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Friday, June 27, 2008
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.
May 18, 2008
Advice to future nurses: ask questions, be proud
By Kim McAllister
It's that time of year when nursing and medical students shed their label (and protection) of student and head out to the workforce with their new licenses. Over at Emergiblog, veteran emergency room nurse Kim McAllister shared advice with new nursing graduates.
Here are her words of wisdom.
To the new nursing classes of 2008:
Your first year will be the most difficult as you acclimate to your new role as a professional nurse. Hang in there! Keep your focus on why you went into nursing to begin with.
Keep your eyes and ears open. Watch the nurses around you. You will be surrounded by role models. Take the best of what you see and incorporate it into your own practice. It may be hard to believe, but by the time the next class enters the profession YOU will be the role model they look up to.
Ask questions. Ask a lot of them. Keep asking “why?” This will keep you learning every day. I still do it after 30 years. Don’t take symptoms or lab values or behavior at face value. Find out why.
Don’t let yourself get cynical or burnt out. Don’t work so much that you are exhausted on your days off. Work what you need to work to get by - keep overtime to a minimum. Yes, the money is nice but so is your mental health. Nursing is hard, demanding work. You need your downtime to recharge.
Speaking of cynical or burnt out, you will work with nurses who suffer from both. Don’t let their attitude bring you down. (And I hereby apologize to all those nurses who had to work with me when I was suffering from both those maladies). You will feel the same on occasion, but keep in mind that “this, too, shall pass”. It does.
You are professional nurses! Don’t let anyone treat you like a housemaid, a slave, an underling, or anything other than the educated, professional people that you are. Don’t accept the status quo. Don’t accept that things “have always been done this way.” Don’t accept stupid water bottles with hospital logos on them.
Please, please remember that you practice nursing and not medicine. The professions are complimentary, not identical. Should a patient refer to you as “Doctor”, let them know you are a registered nurse. Act like the consummate professional, and you will find that the doctors will treat you accordingly. Those who don’t have a problem. You do not.
Tell everyone what you do! Promote the profession! Encourage young people to consider nursing. Explain the difference between nursing and medicine to those who are confused.
And finally, there will be days when you leave work exhausted, emotionally drained and aching from head to toe, wondering “What the hell was I thinking?”
On those days remember that you made a difference in someone’s life.
Because you are a nurse.
Congratulations to the Nursing Class of 2008! I’m proud to call you colleague.
May 18, 2008 in Nursing
I sit on the Dean's Advisory Councils of the Colleges of Health at two public universities in Florida. Both Colleges are led by extremely capable PhD nurses, and have a variety of programs that train students to be health professionals, including nurses.
A few months ago, I was startled when one of the Deans mentioned that her Nursing program had 500 qualified applicants for 132 student slots. In other words, at a time when the market wants her to gear up, she turns away 3 qualified applicants for each one she accepts. As it turns out, it's a national problem. In 2006, Colleges of Nursing turned away 43,000 qualified applicants.
It's not news that health care institutions face a critical nursing shortage. An April 2006 AHA report estimated that American hospitals currently need 118,000 RNs to fill vacancies. That number is expected to triple by 2020, to 340,000 vacancies.
What is less clear to most of us is exactly why the shortage exists. Most of the facts in this piece were drawn from an excellent presentation by Geraldine Polly Bednash, PhD RN. Dr. Bednash is the Executive Director of the American Association of Colleges of Nursing (AACN). AACN's site has a wealth of data on the problem, and the distinguished members of that association draw a VERY compelling picture of benign neglect of the training process by the sector it serves.
To read the full article click on this link. http://www.thehealthcareblog.com/the_health_care_blog/2007/08/why-do-we-have-.html
The comment below is posted by Nurse Advocate
Pay attention to the comments made at the bottom of the article. There are many good ideas posted there.
I believe that if all hospitals in a state or a group of states would work towards subsidizing the pay differential for nursing professors with the idea that a partnership would be formed between the universities and colleges the shortage could be solved or at very least improved. This however will require a commitment of money and it is my opinion that most hospitals are not interested in redesigning their staffing matrix to fit the higher acuity of our current patient type because it will decrease the all mighty profit margin associated with each patient or unit of service.
Think about it; If you increase the number of nurses you employ and reduce the ratios because you now have an adequate pool of nurses for the higher acuity patients, your profits fall!!
This is not in the best interest of the current for profit system of health care in America. We must mandate ratios according to acuity or a flat nurse to patient ratio plan. I believe that most bedside nurses and the unit level nurse managers want and do give the best care they can but they are not in control of the purse strings and those at the top owe their loyalty to the stockholders and the profit GOD. Don't be fooled into believing that greed and general business practices are not the dominating force of health care as it is in any other for profit industry.
