My community hospital just had its budget cut by 47%

[Heddi]

Let me tell you about my hospital:

it is a teaching hospital associated with a state-run university. It's actually the university that got its budget cut by 47%, and that cut was made by the governor who is focusing the brunt of budget cuts to health and education

it is a level-1 trauma center that caters to at least 6 states

it is also a community hospital. Being state run, we cannot refuse anyone any care unless we do not have the staff to do so.

As it stands, only 30% of our patients have insurance coverage of ANY kind. That includes VA benefits, Medicare, Medicaid, and private insurance. The other 70% of patients have no way of paying. They are homeless, immigrants, working poor, unemployed, or trauma victims shipped in from our state or other states.

We, as well as every other hospital in the area (and there are many hospitals here) are on a hiring freeze. We just cancelled all of our travel RN contracts. I am a travel nurse, but my contract was not cut and I was allowed to come on as per-diem with the hospital because of the area of specialty that I work in

Not only is it the hospital that will be affected (and we're already feeling the effects now). Also affected are the 30 or so community health centers the university and hospital operate. These are clinics that primarily serve the homeless populations, but there are also many low-income and sliding scale income clinics. They range from primary care to maternity and pediatric care and mental health services. These facilities ensure that the already bulging ER isn't filled to capacity on an even more regular basis. They treat the ear infections and ingrown toenails that otherwise would come to the ER for treatment because of lack of outside resources. Now those resources are gone and the ER will be just as full as ever.

(the other night there were 87 people waiting to be seen in the ER, another 100 in the ER waiting to be admitted to rooms and only 15 rooms open in the entire hospital)

The hospital admins have already decided that they are going to negate the contract they just signed last fall for pay increases. I know this is against the law and there are talks of a "blue flu" occuring when pay raises in June are slated to happen. I don't recall, however, the admins agreeing to a pay cut, or to come on the floor and help out during busy times. I don't recall the admins having to work 12 hour shifts without sitting down, without eating, and without peeing, with no resources and increasingly sicker and sicker patients being admitted inappropriately because they have to put them somewhere and there are no ICU beds available.

They are also cutting our support staff. The hiring freeze doesn't just affect RN's. Medical and Hospital Assistants, Nursing Assistants, Phlebotomists, Lab Techs, Radiology, Transportation....all are being cut. The MA's are being downgraded to HA's so that they won't be able to get THEIR union-guaranteed pay raise.

They have also cut ALL overtime. None. Never. Ever. No matter what the reason. So the other night, when we were 4 nurses down, we had to suffer and just work 4 RN's short because we couldn't call anyone in, not even for straight time. We had to suffer and the patients had to suffer and their families had to suffer. Oh well...it's just a hospital what's the worst that could happen being understaffed and overworked?

---
What this means for me (nurse) and ultimately you (patient):

Right now I work on an acute care floor. People that are too sick for the medical floor, but not sick enough for ICU. Chest tubes, strokes, massive truamatic wounds, heart attacks....I get it all.

Right now we take 5 patients at a time. That is QUITE a load when all of your patients are sick as dogs and need 1:1 attention. Right now they're getting 1:5 attention. Because of the hiring freeze, our census may go up. That means that I may have to take more than 5 patients.

Already as it is, I do all blood draws, all respiratory treatments, all iv starts. The only saving grace are the MA's which are allowed to do some blood draws, do the EKG's, and check blood glucose. When they are demoted to HA's, they will only be able to clean and turn patients. They will not be allowed to do EKG's, blood draws, or blood glucose.

So that means that not only will I (and every other RN on our floor) have +5 patients, that means that we have +5 patients to assess, treat, medicate, call the MD's on, take blood sugars, do EKG's, do all blood draws, do all respiratory treatments, all wound care, all IV starts. I know there's more I'm forgetting......

As it is with 5 patients, we never have time to sit down. Lunch? What's that...a fringe benefit? Bathroom breaks are a joke and we always joke with each other about having foley catheters while we work so we don't have to take precious time to pee. How inconveneint that bladder can be.

---

For you, the patient, that means that when you use the call light, we won't be there in 5 minutes with your pain meds. It may be 15 minutes. Or an hour. Or three hours. It means that the limited personal attention we used to be able to give you will be gone. You'll be lucky if I remember your diagnosis...don't expect me to remember your name, or even care what your name is.

For unstable patients, that means that you better hope God is on your side because I can't be due to my workload. Or you better hope you're the sickest patient on the floor because that's the only way you'll get needed attention. Otherwise, I'll see you at 9pm for assessment and meds, and 4am for assessment and meds. I hope that the time between them you are the most stable you'll be, because I can't guarantee that you'll be tended to.

For the love of god, please don't have dementia or alzheimers, or get confused in the middle of the night and need constant attention to make sure you don't fall, or pull out your IV, or remove your catheter, or your feeding tube. I just don't have the time to replace all of that, especially when 2 of my other patients are coding and I'm running both of the codes because we have no other RN's to do so.

Please don't ask for a warm blanket, or water, or to use the bathroom. Those are gone along with the extra staff. Pee in your bed and die of thirst....my priorities are to keep you and 7 other people under my direct care as alive as possible. Blankets aren't a priority. Hell, I'm not sure that breathing and having a heart-beat are a priority either according to the way the hospital expects things to go.

I suppose the hospital is supplementing my lowest-pay-in-the-state with a couple of extra arms. Or at least I hope so. That's the only way things are going to get done, because they're not hiring the staff we desperately needed BEFORE the budget cut, need even more now that they've fired the travelers and agency, not counting the hundreds of RN's we needed even with the travelers and agency that were there.

At least rest assured that neither I, nor any other RN I know, will do anything to jeopardize our patients or our licenses. So you're either going to have an RN that hasn't sat down in 12 hours (that's GOOD for mental processing!) or you're not going to have any RN at all because we're all going to strike, or quit, or just find another line of work.

Here's to being health....for god's sake, please....don't get sick.....

[dana_b]

1. good luck to you

I don't know how in the hell states without ratios, or at least reasonable ratios, do it. This need to be a federally mandated thing. I live in California and Med-Surg is 5:1, peds 4:1, transitional 3:1, ICU 2:1. Even those are really difficult at times. Before the ratios took effect I almost quit. Having 8 patients at a time like you described nearly sent me over the edge.

[Heddi]

6. A question about California

another travel RN I worked with said the 5:1, etc, ratios in California meant that you had no CNA's or other staff to help with the care of patients, that you did EVERYTHING without any help on the floor. Do you know if this is true?

Right now our ratio is 2-4:1 from 7p-11p, then up to 5:1 from 11p-7a. My husband works in telemetry and his is 6:1 all night shift long, which just makes my head spin.

I cannot believe the union would allow this to happen. We were able to get some of our cost-of-living increases in our last contract after threat of a MASSIVE walkout, and after every RN, LPN, HA, MA and CNA signed individual letters of disgust that were delivered and dumped on admins desk. About 150 angry people showed up to deliver the letters, too. The contract was signed that day.

