I am a supporter of the Affordable Care Act. I have waited a very long time to see the availability of reasonably priced insurance come to pass. I never actually believed it would happen, so I tried not to get my hopes up. It did happen, though, and I am very happy, even though I am worried.
What has me worried is the fear that it will be taken away just as quickly as I got it because of people stereotyping those who need it.
I know there are many people who are not as pleased as I am. I'm seeing the negative stories in the news, on TV and all over social media. I feel terrible for the people who have lost insurance, blaming the ACA. Or the people who have seen rate increases and services decline from their current providers.
The blame, however, belongs to the same group it has always belonged to, and that is the Insurance Industry. Along with Big Pharma, I believe they are responsible for 99% of all the evil and woes of healthcare. Insurance companies are using the AHA as an excuse to drop clients and charge higher deductibles. The government has given them a perfect scapegoat, allowing them to look innocent while doing what they have ALWAYS done.
I know for a fact that hospital benes were changing and shrinking long before the ACA was even a twinkle in Hillary's eye. When I first began working in hospitals in the 1970s, we had 100% health and dental coverage, and a 50% discount for any employee using their hospital's services, including pharmacy. I watched benefits shrink over the last 45 years to almost nothing. So no, you won't see me blame the ACA for that.
When I moved from Virginia to Maryland in 2009, my insurance company, BC/BS Care First, a minimum plan with huge deductible, said they would no longer carry me, and that I would have to apply to Maryland Care First. I did, and they turned me down for coverage because of pre-existing conditions. I tried many other companies, but the word was out-I had PExC and no one would cover me. I contacted Virginia Care First and asked about coverage if I still worked in their coverage area. Ah HAH! Yes! I could get coverage with my former plan as long as I worked in Manassas, but my rate would be increased from $233/mo to $476/mo. I couldn't possibly afford that, so I did without.
Now with the Affordable Care Act, I am insured with health and dental for the first time in 5 years at a rate, that while not cheap, I can afford. I'm not a junkie, an illegal, or lazy. I'm retired. I worked hard all my life, and I am happy I had this choice. I'm not the only one either, and we don't deserve to be made to feel badly about it.
A laboring mom in Florida was left alone in her room, and the baby was born in the bed without staff present.
I know babies are born safely all the time outside of hospitals, but people who don't want that to happen, go to hospitals!
Thank heaven the baby is OK as far as we know. That's the good news. The fact that the story went national, in my opinion, is also good news. It SHOULD have, because the public needs to know how things are. But I want to talk about some other things that I really dislike about this particular story.
What I dislike are the words "abandoned" and "flee." I think that implies intent, or negligence. I don't believe that was the case here. I also dislike that I hope to really shame Dr. Elana Deutsch for throwing the nurse under the bus like that. Here are her remarks:.
“It must have happened very rapidly, because I was only in the C-section for 30 minutes,” obstetrician Dr. Elana Deutsch told the Post, adding that a nurse should have stayed with the couple but was likely “nervous” about being there alone. “By the time she [the nurse] was back in the room, the baby was in the bed,”
The thing I dislike the most though, is that the people who are really negligent will share none of the responsibility, or blame.
You know as well as I do that this unit was not well staffed. I don't care how they crunch the numbers to make it look like they had the necessary FTEs on duty at the time, they obviously didn't, or that couple wouldn't have been left alone.
Listen, you can't fool me. When I was still working as a supervisor, I got more than one call to go to the labor unit because the staff had to attend a stat C-section. And often I was the only RN on the floor. Hell, sometimes I was the only PERSON on the floor...left with laboring moms...and I'm no OB nurse. I've actually "fled" to the OR Suite to demand someone come back out because of impending birth.
That just isn't right. The American Hospital Association needs to re-evaluate their priorities and get back to the business of patient care instead of the business of business, because, believe me, the two are not the same, and hospitals are failing dismally at so called customer service!
Something very strange has happened to me. As you know, I have an opinion about everything. And for some reason, people often seek my opinion on matters, which I happily, and admittedly, often haughtily give. I am currently stumped on a recent development in medicine, and actually, in our country. I am speaking of the legalization of marijuana. Medical marijuana. Even the name confuses me. I just see an oxymoron.
