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
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.
Congratulations to you for making it through on your own. The problem you illustrate, though, is in the way that the system is set up to reward you for not working. Your "mistake" was working 32 hours a week as a CNA. If you had worked only, say, 15 hours a week you'd have qualified. The program is structured so that if you work more hours, you lose more benefits than you gain from the extra hours worked.
LilPeanut, I applaud you for advocating for yourself. I do realize that there are times a patient does know when something doesn't sound quite right, or that something is wrong - after all the pt. knows their body better than anyone else possibly could. But in this situation, the pt. was alseep, with no medication on board, and her mother was the one complaining about all the pain she was in! The mother even stated that the main reason she wanted her to deliver was that she had already taken the day off work, lol.
And I agree that being a pain in the nether regions has nothing to do with how your bill is paid. I was once given h--- from a FOB who, when I pulled the sheet back for his wife to lay on, promptly began to inspect the bottom sheet from end to end to make sure they were clean, then proceded to tell me "what I was going to do"! These people were from a very well educated, well-to-do family. I never meant to imply in my original post that my complaints were due to socio-economic status.
I have had a couple of patients/families who refused to leave after being discharged by the MD. Assuming the patient is medically stable and nothing major has changed; I have called security to escort them out. What they do after that is their business. There are patients that may actually need the bed for medical purposes. I had one mom that didn't want to leave because she just needed "one more night of rest" before going back to her family. I suggested she rent a room at a hotel somewhere- the service and rates are cheaper.
As for venting about Medicaid- I do realize bad attitudes have nothing to do with wealth or even education. I understand we get paid by our hospital and they get paid by Medicare (which happens to pay better than the HMO offered to us as employees). HOWEVER- WHERE DOES MEDICAID MONEY COME FROM?? Part of it comes out of my check- and I have WORSE medical coverage- which I have to help pay for out of my check too!!
I have nothing against people getting some extra help when times are tough or if they really don't have an option. There is a need and purpose for it. It's For BOTH of those reasons (my taxes and people with genuine need) that the ones that abuse the system (and it's not that uncommon) evokes such intense emotions. :angryfire
Specializes in Happily semi-retired; excited for the whole whammy.
Okay, I've debated sharing this, because it is so personal, but given how offensive I find the 'Medicaid is charity' schtick, I've decided to illustrate what results such an attitude can have. My Dad worked his entire life. To him, applying for assistance of any sort was an indication of laziness, sloth, greed, and probably several other sins, too. I don't think he was ever unemployed. When he was in his late 40s/early 50s, he decided he wanted to try working for himself, and purchased a route for a large bakery chain in the section of PA where we lived. So, after 30 plus years of paying into the system and never filing a claim- either workman's comp or unemployment, he was on his own. That he didn't purchase disability insurance for himself was a big mistake, one for which he paid dearly. He was dxed with DM in 1991, the same year he had the first of 4 MIs. He had no insurance. This man who had worked from the time he was around 13 years old, spent every dime of his savings on health care. He never told us he didn't have insurance, or how dire his situation was. He didn't properly medicate himself. He finally, finally swallowed his pride and applied for Medicaid. We found the card in the mail that we went through after his funeral. It made me so sad for two reasons. The first is that I knew what that had to have done to him, to have to apply for help. I can't think of anyone who deserved it more than he did, though. He spent a lifetime paying into the system. He should have received benefits when he needed them. But because he bought into the attitude that people who ask for help are automatically slackers, he wouldn't ask until it was too late. And it made me sad because I know the decision not to apply till it was too late probably cost him around 5 years of his life. In those five years, two of his children were married, and two of his grandchildren were born. I never assume I know what circumstances have brought people to the point where they have to ask for help.
Okay, I've debated sharing this, because it is so personal, but given how offensive I find the 'Medicaid is charity' schtick, I've decided to illustrate what results such an attitude can have. My Dad worked his entire life. To him, applying for assistance of any sort was an indication of laziness, sloth, greed, and probably several other sins, too. I don't think he was ever unemployed. When he was in his late 40s/early 50s, he decided he wanted to try working for himself, and purchased a route for a large bakery chain in the section of PA where we lived. So, after 30 plus years of paying into the system and never filing a claim- either workman's comp or unemployment, he was on his own. That he didn't purchase disability insurance for himself was a big mistake, one for which he paid dearly. He was dxed with DM in 1991, the same year he had the first of 4 MIs. He had no insurance. This man who had worked from the time he was around 13 years old, spent every dime of his savings on health care. He never told us he didn't have insurance, or how dire his situation was. He didn't properly medicate himself. He finally, finally swallowed his pride and applied for Medicaid. We found the card in the mail that we went through after his funeral. It made me so sad for two reasons. The first is that I knew what that had to have done to him, to have to apply for help. I can't think of anyone who deserved it more than he did, though. He spent a lifetime paying into the system. He should have received benefits when he needed them. But because he bought into the attitude that people who ask for help are automatically slackers, he wouldn't ask until it was too late. And it made me sad because I know the decision not to apply till it was too late probably cost him around 5 years of his life. In those five years, two of his children were married, and two of his grandchildren were born. I never assume I know what circumstances have brought people to the point where they have to ask for help.
