We may need fewer nurses in the hospital...

[Chin up]

WCVB channel five Boston, is now airing, Healthcare Uncovered. A live panel show discussing healthcare and it's cost in Boston. The moderator, Timothy Johnson, MD. One of the panelist, Zane, the CEO of Tufts Medical Center whose 1100 RN's just voted 70%, to authorize a one day strike. This is what I just heard and this is verbatim.

"We may need fewer nurses in the hospital, but we will need more in the community, helping patients to stay healthy. so there maybe some modest job losses, I think there is a great opportunity to retrain caregivers in new professions."

"Doesn't the rank and file worry though, if I am dislocated as a healthcare worker. The job that may be available for me on the other end is nothing of the caliber of the job I trained for and gone to school for as a RN or whatever."

They avoid that question and go on about being unable to sustain the hospital budgets. Over half of budgets are employee salaries(nurses). We must address these salaries and benefits and look into job revocation. They go on to justify this thinking, due to small business unable to afford healthcare here in Mass and therefore leaving the state. There are great opportunities to shift our thinking from acute care to physician and patient remaining well. (paraphrase).

Helen Zane: what the trajectory we are on, the public will not tolerate. Better we get ahead of it. ( she is addressing nurses who want better nurse/ patient ratios). Fueling her position, against the nurses.

They go on and defend physicians who do needless test...talk about salaries and fraud in the same sentence. Implying, nurses must make sacrifices...my reading between the lines. Then go to prevention and teaching. Intervention is most important right now. (agree,but, where are nurses in this) Their focus, doctors, PA and NP.

You all need to watch this, there is so much more. Primary care doctors aren't paid enough, but no mention of professional nursing. Again, ANA where are you?? BSN's you are not being addressed at all. They are talking about eliminating your job. They are talking about retraining you and "retooling" your career. And you all are worried about the difficult patient? We need to get busy...are we even listening to what is happening right before our eyes? Are you all satisfied with your degrees when you have no say in policy? Do we even care?

The lie has been told so much, ever since I can remember 27 years ago. All we needed was BSN to get taken seriously...really?

[neuroms]

Well, remember that there are preventative, medical treatments that could greatly reduce the rates of a lot of major problems, eg. bariatric surgery, statins, smoking cessation drugs. But I agree that you're correct that preventative teaching is really a token.

[linearthinker, DNP, RN]

All of the data suggest primary prevention improves outcome. All of it. Natural selection is what it is, though, that we agree on. There simply won't be licensed registered nurses to care for the ignorant and/or stubborn. No it won't be the same, and arguably wont be as good, but the country can't afford "as good." Time to tighten belts and cut corners, like it or not. I don't think any of this is good, I'm not supporting it. I'm just saying that the train is unstoppable at this point, and it's going to crash.

[Chin up]

Well, remember that there are preventative, medical treatments that could greatly reduce the rates of a lot of major problems, eg. bariatric surgery, statins, smoking cessation drugs. But I agree that you're correct that preventative teaching is really a token.

It doesn't have to be. Not if the three strike rule is enforced. It is where we are headed. People don't know, or just dont want to believe it. While everyone is arguing about this and that, measures are being taken and I believe one day we will all wake up and...bam, there it is.

[BrookeeLou_RN]

Are you French? A few years ago I took an American tourist off a plane with a broken hip. He fell in Paris. The ambulance took 40 minutes to reach him. He didn't get any pain meds until he had been on the floor for several hours, never mind the ambulance or the ER. So from injury to morphine was about 18 hours according to him. Then, five days later he was still waiting for surgery- and bailed, arranging to fly home. I was transporting him from the plane to the hospital, seven days after his injury, in constant pain, with an unstable hip. This did not impress me.

This could have happened any where in USA also and does on regular basis, especially for uninsured/under-insured.

Mandatory coverage sounds great but if one can not pay then what??

Healthcare, welfare, food stamps etc all need to be overhauled but politicians are afraid of offending. So yes, the system will crash and then who knows what will happen. So many go to Canada to get drugs now.. same drugs as here in many cases yet cheaper. And no I do not think all the fault lies with FDA, the pharmaceutical companies are out of control and should be stopped. How many drugs are out there that are not being produced just because they do not want to cure a disease when they can profit off of merely treating it.

USA needs to start taking care of it's own and stay our to other countries business. They do not want us, heck half the time they try to kill us and yet we still spend trillions to go rescue people. Yes, USA used to be the Greatest, best in many things but now every day I read where we have dropped to 2nd, 3rd or even worse.

