Published Oct 18, 2002
When I Go On Medicare . . . Who Will Change My Bedpan?
by Jan Jennings
In ten short years I will reach age 65 and will be enrolled in one form or another of the Medicare Program. But, when I inevitably become sick, who will change my bedpan? Today I am in the workforce of baby boomers, the single largest demographic of American society. Actually, born in 1946, I am in the lead year of my peers who were born between 1946 and 1965. Our generation represents 2.3 workers for each current retiree. When we retire, our current workforce shortages will look like the golden era of human resources management.
Twenty years from today, in 2022, when I am 75 years of age, only one half of the baby boomers will have entered retirement. However, even in 2022, there will be only 1.3 workers to support and/or care for each retiree. How will the generation that follows the baby boom meet the usual and customary obligations to seniors?
The press has widely covered the economic dilemma that generation faces in terms of financing Social Security and Medicare. The challenge of paying for these programs pale by comparison to the stark reality that there simply will not be sufficient workers to provide hands on service to the baby boom population.
How could the current circumstance possibly get worse? It is difficult to imagine? Receiving "quality service" has become the standard by which all other oxymorons are judged. In the interest of fairness, I will pick on my favorite restaurant... McDonalds. As a shareholder and an almost daily customer for nearly forty years, I feel empowered to make several observations. Forty years ago, I was never quite good enough to secure a position at McDonalds. It was extremely competitive and a mark of distinction to join the rarified circle of those selected to work at McDonalds.
Today, the McDonalds Corporation faces unique opportunities and challenges. On the one hand, it is a mature industrial giant. The McDonalds Corporation displaced the Chrysler Corporation to join the prestigious circle of 30 corporations that comprise the DOW 30. On the other hand, have you visited a McDonalds recently?
The drive thru line is frequently so long one becomes worried about the engine overheating. At the root of this problem is the quality and quantity of the workforce from which the local McDonalds draws from to make up its employment. It is no longer a mark of distinction to work for McDonalds.
For the American Hospital the challenges of maintaining a viable workforce are far more complex. The typical U.S. Hospital has 75 to 90 functional departments. It is difficult to recruit service employees in housekeeping, security and nursing assistants. The shortage of professional nurses is well known to the general public. There are other profound shortages in technical and professional positions.
For examples, there is an inadequate supply of pharmacists, physical therapists, radiographic technologists, laboratory technicians and others. A Certified Registered Nurse Anesthetist (CRNA) starts in Pittsburgh with an annual base compensation, before overtime, at between $100,000 and $125,000.
The predicted glut of physicians has become a public policy joke. Try to name one physician specialty or sub-specialty in over-supply. The shortages are critical. Money is not the answer, although it is in play. Driving up compensation has a way of distributing the short supply of physicians, but no amount of money can eliminate the shortage in absolute terms. There are too few anesthesiologists, radiologists, rheumatologists, endocrinologists, emergency room physicians, family physicians and on and on.
Most of us are so busy trying to keep the operating rooms open tomorrow we dare not waste a moment thinking about the problems of 10, 20 and 30 years from now. On the other hand, can we afford not to plan for the future? And are there any real solutions? Well, as it turns out, there is hope for a brighter future! We need to go to the industrialized nations of Europe to find our future today. Because of the disproportionate loss of life among young men in Europe during WWII, they did not experience the same level of baby boom that the United States experienced.
Appropriately, the Europeans refer to their birthrate following WWII as a "boomlet." However, Western Europe developed the same taste for service and the same technological explosion that occurred in American Society. With these changes came the same kind of growth and demand for new and different jobs. The gap has been filled with the modification and reform of immigration policies that encourage service workers, technical and professional staff to come largely from the third world or underdeveloped nations.
And so, the character of Europe is changing. If you have dinner next month in a Paris restaurant, your maitre d' may be French, but it is unlikely that any of the wait or service staff will be French. If you are admitted to an Italian hospital, you may have an entirely new concept of the term "foreign medical graduate." And if you visit a friend in a German hospital, you might find that the nurse who greets you has a first language from the Philippines or Indonesia. This is a part of our future as well. The remaining questions relate to how well will this be planned as opposed to whether or not it happens.
