The Measure of a Man

The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.

- Martin Luther King, Jr.

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Friday, June 27, 2008

My Healthcare reform proposal

My Healthcare Reform

I have been a registered nurse for ten years and a person with outspoken opinions for longer than that, so here are my health care reform ideas.

I believe that the infrastructure is one of the only things really worth keeping. I believe the health system in America is in need of total reform for it to serve all in need.

I will use one scenario of a patient type to show how my reforms would work. The ideas I will present will be based on this scenario but will apply to all in one way or another.

My mock patient is a 35 year old man with no health coverage offered at his place of employment, a small 6 person heating and Air Conditioning Company. His yearly income is 30,000 a year. He is married has one child and his wife is a clerk at a local convenience store making 18k a year. He is slightly over weight, eats a diet high in fat and low in fiber, the traditional American diet. He sees a physician only when he is ill and usually at the emergency room when he thinks he just can’t take it anymore. His blood pressure is slightly elevated; he has a family history of diabetes and heart disease.

1. Universal Health Care/ Affordable Insurance: Health insurance for all is where the process starts. It could be a single payer system or a hybrid of our current system. As long as all are covered and that coverage includes all aspects of care to include prescriptions. I believe the employer based health insurance system should be entirely scrapped and the premiums paid for by the states or the federal government. The personal financial responsibility would be based on a persons personal income and those below a certain income would be subsidized or receive free insurance. The premiums normally paid by business would have to be paid into the national health care pool that would provide the base asset pool for the program. Your individual premiums would continue to be removed from your check in the same manner that all other income based taxes are removed. We would all have the same insurance and there would be no difference in the programs for the rich or the poor. This would have to be federal law.
The insurance companies would still be able to make a profit but not what they have become accustom to. They would be required to compete for a given market and would be forced to promote prevention and healthy life style over denial of services to increase their profit margins.

2. Disease prevention: If disease prevention were the focus our healthcare system instead of the treatment of disease and symptom we could prevent many diseases from progressing and contributing to other costly conditions.
Diseases like diabetes and hypertension are chronic conditions that untreated lead to a variety of other costly and often deadly conditions like heart disease, stroke, peripheral vascular diseases, blindness, amputations, renal failure and many more.
We must first begin to promote this with a change in the way we pay our physicians. We should reward our physicians when they keep their patients healthy and for finding problems early when they are less costly to treat. This would require legislation to remove insurance barriers to physicians ordering test for their patients. I am not suggesting a return to fee for service but to a system that values health over short term profits. Our current system does not allow doctors the freedom to treat their patients as they see necessary. After all they are licensed physicians and are supposed to be qualified to make those decisions. I am not advocating for the removal of oversight but do not believe the best person to provide that over sight should be the insurance industry.

Looking at our patient he would have his hypertension treated and that treatment may help prevent his progression to costly treatment of heart, renal and other vascular diseases. The physician would have the tools available to monitor and treat the hypertension with the latest treatments available. The physician also understanding the effects of diabetes and his patients risk factors and could monitor and treat his patient if the disease is present or is found on regular check ups.

If his patient continues to be healthy and meets certain benchmarks then that physician would see and increase in his reimbursement and as a result of his practice would grow.
Many would ask then what will keep practices from refusing patients who are less than healthy and my solution to that issue is to tailor the benchmarks according to the patient’s baseline and accepted theory on disease progression when it is being effectively treated.

Some patients will be non compliant and will continue to work against the goals and measures needed to promote health and those issues would be taken into consideration. You can lead a horse to water but you can’t make it drink. I do not believe in utopia but I do believe that many people are willing to learn a better way and would take advantage of health care if it were available.

3. Inpatient Care: I have been a nurse at the bedside in acute care for ten years now with a brief period of my career as a nurse manager. I believe the greatest reform needs to take place in this arena. There are many issues that the current for profit system cannot solve on its own.

Nurse to patient ratios should be mandated federally and apply to both acute and long term care facilities. There are many ways that this can be done and what ever method is chosen it will require that we deal with increasing the number of nurses willing to work in the inpatient environment.

