I tried posting this earlier, but it got eaten somehow, so I'm trying again. Excuse me if the other post shows up from cyberspace, lol.
At any rate ... I am laughing now about the whole thing, but it wasn't so funny when the whole thing was taking place last night!
At 0300 this morning, I had a 14 yo present to L&D c/o pain rated 9/10 in her lower abd. She was laughing with her best friend and mother and demanding that I get her a tray because the was hungry. I told her that I couldn't feed her until I knew what was going on with her and she became very upset with me ... almost throwing a tantrum. I proceeded to place her on the monitor and start my assessment. 1cm, very thick, very posterior. She had some mild contractions that were irregular - 20 minutes apart at one point. Her UA came back clear. Since she was 39+ weeks. I waited an hour, checked her again - no change. So I called the MD. He gave orders for a hydrocodone and to send her home with labor precautions.
When I went into her room to D/C her, her mother blew up like a rocket! WHAT! WITH HER CONTRACTING AND HURTING LIKE THIS! (The pt was asleep when I came into the room.) The mother then proceeded to ask why in the H--- the Dr hadn't even bothered to check on her. HER Dr came in to check on HER when SHE was in labor!
I told the mother that, had her daughter BEEN in labor, which she wasn't, the Dr WOULD have been there at some point to check in on her.
Then the mother informed me that she wasn't comfortable at ALL with some NURSE assessing her child and judging whether or not to send her home and that she was NOT leaving until they saw he DR! (The mother was also a nurse - or so she said.)
I called the MD back and he told me to just leave her there until he made rounds this AM, but to tell her that this didn't mean that he would be keeping her.
Like I said, I am laughing now, but I was so angry last night that I had to call the PP nurse to sit at my station while I went outside to cool off! :angryfire
Specializes in CCU stepdown, PACU, labor and delivery.
You're not taking care of her for free, you are being paid by your hospital, and your hospital is being paid by Medicaid.
While I agree to an extent on being judgemental ( and what I'm about to say comes from the "human me" not the "nurse me" ) , medicaid comes from the 1/4 chunk that's missing out of my paycheck every two weeks. Techinically you could say we ARE paying for our earnings. The state ( at least in Florida) does not have a money tree at our capital. I've worked other areas in the nursing field and this does bother me. We allow some people ( and based not on judgement but pure birth log statistics at our hospital) come back yr after yr sometimes having 8-9 kids on our tax dollars. What bothers me as a nurse is that there are disabled people being denied or having to spend money to fight for assistance from the gov. These people CAN"T work. I have to ell them how sorry I am that we can't place them in a decent rehab facility, alf, ect. because they can't be accepted due to the fact that their still disputing to get gov aid and they have no personal income.Our senior citizens can't afford to pay for their meds and groceries so instead of starving they buy food and end up sick and hospitalized for a condition that , could they afford it, a pill could help them avoid. People who work all their life and contribute are told "too bad" when they need finacial assistance due to a disease or illness they COULDN"T prevent ( pregnancy is fairly preventable, and in Florida the health department will give you birth control free with no questions asked). It is a frustrating issue and I think that is commonly how it gets expressed by us. I don't think indigent people deserve less or no respect or to be treated differently, but nurse are human too and I can see the personal frustration side also.
Now that I'm probably perceived as a complete villian I have to say I'm also a person, wife, mother of 2. My family and family time is valuable to me also. It's discouraging to work long hard hours to miss out on my family and children not to mention a good chunk of pay for taxes because someone else can remain unemployed and have multiple children on the system we contribute to. MY kids deserve their mom also. I realize this may sound harsh but while I am compassionate to my patients, I don't subscribe to the whole nurse martyr mentality that alot of us nurses are guilted into feeling. I want to take care of my patients but my "other job" is to take care of my family. I have my own children to support also.
Specializes in Happily semi-retired; excited for the whole whammy.