Your father sounds EXACTLY like my father! But stubborn, hard-working old men like them are what "the system" is for. My father was lucky enough, however, that he had his disability insurance and some sort of pension thing available to him as well as two kids who were old enough to help him financially. So he didn't have to "go on the dole" as he called it. Don't you love the expressions that elderly people come up with? These aren't the people who frustrate so many nurses. It's the people who could help themselves if they REALLY wanted to but choose not to. Again, this isn't everyone on Medicaid. Remember, your father paid into the system via income (and other) taxes his whole life, I'm sure.
Specializes in CCU stepdown, PACU, labor and delivery.
Again, I don't think anyone is against medicaid here. Seems the biggest frustrations come from people who CHOOSE to live their lives on entitlements versus those who HAVE to. These people who choose are in effect taking more money and services away from the people who truly need it the most. ( And I stress again, this doen't mean everyone on medicaid or even most. I posted earlier on what happened to my MIL. I will say my SIL and her husband did not report all their earnings and had both of my nephews who were planned pregnancies on medicaid and received free formula from the WIC program. I also have to add their income is more than mine and my husbands, who are currently paying out of pocket for our 6month old's formula. This leaves someone else who has fallen on hard times and truly cannot afford to feed their children jumping hoops to get their aid since the programs here are so finacially taxed.)
i try as much as possible to look at things from the patient's point of view. when people go to the hospital they ultimately expect for a physician to give the last call. i would too. everyone does not understand what nurses do and the level of our knowledge. sorry, but i kind of agree with the patient. a doctor should be there to confirm diagnoses/prognosis. i also think that because the patient was young it also makes the situation appear less threatening than if it had been a nice married couple or a mature woman. scenarios like this makes it very easy to understand why patient education is so important.
In my facility, we do not have 24 hour in house physicians in ob. The patient is triaged by the RN's. If this patient was 1 cm, posterior, contracting irregularly, and able to sleep, then she is not in labour. If she has a reassuring monitor tracing, then it is safe to send her home. This is a determination that the physician made after speaking with the nurse on the phone.To boot, she was given pain med for her discomfort. Not everyone delivers in a facility where house staff come out of the woodwork and assess patients in person. Having a nurse assess the patient is safe and acceptable. Perhaps the doc's office or clinic should've told the patient, she would be evaluated by the nursing staff in the hospital before her physician came in or decided if he/she needed to come in. The fact of the matter is that many patients and families feel if they act out then they can manipulate the situation and get what they want. Unless what they want is an on the spot immediate c.section with general anesthesia untill complete healing has occurred, then we can't totally take away the discomfort of childbirth. The latter stages of pregnancy are uncomfortable and there is also considerable discomfort in the postpartum period. This is not a secret that nurses and doctors are hiding. I am so sick of some patients including married couples, teen, primips, and multips, etc. thinking if they kick up a big fuss, it will force us to change how we care for them. Sometimes, unfortunately it does. As one doc told a patient who insisted he come in one night, if your exam indicates you're not in labour, you are not... whether one of the nurses does it and tells me or whether I do it and if you are not in labour and otherwise okay, then you need to go home. This too, was not a patient with extreme sx's, but someone with irregular uc's and a cervix which was nowhere. :angryfire
I know the patient in this case was stable etc., it was just a point to keep in mind for the future. Because of my long term bedrest, I looked like crap and I always looked younger than I was.
As for medicare, well, I would prefer that these people get medical care. Taking advantage of the system or no, from a strictly selfish POV, epidemiologically speaking, it's safer for me to get everyone medical care.
JeanettePNP, MSN, RN, NP
1 Article; 1,863 Posts
Congratulations to you for making it through on your own. The problem you illustrate, though, is in the way that the system is set up to reward you for not working. Your "mistake" was working 32 hours a week as a CNA. If you had worked only, say, 15 hours a week you'd have qualified. The program is structured so that if you work more hours, you lose more benefits than you gain from the extra hours worked.