American immigration policies will change and a whole new wave of people from many lands will sweep into America on a level even greater than the immigration period of our grandparents 100 years ago. These immigrants are likely to arrive more comfortably. For the protection of our heritage, we should never forget the inscription of the base of the Statute of Liberty which refers to "...your tired, your poor, your huddled masses...." The next wave of immigrants should also see a new inscription on the base of the Statute of Liberty which says something like, "...Give us your bright, your enterprising, your innovative and your energetic.... "
Jan Jennings is CEO and President of Jefferson Regional Medical Center. You can reach Jan Jennings at [email protected].
???? Another letter writing campaign in the making here.
This guy is really irritating me. Hes the same one who wrote that pity-the-poor-doctor-working-in-unhealthy-conditions-for-not-more-than-21%-annual-increases article in the thread titled "Physicians vote with their feet --- to early retirement".
So whats this hospital CEO saying now? Recruit all your hospital service workers & healthcare professionals from overseas. And he thinks the reason we are needed is to empty bedpans. If this is the typical thinking of our CEOs, is it any wonder they cant find people to work for them. What an insult.
And whats the point about this comment? What is he inferring by sticking in that line about the CRNA salary where it doesnt even fit what hes talking about.....and is the only salary he chose to mention:
The predicted glut of physicians has become a public policy joke. Try to name one physician specialty or sub-specialty in over-supply. The shortages are critical.
I think he has an issue with RN salaries.
And about all that recruit-from-oversees stuff.... I just hope he hears from the Pennsylvania Nurses Assoc on that.
Message to Congress from the ANA:
The influx of foreign-trained nurses only serves to further delay debate and action on the serious workplace issues that continue to drive American nurses away from the profession.
We must begin by improving the environment for nursing.
There are serious ethical questions about recruiting nurses from other countries when there is a world-wide shortage of nurses. The removal of foreign-trained nurses from areas such as South Africa, India, and the Caribbean deprives their home countries of highly trained health care practitioners upon whose skills and talents their countries heavily rely. ANA CONDEMS the practice of recruiting nurses from countries with their own nursing shortage.
Foreign-educated nurses brought into the United States tend to be placed in jobs with unacceptable working conditions with the expectation that these nurses, as temporary residents and foreigners, would not be in a position to complain.
Immigrant nurses are too often exploited because employers know that fears of retaliation will keep them from speaking up. There are numerous, disturbing examples from our experience with the expired H-1A nurse visa. In fact, several cases came from Illinois. The INS Chicago District issued a $1.29 million fine against FHC Enterprises, Inc. for 645 immigration document violations. FHC, Inc. fraudulently obtained 225 H-1A visas which were used to employ Filipino nurses as lower-paid nurse aides ($6.50 per hour) instead of as registered nurses ($12.50 per hour). The Catholic Archdiocese of Chicago agreed to pay $50,000 in fines and $384,700 in back wages to 99 Filipino nurses who were underpaid. In Kansas, 66 Filipino nurses were awarded $2.1 million to settle a discrimination case in which the Filipino nurses were not paid the same wage rate as U.S.-born registered nurses at the same facility. These are just a few of the cases that have come to light over the last decade.
The practice of changing immigration law to facilitate the use of foreign-educated nurses is a short-term solution that serves only the interests of the hospital industry, not the interests of patients, domestic nurses, or foreign-educated nurses. The cause of instability in the nursing workforce must be addressed. Over-reliance on foreign-educated nurses serves only to postpone efforts required to address the needs of the U.S. nursing workforce. We must begin by improving the workplace environment for nursing.
There are so many issues in this article it is difficult to address all of them. Yet, here are a few thoughts...
To begin with, holding McDonald's stock is foolhardy. The days of becoming an instant millionaire by opening a McDonald franchise ended many years ago. Some of you are old enough to remember that era. In more recent times profits have been slashed to almost nothing. The fast food wars of the 90's ended the good times. As for the fast food employees, there is no shortage of them. Here in Texas most of these workers are non-white immigrants. Interestingly, they take pride in their job. They often go to great lengths to ensure the store is clean and orderly.
The baby boomers will not retire. At least not voluntarily. Their health will fail, forcing them into retirement and poverty. But until then they will have to work until the end. Not only are societal expectations greater now than decades ago, there are many more bonafide requirements for everyday living. Debt among senior citizens continues to rise every year. One can only wonder what will happen if too many of these seniors max out their credit cards up until the final moment. After all, if you have to go, why not charge those prescriptions? You can't take the debt with you!