While I agree to an extent on being judgemental ( and what I'm about to say comes from the "human me" not the "nurse me" ) , medicaid comes from the 1/4 chunk that's missing out of my paycheck every two weeks. Techinically you could say we ARE paying for our earnings. The state ( at least in Florida) does not have a money tree at our capital. I've worked other areas in the nursing field and this does bother me. We allow some people ( and based not on judgement but pure birth log statistics at our hospital) come back yr after yr sometimes having 8-9 kids on our tax dollars. What bothers me as a nurse is that there are disabled people being denied or having to spend money to fight for assistance from the gov. These people CAN"T work. I have to ell them how sorry I am that we can't place them in a decent rehab facility, alf, ect. because they can't be accepted due to the fact that their still disputing to get gov aid and they have no personal income.Our senior citizens can't afford to pay for their meds and groceries so instead of starving they buy food and end up sick and hospitalized for a condition that , could they afford it, a pill could help them avoid. People who work all their life and contribute are told "too bad" when they need finacial assistance due to a disease or illness they COULDN"T prevent ( pregnancy is fairly preventable, and in Florida the health department will give you birth control free with no questions asked). It is a frustrating issue and I think that is commonly how it gets expressed by us. I don't think indigent people deserve less or no respect or to be treated differently, but nurse are human too and I can see the personal frustration side also.
Now that I'm probably perceived as a complete villian I have to say I'm also a person, wife, mother of 2. My family and family time is valuable to me also. It's discouraging to work long hard hours to miss out on my family and children not to mention a good chunk of pay for taxes because someone else can remain unemployed and have multiple children on the system we contribute to. MY kids deserve their mom also. I realize this may sound harsh but while I am compassionate to my patients, I don't subscribe to the whole nurse martyr mentality that alot of us nurses are guilted into feeling. I want to take care of my patients but my "other job" is to take care of my family. I have my own children to support also.
Medicaid is paid for out of our taxes, yes. That is not the same thing as providing free care. It makes more sense to say that 'we' (I'm a taxpayer, too) are providing free healthcare coverage, since payment for the service (albeit insufficient payment in most cases) comes from Medicaid. In another thread, someone wisely pointed out the folly of resenting Medicaid. Would you rather our facilities get stuck eating the bills of care provided for people who can't pay and DON'T get Medicaid? That is charity care.
Specializes in CCU stepdown, PACU, labor and delivery.
I don't resent medicaid, my point is just that we nurses are also human and I can completely understand the frustrations alot of people do have with "the system." We have nurses who come back in from wheeling someone down to their car to go home and come back upset as they are working their 4th 12 hr shift that week to make ends meet and this person who was a medicaid pt and that nurse just helped apply for WIC, drove off in a new SUV. Do ALL medicaid pts "work the system"? Of course not, most are good people just trying to get by in life. But we're human also and sometimes it is easy to get caught up in the unfairness of life from time to time. That's just human nature.
While I agree to an extent on being judgemental ( and what I'm about to say comes from the "human me" not the "nurse me" ) , medicaid comes from the 1/4 chunk that's missing out of my paycheck every two weeks. Techinically you could say we ARE paying for our earnings. The state ( at least in Florida) does not have a money tree at our capital. I've worked other areas in the nursing field and this does bother me. We allow some people ( and based not on judgement but pure birth log statistics at our hospital) come back yr after yr sometimes having 8-9 kids on our tax dollars. What bothers me as a nurse is that there are disabled people being denied or having to spend money to fight for assistance from the gov. These people CAN"T work. I have to ell them how sorry I am that we can't place them in a decent rehab facility, alf, ect. because they can't be accepted due to the fact that their still disputing to get gov aid and they have no personal income.Our senior citizens can't afford to pay for their meds and groceries so instead of starving they buy food and end up sick and hospitalized for a condition that , could they afford it, a pill could help them avoid. People who work all their life and contribute are told "too bad" when they need finacial assistance due to a disease or illness they COULDN"T prevent ( pregnancy is fairly preventable, and in Florida the health department will give you birth control free with no questions asked). It is a frustrating issue and I think that is commonly how it gets expressed by us. I don't think indigent people deserve less or no respect or to be treated differently, but nurse are human too and I can see the personal frustration side also.