The studies have been performed and have all come to the conclusion that patients suffer and are more likely to die or end up with costly and debilitating complications due to high nurse to patient ratios. If the ratio of nurse to patients match the reality of the care needed by the patient then we can decrease the days a patient is in the hospital, maximize the patients possibility of return to their baselines and decrease the potential for long and costly treatments as a result of injury due to lack of care. We have failed to keep up with the survival rate of our patient population. Years ago the patient that is now on the medical/surgical floor was in the ICU and those that are now in the ICU were dead. With that said our current for profit system has failed to acknowledge that these patients now require more than they used to and that requires more nurses and fewer patients assigned to each nurse to maximize outcome.

The next issue is the freedom for nurses and other health care providers to report abuse and problems in our system without the threat of termination or reprisal from their employer. Nurses are not allowed to speak freely about the issues that face health care and I have experience the repercussions of speaking out for reform, first hand. Employee’s rights to organize should be strengthened by the formation of a national union for health care workers that promotes fairness in the work place that works for all.

Technology: The use of computerized records should be mandatory. Paper should almost be a thing of the past in a modern health care setting. We spend 40-50% of our time charting and documenting in redundant ways. Technology if used properly could in my opinion reduce that time in half. Physicians placing their orders directly into the patients plan of care instead of having it processed by two or three people would reduce errors in transcription that result in delayed treatment and medication errors that kill thousands of patients every year. Programs have the ability to check the medication against know allergies and to even assist nurses in their recognition of unwanted symptoms and interactions with other medications. We are not taking advantage of what’s available and people are suffering for that. These technologies are expensive but will pay for them selves over time and will decrease the likelihood of costly and potentially deadly errors.

The old timers and the alarmist who are resistant to technology should be helped to get over their fear or be left behind. My health information privacy is important to me and all measures should be taken to protect it. The ability for someone to hack into my information should not keep us from moving forward. I value my life more than I value the information about my life and it is my opinion that the health care system moving into this century out weighs the possible risk to my health information.

If just these reforms were made, I believe we would all be better off. I love my profession and my country and wish for the day that I can say as an American and a nurse that we value human life and that when it comes to the health of our citizens we believe all should be treated equally.


  1. I did not have time to fully read your post, however I do understand the overall concept. I too am a RN with 8yrs of critical care experience. I enjoy nursing with the exception of the hospital environment. Meaning, there are many frustration and obstacles in taking care of your patient. The numerous inefficancies in healthcare are astounding and they weigh heavily on all who are involved with the patients care. I have conjured up many ideas in healthcare that would improve efficancy in the overall treatment of a patient. But who would listen?? Hospitals are caught between a rock and a hard place. Lack of funds, strict compliances that lead to heavy fines if not followed. Administration lead by non medical staff trying to run a business first before taking care of patients or at least place their needs in the scheme of things with their business decisions. Physicians I find to be one of my most challenging obstacles. Inconsistent care among patients with the same diagnosis. Lack of communication with nursing staff on patient care. Slow to address patient needs that progress into declining patient outcomes. On and on and on and on. I plan to start a blog page on these items as well as submit articles in various nursing literature. I have personally witnessed many inappropiate care by staff of all degrees on all levels. And I feel that healthcare reform can only be changed if one the public become more responsible for themselves and their health and financial situations. Two, more consistant care and time related matters among physicians and nurses and all staff. And last hospitals have multiple actions to change to make healthcare environment more efficent as well as insurance companies with all of thier variety of problems. Sorry running out of time to be more specific. Anyway as we all are aware healthcare is a work in progress. Thanks for the post. Independent Nurse

  2. I have been a nurse for over 30 years and have seen much change and am appalled at the state of our current health care system. I think you are right on track and that it will be changed by a unified effort of nurses, other members of the health care team, and the "consumers" of health care and their families advocating for and not accepting less than quality care.