Oh I know what it is, but I remember (sorta) the ‘60s when it was named pot...weed...maryjane...grass...wacky tobaccy. I am really struggling with the stuff from the ‘60s being seen as a serious weapon in the arsenal of treatment modalities. Yes, yes, I know it's true, but my twisted brain can't get past, well, the past.
I can't help but thinking that patients will still have these illnesses, but after a few tokes, (I mean therapeutic inhalations) they just won't care anymore. Or they'll giggle incessantly about being sick. I see progress notes saying things like, "the patient no longer suffers from her high-atal hernia." Or "the patient's kidneys are now successfully re-stoned." And "the patient reports no more nausea, but has developed a severe craving for Cheetos."
So I've decided all I can do is just sit back, fire up the pipe (um, I mean woodstove pipe) and wait for the re-make of Reefer Madness 2015. I have my Cheetos ready.
I cannot believe how much things have changed in a year, and yet how much they've stayed the same. Since I retired, hospitals are laying employees off again, nurses are looking for new jobs in what seems like record numbers, and everyone blames everyone else.
I spent the biggest part of my career working in Virginia, and things there are changing fast again. For example, one of my former employers, Valley Health System, made personnel cuts affecting all SIX of their hospitals. They acquired six hospitals because they wanted to. When the news of the cuts was reported in the local paper, the comment section almost caught fire.
The remarks were almost identical to the ones that were made when the 90s layoffs occurred. People complained that the CEOs unnecessarily made 6 figures, a fortune was spent on things like artwork, aquariums, pianos, and other aesthetically pleasing items rather than needed equipment and supplies, and that money was just plain wasted instead of being used where it was needed. It seems to me that this is just a cyclical purging. Hospitals spend money until they're broke, they blame the economy, or Obamacare, and the staff pays the price.
My question is, why isn't a CEO ever laid off? Why is it NEVER poor management? Lose him and keep the 33 other people you just let go. I'd rather have a good experienced nurse in the house than some CEO. Believe me, I've known a few CEOs, so I can tell you...they aren't all that. And in the case of hospital layoffs, the good of the one NEVER outweighs the good of the many. They should be ashamed.
This is the season to wonder. And I'm faced with wondering what the heck to write about. I really wanted to talk about joy and family and cookies and puppies and elves this year, but I just can't shake off the blahs.
I think part of the problem is that I'm not busy anymore. Since retiring, I don't have the concern of having to be somewhere at a specific time, and I don't have to try to find the time to shop and wrap gifts. No more Secret Santa, no more traveling hospital dinners, or the big party; no more schedule-swapping or arguing about which holiday you worked last year. Can it be true that I miss all that? It's like when you graduated from high school. You couldn't WAIT to get out of there, and the following year, you go back to check out what's going on since you left.
Not being busy leaves me way too much time to think about what I miss. I want to love the holidays again but thinking about it has made me a little sad. I can't remember the last time I bought a live tree, and it's been almost 5 years since I put one up at all or even decorated. I do have a wreath on the door, and a stocking hung over the woodstove, but that's it. I live alone, and away from my family, so if I want to spend this special time with them, I have to travel several hours to do so. And I do so gladly, because I love my family, but there's no point in my decorating my house just for myself.
I do, however, take great joy in knowing that I do have a home I could decorate, and a family that I will get to spend time with. Oh the love of my sister's homemade cookies, and the joy of watching the wonders of the season as seen through the eyes of my three perfectly wonderful little grand darlings. Shhhh! The elves are bringing them a puppy this year!
And would you look at that! I did write about wonder, joy, family, elves and puppies after all!
Happy Holidays everyone!
So I see that full disclosure of medical mistakes articles are re-emerging again, like the one that NBC NEWS online just ran. Like most nurses, I have an opinion about this. I think we do a pretty good job about telling on ourselves, so we don't really need to tell on each other so much...but doctors? That's another story.
Anyone who thinks the "Good Ole Boy" network is a thing of the past is clearly naïve. And forgive me for being sexist...I'm using an antiquated term, but the meaning remains the same. They don't tell on each other, and nurses are afraid to tell on them because of retaliation. See, they SAY that there will be no consequences, but we know there always are. Certainly a grueling interrogation by risk and human resources will be had, and maybe a change in your schedule, or assignments.