As has often happened in the past, the solution to many of the USA's problems will likely be to increase the immigrant population. Indeed, there will be little choice with so few workers contributing to social security and the current major economic downturn. Corporations have no justification for capital expenditures without consumers. A larger population translates into a larger customer base.
And so with the expansion will come greater crowding and scarcity of resources. At last count there were 2,000 new electric power plants under construction. When these facilities come online there will be more pollutants spilling into the skies. The nurse of the future should be prepared to deal with respiratory problems.
This guy has no clue that it is the way people in his position think that is a big part of the problem. His attitude toward working people really shows though in these articles he writes and it is not pretty. I only go to McDonald's once in a blue moon but when I do the service is always good. Healthcare CEOs could learn a lot from the way McDonald's CEOs do business.
What an idiot! Julie I can't put it any better than you did. And I'm afraid that MK2002 is right. This generation is going to have difficulty being able to retire. I see what has happened to my parents and it is absolutely heartrending. Their savings is gone, gone, gone. To medical bills.
This CEO is so clueless that the only job he could do is be a CEO. Wonder how much he makes?
ask him! let us know what he says. :)
ok, I did. As well as a couple other questions. Here is what I sent. I copied the ANA stuff, hope you don't mind.
Thought I would drop you a line, and let you know your article was posted on a nursing bb site. As a RN I would like to ask you a few questions, if you don't mind.
A Certified Registered Nurse Anesthetist (CRNA) starts in Pittsburgh with an annual base compensation, before overtime, at between $100,000 and $125,000.
Why did you only mention the wages of the CRNA in this article? Why not put the average wage of physicians also? And than perhaps compare it to the average wage of a bedside RN, who makes far less than the CRNA.
It is unfortunate to see a CEO who believes that there is hope for a brighter tomorrow by importing immigrants into positions that others are walking out of, particularly RNs. It is unfortunate because the answer is right there in front of any administrator in healthcare if they cared to look. The answer is better treatment of the nurses in the profession already. When 18% of those with a nursing license have completely removed themselves from the profession there is a reason for that.
The shortage of professional nurses is well known to the general public.
The nursing shortage IS becoming well known by the general public, and they are increasing asking why. And there are plenty of nurses out there that are happy to supply those answers.
You are aware of course, what the ANA's stand is on foreign nurses? I thought I would send that to you just for clarification purposes. This is the message that congress heard from the ANA. Please bear with me, it is long.
Message to Congress from the ANA:
Immigrant nurses are too often exploited because employers know that fears of retaliation will keep them from speaking up. There are numerous, disturbing examples from our experience with the expired H-1A nurse visa. In fact, several cases came from Illinois. The INS Chicago District issued a $1.29 million fine against FHC Enterprises, Inc. for 645 immigration document violations. FHC, Inc. fraudulently obtained 225 H-1A visas which were used to employ Filipino nurses as lower-paid nurse aides ($6.50 per hour) instead of as registered nurses ($12.50
per hour). The Catholic Archdiocese of Chicago agreed to pay $50,000 in fines and $384,700 in back wages to 99 Filipino nurses who were underpaid. In Kansas, 66 Filipino nurses were awarded $2.1 million to settle a discrimination case in which the Filipino nurses were not paid the same wage rate as U.S.-born registered nurses at the same facility. These are just a few of the cases that have come to light over the last decade.
One final question. Since the only wage you mentioned is the CRNA's I was curious if you would be willing to share what your wage is. There are many of us who are quite interested.
Last thought, the better question to ask instead of who will change my bedpan, is who will be there to make sure I get appropriate care. After all nurses do much more than change bedpans. Unless of course you were thinking of immigrants who would be willing to take the lesser of the nursing jobs, sort of like when the Irish came and the jobs they got were the ones no one wanted either.
Thank you for your time.
Thats what its there for!!!
Nice letter. I like that part about the Irish.
What do you think the odds are that this medical publication will print the voice of nurses?