The old hospital I worked at was 5:1 on tele, 1-3:1 in ICU and up to 9:1 on Medical floors. I floated to med/surg one night and they started me out with 7 and I ended up with 9 at the end of the shift. only one CNA for 45 patients, and every.single.person was crazy, crawling out of bed, pissing all over the place.....it was madness.

[dana_b]

26. CNAs

I don't know about all the other hospitals but that is partially true at UCSF. During the day the CNAs (we call them PCAs) have a 9:1 ratio and at nights it can be one PCA for the floor. The big med-surg units (we have a LOT of them!) have 36 patients and the CNA will have 15-18 patients. The tele units here are a max of 3:1. They're very busy because UCSF gets the people that other hospitals may not have the resources to handle but it's better than 6:1!! Insanity.

The worst I ever had it (before raios) was 10 patients on a liver transplant, surgical floor. I had three liver patients, an appendectomy, a patient who just came back that evening from surgery (a Whipple) and five more that I can't even remember. I went home in tears thanking God that noone died.

Good for you all for sticking up for yourselves. They need to listen. I can't believe how they mess with people's lives like this. It's not like we're dealing with a broken piece of machinery or cleaning houses or whatever else you can think of.

[truedelphi]

29. You are at UCSF? Gosh, I love that place.

Everyone acts professionally, the nurses are top notch. The Nurse assistants speak English. The patient care is wonderful.

I am sure if you work there, you don't have such a rosy outlook. But the other hospitals I have to take my elder care patients to are far far worse.

[dana_b]

30. oh I believe you

I know that we have it pretty good, especially now.

[Warpy]

2. 50% of licensed nurses have left the profession

because of brutal working conditions like the ones you described so well.

In addition, most hospitals require nurses to work additional 12 hour shifts at their convenience. That means no planning anything at any time because you could easily be called in and have to cancel at the last minute, really hard on spouses and especially kids.

The system is broken beyond repair and nowhere is that more apparent than in hospitals.

Cost cutting has more than run its course. We've cut costs so much that we've lost half of the highly trained professionals who could make a difference, along with putting patients at risk. What was once the envy of the world has been cost cut into a system that is as bad as that found in most third world countries. We just have newer machines.

We need to design a health care system from the ground up, with the actual delivery of care to sick citizens as the priority.

We can keep doing what we're doing and trying to stick bandaids on it only if we all have a death wish.

[Heddi]

5. Thank GOD we don't have mandatory overtime

We don't even have on-call RN's. Once in a bloooooo mooon I'll get called on my day off to see if I want to work, but I always say no (heh. I have other things to do...like, not being at work), and I'm never forced.

[corruptmewithpower]

3. How in the world do you operate on half a budget and not enough staff . . .

and too many patients with too severe illnesses? Sounds hellish!

[Heddi]

7. well they can't shut the hospital down

and seeing as all the hospitals in the area are on a hiring freeze, I suppose the collective mentality is "where the hell are ya gonna go if you quit working here?"

You can only squeeze so much blood from a turnip, and this turnip has run dry.

[corruptmewithpower]

14. Good point!

[midnight]

4. We can't afford to help out the homeless, the sick, the college

students, but lots of money for the war.

[Heddi]

8. and lotsa money for new buildings

we just opened a several hundred million dollar building in December that is EMPTY because 1)there aren't enough patients to fill it and 2) even if they had patients, there aren't enough RN's.

And these are SWEET ass rooms, compared to the 150 year old hospital *I* work in. All private rooms, new equipment, ENOUGH equipment.

The problem is that this was supposed to be for people having planned surgeries. Well, that's a problem b/c people in our area don't see my hosptial as being anything BUT the place you go if you're homeless or in a car wreck. People don't COME here for voluntary treatment. They come here because they don't have insurance and it's the only place they can go, or because their head got knocked off by a train and it's the only place that can sew it back on.

So now this building sits EMPTY and we're paying RENT ON IT. Oh, they can pay for that, but they can't pay for working BP cuffs or pay raises that bring us up with the rest of the state, or equipment, or staff.

Again, Admin hasn't taken a pay cut.Or had mandatory overtime, or gone 12 hours without taking a piss or eating a peice of bread. Get their high-heeled and suited asses up on teh floor and see what THEY think is unreasonable working conditions.

I have always felt that if hospital admin was made up of people that had to spend 8 days a month working on the floor of their hospital (that's just 2 days a week...not too much to ask), that hospitals would be so overstaffed you'd have nurses falling out the windows, the equipment would be replaced as soon as it farted sideways, and you'd never get anything less than a 5 hour break in the middle of your shift.

[LeftishBrit]

44. Ohhhh, you're telling me, it's the same in the UK with loads of things!

In both education and the health service, there seems to be money for buildings but never for people! It's changed a *little* in the last 5 years or so; but still bad enough.

[Triana]

9. is your governor a Republican? n/t

[Heddi]

10. No she's a fucking democrat

I would have hated to see what would have happened if the Repub running against her came to office....we'd probably have to take pts home with us at night to offset costs :eyes:

[Zodiak]

11. Oh...one of THOSE Democrats

The kind that we are supposed to be happy about for no more reason than they won, not that they actually do anything for the people.

We have way too many of THOSE Democrats.

[Heddi]

15. 'zactly

The bozo that ran against her the last 2 times was an absolute horror. It's a choice between Hitler and Himler, ya know. I mean, she's not THAT bad all things considered, but she really needs to re-think cutting health and education budget so much. I mean it's not like people aren't going to get sick because the budget is cut. It just means that being sick is going to mean a whole lot more now.

she should stop funding these mega-stadiums that keep popping up every 2 seconds. I don't know. cut something but don't cut social and human services...shit.

[Why Syzygy]

12. rec'd

I've seen it from the patient side. Even though I have hospital coverage, when I needed care I always wanted to go to the county hospital. It was still the best one in the city.

You need to testify before Committee.

[Heddi]

13. Yanno, that's the thing

we, the staff, are so worked to the bone and have no equipment and are so tired but one thing that will not happen, and that I've never seen happen, is lack of care of patients. It's hard because you can only be stretched so thin, but we help each other out and do what we need to do to get the job done.

I love my hospital, and I love the patients that I serve. It can be challenging (how do you do diabetes nutrition education for someone who gets their food from a garbage can?) but I love it and I vowed that I would never work for a for-profit hospital again

but it goes to show that the non-profit ones are suffering just as much. Hhospital is non-profit. Admin...not so much

:)

[uppityperson]

16. "neither I, nor any other RN I know, will do anything to jeopardize our patients or our licenses"

Indeed. This is why I got out of hospital nursing. Good luck to you and good luck to us all. The system is broken and what you write is really unreal, or unreally real.

Maybe they'll do what 1 place did for us. Hire a consultant for $20,000 and then give us coffee cups with "we heart our nurses" on it.