I once worked in a small facility that I and others believed had a terrible postoperative infection rate, and nothing was being done about it. I had personally witnessed and reported possible reasons for it, and was ignored. Classic example: One weekend evening as the supervisor on duty, I was making rounds and entered the OR to run a machine on its cleaning cycle. After I got all suited up and gloved, I enter to find none other than an ortho surgeon with his son, another child, another parent, and a coach in one of the surgical suites. The surgeon was putting stitches in the other child. They had just come from the baseball field, and were filthy dirty. I questioned the wisdom of this decision, and was rudely dismissed by the surgeon. Later in the evening, I had the chance to tell the anesthesiologist about it, and was blown off. Of course I documented it on the proper form, and submitted it to my director and risk management. The result? I was told by risk that I wrote entirely too many risk reports, and no one addressed the issue with the surgeon.
So should colleagues tell? Yes. Will they? I seriously doubt it.
Ahoy all nurses! I just returned from a cruise with friends and I was a passenger, not a Medical Officer. I can't tell you how much fun we had. We were four nurses, out to have a ball, and we did. Comparing notes at the end of the day, we found we didn't get too far away from our RN persona. At least once a day, each of us had some sort of medical encounter.
One of my traveling companions heard the entire sexual STD history of a complete stranger. I personally advised a new graduate on ways to ensure a staff position in the emergency room. People would ask what we do and saying "I'm a Nurse" always opens up conversations...Proof again that the public really trusts us.
The public may, but apparently our colleagues don't. We visited the private island where I actually worked with my cruise line, and I knocked on the medical staff door so that I could show my friends the well equipped clinic. I was met by the ship's MD who wasn't terribly friendly, and wouldn't let me in. I guess she didn't believe my explanation...even though my name was written all over the clinic journal since 2007. No fuss was worth it, I was on vacation, and no harm done.
My friend was able to get a good idea from my description. Anyway, we had no other need of the medical team, so the slight was forgotten. The only bad thing about the trip was how sad I felt about resigning from my cruise line. I so enjoyed sailing as a Medical Officer, and I will really miss it. I worked with some amazing teams, and made what I hope will be life long friends. I wish them smooth seas and fair winds, and hope to see them again someday...as a passenger and not a sailor!
Since last I wrote, I have been giving a great deal of thought to what I want to do in my retirement. Some of you offered very good suggestions, and I thank you for them. One thing I decided to do was to stop worrying so much about it, and just enjoy what is happening in my life right now...Other decisions can come later.
I still hear from former colleagues, even if it isn't face to face, and I find my opinion is still sought on matters. I like that. (Write to me PGVRNBSN@gmail.com if you want an honest no BS opinion about nursing!)
I'm going on a cruise in 2 weeks with family and friends, NOT as a Medical Officer but as a passenger, and I'm so looking forward to being spoiled!
I actually have long fingernails again. I haven't been able to grow mine in over 25 years!
I'm watching every TV show that is suggested to me, and loving them all. I have never denied or apologized for the amount of TV that I watch. My mind has not turned to mush as the TV snobs say will happen, and in fact I consider myself exceptionally well informed because of TV! (BTW, thanks Sissy for telling me about Sons of Anarchy. Jax's naked backside is gorgeous!!)
My ex and I are back on friendly terms, and I am very happy about that for the sake of my son and my grand darlings. I've re-connected with family, and especially first cousins that a busy nursing life kept me away from for far too many years.
So I guess I will survive this retirement thing after all. Just like everything in this life, it's all about your attitude!
I wanted to continue with this blog after retirement, because I thought I would be able to tell you what it's like for an old RN like me to be out to pasture. I'm going to try, but the truth is, it's been weird in both good and bad ways.
The foremost thing I've noticed is how much I sleep, or sometimes don't sleep...actually, it's a total screw up of my internal clock. Never before could I sleep in a chair, but I can now. I'll be in my chair watching TV, and before I know it, I'll wake myself up snoring, and it will be two hours later! Or I'll be reading or watching TV in the evening, and suddenly it's 0530. I've talked to other recently retired nurses who say that this little game goes on for about a year, and longer if you worked different shifts.
