I feel like we are rapidly reaching jump ship level. My own sister (in her 40s with 4 kids and natural born Texas/US citizen) is actively migrating her family to Canada next year. Her daughter with a clef pallet cost her family 90K last year WITH insurance. Her husband makes $150K a year, so they managed...but Christ! My sister is so serious that she already submitted all her immigration papers and is waiting to hear back.
I work in a clinic. The ER at the hospital I work for has sent critical patients to our clinic because they 1) apparently have no staff that know how to evaluate for a emergency (I say this having 8 years ER experience under my belt). I had a patient go to the ER twice in 24 hours for urinary pain, bleeding 1 week post op. They sent him to the clinic pale AF, orthostatic blood pressure 80/40, bladder scan showed 330 after voiding (ended up being a giant number of clots that I got to try to hand irrigate in the OFFICE!). The ER did a UA at both visits and NOTHING ELSE.
You might want to say this is my institution in particular...however I haven't held a job at 1 institution for more than 3 years. I've traveled. So, yes, there are better and worse.....but they are ALL getting worse. Process improvement usually involve trying to make up care gaps with unlicensed, under educated, unqualified people OR have one qualified person do the work of 3-4 people (both of which create gross care gaps).
I wish I could go with my sister. This has only gotten worse in the 15 years I've been a nurse. I'm not proud of my field.
What do you mean? Our system is already compared to the British system.
Our two-tiered system is de facto. We have nothing like the NHS here in terms of free care. But as in Britain, people that can afford health insurance can buy it to avoid the NHS system. What am I missing?
Specializes in NICU, PICU, Transport, L&D, Hospice.
subee said:
Our two-tiered system is de facto. We have nothing like the NHS here in terms of free care. But as in Britain, people that can afford health insurance can buy it to avoid the NHS system. What am I missing?
Correct. Our system is not like the NHS, it has worse patient outcomes, in general.
Specializes in Case management, supervisor, unit manager, etc.
I have been a nurse since 1994. The changes I have seen are mind blowing. As a medical professional we can pick apart each other, but the primary problem is insurance.
I remember when insurance companies started changing medications on patients because that was now their formulary product. I actually laughed the first time I saw that because I thought no way can they just change a doctor's order on an old inexpensive medication that works for a new much higher cost medication that is not effective for the patient.
Many years since and over a decade of case management later, I understand that insurance is the beast that feeds the beast. Customer satisfaction is a key role in getting insurance contracts and being a preferred choice for many insurance companies. Length of stay: this becomes where the administrative and supervisors now exceed direct care staff on a daily basis (not the staffing pool numbers they whip out with this conversation). For payment purposes the amount of oversight on making sure documentation and all t's and I's are crossed, minutes treatment /care performed, all assignments finished, aide documentation, meetings with medical director, etc. now mix in medical equipment and supplies and what insurance will pay vs what America's litigious society mixed with government regulations required for each problem the patient has or could have and you get another imbalance.
Now to all the executives that make unbelievable salaries as well as bonuses. These people make this money by making a penny scream. To them it is almost like a SIM game or some such. They push to have the customer rating documented, assessments completed, all the mandatory items required they delegate to executives to CEO to CFO and down to you. They utilize their own facilities to incentivize better compliance throughout. Making the CEO of the facility have to push all of their staff to reach these benchmarks and if they are in the top numbers they get bonuses if not they have to find another job.
Insurance pushes this behind the scenes.
The days of travel to US for medical care is going because we are becoming an assembly line of medical standard to fit all of these rules. Length of stay is short. No nurses around to give special care to them. Rushed doctors who do not have time to coddle. Other more wealthy countries are now getting those people.
I remember as a child at the dinner table, the phone would ring. My dad would stop the kids mad rush to answer saying 'Don't get that it's an insurance company' This country has went from that to now insurance is required and difficult to get or waiting a year for preexisting chronic illnesses to be covered. It is grossly expensive per paycheck for premiums and then you have deductibles that exceed what the average person spends on medical care annually. And you cannot add or change except at a magical time of annual re enrollment or life changing events.