[Heddi]

17. we are praying that our hospital doesn't try for Magnet Status

Good gud what a racket that is. The old hospital I worked for was going in that direction just as I left. THey can't give pay increases that make any difference (other than putting us into a new tax bracket therefore making us take home LESS than before the raise) but by golly by gum they can hire some tight-asses suits to walk around and critique what the hell we do for 12 hours a night....and we didn't get mugs. We got shitty pens that leaked ink all over your damn hands and smeared when you were doing charting....ugh

Oh! ANd the old hospital (community but not non-profit) had what we called the 20 Million Dollar Dildo. They had this Feel Good When Managment Sticks It Up Your Ass morale building bullshit that everyone had to go to. It lasted 4 days (Hellooooo I work NIGHTTTS. I AM NOT FUNCTIONAL AT 9AM!!!) and it was all about "You can't be a problem solver if you only complain and don't have solutions". What a bunch of malarkey. And not only was it during the daytime which sucked, but when I got paid I didn't get my night-shift diff, so I got shafted forty five ways from Sunday. It was such a sham. And not only was it the 4 days of classes....it was CD and DVD and take home booklets to read and remind yourself why you are a shitty employee if you think "Working without adequate staff and resources" is a REALLY NEGATIVE THING TO SAY because, by gush, you're not offering SOLUTIONS. You're just part of the problem

grr.

Thankfully my nonprofit state run crumbling floor institution doesn't go for that frilly shit. Hell, they consider toilet paper to be a fringe benefit. Everyone wipes their ass with the butt wipes we use on the patients. At least I have a soft shiny hiney.

[tavalon]

19. Amen!

When a certain unnamed Austin Catholic Hospital was going for Magnet Status, I called them and listed so many reasons they shouldn't get it. They got it and I will never buy, nor do I encourage my fellow nurses to buy into the scam that is Magnet. Just another gig to make money for the credentialing company and a chance to try to pull the wool over the nurses eyes.

[Heddi]

21. I have found that

the only people woo'd by Magnet Status are new grads or people who come from non-hospital environs, like LTC or nursing home or clinics. They have NO idea the bullshit that Magnet entails, and what bullshit you go through when you're in the nomination process. Management hand-picks the asskissers to talk to the Magnet committee about how great admin is and how supported we are and yes we get breaks and perks (ha! a perk is getting to take a pee once every 12 hours!!). They ensure that the "trouble makers" (i.e. non-ass-kissers) are miraculously off when the magnet people come to tour the units, and they try to placate everyone with free sammiches and tea. HELLO...a raise would be nice. Stuff the stale bread....give me a cost of living increase fer fuck's sake.

But people who haven't been through that because they're new, or not from that environment are like "oooh...shiny things!" and get distracted and think a pen that says "World's Greatest Nurse" or "Nurses Have All The Patients" (get it...patients...patience ha ha ha good one) means that the company really does care for you.

Raises, or cost of living increases, or investment in education, or hiring of essential staff, or upgrading equipment...bah...that's no way to show your workers that you CARE. Nooo. Pens and mugs and sticky pads are. My landlord PREFERS stickypads as payment for rent. Money...that's what they used in olden times. Money and salt.

Of course when they get the notice that their vision coverage is cancelled this year and it now costs $700 to ensure them and their family (up from $500 the previous year), they might get the idea.....

Hmm....this salt thing has me thinking....would it be better if I got a salt wheel every month instead of a paycheck??

[WillYourVoteBCounted]

37. Do you have a blog?

if you do, I must subscribe. You crack me up.

If you don't have one, you could always have one with a pseudonym.

[tavalon]

18. You said It better than I could

Health care system? What health care system? My hubby asks me why I never go to the doctor and I told him I can take care of myself. I don't care to subject myself to overworked doctors and nurses. I am an overworked nurse and I know how to self treat, at least as well as someone who has 5 minutes or less to spend with me. I can figure out what's wrong on my own and when the best at home treatment is. If I break a bone or have a bad appendix, I'll go, otherwise, no way. Hospitals these days are so screwed up, a person could die there, a person who wouldn't otherwise have died. As a registered nurse of almost 20 years, the hospital is the last place I would take my family - the last option.

[Heddi]

20. My family and co-workers know....

that if i were to collapse, just kick me into a dark room, close the door, and leave me be. Do not resuscitate. Do not touch. Go get your coffee and have a smoke and let me goooooooo.

I work at a teaching hospital, so all the Md's are still students. God I love them because they haven't learned to be assholes to the RN's....they actually LISTEN To what we have to say (mainly because they don't know what they're doing and know we know what drugs they need, how often, and what dose :) ) However they can be a bit over zealous sometimes, especially with codes. We had one guy they just ran in and started doing compressions because the "box" showed a flatline. Well duh, the leads weren't hooked up yet!! The patient is like WHAT *crunch* THE *crunch* FUCK *crunch* ARE *crunch* YOU *crunch* DOING *crunch* ha ha. I mean not funny ha ha....well, yeah, funny ha ha. Or they do compressions without the CPR board beneath the patient and the poor patient is being bent in half from being compressed on a mattress ha ha.

Oh god I love my job i love my job i love my job

Generally, though, I've seen nothing but great care, and since 80% of our patients are homeless, mentally ill, inmates, poor, working poor, immigrants, etc, I haven't ever seen reduced care aimed at them. Shit, you're more likely to get a heart cath or stents or open heart if you ARE Homeless or uninsured because they don't have to wait for insurance approval. The little old lady with 105% occlusion in every artery whose blood is nothing but lard but has blue cross blue shield...she'll wait a few days for approval. Scruffy Jim, our floor mascot who is at the hospital more often than I am has had more procedures than I can shake a stick at. But he's gotten them because he's homeless and uninsured and they don't have to get approval to roto-root his veins like they do for Little Blue Hair from the nursing home.

[tavalon]

23. Yep, that would be the biggest secret that insurance companies would like kept

They would hope that the average person didn't realize that they have it set up now that they get to decide who gets what and how much, not the doctors or the hospitals. And big pharma is right behind them sucking whatever blood is left and there isn't much.

[Heddi]

25. Doctors generally have no say

When I worked for the not-non profit hospitals, doctors were always scrambling to come up with creative diagnoses so that people could get the treatment they needed. Just saying what their disease was wasn't enough, so they'd be creative and, um, embellish or exaggerate diagnoses so that patients could get physical therapy or nutrition counceling or heart cath or open heart or whatever. The patient needed it, regardless of the diagnosis, but if the diagnosis wasn't right, insurance or medicare or medicaid wouldn't pay. So the MD's knew these folks NEEDED treatment but had no way to pay so therefore wouldn't get it so they would do whatever they had to so that the treatment would be paid for.f

Is that fraud? I think it's a fraud that someone's need for physical therapy is denied by someone who has never seen tehm as a patient, who has no education in medical matters, and has no idea whether it's needed or not. THAT is fraud. Doing what you have to do to make sure a patient is health and gets necessary care...that's not fraud, that's humanity.

[truedelphi]

32. You, Heddi, are getting my laugh of the week award

But then the fact that I was laughing so hard about your story of the box and the compressions etc shows what a nasty person I am.

