the inability to properly communicate is still concerning, even if it makes it half price. RN to BSN Bachelor's Degree - Rasmussen College
  8. MunoRN

    Do Bachelor's Degrees Save Lives? - The Facts about Earning a BSN

    I think you're misinterpreting what the Penn (Aiken) studies say about the current state of RN education. The studies did not focus on current graduates, they included all nurses which included a large number of nurses who graduated when there was a significant difference between BSN and non-BSN curriculum. Partly as a result of these studies, there are few ADN programs left that don't utilize a partnering BSN programs curriculum. The studies didn't isolate what specifically about BSN grads that lowered their patient's mortality risks, but the only likely contributer would be the substance of their nursing education, which currently does not vary significantly between BSN and ADN grads. So was it not the curriculum? I'm all for better education, but not a in-name-only change that not only does not improve the education of nurses, but makes it far worse. To take the current ADN programs and move that capacity to BSN granting schools would double the number of students squeezed into already overloaded clinical sites around BSN schools, which would significantly harm the quality of education. What makes much more sense is to take what's good about BSN programs, presumably the curriculum, and distribute it to optimize clinical opportunity, which is where we are already at.
  9. MunoRN

    Do Bachelor's Degrees Save Lives? - The Facts about Earning a BSN

    While I get Rasmussen's desire to sell their $47,000 RN to BSN program, it is a bit ironic that one of the supposed advantages of a BSN is a better understanding of statistics and research, and yet they mangle statistics to try and sell their program. While I'd love to believe that bachelor's was undeniably worth the extra money compared to an ASN, there is no current evidence to support that. The Aiken research the article refers to on the effect of BSN staff proportions on outcomes compared BSN nurses to nurses who graduated from various types of programs going as far back as the 70's. If non-BSN programs have not changed significantly going back to the 70's then this would be an accurate comparison of current ADN and BSN programs, but of course that's not the case. Either due to state mandates or competitive necessity, more and more ADN programs have been required to adopt the curriculum of their partnering BSN program, so while Aiken's research makes for an interesting historical look at the difference between these programs that no longer exists, it's of little relevance to the newer generation of ADN programs. As for the ability to find a job, Rasmussen refers to the language used in job postings, which often has nothing to do with who they will actually hire. The last two facilities I've worked at had "BSN required" job postings, yet we hired more than half ADNs. A more accurate measurement would be actual job placement, which the BLS studies regularly and the last data from them I'm aware of showed only a 4% decrease in the likelihood of an ADN grad having a job in nursing at 6 months compared to a BSN.
  10. MunoRN

    The Slow Code: Justified?

    If those DNR orders were written when the MD could discuss the patient's wishes with them then that really shouldn't be happening, even more so if coding the patient could be considered futile. There are a number of references that say the same basic thing: https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000473.htm https://www.ohiobar.org/ForPublic/Resources/LawFactsPamphlets/Pages/LawFactsPamphlet-24.aspx CPR is a medical treatment and the same basic rules apply. If a patient had the option of high risk open heart surgery or comfort care and the patient expresses to the surgeon that they do not want surgery, imagine if after the patient lost the ability to communicate their wishes the family told the surgeon to do surgery anyway, I would hope every surgeon would refuse to do that. For patients where CPR would be futile that would be like if the surgeon declined to offer surgery and the patient didnt' want it anyway, and then the family told the surgeon to do surgery, that's pretty clearly not appropriate in that situation. Aside from the basic premises of not offering inappropriate treatments which protects MDs, your state of NC has an additional law that specifically shields physicians from liability for making a patient DNR due to medical futility.
  11. MunoRN

    The Slow Code: Justified?

    I think my link above might be broken, here it is again: Hiring an End of Life Enforcer - NY Times
  12. MunoRN

    The Slow Code: Justified?

    You can also hire a professional proxy, which I wasn't sure what to think of at first but after having a few patients who used them it can actually be very beneficial. I thought families might be offended to find out someone they've never met will be making the decisions, but as it turns out they've been relieved not to have that responsibility. The ones I've dealt with included a nurse, an NP, and a retired MD, which meant they were able to have a much more meaningful discussion with the patient about various possible scenarios, unlike a non-healthcare family member or a lawyer. http://newoldage.blogs.nytimes.com/2013/10/24/hiring-an-end-of-life-enforcer/?_r=0
  13. MunoRN

    The Slow Code: Justified?

    An overview; The Responsibilities of Medical Durable Power of Attorney for the Elderly | LegalZoom: Legal Info A DNR order is even less subject to being overturned since it is not an advanced directive, it's a medical order. If for instance a patient is in the hospital with a particular medical condition, and after discussion with the doctor the patient decides if that course results in cardiac or respiratory arrest that they would not want to be resuscitated, then the patient's wishes have been established and the POA would have to present a valid argument as to why they believe their wishes have now changed. That being said, you do still need to be very careful about who you chose to be you POA since they will be responsible for applying what they know about your wishes to medical decisions where those decisions have not been specifically determined in advanced directives, so it needs to be someone you trust to do this accurately.
  14. MunoRN

    The Slow Code: Justified?

    At least in my part of the country, case law is pretty clear. I know that cultural views on futile of life care are not the same everywhere in the US, so maybe the legal precedent varies as well. But in every place where I've worked, risk management is very vigilant about ensuring that we do not subject patients to treatments at the end of life that they were able to specifically state they don't want, particularly if the POA comes right out and says they are making a decision based on what they want, not what they patient would want. That potentially opens the staff and facility up to assault and other charges, not to mention civil suits. In addition to that, resuscitation is a medical treatment, and Physicians are under no obligation to offer treatments where no benefit can be expected and are actually obligated to ensure that futile treatments are not performed.
  15. MunoRN

    The Slow Code: Justified?

    The POA doesn't actually have the right to override the patient's clearly stated wishes in any state. Their legal responsibility in every state is to abide by patient's clearly expressed wishes and to ensure that those wishes are followed. They can help determine what a patient would want in a specific situation by applying their knowledge of the patient's wishes to that situation. This can sometimes make it unclear if they are going against the patient's wishes or not, but they cannot overtly reverse a DNR because it's what they want, rather than their interpretation of what the patient wands.
×