    Some observations:
    1. Nurses are so necessary for patient care in hospitals, and are the largest in number of employees. This carries a lot of "clout" on one hand, but also carries a large price tag, and a larger, more complex system in which changes come more slowly and are more cumbersome.

    2. Medical Directors--Other departments in hospitals were historically started by physicians. They are more closely linked to the field of practicing medicine and are often money makers for the hospital. (Laboratory, Radiology, etc.) I was a Medical Laboratory employee in a nursing position and saw this first hand for 10 years. This carried clout that I did not see present in nursing. If there was a dispute with a physician over care, the medical director dealt with it physician to physician, most of the time he listened to me and advocated for quality of care for my patients.

    3. Revenue--These departments generate revenue for hospitals and often have the ear of administrators. As a rule, nursing care costs money and is part of the "room charge." This needs to change. I think if nurses were in a position to truly practice nursing instead of checking off tasks, lives would be saved. That kind of expertise costs money and is difficult to capture on paper.

    4. Having a voice-- I observed a very different personality of employees in Laboratory scientists. There were lively discussions in meetings, they asked hard questions, expected answers, and were not afraid to express themselves. I observed the same thing you did with nurses...complaining among themselves but not willing to take it to the people with the power to effect changes. Dead silence in front of the "boss."

    5. Narcissism... Nurses are not the only people in health care. We can not do it all and need to be willing and encouraged to incorporate other members of the team for the patient's benefit. I have found an attitude of superiority in nurses that deems others in the health care field less knowledgeable or necessary than "us". I am also hearing reports nurses who are “just in it for the money.” With so many jobs lost, healthcare will “always be there and there is good money in it” becomes a motive for becoming a nurse. “Just the pay check , mam, Just the paycheck.”

    7. Personal experience with a family member:
    MD did major abdominal surgery and left town the next day for a 2 week vacation without informing pt. of this at the time surgery was scheduled. Patient followed by partner and sent home running fever masked by Tylenol, readmitted 2 days later with dehiscence, and early stages of sepsis. If I had not been a nurse, I fear he might not have survived the sepsis, or at the very least have spent time in ICU and a much less favorable outcome. MD rebuffed my request for hand washing with “I assure you that what is in that wound is worse than what is on my hands.” Refused requested Infectious Disease consult for 3 days. Told the pt. “you know, I have patients sicker than you.” Almost every nurse broke technique in wound care. (Clean technique does not mean no technique) Micro result?? MRSA!! 6 months later and 4 surgeries later with several more to go to repair the damages this 30 something year old young man has had a first hand look at the failures of today’s health care system, and so have I.

    6. Health care reform extends beyond nurses but with our numbers, if united, we could affect reform.

  3. And am also a nurse of over than 30 years and I think you are full of sh*t. Get a job and get back to the bedside where you can get a real perspective- if you can ;)...


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My Story

My Story

I have been a nurse for just over ten years. I earned my degree with the support of my wife and financial assistance for the GI bill. I was drawn to the profession of nursing after a brief exposure to an advanced course in field triage while serving in the army. I find the human body fascinating and am always learning. I also was attracted to the profession for all the usual reasons that bring people to the profession of nursing. I enjoy the reward of giving to my fellow man.

I believe that health care and the advocacy of safe care is the foundation of nursing that was started by our founders like Florence Nightingale. Our practice act calls for our profession to advocate for our patients and against practices that puts their safety in jeopardy.

The healthcare industry has for the last twenty plus years constructed an environment to maximize profits at the expense of patient safety and our profession. We as nurses have stood by fairly quit and allowed for this to happen.

Recently, I and others voiced concerns related to patient safety and working conditions at Summit Hospital a hospital owned by Healthcare Corporation of America. Our issues included the working of nurse with approximately six month of experience for more than twenty four hours straight. This particular nurse did volunteer to work these hours but in my opinion should not have been ask to do so. She is a great nurse for her limited experience but put her license and the safety of her patients at risk that night. The manager of the unit failed her and the patients in her charge. Study after study has shown that the error rate goes off the chart after twelve hours. I and fifteen other nurses also expressed to management our concerns over the floating policies that were sending unqualified nurses to our unit. We noted several instances were these nurse made errors that put the patient in potential jeopardy. We also expressed our concerns over ratios of 3 to 1 becoming the norm in the unit when 2 to 1 is considered the norm in intensive care across most of the country.