My heart sank when I heard that the stimulus bill was including 20 Billion bucks for computerizing our med records. First of all it is a scam - local hospital activists have already proven that one hospital inside a chain will pay out say, $ 300,000 for the computerization software. Since the hospital is owned by a chain, that programming code set should just be sent to all the other hospitals in the chain, but that is not the way it works. The HMO pretends that each hospital is a separate entity so that it can get that $ 300,000 all over again from every community where one of its hospitals is located in the state of California.

And sometimes, I am not sure how good it is to have such data computerized. Back when I was insured, I got a call from some physician's office inside Kaiser - why hadn't I had my kidney infection medication filled? Didn't I realize I could destroy my health by not doing the meds as prescribed?

I tried to point out that I had never ever had a kidney infection, had never seen that doctor, and never been prescribed that medication - all in vain. Finally my husband called that office and explained and they listened to him.

But what if I had been hauled into Kaiser for something else like injuries after a car accident and couldn't fight off what the hospital staff knew about me via computer records??

[Horse with no Name]

41. I am too

And I keep wondering if she isn't one of my disgruntled coworkers--however, she says she does love her job, and where I am, NOBODY loves their job. Simple truth.
My computerized health info was stolen out of a car. I got a nice little letter from the hospital system letting me know. However, since I saw it on the news, I had a sneaking suspicion.
I am on a medication and I was taking 10 mg of it and had a 90 day supply. However, I had some side effects and cut the dosage down to 5 mg (I am also a nurse so I self treat,lol)...so obviously, I didn't need it refilled.
The pharmacy sent me a REMINDER to get it filled...seriously, what the fuck?
It is an expensive prescription with a high co-pay and no generic available...yet they never send me reminders when it is time to get my $4 prescriptions refilled.
It's all a scam and there isn't a pretty purple pill invented yet that will fix the mess.
For now, the best we can hope for is to endure.:(

[lostnfound]

22. I am so sorry. And horrified. And pissed.

People out of work all over the place and we are desparately understaffed in hospitals. This seems like a straightforward easy area to solve with a stimulus bill. Federal money to employ additional nurses and particularly emergency room staff would be something that no sane person should argue with.

[Heddi]

24. What I would do if I was president

1) Mandatory national staffing ratios for every medical facility from hospitals to long term care and nursing homes. No one should have to be responsible for more patients than is prudent and safe to care for

2) Expand current nursing programs and open more. Pay nursing instructors (and all other educators) decent salaries. As it is, to be a RN instructor you have to have a master's in nursing. In a clinic setting, you can make upwards of $75k+ a year. As a teacher, though, you're looking at $30-40k a year.

So pay the teachers what they're worth as educators and clinicians
Put money into schools so that they can hire more educators (one block to getting more people into nursing school--not enough to teach them)
Put money into schools to expand lab and classroom space (another block to getting more people into school - not enough space to hold them)
Put money into hospitals and hire more RN's so that there are enough experienced RN's on the floor to handle the load of students and new grads (another block to getting more people into school - not enough staff on the floor to supervise the students when they're there

Anyone who goes to school for nursing, or any other medical related job (phlebotomy, lab tech, radiology) as well as other areas of high needs will get special no-interest loans. Also, if they work in the US for 2 years, not consecutively at one facility, their loans will be paid back in full. If you happened to pay for your schooling out of pocket without loans, then after two years the money you invested in school would be returned to you in the form of un-taxable check, or as a write-off of that much on your taxes that you file.

Forbid hospitals from setting up hiring freezes unless they can demonstrate that they have enough staff to fully cover every shift, including the occasions of heavy snow, sick calls, holidays. Even then, a hiring freeze must be approved by members of the community, members of the RN union, and non-union RN's in the community.

Increase nurse pay across the board 10%. People who work in high demand fields such as nursing, education, etc (I don't know what all is high demand these days) get tax breaks for being "front line" defenders. We are required to come in regardless of weather, or holiday, or national disaster. THe hospital can keep us from leaving if there is a fear we won't return for a followup shift. The hospitals recently did this when there was heavy snow in our area. Stay here and sleep because if you go home, you won't come back.

Remove insurance companies from every and all aspect of human care. We already HAVE universal health care if you look at it frommy point of view---80% of our patients are non-paying. We're ALREADY paying for health care, just not in a streamlined way. Get rid of the middle-man. Get rid of the insurance companies. The money is there in the defense budget--cut defense by 2% and there's your universal healthcare for every person in this country hands down without having to raise a single fucking tax.

Make it to where people WANT to work in health care. Upgrade the hospitals. Put in new equipment. Train people.

I am just as much a part of homeland security as is any soldier or marine. I'm just as needed during a national disaster or terrorist strike. Treat us like we are a part of this country, and a valuable part of this country, not just some whiny asses that no one cares about until they're having a heart attack

[northernlights]

27. did you submit your ideas to the Obama transition team?

There was recently a Health Care Transition Team meeting in Augusta, Maine. I'm guessing there was one held in every state?

I wasn't able to attend, but somebody in DU sent me a link where we could submit input.

I suggested pretty much what you've suggested above:

On the one hand there are shortages of health care staff. On the other, waiting lists of students to get into nursing, med lab, and other health care school. So start by increasing the size of existing training programs. That will immediately put back to work the teachers being laid off and help with retraining the unemployed.

Health care delivery students shouldn't have to take out a student loan the size of a mortgage. They work ungodly hours in every weather condition, every day they are exposed to virulent, antibiotic resistant pathogens. They provide a community service and the community should pay for their training. Grants or provisional loans that are forgiven once they are certified.

It amazes me the way DUers keep screaming for universal health care. Who do they think is going to deliver it? There was a news segment on universal health care in Massachusetts -- and the shortage of staff it highlighted. They interviewed a doctor who works 7 days per week, with 3,000 patients. And people calling her staff, begging and crying to be added to her patient list, but she simply can't take on any more.

[eilen]

46. Hear Hear!!!

I am a staff nurse refugee. I left the hospital floor about 1.5 years ago. I couldn't take it anymore. I was so miserable. We had a period of time where it seemed almost 40% of our patients were some kind of outlier, out of specialty, out of their minds, out of time (DRG) or outside the criteria for placement. I have just recently felt like I wanted to take care of people again but just not in my old specialty (oncology). I don't want to watch people die, watch families lose their loved ones and don't want to expose myself to the chemo anymore. People are only admitted if they are really really sick, getting their work up, getting life threatening treatment, or getting treatment that won't get paid for in the outpatient clinics anymore. I used to work in the same type of facility as you -- a state U that also was a Level 1 Trauma center in which the radiology and ICU floors looked like something from NASA but the med surg floors were so rag tag, we had to hold a bake sale to buy a decent working thermometer and were constantly harassed about the hall looking messy but were provided no place to put the equipment (wheelchairs, stretchers, extra family chairs, big recliners for patients, ekg machine, oximeters, etc.

