We may need fewer nurses in the hospital...

ZippyGBR, BSN, RN · Apr 17, 2011

scary stuff for us, especially those of us just starting out. do you really believe that the days of nursing (as we know it) are coming to a close? i'll admit, i am not that educated about the trends and what is down the pike (i am still fairly new to nursing).
i guess we just make money while we can... my husband wants me out of nursing anyway (to join him in his career). i don't even really understand what changes will happen in 2014 - i understand the healthcare changes, just not what it means for us. i hear too many different opinions on it. guess time will tell....

put the shrouds down a moment ...

If you look at the UK for a moment there has been a steady decrease in Acute hospital beds and consequently staff to staff those beds, but this is countered with with intermediate care ( both sub acute inpatient and community based) plus things like community IV therapy - why keep someone in an acute hospital bed solely for BD or TDS IV antibiotics for cellulitis etc - especially if they can be bolused or given as a short (15 -20 minute) intermittant infusion ... risk / benefit of day case vs inpatient for some types of chemo ... 'hotel' vs 'hospital' for some radiotherapy patients ...

Then if you add in the the amount of surgical and other procedures which can safely be done as day cases and the fact we are reducing inpatient stays for MIs thanks to PCI and we are going to see changes in the pattern of admission length for CVAs are thrombotic strokes are increasingly thrombolysed ...

martymoose, BSN, RN · Apr 17, 2011

Herein lies the problem in the USA, The majority of taxes are paid by the "Middle Class", who do not qualify for the services thier tax money is paying for. Simply put, the Middle class makes enought money to be taxed to pay for free healthcare, but, they make to much money to qualify for said free healthcare.
Teaching people about preventative care may help a few, but, the majority of people are going to continue thier current lifestyle requardless of the outcome. I believe the reason they do this is because they know they will be taken care of:
1. Drink too much & killed your liver?? We'll get you a new one. (and while your waiting we'll pay for Dialysis to keep you alive)
2. OD'd on you drug of choise? Free hospital stay (for you, we pay for it) we'll make you all better then send you out to do it all over again.
3. Full blown Diabetic, (had all the teaching (dietary & selfcare)to care for yourself) but now your leg needs to be amputated? No problem.. we'll put you in rehab, give you a prothetic, reteach you, get your BGL's back to where they should be, send you home (and keep a room set for you when you come in to have the other leg amputated because you went right back to your old ways as soon as you left us)
People took better care of themselves when they knew the cost of thier healthcare was not covered by the rest of society. Granted we didn't live as long, but we knew we had to eat right, excersize, listen to what the Dr told us.
I know I'm a bit burnt out at this stage, I'm not saying to stop all coverage for the poor. But, when I see the "poor" coming in with Blackberries, I Pods, hair done by a hair stylist, beautiful new fake nails, designer purses, more jewelry than I own (and thiers are real stones/gold not the Avon I own) driving a brand new car, with thier bags from Taco Bell/ Mc Donalds/ KFC. (I can't afford this stuff, and I work full time!) I just know something has to change, and I don't think changing how we provide healthcare is it.

Quoted For Truth!!!!!

caroladybelle, BSN, RN · Apr 18, 2011

put the shrouds down a moment ...
If you look at the UK for a moment there has been a steady decrease in Acute hospital beds and consequently staff to staff those beds, but this is countered with with intermediate care ( both sub acute inpatient and community based) plus things like community IV therapy - why keep someone in an acute hospital bed solely for BD or TDS IV antibiotics for cellulitis etc - especially if they can be bolused or given as a short (15 -20 minute) intermittant infusion ... risk / benefit of day case vs inpatient for some types of chemo ... 'hotel' vs 'hospital' for some radiotherapy patients ...
Then if you add in the the amount of surgical and other procedures which can safely be done as day cases and the fact we are reducing inpatient stays for MIs thanks to PCI and we are going to see changes in the pattern of admission length for CVAs are thrombotic strokes are increasingly thrombolysed ...

Ahhhhh, but y'all have that evil nationalized health service. We know that you save money merely by eliminating choice, trampling on old people and having evil death panels, as we have been taught by Michele Bachman. (sarcasm intended)

You see, some of our superior insurance/Medicare often refuses to pay for outpt IV abx, and for some reason requires us keep able bodied people in the hospital where they can get noscomial infections etc. ( sarcasm also intended).