We submitted these concerns in writing and signed by sixteen nurses from our unit. Management responded by holding meetings with a group of employees that they chose and their representatives which included the director of HR, our unit manager and the director of nursing. The meetings at their start gave us some hope that our issues might be taken seriously and dealt with. It was soon apparent that would not be the case and these meetings quickly moved away from our issues to their issues. They would agree that their were problems but would not put any solutions into writing, stating that they needed to be able to remain flexible and made statements like we will try instead of we will.

At around this same time I was informed of an organization called the NNOC or National Nurses Organizing Committee, that was holding meetings in the Nashville area to organize nurses to advocate for patients and against many of the problems that I expressed above. I met with their organizer and felt that their movement was something that I could support. I became a member of the NNOC and began attending meetings on a regular basis. I also began placing invitations to attend meetings in the break room of my unit and speaking with interested coworkers, while on break, about the need to organize and advocate for our patients and our profession.

After a short period of time I was ask by my manager about my involvement with the NNOC and my desire to form a union at Summit Hospital. I did not deny my association and did not hide my opinion as to why I felt that organizing was needed. I also informed them that I had the right as outlined in the National Labor Relation Act. The nursing staff at Summit was then subjected to mandatory anti union meetings and letter sent to our homes and to our email accounts at work. I was required to attend meetings with the hospital attorney and informed that because I was a charge nurse I was considered management and could not associate with the NNOC. I contested that I was a member of management but submitted to their demands to end my association with the NNOC. I never attended another meeting or recruited for the cause after that meeting. I did however continue to operate a blog, , that advocated for reform of the healthcare system and employee rights to organize. I did not use computers at work for this endeavor and did not use my real name on the blog or use any other names that would tell a reader where I worked or who I worked for.

I was ultimately terminated from Summit Medical Center on June 11th, 2008 for what I was told was the operation of a blog. I was given no specifics of what about the blog was grounds for my termination despite my asking. I appealed my termination through the hospitals employment dispute resolution process, attempting to get clarification as to what about my blog was cause for my termination. The peer panel dispute process was a sham. The panel as outlined by the hospitals policy was to be made up of my peers, who were “not familiar with the problem or have a close relationship with any of the parties involved”. The panel was anything but and was made up of persons who had expressed an open hostility to my rights to organize and to freely associate with the NNOC in the past. Two of the panel members were charge nurses from the ER also under the supervision of my manager, who had terminated me. These two persons were also at the meeting with the hospitals attorney and expressed anti union sentiment. Another panel member was a person who was well aware of my personal views related to unions and the right to organize and had been present at private settings outside the hospital were I had expressed my opinions related to the issues that started all this. This puts three of the five panel members in clear violation of the policy. I then was refused the right to seek any clarification as to what about the blog was grounds for my termination despite that being the stated reason for the panel. I was not given the right to hear the reasons as stated by my manager and the director of HR.

I am writing this because I believe that my fundamental right to due process has been violated. This is a right to work state and right or wrong that gives Summit the right to do as the please when it comes to hiring and firing of employees but most people believe and Summit attempts to mislead their employees that they are fair and just when it comes to matters of employee issues.

If Summit is allowed to get away with this and is not challenged then patients are at risk. Health care workers need to be free to advocate for safety for their patients and if they are scared into submission then patients will suffer.

Join me in fighting for our rights to free association and to advocate for our patients as our practice act requires. Support the employee free choice act, and send a message to Summit and other corporate bullies that feel you are entitled to the rights they give you and nothing more.
Also visit sited like Leap for Safety and support petitions to mandate stronger legislation that will ensure a safer environment. Visit to get involved.

I truly believe that our healthcare system is in dire trouble and we as nurses have a responsibility to get involved. Please join the fight. Your family may one day depend on what we do today.

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