I actually applied for three different positions at a local hospital that had a job fair for nursing back in November. I haven't heard a whisper. I called to find out if there were any problems as my credentials are top notch. They haven't filled any of these positions. They deny there is a freeze but wtf? I even applied for a part time float position. One job I applied for at another hospital-- they called and asked me if I realized the job was day/night rotation. Half the shifts are on day shift and half on night. I didn't. I don't want it. Are they fucking serious? Who would do that to someone on purpose? Don't they want alert nurses? The shift listed on the job post said "varies" although the HR person claimed it was clearly listed.

I haven't gone back for my BSN and am on the fence about it. On the one hand it will make me more marketable -- I am not sure it will improve my practice. On the other hand, it is so devalued, that maybe I need to decide if I wouldn't rather head toward a different specialty in the healthcare field. In my heart, I'd rather not pour money into a goal that just makes me another cog in a horrible broken system. I don't think I want to be a manager or work for the devil-- I mean the insurance companies.

I have this fantasy that I go around my neighborhood and monitor everyone's health, call their doctor if there is a problem (like they need a prescription or if the lungs sound crappy, check the baby's weight and color, stock the freezer with healthy foods and check the food and blood sugar diary, help them get on a pharm program to help pay for their meds, give the flu shots, etc). and keep them out of the hospital and out of the germ filled waiting rooms. I can take the two blocks of my road with once a week visits. It sounds like it should be an easy thing, what's more easier than walking out of your house and knocking on a door? But it is so incredibly complicated and there are so many regulations. Maybe I should do it anyway and call it "guerilla nursing". Hell, I'm not getting paid anyway just sitting here. I'd try "home care agencies" but I just don't want to drive all over the county.

[Heddi]

47. I want to be a stay-at-home, internet triage nurse

but that's not working out so well..... :)

I thought about getting my BSN, but the only thing I'd get it for is to work overseas (the money generally sucks, or isn't any better than the US but the idea of being able to live/work in Ireland, or Scotland, or the UK, or, um...oh! Australia/NZ sounds pretty kewl). There's no job in the hospital I am not qualified for b/c I don't have a BSN, and I'm not interested in community or clinic nursing, so I wouldn't get it for that reason.

If I were to go to an RN-to-BSN program, it would cost about $13,000 or so and I'd only get $1 an hour more for having my BSN as opposed to my ADN. Fuck. that. noise.

Oh, I suppose I'd be on the short list for people who are "Managerial Types" but the LAST place I will ever be in a hospital is sitting behind a desk with "Nurse Manager" on my badge. Oh hell no.

Oh, and the "alternating shifts"---screw that noise. I mean, it's not like it's COMMON FUCKING KNOWLEDGE that it takes MINIMUM 2 weeks to get circadian rhythm adjusted to new schedules. Bah, I'm no fan of day-shift either. Yeh, we got shorter staff on nights but it's soooooo much more laid back as far as not having to deal with families and CT and PT and the chaplains and discharges and social work blah blah blah.....

I tend to work better when family members are gone, or sleeping, and the patients are dozing heavily. Although there are nights when I'm SURE there should be some law that prohibits patients, families, doctors, and nurses from entering hospitals :D

One thing a friend of mine did (and I don't know if they have this where you are) is she does Daycare checks for the state board of health. She goes to the different daycares, the ones that are in people's homes and the ones that are regular brick-n-mortar places, and she makes sure their health records are up to date, that they're not changing diapers on the kitchen counters, she does routine well-child checks...just temp and stuff like that. She does it through the state and she gets about $50 an hour, it's only a few hours a week and she does it for extra cash. I would do it, but I generally tend to hate children, so I'm not thinking that's such a good idea.

Sorry for bad spelling/punctuation. It's 6am and it's my "night" off but I haven't slept since yesterday. That means I'm GOOFY

[eilen]

49. I've done nights enough to know that I'm not a night shift person

so I tip my cap to you. What I don't understand is why they just don't allow natural night shift peeps to work straight nights -- I am an evening shift person. I've done days but it is just too cluster-fuck for me. Many places only offer 12 hour day or night. The HR nursing recruitment woman told me that there were many many people waiting for a day/evening position. Which begs the question, why do they do it this way? Since I am looking for a job, I restrained myself from asking her snarky questions. So I asked her if there were evening positions and she said I should look up on the website and reapply for those. Some recruiter.

Yeah, this internet triage nursing thing doesn't pay lol. An interesting fact is that the likes of me are legion. I meet so many nurses who aren't in nursing anymore. They quit in exhaustion and frustration deciding "I guess this just isn't for me." I don't know of another job that drives such numbers away, burning them out -- maybe social work? The head of our hospital stated that he thought the airline stewardesses that were all laid off could come to work for our hospitals as nurses.

I like kids so maybe I'll check out your tip. I've looked at the county employment and they mostly want prison nurses. I dislike working with prisoners, so, no thanks. I'll pass on the gratuitous TB. I'm going to apply with the schools as well as a substitute nurse. Otherwise, I'm having fun being mom and being able to drive the kids to activities. Before I felt only regular people that could that -- "civilians".

I have pretty much come to the same conclusion on the BSN as you. You sound like me (the way I used to talk on the floor, I'm amazed I kept a job, thank god for unions-- but I kept everyone laughing). It seems like there is this unsaid rule that you can't really tell people the way it is in nursing. It is so odd. I went to a hospital school that projected the assumption that we were in nursing as a vocation (like nuns or something) and should be self-sacrificing. When I was new and said I really needed a break, I hadn't eaten anything all day and I was feeling dizzy, I was told that I should think ahead and bring finger food. Where the hell would I eat it? If I was caught at a desk eating while charting, I would be written up. If I'm in the report room, the other nurses are complaining I'm not answering my lights.

I worked in oncology for 8 years, on the floor, in transplant and in infusion clinic. Prior to that I worked in Med surg. The last interview I went on was for a telemetry unit where the manager told me that the day shift had 1:4 (mostly) and no CNA's-- we do all our own baths and assist in procedures. Lots of vascular surgeries, CABG's, and angioplasties and a plethora of drips that previously were only allowed on the intensive care floors. Evening shift is 5-6 patients and nights 6-8 (ranges take floating off unit into consideration, they float one of your peeps, you are up 2). They still haven't filled that position so I'm guessing she's looking for more telemetry experience.

[elias7]

28. Administrative decisions tend to be sound only from a short term economic standpoint

I have worked community hospitals for about 15 years and the one truism that stands regarding policy is this: Decisions are made without the input of those who do the actual work. For once, I would like to be asked for my input regarding a need for change without having that change foisted upon me by administrators who may know business, but don't know medicine or the actual work involved in day to day care.

If the people in the trenches were presented with the need for cuts, I think we could provide a more practical and realistic bit of input to help make those tough decisions; rather we get left out of the process, suffering through arbitrary changes without consideration of an alternative approach...

[truedelphi]

33. When you examine who the money goes to, a clear pattern emerges.

There is this hospital in Rhode Island that Frieda Harrop used as a litmus test sample.