Now that I'm probably perceived as a complete villian I have to say I'm also a person, wife, mother of 2. My family and family time is valuable to me also. It's discouraging to work long hard hours to miss out on my family and children not to mention a good chunk of pay for taxes because someone else can remain unemployed and have multiple children on the system we contribute to. MY kids deserve their mom also. I realize this may sound harsh but while I am compassionate to my patients, I don't subscribe to the whole nurse martyr mentality that alot of us nurses are guilted into feeling. I want to take care of my patients but my "other job" is to take care of my family. I have my own children to support also.
Specializes in Happily semi-retired; excited for the whole whammy.
I don't resent medicaid, my point is just that we nurses are also human and I can completely understand the frustrations alot of people do have with "the system." We have nurses who come back in from wheeling someone down to their car to go home and come back upset as they are working their 4th 12 hr shift that week to make ends meet and this person who was a medicaid pt and that nurse just helped apply for WIC, drove off in a new SUV. Do ALL medicaid pts "work the system"? Of course not, most are good people just trying to get by in life. But we're human also and sometimes it is easy to get caught up in the unfairness of life from time to time. That's just human nature.
In which case, it makes more sense to vent against the particular patient or situation, rather than taking a paintbrush and broadly covering all patients on Medicaid with the 'ungrateful, entitlement seeking' label, which is what was done in the post to which I initially responded.
Specializes in CCU stepdown, PACU, labor and delivery.
I think you're still missing my point. The person who posted that is just that... a person. We all ( some of us are just more forth coming in admitting it) say things when we are frustrated, passionate, or angry about something. Just as that person shouldn't "blanket" people we shouldn't either. That post sounded ( at least it was perceived by myself) to be a post out of frustration. We work in a high stress job that requires alot of self sacrifice and most of us do it gladly, however we vent just like everyone else. I know I've said/done some pretty silly things that either I didn't mean or were misinterpreted as something completely different than what I had intended when I have been frustrated or stressed. We deserve a place to let off steam somewhere. Please don't misunderstand. I don't mean this discussion as an attack or being defensive I just don't think it's fair to generalize anyone including us nurses who might have had a difficult, bad, or stressful day and need to vent. We all deserve a "bad day" too sometimes without the worries of violating "venting ettiquette." No hard feelings here, okay?
Specializes in Happily semi-retired; excited for the whole whammy.
I think you're still missing my point. The person who posted that is just that... a person. We all ( some of us are just more forth coming in admitting it) say things when we are frustrated, passionate, or angry about something. Just as that person shouldn't "blanket" people we shouldn't either. That post sounded ( at least it was perceived by myself) to be a post out of frustration. We work in a high stress job that requires alot of self sacrifice and most of us do it gladly, however we vent just like everyone else. I know I've said/done some pretty silly things that either I didn't mean or were misinterpreted as something completely different than what I had intended when I have been frustrated or stressed. We deserve a place to let off steam somewhere. Please don't misunderstand. I don't mean this discussion as an attack or being defensive I just don't think it's fair to generalize anyone including us nurses who might have had a difficult, bad, or stressful day and need to vent. We all deserve a "bad day" too sometimes without the worries of violating "venting ettiquette." No hard feelings here, okay?
I don't think I'm missing your point, I think I am disagreeing with it. I think nurses who make judgmental comments like 'charity patients act this way or that way' reflect badly on all of us, which is the reason I object so strenously to such remarks. I don't want people who receive Medicaid assistance to be making blanket statements such as 'all nurses hate poor people'. It wouldn't be true and it wouldn't be fair. The OP was able to vent her frustration without implying that all Medicaid patients behave in a certain way, or expect certain privileges.