Until a spotlight shines on them, they are in control of our medical system. Nurses need to find their lobbyists and utilize them or someone better than them to began our change. It would make such a difference for our issues to be addressed because of the huge workload we are placed under because of this.
I have been a nurse since 1994. The changes I have seen are mind blowing. As a medical professional we can pick apart each other, but the primary problem is insurance.
I remember when insurance companies started changing medications on patients because that was now their formulary product. I actually laughed the first time I saw that because I thought no way can they just change a doctor's order on an old inexpensive medication that works for a new much higher cost medication that is not effective for the patient.
Many years since and over a decade of case management later, I understand that insurance is the beast that feeds the beast. Customer satisfaction is a key role in getting insurance contracts and being a preferred choice for many insurance companies. Length of stay: this becomes where the administrative and supervisors now exceed direct care staff on a daily basis (not the staffing pool numbers they whip out with this conversation). For payment purposes the amount of oversight on making sure documentation and all t's and I's are crossed, minutes treatment /care performed, all assignments finished, aide documentation, meetings with medical director, etc. now mix in medical equipment and supplies and what insurance will pay vs what America's litigious society mixed with government regulations required for each problem the patient has or could have and you get another imbalance.
Now to all the executives that make unbelievable salaries as well as bonuses. These people make this money by making a penny scream. To them it is almost like a SIM game or some such. They push to have the customer rating documented, assessments completed, all the mandatory items required they delegate to executives to CEO to CFO and down to you. They utilize their own facilities to incentivize better compliance throughout. Making the CEO of the facility have to push all of their staff to reach these benchmarks and if they are in the top numbers they get bonuses if not they have to find another job.
Insurance pushes this behind the scenes.
The days of travel to US for medical care is going because we are becoming an assembly line of medical standard to fit all of these rules. Length of stay is short. No nurses around to give special care to them. Rushed doctors who do not have time to coddle. Other more wealthy countries are now getting those people.
I remember as a child at the dinner table, the phone would ring. My dad would stop the kids mad rush to answer saying 'Don't get that it's an insurance company' This country has went from that to now insurance is required and difficult to get or waiting a year for preexisting chronic illnesses to be covered. It is grossly expensive per paycheck for premiums and then you have deductibles that exceed what the average person spends on medical care annually. And you cannot add or change except at a magical time of annual re enrollment or life changing events.
Until a spotlight shines on them, they are in control of our medical system. Nurses need to find their lobbyists and utilize them or someone better than them to began our change. It would make such a difference for our issues to be addressed because of the huge workload we are placed under because of this.
And just reading this post reminds me that our system is bizarre and would make no sense for any logic-loving person. It's wasting money like the person sticking half their salary putting cocaine up their nose.
Until our legislators, all of them, not just the guy from another state, rewrite tax code, not much will change. Sadly, most folks like the elected officials for their state and blame the other states elected officials. The wealthy simply use existing tax codes and write offs to their advantage, which isn't a crime in and of itself. The crime is continuously electing and re-electing these bozos, who keep the status quo for their buddies with money
I have an off topic, but connected thought. What happens to those who have 401ks that are deeply entrenched in healthcare? Many older nurses, and retired nurses, in the US have pensions. Those younger have the 401ks that are heavily invested in healthcare related entities. What becomes of those who would lose most, if not all, of their retirement savings? I'm lucky enough that I'll get a moderate pension, plus have some 401k and IRA savings. When we have the "switch to socialized medicine" talk at work, those in the 40-55 year age range have voiced this concern. I can understand, because at the higher end of the age range, not much time to start saving again. Just pondering...