For several years they have been begging the administrators at their HMO headquarters to allow for a 10% increase in bill reimbursement payments. Each time they make the request they are refused. They know with that ten per cent they could maintain a standard of excellence for their patient care, but headquarters does not care.

Meanwhile the top CEO of that HMO lives in Minnesota. His salary: it is equal to the pay of all 3300 employees of that hospital in Rhode Island!

[w8liftinglady]

31. Heddi-I'm right there with you

I'm an RN on a busy surgical/telemetry floor...same circumstances.Now,our new management (I believe)is trying to eliminate some of the more seasoned,higher paid RNs(We quit using travelers about a year ago).We work our freaking asses off...and save a LOT of lives because of our experience(that 6th sense thing).My new boss wrote me up the other day for saying "sucks" in the nursing area(away from patients).She wrote me up for failing to have a tele beeper(even though half of them don't work).She wrote my friend up for "not smiling enough".My patients love me,and I am superb at what I do.No mention of that.I have an interview with the county health department next week,working in their std clinic.I can't do it anymore.

[Heddi]

48. Last month they opened a 2nd tele floor

but the floor was just med surg, and now it's tele....

great! more monitored beds. I can dig that.

BUT....they have no tele trained RN's...well, they do, but not enough. So instead they've got RN's with less than 6 months out of school (so only 3 months out of orientation) teaching the NEW grads all about tele. So we (people from my tele floor) float up there all the time to be the backbone and take tele patients because their staff isn't qualified to.

And they're so freaking new. I mean I've only been an RN for 3 years, so by god I am not the end all know all of nursing, but these new grads should be SURROUNDED by people with varrying levels of tele knowledge...from the I've Worked Here For 200 Years nurse to the 10 year RN to the just graduated last year. But they don't have that. They've got people who may have been Rn's for 20 years, but just learned tele and passed the test 2 months ago, so they're not an expert.

I had one gal give 10mg IV Metoprolol fast push and then was surprised that the HR went from 140 to, like, 42 in a matter of seconds. Had another chick walk out of the med room wanting to know how fast you pushed IV Potassium. Oy vey...I didn't even know we had K+ on the fucking FLOOR....um honey, put the vial down and lets have a nice long talk about meds, m'kay?

One student (granted, student, not staff) had to draw up insulin but we were out of insulin syringes. Stupid thing is that in our hospital, you don't need a sign off for insulin, you just draw it up. So we were out of syringes and she comes out with a 20 ml syringe (empty) and asks "So, 14 units is, like, 14 mls, or 1.4 mls???" About 12980384029384n people jumped through the RN station to get that fucking thing out of her hand. NO. NO NO NO PUT THE SYRINGE DOWN AND WALK AWAY FROM THE INSULIN PLEASE :grr:

But I feel for them because at any given time we have 10 or 12 students on the floor from 1st quarter or 1st semester up to about to graduate. There's no way of knowing what they can or can't do, and there's at leat 40 students in the whole hospital being looked after by 2 nursing school clinical staff. The RN's on the floor have far too much to do with regular patient loads, not even considering the new grads and students and this and that. These kids are really getting the short end of the stick and I feel bad for them. Because of budget cuts and staffing shittyness, they're going to get out of school with limited clinical experience because no one has the fucking TIME to devote, and they're going to get shafted on their orientation because WE NEED WARM BODIES ON THE FLOOR FOR GODS SAKE and they're going to end up hurting a patient or putting their license at risk---worse THEY WILL NOT KNOW IT BECAUSE THEY ARE SO NEW and the hospital will shake its head and say "oh gosh what could we have done" knowing full fucking WELL that bad training and a poor environment caused it.

But I guess in the long run it's easier to pay out the 1 in a million sentinel events that goes to court or mediation than to pay for adequate training and staffing and ratios.

I need to go to bed. I'm getting wound up :D

[WillYourVoteBCounted]

34. This isn't in the mainstream media, but should be

I didn't know it was THIS bad.

Thank you for sharing.

Wonder if you might speak with your local newspaper and get them to do a story?

You could just give them the info and keep your name out if you wanted to.

[Heddi]

35. oh, the local media is well aware

of the problem. There have been stories about all the hospitals and their shortcomings and budget woes and such and such. This would just be Whiny Nurse Number 2539084 letter to the editor or story of the week.

People, generally, don't care. They read the paper and they say (as seen in various LTTE and local NPR phone in shows) that the way to solve this is
1) cut RN pay. There ain't but no dang good reason why someone should be gettin paid $25 an hour to do ANYTHING unless you're Bill Gates. Regardless of how much of that 'fancy schoolin' you been too, and no matter how many people's lives are directly affected by your skills and knowledge, them nurses should be making no more than $3, $4 an hour tops.

2) Cut RN benefits like pension and health care. I mean what is the need for nurse to be healthy and such? There ain't but no good reason fer it because it's not like nurses constantly work around people who are sick, or have compromised immune systems and such. There ain't but no good reason why nurses should get health care, period. If they twern't good enough, they'd keep themselfes from even GETTING sick in the first place.

People don't care unless they're like the guy I had as a patient the other night that sat in ER for 15 hours waiting to be seen (he had a minor burn....nothing life threatning). Wanted to know why the hell his tax dollars were going for this and that and he had to sit for 15 hours blah blah blah and I said "Well, *our* tax dollars aren't enough for hiring new nurses to replace the ones that have left the profession. I'm sorry you had to wait, but that's not the fault of the hospital, it's the fault of the State of Washington, and I suggest that you write a lovely letter to the governor and let her know what you think of her budget cuts that prevent us from hiring necessary staff, because that's what kept you waiting."

[WillYourVoteBCounted]

36. Heddi

Maybe you would consider submitting your OP to www.OpEdNews.com they reach millions of
readers too.

You have gotten the word out here, and everything you wrote was perfectly said.

It isn't hard to sign up to submit articles there, and you are a fine writer.

Thanks again.

Oh, and I did a google and it sounds like this is happening all around.
I did not know that!

I don't have health insurance so I try to block out the idea of needing treatment
in a catastrophic moment.

Maybe we'll get UHC through default, when the entire system collapses.

[Why Syzygy]

38. Personally,

I would rather see a nurse practitioner or PA every time! I just feel guilty because I know they deserve to be paid MORE!

[eilen]

50. I had a patient

who had to neph tubes and a picc line. The home care agency nurse costs $40/hr (you know she's not getting it--maybe she gets $15 or $18, the agency gets the rest). So the man, who would have to pay out of pocket because his insurance won't cover home care nursing no matter how many fricking tubes are coming out of him refuses the agency nurse. He has two daughters. One has an LPN friend and has her change the dressings on the neph tubes. They bring him to the clinic every week for labs and to have his line dressing changed and flushed. Thing is, the PICC should be flushed more often. The daughters refuse to learn but don't trust their LPN friend to learn and do it (I even said, bring her in, I'll teach her). I don't think they are even paying their friend anything.