I told him almost the same thing last night:
With all due respect, as a Registered Nurse I find the title of your article to be insulting. If this is all our CEOs think of us, is it any wonder we dont want to work in hospitals anymore? If something is not done soon about the workplace environment and conditions, devaluation and disrespect that are driving us away and keeping us away, you will have much bigger things to worry about than your bedpan.
who will notice that your breathing pattern has changed ever so slightly, indicating a potential life threatening complication may be developing and who will take immediate action to stop it in its tracks? Who will notice the early, subtle signs of infection after your surgery and intervene to prevent life threatening complications? Who will administer your blood transfusions, chemotherapy, hemodialysis, and manage the mechanical life support systems that may be keeping you alive? Who will be at your bedside to save your life?
Its not your physician --- it's your Registered Nurse, but hospital administrators are driving us away, so I dont know who it will be when you get to medicare.
CEOs must start recognizing that RNs do much more than empty bedpans, that we are an integral part of their insititutions, that the physicians cannot do their jobs without us, and that the patients cannot survive without us. If there is to be a sufficient number of nurses to do the job in hospitals across this country, an investment must be made in them by the employers. Their workplace environment and conditions of employment must be drastically improved - starting with the administration's perspective of and attitude towards them.
As for your recommedation that hospital staff be recruited from overseas, the American Nurses Association has already taken a strong stand on that:
.......ANA believes that the U. S. healthcare industry has failed to........
good show -jt, thumbs up
Here is the response I got back.
Dear Whomever: I don't know if I am writing to David or Helen or both:
My article was not targeted at nursing. The fact is there simply will
not be enough healthcare workers of all types to meet the demands of the
baby boomers. That is a fact. I wish it were not so . . . but it is.
We simply do not have enough prospective U.S. citizens to fill all of
the vacancies for positions that are developing over the course of the
next 10-20 years???
With respect to nursing, the challenges are so extensive, I hardly know
where to begin. The women's movement have moved into this generation
many women onto our Medical Staff's who would in an earlier generation
been nurses. The biggest factor is the one you highlight. The nursing
duties, responsibilities and working conditions are so difficult, it is
hard to know how we keep anyone doing these jobs.
My suggestion that workers might come from other countries is a return
of what happened 100 years ago. Many of our grandparents came to the
United States to seek opportunities under remarkably similar workforce
issues facing us today.
Is that any reason to take advantage of these people? No more today
that 100 years ago. Their were unethical practices in motion then and I
am certain there will be abuses now. On the other hand, many employers
will welcome qualified foreign trained personnel and treat them like any
other in a similar role.
I have no quarrel with the ANA position and I think it is wonderful
that the abuses of unethical employers have been documented for all to
My Father was a labor leader. We only had three holidays in our home,
Christmas, Easter and Labor Day. Pittsburgh is a city where many of us
celebrate the sanctity of work and blood has been shed in this city in a
previous era to protect the rights of workers.
I will fight for nursing here at Jefferson. I am not too encouraged by
what I see around me. Two Saturdays ago, I went to the Hilton Hotel
where one nurse from each of the area hospitals was honored for
distinctive service. I was stunned to learn I was the only Hospital CEO
among 500 guests.
I did not mean to strike a nerve with my little article. The facts are
what they are. I wish I could change them.
Not one question answered. But then I guess I didn't expect one to be. Maybe I should give him a cookie because daddy was a labor leader? Me thinks he has forgotten his roots. I was going to write a stinging reply back, but then thought why bother. Will only take up my time that is valuable to me.
Dont write a stinging reply - youll lose credibility. Write as the professional you are & without emotion. The facts, ma'am. Just the facts.
I thought it would be an interesting read if he elaborated on that sort of thing & what it represents.
I think this guy is making a valid point. In 10-30 years, even without the baby boomers hitting the health care system, there will not be sufficient care givers to take care of them. Not to empty a bedpan, and not to do more highly trained nursing duties.
His vision for the future is a grand influx of foreign trained nurses. I sincerely hope not. It is my strong belief that there are enough nurses, enough young men and women who would gladly enter the nursing profession, IF the problems within our profession were solved.
To me that means the free-for-all Wall Street race to provide bigger investor dividend checks must be stopped. Millions of investors are getting rich at the expense of nursing benefits, wages, working conditions, staffing ratios, equipment, supplies, and patient care. As long as CEOs' focus is on quarterly profits, then the looming disaster that the author predicts will most assuredly happen, but it will be worse than he imagines. If I had my way, every health care facility in the United States would be "not-for-profit" and a nursing union would be in every one of them.
He says he doesn't know how to solve the problems. Funny. We do.
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