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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Thursday, May 29, 2008

The U.S. compared to other nations health care systems

This is a copied article from Nurse Connect by Jennifer Decker Arevalo.

I found this to be very balanced in it's presentation and facts. I believe it better to show the article in its entirety rather than excerpts.

This article supports my position that we are in need of reform in the US. The money we spend is not providing the care we deserve or have paid for. We are getting ripped off and should demand more. The world has provided us templets to adopt and creat a fair and effective health care system. Get away from the idea of adopting one system from another nation but the idea that we can take the best pieces from the other nations of the world to provide our citizens the best in the world. We must however take profit out of the equation our we will fail. Our goal should be to be fiscaly balanced and to provide the best care.

I hope you read the entire article below and think about why we rank so poorly when compared to other nations despite the fact that we pay twice as much per patient as any other country.

Review by Nurse Advocate.

Article by:
Jennifer Decker Arevalo, MA, contributor

When it comes to issues, such as affordability, access, care coordination and patient safety how does the U.S. stack up against other countries? Not so good, according to the Commonwealth Fund's 10th International Health Policy Survey released in October 2007.
Results from a Harris Interactive survey of 12,000 adults in Australia, Canada, Germany, New Zealand, the United Kingdom, the United States and for the first time, the Netherlands, were published as a Health Affairs Web Exclusive, entitled Toward Higher-Performance Health Systems: Adults’ Health Care Experiences in Seven Countries.

Thirty-four percent of American adults indicated that the U.S. health care system needed to be rebuilt completely; this rate was higher than in any of the other six countries. Although there is no perfect health care system, much can be learned from the innovations and strengths of other countries and then considered for transferability to the U.S.

According to senior vice president for Research and Evaluation and study co-author, Cathy Schoen, in the Commonwealth Fund’s website presentation, “U.S. adults are the most likely to go without care because of costs.”

Thirty-seven percent reported that they skipped medications, did not visit a doctor when they got sick or did not get recommended care because of financial reasons, compared to people from Canada, the Netherlands and the U.K., who were the least likely to skip care because they could not afford it. This may directly correlate to the 47 million Americans who lack health insurance coverage, unlike citizens of the other six countries who have some type of universal health coverage.

“In the U.S., both the insured and uninsured population reported out-of-pocket medical costs as high as $1,000,” said Schoen in the web cast. “Such high out-of-pocket expenses were rare in other countries.”
Only five and four percent of adults in the Netherlands and the U.K., respectively, paid over $1,000 in the past year compared to 30 percent of Americans, 19 percent of Australians and 12 percent of Canadians.
Nearly one-fifth (19 percent) of U.S. adults had trouble paying medical bills; this was more than double the rate of the next highest country.

Schoen also stated in the website presentation that, “US and Canadian adults were the least likely to report rapid access to seeing a doctor in their community when they got sick.”
For same day appointments, 30 percent of Americans and 22 percent of Canadians had quick access, compared to 50 percent or more of Germans, Dutch and New Zealanders. In the U.S., Canada and Australia, over two-thirds of those surveyed reported difficulty getting care on nights, weekends or holidays.
“The Netherlands reported the least difficulty in getting after hours care,” added Schoen, most probably due to nurses and physicians who staff phone banks to provide assistance.
Care Coordination

Across all seven countries, only 50 to 60 percent of adults had access to a “medical home,” as determined by the following criteria: the physicians and staff knew a patient’s medical history, were available by phone during office hours and coordinated a patient’s care with other providers.

“The vast majority reported having a regular doctor and source of primary care where the staff knew information about their medical history,” said Schoen. “However, this percentage dropped off and varied by country when asked about access, that is how easy and quickly it was to get in. It dropped off even more when asked about coordination of care.”
“In all of the countries, patients with a medical home were the least likely to report problems with coordination of care and the most likely to report that information had flowed well and that their primary care physician had helped them to find the right specialist,” continued Schoen in the web cast.

However, for patients without medical homes, 23 percent of U.S. adults stated that either test results were unavailable at the appointment time or doctors ordered duplicate tests; 19 percent of Germans and 18 percent of Australians reported similar problems.
Across all seven countries, patients in medical homes had more: positive care experiences, time spent with their doctor, and involvement in their care decision.
Patient-centered care is a key element of medical homes. “Across all countries, three out of four patients with a medical home said their doctor provided these key elements of patient-centered care,” said vice president and director of International Program in Health Policy and Practice and study co-author, Robin Osborn, during the website presentation. “This was 20 to 30 percent higher than for those without a medical home.”

“It is critical for patients with chronic medical conditions to have a medical home, as they see multiple providers, take multiple medications, are at higher risk for hospital or emergency room admissions and are at greatest risk for poor handoffs between providers and settings of care,” continued Osborn. “This is the most vulnerable population in the health care system; vulnerable to system shortfalls in coordination of care.”