He tells me, "$40 for a nurse? I could understand the money for a plumber or a auto mechanic, but a nurse?" This guy is one infection away from a 6 foot hole in the ground. Go figure. I would like the general public to know that comments like that do not endear the nurses to you. Plus he is a weight shifter (meaning when you are helping him stand so you can access his behind to clean the shit off of him he will shift his weight without warning to dead weight once he thinks there are enough to support him --usually in front of family, but is later observed getting himself back to bed okey dokey after visitors have gone home) Don't ever do this. Seriously. Don't do it.

[area51]

39. Kick for this important issue. (n/t)

[Horse with no Name]

40. Excellent.

My hospital is doing the same, so FWIW, I feel your pain.
I've survived three layoffs--however, there is talk of a fourth, and I am currently low man on Totem Pole, but am also highly qualified--and certified in areas my colleagues aren't, so, we shall see.
You want to know what I think is fueling these cutbacks? They want to destroy the hospital infrastructure so that if Obama manages to be able to get "socialized medicine" passed, the healthcare industry will be on it's knees already and certain to fail. They are going to take every single dime out it, even at the expense of the patients and staff. They will leave it in shambles just like they left the country in shambles.
Don't ever forget who drives the healthcare industry in this country. It is the republicans.
:hug:

[LeftishBrit]

42. This is shocking.

Hospitals are the WORST places to make cuts! Sooner or later, people will die from this policy, yet the government will never face manslaughter charges.

Who's the governor? I'm guessing Arnie; but that might be just because he's one I've heard of!

ETA: I have now read some of the other posts that reference California, so it seems that my guess was right. Ugh!

[Heddi]

43. No, not california

and not only can I not blame the Governator, but our governor is a DEMOCRAT (supposedly). Ugh.

[LeftishBrit]

45. I sympathize - and after nearly 12 years of New Labour, even the 'Democrat' part doesn't surprise me

[area51]

51. Another kick. (n/t)

[busymom]

52. I know that no one wants to hear this, but...

My husband is a physician...and he trained in Germany and the UK before coming here.

Some of the conditions were...appalling. I was a patient and gave birth in both countries...most Americans probably won't accept the kind of rationing that will come under socialized medicine in this country.

I think we need to figure out how to get some sort of universal coverage, but....we need to be careful to also hear what is NOT working in other countries too, not just panic about how bad things are getting here.

When I had my 14 year old, I labored in a room with other laboring women and their husbands AND I was later in a room that I shared with 3 other women...and there were no little dividers to divide up the rooms. In Germany, you bring your own towels to the hospital because, as they told me after my son was born "this is not a hotel". Oh, and speaking of nurses...see if you can google what a nurse in Germany is allowed to do....basically bupkis...they are low on the social/medical totem pole and there are only 1 or 2 on an entire unit each night. Anything more would simply be too expensive for the health care system there. Costs must be cut to deliver care to everyone in this manner.

In the UK, I had a similar post-delivery experience (except that I shared the room with many more women) AND my husband vividly remembers being called to multiple codes and having the med cart be empty.

Also, there isn't money for fancy clinics, private rooms, etc. My father-in-law had his bone-marrow biopsy in his bed...with 3 other roomates in the room...there was no privacy. I tell you what...when I had to have a BMB, I was glad to be in a nice little cancer center in a single room. I was a patient at a catholic facility, which accepts all people regardless of their insurance status and treats them the same as other patients.

Yep.

It's not all what you think it is either. In the Germany and UK, they limit treatments for older people...I want to hear us all hollar about that here....and because of financial constraints there is no monetary recourse if things go wrong...ie lawsuits.

One of my closest friends still lives in the UK. Her 6 year old went without treatment and adequate diagnosis for a kidney problem...When they were visiting recently, my husband got her in to see someone here ... and she had to go back to the UK armed with letters from US doctors to get her child in to see a pediatric nephrologist. After years of no treament, she has damage to both kidneys, weighs 36 pounds and has a tough road ahead of her.

At least in this country if you are uninsured (which sucks and is totally wrong) you can't be turned down by an ER if case of an emergency and there are state and county hospitals (some of them quite good, some of them rotten) to go and get treatment for free. I know this because it is how my brother got his health care for quite some time.

Are we ready to deal with rationing, inability to sue in real cases of neglect or damage and to deal with the government in our health business?

I don't think I am.....

[Heddi]

53. That's odd, and I'm not discounting your story

but I work with several RN's who are 1) from Europe and worked there as RN's or 2) are from the US and did short-term assignments in Europe and I've never heard any stories that are as horrible as what you've described. Again, not discounting what you're saying, but the folks I've worked with have never conveyed the conditions that you describe.

And I, myself, have been to hospitals throughout Europe and while wards are popular moreso than the US, I've seen private and semi-private rooms, and the wards had separators between the beds.

There was adequate staffing and this is from what I've seen and what i've heard from RN's that worked in the hospitals there.

I do know that nurses in the UK do not use or have the skills that US-trained RN's do, as far as medications they can give, starting IV's, etc. One nurse I work with is from Scotland and said he felt he was being asked to do Junior Doctor skills here in the US--starting IV's, giving drips, giving IV meds....not allowed to do that.

However, I take exception to your comment "you can't be turned down by an ER in case of emergency"---well, that's partly true. If it's a LIFE THREATNING emergency you must be STABILIZED and then MOVED to another hospital that takes private pay, medicare, medicaid, or people without any insurance coverage. If you are uninsured and go to the ER with bronchitis, and the ER is a private hospital, they do NOT have to treat you and can refuse to treat you.

And the treatment you receive while being "stabilized" in the private or non-community ER...you get billed for that. And you get billed mightily.

And seeing as I work at a community hospital, where 80% of the patients we see are uninsured, I can't tell you how many times someone without insurance goes to Private Hospital X for, say, 2nd degree burns (this happened just a few weeks ago). The ER put a bandage on their arm and put them in a taxi to go 60 miles (on their own dime) to MY hospital because, according to that ER, the burns were "too severe" to be treated there (but not too severe to send the patient in a taxi, not ambulance, to our hospital). They were SECOND DEGREE BURNS on the ARM from STEAM. That is *NOT* an emergency that couldn't be covered by their services.

But, being a private hospital, they don't have to cover ANYONE, unless it is to stabilize their condition so that they are stable enough to be TRANSFERRED to another hospital.

And that dude will undoubtedly get a bill for several hundred dollars for being seen in the private ER for 30 minutes and getting $2 worth of bandage on his arm.


Another issue I have is that community and public hospitals aren't a pancea for lack of adequate health care. The Emergency Room is not the place for minor upper respiratory infections, or ear infections to be treated. Yet MY ER is clogged with people who have NO access to routine health services. So they come to the ER for an ingrown toenail, for an ear infection, for a stomach ache. Meanwhile, their care could be provided much cheaper in an outpatient setting (which is more appropriate), their time would be much better served than sitting in an ER for 12 hours to get antibiotics, and we'd actually have ROOM and STAFF for the *REAL* emergencies that come through.