Sunday, June 22, 2008
It is my opinion that the climate in our corporate culture has been very harsh to those that voice opposition to their position on a subject. Even if we disagree on the solutions to staffing issues, how continuing education for nurses should be handled, unions and the right to organize, floating, pay and benefits, overtime, and the way out of the nursing shortage aren't we better off by communicating on these issues than by creating an environment that fosters silence. When as Americans did we give up our rights to free speech and allow our employer to dictate what we think, who we speak to and ultimately what we believe.
This culture of suppression is an epidemic in health care across the nation and if things are to be improved it needs to be changed. We can never get to reform and solutions if nurses as the frontline providers of acute care services are denied their rights to advocate for needed reform. We are in the trenches every day and see first hand the failings of our current system and approach to the problems I identified in the first paragraph. What are the administrators afraid of? Give the public the respect to figure out the truth of the situation based on a free exchange of ideas and assessments from both sides of the issues.I believe that when you support a free exchange of ideas, even those that are different to your own, you promote positive change and empower people to work towards the betterment of our profession and we all win.
When you suppress information and discussion that is not in agreement with your own you create a breeding ground for discontent, frustration and ultimately we all lose. This method is not democratic is not fair and denies Americans of the basics of civil liberties as established by our Constitution. I believe our founding fathers recognized that if one side is able to dominate the discussion and the voice of dissent is silenced then we all suffer and that true progress is the victim.Please stand up and voice your concerns and opinions to your administrators, congressman, senators and the public as they have a right to know there is a problem. I am not alone in recognizing that there are many areas of health care that are broken. You have a responsibility to voice your concerns. Those that attempt to keep you silent will only be stopped when enough of us say enough.
Friday, June 20, 2008
The Oakwood Decision and Labor Rights
Linda Bennett never realized she was a manager. As a nurse in Oakwood Heritage Hospital in Taylor, Michigan, she had no ability to hire, fire, promote, or discipline other nurses. But because she was a “charge nurse”, who divided up the work that needed to be done on her shift, the National Labor Relations Board recently held that she was a “supervisor” and did not have the right to join the nurses’ union at her facility. She cannot negotiate collectively with other nurses over her pay and benefits, but must accept whatever management offers or quit. She won’t be protected from arbitrary termination; management can fire her at any time on a whim.
Bennett isn’t alone. Millions of other rank and file workers lost the right to join unions on October 3 when the National Labor Relations Board issued three decisions that classified them as supervisors. These decisions hold that any employee who is responsible for the work of another employee is a supervisor, and not protected by the National Relations Act, unless the work is completely routine. By this definition, every teacher with an aide, carpenter or welder with an apprentice, and executive secretary with an assistant in America is a supervisor. The Economic Policy Institute estimates that up to eight million Americans will lose the right to join a union under these decisions.
The Oakwood decision comes on the heels of other Board rulings that are divorced from reality. In a case involving Brown University, the Board held that graduate students who are paid for teaching college courses are not employees of the university. In other cases, it held that disabled workers who receive counseling as part of their compensation and models at art schools are not employees.
This isn’t fair and is not what Congress intended when it passed the National Labor Relations Act. As the Supreme Count stated in the Bell Aerospace case, Congress intended to distinguish between “real supervisors who have genuine management prerogatives” who are considered part of management and “minor supervisors” who are still workers themselves and are to be covered by the Act. The current National Relations Board, led by a majority of Bush Administration appointees, has forgotten this important mandate.
These rulings couldn’t have come at a worse time. Americans have watched their take home pay (adjusted for inflation) shrink for over a decade, despite soaring productivity and record corporate profits. Employers are also cutting back on medical benefits and eliminating pension plans. Employees with unions, while not immune to these problems, do far better. The average union member makes 20% more than employees with comparable jobs that don’t belong to a union. Union members are also far more likely to have employer-paid medical care and retirement plans. Taking away the right to organize denies workers their best opportunity to maintain a decent standard of living.
The Board needs to rethink its rulings in light of the Act’s fundamental objectives. If it can’t, or won’t, Congress needs to amend the National Labor Relations Act to correct these mistakes. At a time when real wages are declining and job security is becoming a thing of the past, the last thing the country needs are misguided rulings that deny employees the right to join a union.
Friday, June 13, 2008
I titled the post depressed because the subject matter is down right depressing. When you think that so many hard working Americans will never reach the American dream and so many others will have it snatched out from under them due to the rising cost and inequalities of health care and the economy in general and the stagnation of wages.
Our government, our corporations and our leaders are letting us all down. We need to take control back. Please vote your conscious this election year. Get involved!!!
Tuesday, June 3, 2008
This video presentation by The Pinky Show does an excellant job of presenting the facts about our managed care system and the need for reform. Please view this video and forward it on to your friends and fellow nurses. I will post the second part when it becomes available. I will also post a link to the pinky show web site on our links to the right of this post.
Monday, June 2, 2008
Share your opinion
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!!
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, http://www.calnurses.org/nnoc/about-nnoc.html 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, http://nurseadvocates.blogspot.com/ , 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, http://www.freechoiceact.org/page/s/aflcio 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 http://www.leapforpatientsafety.org/ 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.