I wouldn't say many older or retired nurses have pensions. Those were largely done away with in the 1980's. Federal employees, states and some hospital groups (I.e.Mayo) still offer pensions. It's really up to us to manage our money even in our 401k's. And as a federal retiree, I would advocate for anyone to work federally. I lived on an Indian reservation for many years and I received my housing for next to nothing. Great benefits that I keep for life, pension and a 401k. And, yes, I did it with a family.
I wouldn't say many older or retired nurses have pensions. Those were largely done away with in the 1980's. Federal employees, states and some hospital groups (I.e.Mayo) still offer pensions. It's really up to us to manage our money even in our 401k's. And as a federal retiree, I would advocate for anyone to work federally. I lived on an Indian reservation for many years and I received my housing for next to nothing. Great benefits that I keep for life, pension and a 401k. And, yes, I did it with a family.
I got my pension from a hospital that I worked at from 2003--2012, they stopped investing in their pension plan in 2010, anyone with 5 or more years reap the rewards, they converted to 401k after. Another area hospital still has a small pension, as well as 401k option. It's one of the nice things about a rural layout that hasn't been bought out by larger entity hospital systems. My mom retired from a large hospital system, is in her late 70s, and she has a pension as do many of her peers...I agree with going to an Indian reservation if able. Not everyone is able to do so
Specializes in NICU, PICU, Transport, L&D, Hospice.
jobellestarr said:
I wouldn't say many older or retired nurses have pensions. Those were largely done away with in the 1980's. Federal employees, states and some hospital groups (I.e.Mayo) still offer pensions. It's really up to us to manage our money even in our 401k's. And as a federal retiree, I would advocate for anyone to work federally. I lived on an Indian reservation for many years and I received my housing for next to nothing. Great benefits that I keep for life, pension and a 401k. And, yes, I did it with a family.
I got my pension from a hospital that I worked at from 2003--2012, they stopped investing in their pension plan in 2010, anyone with 5 or more years reap the rewards, they converted to 401k after. Another area hospital still has a small pension, as well as 401k option. It's one of the nice things about a rural layout that hasn't been bought out by larger entity hospital systems. My mom retired from a large hospital system, is in her late 70s, and she has a pension as do many of her peers...I agree with going to an Indian reservation if able. Not everyone is able to do so
Of course, not everyone is able to or wants to. I just wanted people to know that many IHS raise their families on the reservations. So, I wouldn't want anyone to think that they couldn't do it because they have a family. The other way that staff works around this is to have a home nearby and commute. I lived in 4 corners so staff had homes in Colorado and Arizona.
Of course, not everyone is able to or wants to. I just wanted people to know that many IHS raise their families on the reservations. So, I wouldn't want anyone to think that they couldn't do it because they have a family. The other way that staff works around this is to have a home nearby and commute. I lived in 4 corners so staff had homes in Colorado and Arizona.
Some of my state nurses (surveyors) have pensions as well, and I know that other states may have this for some
Some of my state nurses (surveyors) have pensions as well, and I know that other states may have this for some
Yes, I mentioned states in my post. I worked as an investigator for the state of AZ and their pension was terrible and mostly self funded. Federal is much better.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
In regards to insurance and government regulation of care....I'm not so sure I find the latter all that unappealing. As someone who moved from a state with high taxes due to a robust Medicaid program (Illinois) to a state that has low taxes and a next to nothing Medicaid program (Texas); I am now even more sure that a national healthcare system is needed and the next step for US healthcare.
What I can see now that I didn't fully appreciate before moving to another state, is how much medicaid affects the standards of care for all patients....even those with insurance.
Examples:
43 year old female goes to the ER with shortness of breath, a CT is done and several masses are found.
In Texas: They discharge the patient from the ER instructing her to follow up with breast specialist as soon as she can afford to. It took her a month to be able to see the doctor because you can't schedule an appointment without being able to pay up front. Texas Medicaid does not cover many cancers so this lady needed a biopsy to have proof that her cancer was breast cancer before she can possibly get Medicaid. Took another 2 weeks to get her biopsy and then 2 more weeks to get the results. So she had stage 4 cancer before she even got approved to get Medicaid and possibly organize treatment.
