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.
Also, operating with not enough nurse and no techs. So nurses are doing the work of 3-4 people, but the hospitals have the money to pay the doctors, pay lawsuits, give the housekeepers breaks, but when it comes to the nurses, no one knows anything about it.
I need to add another aspect of the failing system. As Americans we surely are accustomed to better healthcare than many other nations that struggle to have even facilities and supplies, let alone advanced, up to date care. However, I am worried that the services we do have are going to decline even further.
I have a friend who went to an ER (large medical center), via 911. Excruciating HA, blurred vision, dizziness and vomiting, 4 days following a complex TMJ surgery. She waited in that ER for approximately 30 hours with very minimal monitoring or ongoing assessment. It was discovered she had a stroke WHILE IN THE ER. Had blood clots r/t her surgery, on a heparin drip with the same sub par monitoring or intervention. She waited 2 more days waiting for a bed to open up in-patient. She survived with permanent hearing loss and chronic HA's. I've heard several stories of people dying while in the ER. It didn't used to be this way, and I know there are multiple factors that can play into this. However, the fact that insurances companies, pharma, corporate owned systems who are profit driven have everything to do with the decline for patient outcomes and services.
I'd really like to know why this has been allowed to happen? Have no clue how to go about fixing it. Obviously, staffing shortages in several disciplines are a key factor in the lack of services and care that is available. I don't believe Baby boomers retiring is the main cause.
Wow, I'm sorry about your friend. That's terrible.. And you're so right, this should never happen.
I'm talking about those who refuse to participate in basic self care (diet, exercise, hygiene, etc) then want to blame the system when it blows up on them, or wants the newest magic pill that they've seen in an ad, heard from a friend, or pushed by a Dr
I know what and who you are talking about. I don't blame the American people for their lack of access to health care or their slow poisoning by the corporate food industry. The people are victims here with increasingly poor health, terrible access to care and falling life expectancies. It's not their fault that they are targets for pharmaceutical marketing in a country where actual health care may not even be available to them.
The fat acceptance movement is ultimately a negative one for health. I see obesity as a health issue, but many people see it as a vanity issue. I agree that people of all types should be loved and honored for who they are. But to ignore the massive health risks associated with obesity, or any other controllable risk factor, is just dishonest and ludicrous.
It's called fat shaming, and that's a whole other discussion. Fat shaming is totally wrong and that's most likely what started the movement. The problem we have as HCW is trying to find the balance between preventing someone from having a chronic illness who we see as overweight and criticizing/critiquing said person because of their weight.
I work in a small, rural hospital. Currently, 4 of our 21 med surg beds are occupied by elderly dementia patients who aren't acutely ill, but can't be discharged b/c their families will not or cannot care for them and there are no beds available in local nursing homes. One has advanced dementia and requires a sitter b/c he's constantly climbing out of bed and is a high fall risk. The nurse assigned to him must constantly keep eyes on him as the sitter cannot touch him. Meanwhile, he or she must also care for 4 additional patients. I can only see this getting worse as the local population ages. It's exhausting.
This is a thing. Once they're on a sitter one-to-one or in mitts or restraints they won't get put in Skilled or Rehab (they have to be off for 24 h.) But in that 24 h period they will most likely injure themselves or staff or worse, fall. Huge Problem.
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.
these stories make me so sad. these are the times I cry at work
Specializes in NICU, PICU, Transport, L&D, Hospice.
HiddenAngels said:
ha ha ha! I knew it..
You know what? You know that our profit driven system victimizes we the people? You know that this system is not sustainable and that nurses are suffering as profit is prioritized over patients while a fantasy world is marketed to the general public?
We are already paying for universal care, the middle man is robbing us.
Great article and at the very least Universal Healthcare would most likely open more Primary Offices, have ppl see their primary care more often and possibley adapt effective health maintenance behaviors eliminating multiple trips to the ER. I like it
You know what? You know that our profit driven system victimizes we the people? You know that this system is not sustainable and that nurses are suffering as profit is prioritized over patients while a fantasy world is marketed to the general public?
I knew that post referring to people who want a magic doctor would get a lot of feedback.. This subject comes up constantly out and about
subee, MSN, CRNA
1 Article; 6,116 Posts
Great point! Canada pays half of what we pay in administrative costs since there are no insurance companies to take their slice of profit.