Prevention must be working some as Medicare covered home health requires teaching in order for reimbursement, agencies are rated on how well they succeed at keeping people out of hospitals. Now I am not naive, it is not a cure-all but it is a start. If fraud could be decreased , it might be discovered that it really could be more than just a start.

Unfortunately until lobbyists are stopped, I do not think any politician will ever succeed with reasonable changes.. It does not truly matter who is the actual President as he or she really has such limited power. And I truly believe the middle class will not exist at all much longer.

[CompleteUnknown]

Interesting discussion. I'm in Australia and I sometimes think that perhaps people don't fully understand what is meant by preventative interventions.

It's not just about quitting smoking and eating better and losing weight although of course that's a big part of it.

Women over a certain age (I think it's 50, might be 45) are entitled to free mammograms. And it's easy - you just go to the breast screen clinic or, if in a small town, the mobile breast screen caravan visits the area at regular intervals. When you turn 50 and when you turn 55 you are sent a faecal occult blood kit for bowel cancer screening. Again it's easy, you collect the sample according the instructions and post if off (no postage costs). Nobody is made to do these things and there is no 'comeback' later if it turns out you have breast cancer or whatever and the free test may have picked it up earlier.

My daughter-in-law recently had a baby. The midwife visited her twice at home after discharge from hospital just to make sure there were no problems. There is no charge for this. She can take the baby to the nearby 'baby clinic' if she's worried about anything, and mothers are encouraged to go regularly to get the baby weighed and measured, for a health check from the midwife, and for general baby care advice. Again, there is no cost and you generally don't need to make an appointment. If you live in a very small town there may not be a permanent clinic, instead there will be a visiting clinic once a week or whatever.

My son and daughter-in-law were encouraged to have free whooping cough immunisations after the baby was born. The government is also funding free whooping cough immunisations for grandparents of babies under 6 months for a limited time.

Visits to the doctor are free if you're lucky enough to have a doctor who 'bulk bills' but even if your doctor doesn't do this, the cost is reasonable.

These may seem like small things, but they do help to identify problems early, help to manage chronic conditions, and help to keep people out of hospital.

Naturally things aren't perfect in our health system, far from it, but all things considered, I'm happy with it. Oh, and yep, this isn't really 'free', we pay for it with our taxes. But that's the thing, everybody pays and it's there for everybody.

[casper1]

In one segment of this piece there was a discussion on lowering cost of care for medicare patients. They talked about dramatic reduction in the cost of care when hospitals use Nurses

as case managers to help manage and organize and deliver care to chronicly ill seniors who utilize a large portion of medicare dollars. The Hospital that utilized this program saw a dramatic reduction in cost while seeing a improvement in patient level of wellness.

Then in the next segment I here the same administrators taking about laying off nurses.

[jammin246RN]

There are quite a few things that could happen to lower costs, and provide care for everyone. In England everyone has healthcare... however this is at public hospitals.... semi private rooms, new grad RNs, New grad docs, longer wait times, rationed care. If you would like to purchase medical insurance you can go to a private hospital with a private room, seasoned nurses and docs, and more frills. Even in India there is the same type of health system. The docs donate a set ammount of their time (tax deductible) to the government institution, and make their money at the private institution. Put caps on malpractice lawsuits. Enforce the law such as if its not a medical emergency (case in point a meth addict's chronic toothache) don't treat the patient in the ER. I know of a few hospitals who do this and their bottom line has improved since the non emergency patients have learned that it is not a "quick dr's office" at the ER. Make use of current proven technologies such as insulin pumps for diabetic noncompliant patients.... Sure it costs $8,000 to put in BUT it's cheaper then seeing that patient every other week for a blood sugar of 600 in DKA and hospitalizations. There are quite a few things we could do, but it's not politically savvy for the politicians.

[Chin up]

In one segment of this piece there was a discussion on lowering cost of care for medicare patients. They talked about dramatic reduction in the cost of care when hospitals use Nurses

as case managers to help manage and organize and deliver care to chronicly ill seniors who utilize a large portion of medicare dollars. The Hospital that utilized this program saw a dramatic reduction in cost while seeing a improvement in patient level of wellness.

Then in the next segment I here the same administrators taking about laying off nurses.

I did not see that segment, but will watch in it's entirety tomorrow. But, that is what I got out of the little I did see, inconsistencies. But are they really? Maybe they mean, certain folks will be RN and the rest retrained. Which brings up another question, who will be the lucky ones and how will they choose? Thanks for your input.