(yes, you know I have been fighting with Kaiser this week)

WIN007 · Apr 18, 2011

Sorry to say it but Mass is a single payer state. THAT is the reason for the collapse among many other reasons that should be obvious with the socialistic disaster that Mass has turned itself into.

Actually single payer systems are LESS costly. They allow for more clinicians in the hospitals and less bureacrats who do nothing but handle the details of managing 900 different types of insurance and claims, denials, system support and contract negotiation.

WIN007 · Apr 18, 2011

Herein lies the problem in the USA, The majority of taxes are paid by the "Middle Class", who do not qualify for the services thier tax money is paying for. Simply put, the Middle class makes enought money to be taxed to pay for free healthcare, but, they make to much money to qualify for said free healthcare.
the Dr told us.
I know I'm a bit burnt out at this stage, I'm not saying to stop all coverage for the poor. But, when I see the "poor" coming in with Blackberries, I Pods, hair done by a hair stylist, beautiful new fake nails, designer purses, more jewelry than I own (and thiers are real stones/gold not the Avon I own) driving a brand new car, with thier bags from Taco Bell/ Mc Donalds/ KFC. (I can't afford this stuff, and I work full time!) I just know something has to change, and I don't think changing how we provide healthcare is it.

Wow.. you had me about the middle class being raped to pay for the health care of people below AND definitely ABOVE us too.. and with the preventative stuff. Now you just lost me. I don't know what "poor" folks you're seeing but my poor patients definitely werent' living on the high hog and driving brand new cars. hell, I was scrambling with case managemnt for taxi vouchers to take them back to the ghetto. You can get an ipod for 15 bucks now you know.

Here's a concept; how about making the biggest employer in the country, Wal-mart, provide coverage for their employees hospitalizations instead of sticking the rest of us with the bill. After all 17 of the Forbes richest 50 are Walmart heirs and spouses (IE, inherited wealth when Sam died). I'd say they can afford it more than I can. 'Course, I know , having those that can afford to pay is 'socialism' but dumping it on me isn't. Or something.

Anyway...

Yes, there will be reductions in nurses everywhere. Thats' how for profit business works and today, thanks to a host of factors from the Limbaugh radio show to the Tea Party, it's cheered and saluted even by the affected.

So, technology will continue forward to automate nursing functions; cheap immigrants will continue to be hired, Republican governors will continue to attack the nursing unions and state boards that are independent so they can have QMA's give meds instead of RNs' and so forth.

As you sound like your all for the results of crony capitalism, so clearly it's a good thing, right?

First they came for the autoworkers and you didn't speak because you weren't an autoworker..and besides business is business. Then they came for the air traffic controllers... the longshoreman, the high tech workers, the state workers in Wisconsin...and when they finally come for the nurses they'll be nobody left to speak for us.

WIN007 · Apr 18, 2011

Although the Canadian health care system also contains numerous flaws, the US could benefit from adapting a similar model. Canadians enjoy a high standard of health care, accessible to all and largely funded by taxpayers and our government. in addition, Canadian nurses are unionized, and the pay is fairly standard for nurses throughout the country. While Canadians are also grappling with recession, it hasn't been nearly as devastating here.
I don't know what the answer is, but clearly, the US system has not been working well for some time. In any case, health care should be a right for everyone, not a privilege. I never fully appreciated Canadian health care until I began to learn about those who are forced to do without.

I agree with you. I worked in Canada a few years in the 90's. At the time the US economy was doing fabulously, President Clinton had closed the deficits and created 23 million private sector jobs and yet somehow over half the country tuned into Rush Limbaugh and hounded and hunted him. Having come from Texas, probaby the epicenter of it all, I'd been educated with plenty of rhetoric about the Canadian system.

Imagine my surprise when I got there and was as a worker immediately eligible for better health care than I'd ever gotten here. -granted my health was/is good and I wasn't exactly needing big ticket items. Still, I'd heard the crap about endless waiting lines and rationing - bunk - no more so than any HMO here. A friend there had a positive mammogram and they had her biopsied in less than 48 hours. The hospitals certainly weren't as fancy as many here - form follows function all the way. So what? I don't need fountains and artwork - I'm there for health services.

Hospitals had specialities usually and there would be one or two hospitals competing in a 20 mile radius for being the best in cardiology or cancer - not 5 - that's a real problem in the USA - the inflationary effect of so many redundant specialists. The other thing that turned out to be 100% bunk is that Canadian healthcare is socialized. Er, no, single provincial (state) payer plans is not socialized medicine - it's an efficient payment system.