And just to play devil's advocate, because I was in a situation similar - I was 34w. My dr. had taken me off my terb pump for a variety of reasons. I was 3-4cm and complete, but fFN-, BP raising, fluid low, and concerns for toxicity based on the fact I had been on terb for 10w at that point. Plus, since it was my 1st pg, she had no way of knowing what was "normal" for me. I had been in in the afternoon, she actually had me walk to see if that would progress things, it didn't, so she sent me home.
At 10pm, when I was back in, the dr. on call just said to mag me for the next 2 weeks, without examining me, looking at my chart or talking to any of my usual caregivers. I told her I would consent to the mag if she would come in and talk to me (this was all relayed through a nurse) or if she would speak to my usual OB or peri about my case. Mag is a serious drug and I didn't want to go on it if it wasn't absolutely necessary. She hadn't seen me since 23w and was not aware of the extent of my case. She refused, and so therefore, so did I. We compromised with more terb and demoral until my dr. came in in the morning.
Thank God, because they hadn't planned on doing any more u/s, and it turns out that I had almost no fluid left. They almost couldn't do an amnio (done as a compromise as well) because there was so little fluid. Once I would have been on mag, I would not have been able to advocate for myself and my son could have died if they kept me pg much longer. As it was, I delivered the next day. I did go on the mag because his lungs were immature at the amnio and they wanted to give me more steroids, which was a valid reason (this was before we knew that multiple courses of steroids didn't confer multiple benefits.)
Blah. long-winded post to say that pts. do sometimes know what they're talking about.
And I will fully agree that stupidity and selfishness know no economic boundries.
To focus back on the issue at hand - the patient and her mother refused to leave and were angry that they were approached for discharge.
I believe the physician handled the situation the best felt necessary. The patient was allowed to stay and was then induced upon his entrance to the patient's resolve.
Suggestion for future reference: You did the right thing - you notified the physician and the situation was handled. The only additional advice would be to notify the house supervisor or manager as to the situation should this arrise in the future in case there are issues - That is why they are "running" the unit and should the next physician not agree that the patient should stay - the supervisor or manager can step in on behalf of the hospital system for the documentation should a case as such would errupt into a liability issue.
Judgements aren't needed here. We are treating patients and we are all in the same boat - We all have difficult patients and personal beliefs that can affect our focus of the patient. We need to leave that baggage at the door when we enter the organization which we work. We need to stand together as a profession and celebrate the "crazy stories" that makes our profession such a unique one!:balloons:
What I don't understand is how some Medicaid patients don't get caught lying about their income. When I was in nursing school in the 90's, the program took 27 hrs/wk, not including travel time, studying, clinical prep and papers. I then worked 32 hrs/wk as a CNA. A big chunk of my check went to pay my taxes and health insurance for my 2 kids and I. After that I had $150 net.
Since my income was that low at the time, my ex-husband had to pay $200 a week in child support. Rent is high in MA, so I could only afford the dumpiest of apartments. I got my sm amnt of furniture @ the Salvation Army, we slept on mattresses on the flr, and I drove a clunker of a car. I didn't have a cell or cable or any luxury items like that. Luckily, student loans don't have to be paid until 6 mos after graduation, so I had it good in that dept! My kids cried sometimes b/c they had to do without, but now they can look back on it all and be proud of me, which is the best feeling in the world!
I was told when I visited the welfare office (one of the worst days in my life) that I didn't qualify for any type of public assistance whatsoever. Actually, they were right in turning me down b/c in the end, I did make it without relying on the taxpayers.
I'm just wondering why people who obviously live a middle-class life-style (unlike the one I just illustrated) are able to qualify for assistance. I'm not saying all Medicaid patients are like that, but I see a lot who don't seem very poor! I also see many (not all) who are able to work and don't.
Specializes in CCU stepdown, PACU, labor and delivery.