[Chin up]

Interesting discussion. I'm in Australia and I sometimes think that perhaps people don't fully understand what is meant by preventative interventions.

It's not just about quitting smoking and eating better and losing weight although of course that's a big part of it.

Women over a certain age (I think it's 50, might be 45) are entitled to free mammograms. And it's easy - you just go to the breast screen clinic or, if in a small town, the mobile breast screen caravan visits the area at regular intervals. When you turn 50 and when you turn 55 you are sent a faecal occult blood kit for bowel cancer screening. Again it's easy, you collect the sample according the instructions and post if off (no postage costs). Nobody is made to do these things and there is no 'comeback' later if it turns out you have breast cancer or whatever and the free test may have picked it up earlier.

My daughter-in-law recently had a baby. The midwife visited her twice at home after discharge from hospital just to make sure there were no problems. There is no charge for this. She can take the baby to the nearby 'baby clinic' if she's worried about anything, and mothers are encouraged to go regularly to get the baby weighed and measured, for a health check from the midwife, and for general baby care advice. Again, there is no cost and you generally don't need to make an appointment. If you live in a very small town there may not be a permanent clinic, instead there will be a visiting clinic once a week or whatever.

My son and daughter-in-law were encouraged to have free whooping cough immunisations after the baby was born. The government is also funding free whooping cough immunisations for grandparents of babies under 6 months for a limited time.

Visits to the doctor are free if you're lucky enough to have a doctor who 'bulk bills' but even if your doctor doesn't do this, the cost is reasonable.

These may seem like small things, but they do help to identify problems early, help to manage chronic conditions, and help to keep people out of hospital.

Naturally things aren't perfect in our health system, far from it, but all things considered, I'm happy with it. Oh, and yep, this isn't really 'free', we pay for it with our taxes. But that's the thing, everybody pays and it's there for everybody.

I agree with you. We don't get what true preventative is. Our minds are small. We think, obesity, smoking, drugs and etoh, but what you gave as examples in your country make much more sense to me and my sensibilities. Thank you!

[Annaiya, NP]

I really think nurses need to start charing for their services. There are so many problems linked to the fact that we cannot quantify the work that we do. We also are not eligible for the pay-for-performance incentives, because our work is not reimbursed. There is no money to pay our salaries, because we are simply a cost to the hospital. If we actually got reimbursed for our services, there would be more money to pay us. And the patients who are easy would be able to pay less and the patients that take up all of our time can pay more for it. The patients who have to have a 1:1 sitter, can pay extra for taking up all of the time of one staff member. Keeping the work we do invisible on all of the balance sheets is hurting us.

[platon20]

I really think nurses need to start charing for their services. There are so many problems linked to the fact that we cannot quantify the work that we do. We also are not eligible for the pay-for-performance incentives, because our work is not reimbursed. There is no money to pay our salaries, because we are simply a cost to the hospital. If we actually got reimbursed for our services, there would be more money to pay us. And the patients who are easy would be able to pay less and the patients that take up all of our time can pay more for it. The patients who have to have a 1:1 sitter, can pay extra for taking up all of the time of one staff member. Keeping the work we do invisible on all of the balance sheets is hurting us.

Umm, trust me you dont want that. Doctors already spend ungodly hours with paperwork for reimbursement. Do you really want to work your 8 hour or 12 hour shift and then go home and do paperwork all night long to "bill" for your services? Because thats what you would have to do.

Medicare/Medicaid/insurance companies are built on denying reimbursmeents. That means they come up with ridiculous paperwork hoops you have to jump thru. So just charting that you "placed an IV on Mr Jones" wont get you reimbursed. You'll have to do ridiculous things like record the lot/part # of the IV tubing you used, document a medical code as to why you put the IV in, document which meds and doses were needed for the IV, etc. What you think is a 5 second scribble to get reimbursed just turned into a 15 minute pain in the ass paperwork procedure to get paid maybe $5 for doing an IV.

[platon20]

My daughter-in-law recently had a baby. The midwife visited her twice at home after discharge from hospital just to make sure there were no problems. There is no charge for this. She can take the baby to the nearby 'baby clinic' if she's worried about anything, and mothers are encouraged to go regularly to get the baby weighed and measured, for a health check from the midwife, and for general baby care advice. Again, there is no cost and you generally don't need to make an appointment. If you live in a very small town there may not be a permanent clinic, instead there will be a visiting clinic once a week or whatever.

.

Ummm, a midwife is not qualified to take care of babies outside of the immediate resuscitation window after birth.