Patients with medical homes were less likely to report medical errors and the study authors believe that regardless of the type of health system patients have, medical homes improve patient safety and satisfaction, as well as efficiency and care coordination.
Patient Safety

Out of all seven countries, adults in the U.S. reported the highest rates of lab test errors and some of the highest rates of medical or medication errors. Patients with multiple doctors or chronic illnesses experienced most of the reported errors, across the board.
“Combining medical and medication errors, as well as diagnostic test errors, one in five patients in Australia and the U.S. experienced an adverse event,” said Osborn. “This is stunning given that it was a general population sample. As you might expect, the rates went up dramatically with patients’ medical complexity.”

Thirty-two percent of U.S. patients with two or more chronic conditions reported a medical, medication or lab test error in the past two years, compared with 28 percent of patients in Canada, 26 percent in Australia and fewer patients in the other countries. Among adults with multiple chronic conditions, error rates were lowest in Germany, at 16 percent, according to the study authors.

“Country patterns reflect striking differences in policy,” summarized Osborn. “Universal coverage matters for access, quality and equity, as does benefit design. Across all seven countries, the survey underscored the pressing need to develop more system integration. Most compelling, there was overwhelmingly strong public support for designing the health care system around the medical home.”

Thursday, May 22, 2008

The Status Quo

Recently I was having a conversation with a nurse on my unit about Ted Kennedy and his diagnosis of brain cancer. The comment I made was that when they thought he had a stroke he was air lifted to the best hospital in Massachusetts. I commented that we all deserve that level of response and care when or if we ever have an event like that. I went on to state that there should not be class care in this country and that we all deserve to be treated with the best available care.

She responded that I needed to accept that there is a class system and it exist every where and that it will never change. I accept the statement as fact but reject the notion that I should accept it as ethical or moral practice. Furthermore I believe that my professional ethics require me to fight against class care and demand that all patients and people regardless of their circumstances or economic or social position in life places them. With that said we won't change the minds of the world that some are entitled to more because of the size of their wallets or the family to which they were born but we can work on changing the minds of nurses that this concept should not apply to health care.

What is the value of human life. Are you more or less valuable than Kennedy or me or anyone for that matter? Should your ability to pay be part of the treatment process?

Please think about those you have seen in your careers that have lived and died and ask if there have ever been patients who might have survived if they had the money to afford better care. The question is not meant to imply that your facility or you made the choice to give bad care or neglect the patient but would more options have been pursued if the money for those treatments had been available. With that said, health care is one area where we should not have a first class and coach.

I hope you will comment on this post and share your comments about this subject.

Monday, May 19, 2008

Copied Article: Nursing Shortage or Hospitals Short On Nurses?

Nursing Shortage or Hospitals Short on Nurses?Posted by: admin in Laura Gasparis Vonfrolio, RN, PhD, Nurse Staffing Issues
Guest Post by Laura Gasparis Vonfrolio RN, PhD
Let me begin by saying that there is no shortage of nurses. There are over 2.8 million of us. Interesting to note, only 66% are working and 44% are employed full time with 10% of working nurses being “very satisfied” with their jobs. A recent survey found that an astounding 75% of RN’s feel that the quality of nursing care at their facility has declined, with over 68% citing staffing levels as a major contributing factor to this problem.
The statement made by hospitals and administration that there is a nursing shortage, are patently false and evade the real issues of why nurses leave nursing thus contributing to the lack of a sufficient number of nurses at the bedside to meet patient care needs. The term “nursing shortage” becomes a pat excuse for every vacancy that can’t be filled. It is the ultimate answer that absolves the people who are responsible for creating problem – shortage of nurses at the bedside.
There is an annual turnover of approximately 200,000 nurses, which cost the hospital industry a total of nearly 10 billion dollars per year. This staggering cost is the result of the hospitals industry’s failure to retain nurses. If the funds now spent fighting a losing battle to replace disheartened nurses with travel and agency nurses, were instead devoted to improving job conditions, the nursing “shortage” could be largely solved. The Harvard School of Public Health conducted the most comprehensive study linking staffing levels to patient outcomes. The researchers found a strong and consistent relationship between nurse staffing and the outcomes in patients. Higher nurse staffing ratios result in shorter lengths of hospital stay and thus reduce both direct hospital costs of treatment.
Other studies include:
August 2005 – Medical Care“Improving Nurse to Patient Staffing Ratios as a Cost Effective Safety Intervention” Research showed that when nurse staffing is improved, lives are saved in a cost efficient manner.
February 2004 – Medical Care“Nurse Burnout and Satisfaction”Patients were more likely to report high satisfaction with their care and nurses reported less burnout when nurses worked in conditions with adequate staff.
March 2004 – The Agency for Healthcare Research and Quality released its report entitled “Hospital Nurse Staffing And Quality of Care.”Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, urinary tract infections and cardiac arrest.
January 2003 – Medical Care“Fewer Licensed Nurses Leads To A Greater Number Of Adverse Events”
August 2002 – JCAHO issued a report “Nursing Shortage poses Serious Health Care Risk.”Focuses on the severity of the current and future nursing shortage and its detrimental effects on patients.
May 2002 – New England Journal of Medicine“Nurse Short Staffing Leads To Deadly Complications”Jack Needleman and Peter Buerhaus found that nurses short staffing leads to deadly consequences for patients. Attention nursing administrators – focus on retaining your nurses – improve the staffing levels at the bedside!
A Nurse With a Heart
Laura Gasparis Vonfrolio, RN PhD is one of the most dynamic and entertaining speakers you will have the opportunity to experience. Laura has held CCRN certifications for over 15 years and CEN certifications for 13 years. Laura has helped thousands of nurses over the last sixteen years to prepare for the CCRN and the CEN examinations. She has held positions as staff nurse, Staff Development Instructor and Professor of Nursing.
Dr. Vonfrolio is the proprietor of Education Enterprises and the former publisher of REVOLUTION – The Journal of Nurse Empowerment. Laura has authored numerous articles in Nursing, RN, AJN and co-authored/edited eleven books such as NURSE ABUSE: Impact and Resolution, Critical Care Examination Review and 12 Lead EKG STAT! In addition to being series editor of a six volume State Board Review, Nursetest. Dr. Vonfrolio was the organizer of the Nurses March on Washington DC, March 1995 and May 10, 1996 and has appeared on Good Morning America and Nightline with Ted Koppel (May 1996). You can contact Laura at