The providers, pharmas, labs, et al are entirely private and driving their German cars too.

meanwhile the efficiency of single payer and above mentioned sensible practice and skipping worthless luxuries makes their healthcare system far far more affordable. We pay almost triple per capita for healthcare as a nation and still have , what is it now, 80 million uninsured people?

For the average person it is a far better system. Nobody files bankruptcy because a family member got cancer or their kid has an expensive illness. Nobody can raise your premium if God forbid you get these things so you are uninsured. The healthcare I and others got was on par with what i get here. It just cost less. A lot less.

The only problem I see is I think Canada is too generous in letting landed immigrants use the system.

CuriousMe · Apr 20, 2011

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

Evidently they are in Australia, which is where the poster is from.

cdsga · Apr 20, 2011

I think the jury is still out. No one knows what is going on with the Healthcare Reform. I think that doctors are building more outpatient centers because they get reimbursed more sending patients to these areas than in the main hospitals. I also see more doctors combining practices to lower the burden of cost. I have also seen a trend that is spreading where the hospitals are buying doctors offices and running them allowing the doctors and their PA's to become employees of the hospitals. That ensures a steady patient population to the hospital but the doctors don't have to hire office employees, or pay benefits and taxes for employees-the hospital does. There is still a hot debate over the amount of money that will be allocated for home health nursing reimbursement through Medicare and Medicaid. Seems like Home Health agencies are not hiring as many nurses trying to wait out what the government decides. I think that hospital nursing will always survive, the patients are going to be sicker when they arrive and that will require strong nursing skills to care for these patients. When the government makes decisions about money, people in leadership make knee-jerk decisions and we go back and forth. The only thing you can control is yourself. Stay up on the latest, be flexible, get your resume' updated and market yourself-but only plan on staying someplace 5 years at the most. It seems like it has to be that way until all this mess is worked out. You just have to ride the tide of change. Doesn't matter about your degree. I still don't think a BS degree is anything but a door opener to a better position (minimum requirement) so do what you love and try not to worry.

RNCCMMS, RN · Apr 20, 2011

i agree health care is unsustainable as we know it. when you figure an individual may pay into their health insurance plan (if they have insurance) for years, what they actually pay won't cover the cost of their care if they become chronically ill. chronic illnesses are costly. a contributing factor to the increase in health care costs is that we live longer, usually longer than the amount of time we paid into medicare and social security. the longer we live, the higher the chances of chronic illnesses.

prevention is key with education starting in elementary school and continuing. this is where nurses can make an impact. those who work in the hospitals are limited in the amount of time they have to educate their patients. nurses in other settings like home care, outpatient, doctor offices, schools, employee health can provide education.

we pay doctors based on a fee for service which means the more they do, the more money they get paid-another driver of health care costs. some states and insurance companies are struggling to build patient centered homes where pcps provide the needed care and focus on prevention. but pcps don't want extra work that they have to pay for-like staff, equipment, electronic medical records systems. individuals need to take control of their own health, but it seems people are not motivated. within my own family, a large number are obese. they will say "i need to lose some weight and exercise, but this hurts, that hurts, i can't live without my pasta and bread". we can not motivate people to care about themselves, that has to come from within themselves. all we can do is provide the information and resources and offer support and encouragement.

check this article out on how people hide assets, so they can collect medicaid in their declining years: [color=#606420]https://www.cms.gov/medicaideligibility/downloads/annuities.pdf

"individuals who might have paid for long-term care costs themselves or would have purchased private long-term care insurance have turned to various methods of estate planning and asset sheltering activities as a means of qualifying for medicaid coverage of their long-term care expenses."

some of those on medicaid are senior citizens. some are legitimately poor and can not pay for their health care/medications and still eat. (the largest portion are disabled children). but there is a large portion of seniors who give their assets to their children, so it is not used for their care. my feeling is if you want mom's money and home, then you should take care of her, not expect the taxpayers to do so. medicaid's look back period is 3-5 years..it should be 20.

this article written in april 2010 by the kaiser family foundation shows how stressed medicaid will be going forward: [color=#606420]http://www.doh.state.fl.us/alternatesites/kidcare/council/8-3-10/27_medicaidbeneficiaries.pdf

here are some articles on who comprise the medicaid population:

"the medicaid program is in effect three distinct health care

programs, each with a different beneficiary group and different proportional

uses of funds. the percentage of total spending devoted to each of these

efforts varies greatly from state to state, because state officials may exercise

considerable discretion about which of these three programs to encourage.

the three groups are as follows. (1) low-income elderly people represent

13 percent of medicaid beneficiaries, but their use of services accounts for

32 percent of all medicaid expenditures. this aspect of the program provides

primarily long-term care. most of these senior citizens were not poor

when they retired, but their incomes have been eroded by inflation, loss of

spousal income, or other factors. as they age, one-fifth of the elderly find

themselves alone in nursing homes, forced to look to medicaid for support

that is not provided by medicare.5 (2) the severely mentally retarded, the

blind, and the physically disabled represent 15 percent of medicaid beneficiaries

and generate 36 percent of all medicaid expenditures. medicaid provides medical care and nursing home services for persons with severe, permanent disabilities and higher-than-average needs for medical care. this group includes an increasing number of people with acquired immunodeficiency syndrome (aids). (3) low-income children from single-parent families and their parents comprise 72 percent of beneficiaries; their care represents only 32 percent of all medicaid expenditures (based on 1993 stats)"

[color=#606420]http://content.healthaffairs.org/content/12/1/132.full.pdf

"jointly financed by the states and the federal government, in 2010, medicaid covered nearly 53 million people and accounted for about 16 percent of all health care spending.[color=#606420]1 it accounts for 17 percent of all hospital spending and is the single largest source of coverage for nursing home care, for childbirth, and for people with hiv/aids.[color=#606420]2 it covers one out of four children in the nation as well as some people with the most significant medical needs.[color=#606420]3 while children account for most of the beneficiaries, they comprise only 20 percent of the spending. by contrast, the elderly and people with disabilities account for 18 percent of enrollees but 66 percent of the costs.[color=#606420]4"

"over the past three years, despite rising enrollment due to the economic recession, nationwide state spending on the medicaid program dropped by 13.2 percent (equivalent to a 10.3 percentage point decline in the state share of the total costs of the program) as a result of the added federal support provided to state medicaid programs through the american recovery and reinvestment act of 2009 (the recovery act).[color=#606420]5 in 2009 alone, due to this action, state medicaid spending fell by 10 percent even though enrollment in medicaid climbed by 7 percent due to the recession.[color=#606420]6 however, this enhanced federal medical assistance percentage (fmap) support is set to expire on june 30, 2011. "

[color=#606420]http://www.hhs.gov/news/press/2011pres/02/20110203tech.html

this is a difficult time for everyone, but maybe we can achieve some of the goals of health care reform, before we are broke.

ZippyGBR, BSN, RN · Apr 20, 2011

Evidently they are in Australia, which is where the poster is from.

as they are in the Uk where even if someone delivers in a consultant led unit their primary professional caregiver will be a midwife and on discharge from hospital themidwifery service is responsible for mother and baby for the first 28 post partum days ...

talaxandra · Apr 20, 2011

Yep, in Australia, NZ and GB midwives clearly have a wider scope of practice - at least in this aspect - than their US colleagues.

talaxandra · Apr 20, 2011

Herein lies the problem in the USA, The majority of taxes are paid by the "Middle Class", who do not qualify for the services thier tax money is paying for. Simply put, the Middle class makes enought money to be taxed to pay for free healthcare, but, they make to much money to qualify for said free healthcare.

Well, that's easily fixed - here everyone has access to subsidised health care.

Preventative education isn't a panacea - there will always be people who prioritise things other than their health, but there's abundant research showing that every dollar spent on education reduces health care costs by $5-$10 over a population lifespan. That's certainly the case in Australia, despite the fact that most health care is subsidised.

A couple of points for gentlecaregiver about the examples given:

1. dialysis is futile for liver failure

2. is the alternative to treating drug-related overdoses death?

3. the vascular damage associated with diabetes is not only insidious, in over 10% of cases measurable PVD is present at the time of diagnosis (the research is European - T2DM may be diagnosed later after onset of symptoms in patients who are not only at higher risk but also have less access to health care, like poor people on the US); even significant lifestyle change will only slow, not reverse or even halt the progress of complications in someone with significant diabetes-related complications.

Coming from a system where all citizens are treated equally for health care access means that my gripes with non-compliance are solely based on behaviour, with little consideration to economic background. YMMV.