In Illinois: This case would have been admitted to the hospital, biopsy preformed and oncology/radiation plan established and set up before discharge. Because in Illinois they can back date Medicaid coverage they go ahead and establish care ASAP which leads to better outcomes.
A 60 year old female presents to the ED with abdominal pain, back pain and lady partsl bleeding x 2 days. She hasn't had a period in 10 years. She tried to make an appointment with her OBGYN but was told the soonest available appointment was 1 month away (that's some *** but a different issue). She has an excellent insurance plan (This is my Aunt so I know her coverage.)
In Texas:
To my flabbergasted dismay, they did a UA and a CBC. They told her that was all they "had" to do and that she should continue to follow up with her OBGYN as soon as possible.
In Illinois:
What would have happened is she would have gotten a UA, CBC, CMP, and some sort of imaging (lady partsl ultrasound or CT) and a stat referral to her OBGYN.
I think both of these demonstrate how little incentive Texas has to provide complete care because they "don't have to" aka there is no funding ensured by the state so ALL patients are given a minimal amount of care. The policy isn't care for the patients and then address funding in Texas. It is address if their insurance will cover the care and then provide care, leading to delayed care and poorer outcomes.
Specializes in NICU, PICU, Transport, L&D, Hospice.
KalipsoRed21 said:
In regards to insurance and government regulation of care....I'm not so sure I find the latter all that unappealing. As someone who moved from a state with high taxes due to a robust Medicaid program (Illinois) to a state that has low taxes and a next to nothing Medicaid program (Texas); I am now even more sure that a national healthcare system is needed and the next step for US healthcare.
What I can see now that I didn't fully appreciate before moving to another state, is how much medicaid affects the standards of care for all patients....even those with insurance.
Examples:
43 year old female goes to the ER with shortness of breath, a CT is done and several masses are found.
In Texas: They discharge the patient from the ER instructing her to follow up with breast specialist as soon as she can afford to. It took her a month to be able to see the doctor because you can't schedule an appointment without being able to pay up front. Texas Medicaid does not cover many cancers so this lady needed a biopsy to have proof that her cancer was breast cancer before she can possibly get Medicaid. Took another 2 weeks to get her biopsy and then 2 more weeks to get the results. So she had stage 4 cancer before she even got approved to get Medicaid and possibly organize treatment.
In Illinois: This case would have been admitted to the hospital, biopsy preformed and oncology/radiation plan established and set up before discharge. Because in Illinois they can back date Medicaid coverage they go ahead and establish care ASAP which leads to better outcomes.
A 60 year old female presents to the ED with abdominal pain, back pain and lady partsl bleeding x 2 days. She hasn't had a period in 10 years. She tried to make an appointment with her OBGYN but was told the soonest available appointment was 1 month away (that's some *** but a different issue). She has an excellent insurance plan (This is my Aunt so I know her coverage.)
In Texas:
To my flabbergasted dismay, they did a UA and a CBC. They told her that was all they "had" to do and that she should continue to follow up with her OBGYN as soon as possible.
In Illinois:
What would have happened is she would have gotten a UA, CBC, CMP, and some sort of imaging (lady partsl ultrasound or CT) and a stat referral to her OBGYN.
I think both of these demonstrate how little incentive Texas has to provide complete care because they "don't have to" aka there is no funding ensured by the state so ALL patients are given a minimal amount of care. The policy isn't care for the patients and then address funding in Texas. It is address if their insurance will cover the care and then provide care, leading to delayed care and poorer outcomes.
Texas has the highest uninsured rate in the nation. In 2019, they had some of the worst health ranking in the country.
subee, MSN, CRNA
1 Article; 6,118 Posts
Our two-tiered system is de facto. We have nothing like the NHS here in terms of free care. But as in Britain, people that can afford health insurance can buy it to avoid the NHS system. What am I missing?