Wednesday, May 14, 2008

Another nurse week has come and gone.

Another nurses week has come and gone and we are still looking at the same problems that faced our profession last year and the year before that. Things are better these days at my particular facility but will it last? If the past holds any prediction for the future I would say no. Once budgets are analyzed and the meetings are held things will creep back to the norm of short staffing with high ratios and unsafe conditions. I at the moment am fortunate but have not forgotten that there are real problems that are facing our profession and that for the most part are not being delt with by our trusted administrators, universities and goverment.

I titled this post nurses week to expose the bribe, although admittedly a small one, that the trinkets, bobbles and food they give us in the name of celebrating our profession and work is meerly a distraction and a bribe. They are avoiding the hard and expensive solution to the real problems that face our profession and the health care industry as a whole. I see thier hallow actions as an insult and do not participate in the game.

If the moneys from all the little parties and socials that were held all over the country this last week were pooled and used for scholarships or for the building of a new nursing program at a university or the hiring of an additional nurse educator or more ancillary staff to assist with patient care then you could say your work was being respected. These measures would take commitment and a larger acknowledgment that their is a problem. But pizza, ice cream, cookies and other door prizes are cheap and fun and isn't that what we are really all about!

We are a caring profession but more accurately we are a highly skilled analytical profession that save peoples lives on a regular basis. Until we accept that and demand the respect we are entitled to we will not get it from our administrators or politicians. Show me you respect me with better working conditions, better equipment to aid me in my care, better pay, better benefits and education and keep your door prizes and cake and ice cream.

Join me in the future by asking your leaders and administrators to keep their parties and the trinkets and bobbles and to create a scholarship or put that money into something constructive and lasting for our profession.

Saturday, May 10, 2008

A look at health care by Bill Moyer of PBS

This video is a must see. The evidence is clear and supported by facts that our current health care system is broken. This video looks at the CNA and their efforts to reform our health care system. The argument is that all Americans are entitled, (yes I said it entitled), to quality health care.

I believe that health care is a basic human right and that the basis of this countries morals and ethics are based on helping those less fortunate than ourselves without regard to their beliefs. I also believe that in order for our country and economy to be strong we have to be healthy as a people.

The act of providing emergency care when people are at their most critical but not the care to avoid getting to deaths door is negligent and inefficient. The sysytem cost the American people Millions of dollars every day. Every time a person due to lack of insurance or the funds to afford medications or routine medical care ends up in our ER's or ICU or the floors for that matter cost every person in the form of higher insurance premiums, more expensive cost of services, higher drug cost ect. The hospitals, insurance companies, drug companies all document millions in charity care however they also regularly increase the cost of their services to recover the losses they incure with that charity care. So I ask you is it really charity? I say yes but we are the ones providing it. So with that said I think it would be much more efficiant and cost effective to cut out the middle man and provide universal single payer coverage to all Americans. We are paying for it any way.

My premiums that I currently pay to Aetna along with your premiums and the premiums paid by the employeers would go to providing coverage for all. The sysytem in the end would cost us all less. Do your reserch and look at the cost of our system compared to that of other nations. We are not getting our moneys worth in our current system and we all need to become better consumers and demand that profit be removed from health care and that we get what we are all paying for.

Do your own research and examine the profits posted by the big insurance companies and health care corporations. Look at the salaries of the CEO's who run those companies and remember that they earn their money by increasing profit for the company which means denial of claims and services. Trimming the "fat" which in most instances is the lay off of staff that provide care is another way profits are increased. Nurses demands for safe ratios are fought because the more patients each nurse provides care for at one time increases profit by reducing the staffing budget. Don't be fooled, profit is king and you and I are only valued as long as we are making that profit. But don't forget that they can not operate without us. We hold all the power to influence change as long as we act toghter. Join me in this cause and take some kind of action now.

Share your opinion

The post are designed to evoke conversation that leads to action. GET INVOLVED!!!, lets us know your opinion, post your comments today.
You can post your comments anonymously if you like or use any name you choose. We are not interested in knowing who you are but what you think!!

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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