What I don't understand is how some Medicaid patients don't get caught lying about their income. When I was in nursing school in the 90's, the program took 27 hrs/wk, not including travel time, studying, clinical prep and papers. I then worked 32 hrs/wk as a CNA. A big chunk of my check went to pay my taxes and health insurance for my 2 kids and I. After that I had $150 net.
Since my income was that low at the time, my ex-husband had to pay $200 a week in child support. Rent is high in MA, so I could only afford the dumpiest of apartments. I got my sm amnt of furniture @ the Salvation Army, we slept on mattresses on the flr, and I drove a clunker of a car. I didn't have a cell or cable or any luxury items like that. Luckily, student loans don't have to be paid until 6 mos after graduation, so I had it good in that dept! My kids cried sometimes b/c they had to do without, but now they can look back on it all and be proud of me, which is the best feeling in the world!
I was told when I visited the welfare office (one of the worst days in my life) that I didn't qualify for any type of public assistance whatsoever. Actually, they were right in turning me down b/c in the end, I did make it without relying on the taxpayers.
I'm just wondering why people who obviously live a middle-class life-style (unlike the one I just illustrated) are able to qualify for assistance. I'm not saying all Medicaid patients are like that, but I see a lot who don't seem very poor! I also see many (not all) who are able to work and don't.
Wow! Congrats on such an accomplishment. I can't imagine going through nursing school and raising 2 kids on my own. My MIL (whose is an RN and is single) is disabled and unable to work due to a pt falling on her resulting in back surgery with screw and rod placement to stabilize her spine. She had the same problem . They denied her due to her car being too "new" ( it was 8yrs old.) She was so upset and embarrassed that she even had to apply. Luckily the family all pitched in ( my husband and SIL dropped out of college due to lack of funds because of this and both started working full time to help my MIL get by) and she was okay while several months passed and she spent quite a bit on lawyers to get her benefits.It sounds like things were pretty rough there for awhile for you but what a shining role model your kids have!
LandDRN
78 Posts
While I agree to an extent on being judgemental ( and what I'm about to say comes from the "human me" not the "nurse me" ) , medicaid comes from the 1/4 chunk that's missing out of my paycheck every two weeks. Techinically you could say we ARE paying for our earnings. The state ( at least in Florida) does not have a money tree at our capital. I've worked other areas in the nursing field and this does bother me. We allow some people ( and based not on judgement but pure birth log statistics at our hospital) come back yr after yr sometimes having 8-9 kids on our tax dollars. What bothers me as a nurse is that there are disabled people being denied or having to spend money to fight for assistance from the gov. These people CAN"T work. I have to ell them how sorry I am that we can't place them in a decent rehab facility, alf, ect. because they can't be accepted due to the fact that their still disputing to get gov aid and they have no personal income.Our senior citizens can't afford to pay for their meds and groceries so instead of starving they buy food and end up sick and hospitalized for a condition that , could they afford it, a pill could help them avoid. People who work all their life and contribute are told "too bad" when they need finacial assistance due to a disease or illness they COULDN"T prevent ( pregnancy is fairly preventable, and in Florida the health department will give you birth control free with no questions asked). It is a frustrating issue and I think that is commonly how it gets expressed by us. I don't think indigent people deserve less or no respect or to be treated differently, but nurse are human too and I can see the personal frustration side also.
Now that I'm probably perceived as a complete villian I have to say I'm also a person, wife, mother of 2. My family and family time is valuable to me also. It's discouraging to work long hard hours to miss out on my family and children not to mention a good chunk of pay for taxes because someone else can remain unemployed and have multiple children on the system we contribute to. MY kids deserve their mom also. I realize this may sound harsh but while I am compassionate to my patients, I don't subscribe to the whole nurse martyr mentality that alot of us nurses are guilted into feeling. I want to take care of my patients but my "other job" is to take care of my family. I have my own children to support also.