----------

Edit to Add:

The more I think about it, the more I'm unsure what your post has to do with what I posted, and what the numerous nurses on this thread have agreed with---as it stands, our health care system is NONEXISTENT. There are far too many people using the public hospitals as it is with the lack of funding that we get.

My hospital's budget being cut by 47% has didly to do with European-Style medicine. Again, your stories just are the complete opposite of what I've heard from numerous (not one...not three...but dozens!) of RN's that have lived and worked in Canada, Australia, New Zealand, England, Ireland, Northern Ireland, Scotland, Germany, Belgium, Italy....and those are just the places I can think of off the top of my head.

Have you stepped foot into a COMMUNITY HOSPITAL...an INNER CITY hospital anytime lately? If you think that I work in the Taj Mahal, with golden spigots and $20 bills for toilet paper, you're sorely mistaken. Community and public hospitals are FALLING. APART. AT. THE. SEAMS.

We don't have even close to enough staff to deal with the "normal" nights of patients, much less now that so many inner-city services have been just completely done away with, especially with so many more people in our area without insurance due to layoffs. The very few free or sliding-scale health centers that are available for outpatient medical care have MONTHS long waiting lists. So that means that every cold sore and bloody nose comes walking through our ER doors.

And I don't blame the patietns. where the hell else are they going to go? Private MD's don't have to take them if they can't pay upfront. Private hospitals have NO obligation to take any uninsured unless their condition is LIFE THREATNING and even then they only have to stabilize the patient until they're stable enough to be transferred to my hospital. This is called "dumping" and it happens more than I could ever convey. Many times, that means intubating the patient and shoving them back on the ambulance to come to me. Or defibbing them in the ambulance as they come up the hill to my hospital.

Community and public hospitals are a great thing and a very needed thing for our society, and that's why I work at one (granted, I could go up the hill to the private hospital and get $5 an hour more....thanks but no thanks. I enjoy my drug addicts, alcoholics, inmates, domestic abuse, homeless, mentally ill, poor, immigrant patients. I don't want Miss MIllie who expects a foot rub with her 9pm meds and complains to the DON if she doesn't get it).

I emplore you to re-think your view that 'oh well, at least the poor have public hospitals" because that is NOT going to be occuring much longer. Most public hospitals are tied to public universities. Education and Health Care are #1 on every budget that is cut, along with other social services. So when the university has to suffer budget cuts, the hospital suffers budget cuts as well

Secondly, there is a tremendous increase in the number of uninsureds thanks to the massive layoffs and firings

Thirdly, medicaid and medicare and welfare and SSI and all those other wonderful programs that help pay for hospital stays are being cut as well. So the little funding and repayment we get to begin with is being cut even more.

Fourthly, because the public health outpatient centers are being closed (because of budget cuts by the university/state), we are seeing an influx of patients who cannot get treatment outside. They come to the ER for medication refills. For ear infections. For colds. Things that are much better treated in an outpatient setting must now TOTALLY be treated by the public emergency service

Fifthly, community hospitals AROUND THE COUNTRY are being closed down left and right because of lack of funding. There *ARE* many communities that have NO public hospital, no community hospital that primarily serves the poor. That means the poor HAVE to go to a for-profit hospital and will get billed out the asshole for routine services that they can no longer get for free or discounted b/c there are no community hospitals for them to go to.

There is only so much blood that can be squeezed from a turnip, and you seem to think that the blood is just endless, and the turnip can be squeezed and squeezed without ever suffering. Well, as an RN in the community hospital setting, I'm telling you that the turnip is running dry as a bone. We cannot keep up with the demand that the anti-universal-health-care'ers are placing on our shoulders. THERE IS NOT ENOUGH ROOM, ENOUGH STAFF, OR ENOUGH MONEY to deal with the normal patient load, much less an increase of even 15%, which is a very conservative estimate of how much our patient load will increase over the next 2 years.

[busymom]

54. I think that you misunderstood me...

I was responding more in general to you and to some of the responses...not to spark more debate, but just to add a different experience.

1. Have you stepped foot in a public (normal) hospital in the UK or Germany? I have and they aren't the Taj Mahal either...And yes, I have stepped foot and volunteered and worked in inner city hospitals in America...so...I have a way to make comparisons.

2. You are absolutely right and it is WRONG. We have to find a way to create some form of universal coverage in this country. There is no excuse for having our nation have so many people without insurance. It is truly shameful.

3. Medicare and Medicaid have cut their payments so drastically that if doesn't pay for doctors to see the patients. Most medicare patients, for example, have multiple co-morbidities and are often time-consuming. Medicare reimbursement doesn't pay squat and yet the patients need the time. I know many docs simply opting out of medicare patients or greatly reducing the number that they take. The bottom line for many doctors is not greed, it is survival. The average medical student leaves medical school with 100,000-150,000 in debt, as you know. Tack on low paying residencies (for the number of hours worked...and often spouses if they have children can not work during this time even if they want to due to multiple moves for training and reliable childcare pick-ups, etc), the costs associated with buying into practices, malpractice, paying staff and overhead etc. Doctors have become sort of villified and yet...my husband is the first person to go in to the hospital at 3am to see someone without insurance. He earns a nice living, but he put in many years of schooling and sacrifice and continues to make sacrifices for his patients.

4. There has to be a solution for this as well. There will be more issues though, because several outpatient centers also rely on tax-deductible donations (I'm thinking of one here in particular). Obama is making it so that the people who earn 250k or more can't deduct these donations from their taxes. The clinic here will go under without the donations. (I work there part time and so I know of what I speak....and they are all very worried about this.)

5. Community hospitals are being closed...I know...It's terrible.

You are right though...we can't keep squeezing that turnip..things have to change. How are we going to pay for it? Are we going to ask that the people who earn 250k and up pay for it for us? In Europe, everyone has to pay because it is so expensive. Taxes in Europe for everyone are quite high..not just for the people at the higher end of the income scale. And what IS the pain threshold for the upper income earners? At what point are high taxes a disincentive?

Healthcare is the most important issue on my list after the economy right now...I want to see us fix it American-style....so that we can keep the high quality and promote ingenuity and hard work....

As for the nurses...

The nurses in the UK are much better trained than those in Germany, btw and they earn more. With the nurses, I was specifically addressing my time in Germany.

Our personal experience in the UK was in Northern Ireland (also a part of the UK)and my friend lives in London. Are there dozens and dozens of people that don't have a problem? Thank God, yes. Unfortunately though, if you or child happens to be that one that slips through the cracks, you have no recourse and have to fight a govt. bureaucracy for help.


I am absolutely NOT saying we aren't having a problem. I agree with you. My response was more of a general one.

And fyi, the hospital here is also seeing >40% less patients due to people not coming in and having no insurance. The budget has been cut, there is a hiring freeze for nurses and doctors, the internists are unable to accept any new patients because the practices are too full and all new admits without docs are now being rerouted to other hospitals at the expense of patient care.....

I'm feelin' it here...I'm with you...I'm just offering my experience and perspective. Hear it or don't....that's ok.