It's also taking some getting used to not being able to "shop" when I want. I never was much of a shopper, but now I have to wait for the second Wednesday of the month when the SS check comes to see what I have left after paying bills. Maybe I can get those shoes, or go out to dinner...or maybe I can't. Regardless, this is a budget that I'll be on forever.
Another thing is how horribly much I miss my colleagues. You see, I was all about nurses and nursing. Not only was this my vocation, it was my social life. Granted, I moved 4 hours away from everyone when I retired, but I'm at home, and I waited a long time to get back here. I just wish my friends from work would visit as much as they said they would. I live in an Atlantic beach resort community, and I do dangle it as enticement, but they are all still working full time and I know how hard it is to get away. Same goes for missing my grandbabies. They're very young and it's a lot for their parents to pack 3 little ones up for a 6 hour car ride!
So what do I do all day? I walk my dog 2 to 3 times a day, and I read a great many REAL books. I'm also writing another book, of course about nursing. I spend time on Face book, which has been great fun, but I need more to do. I believe that everyone needs a purpose. Nursing was mine for 45 years, but now it's time to find another. I'm open to suggestions...
Back in February, I lamented here the fact that in order to continue my cruise job, I would have to recertify my BLS and ACLS. I thought that was over with when I retired from hospital nursing.
My main source of annoyance was that I was going to have to pay for the classes out of my own pocket for the first time ever. This did not make me happy. I also wasn't looking forward to trying to locate a class locally and in the time frame that I would need. I began the searching process where I begin everything...on the internet. It was there that I discovered online recertification classes. What, I wondered, would I get for my money? Would my employer accept it? Should I consider it? After all, we can get a BSN or a MSN online...why not recertify ACLS online?
I got several responses to that Blog primarily from ACLS instructors who didn't feel like it could be a complete or effective learning experience without the hands-on practicum part. However, I also heard from the director of The ACLS Certification Institute who made a generous offer allowing me to take their online classes in return for an honest critique here on my Blog. No fool I, I made the deal.
The site is very user friendly and has a FAQ section that covers a great deal. There is no pressure, no time limit, and a great deal of study material available. The site follows all the latest 2010 protocols, (I was comparing with my last AHA ACLS study manual as I went along) you have a 60-day risk free window, AND you can print your own card and certificate as soon as you pass. I reviewed all the material as presented, followed the site's outline, and took the exam. It took several hours to do everything in order, and I thought the test was hard! I usually breezed through my AHA tests, but I really needed my thinking cap on for this one. It felt like there were more questions on this test too. But I'm not really sure about that.
And what about the practical part? Frankly, I didn't miss it. And also being frank I don't think I needed it, at least this time. Please understand, I've been taking these classes for a very long time now, and I remain proficient at reading EKG rhythms,and my techniques for airway adjuncts, IVs, and compressions haven't changed in 20+ years.
So, what do I think? I think that if you are an experienced RN with multiple ACLS classes behind you, you'll be just fine with this online course, IF your employer will accept it. I think that it is a good alternative to the full classes that include practicum. Now, if I were still working full time and could, I would probably do the online recertification every other time.
I do not think, however, that novices should rely solely on the online course, unless it is used for additional practice and information. Novices need that hands-on experience. Besides, the classes are fun, and the support from classmates and co-workers is always a helpful bonus. Again, though, if you snooze through the drug and treatment modality classes, and keep thinking about the grocery list while you're waiting your turn for Mega Code, then this site is for you.
I'd like to offer many thanks to the ACLS Certification Institute for this very positive experience. I'll get to the PALS recertification in August!
I wasn't going to touch this. No really, I wasn't. I've written before about my own struggle with nicotine addiction (read: Smoker) so I'm pretty sure my opinion will be less influential because of it. I refer to recent headlines that have noted more hospitals are now refusing to even hire smokers.
This trend has slowly been creeping its way into healthcare systems throughout the country. There are now approximately 60 U.S. hospitals that would not hire me...Even though what I do in my private life, like smoking, is none of their damned business. So if I needed to work at one of these places, and I couldn't (or wouldn't) quit smoking, I'd have to lie to get a job. What a great way to start out on a new job!
The rationale is the amount of productivity in dollars lost by smokers. It's all about the money. Of course it is. It's a little under two grand a year per smoker according to the studies. I have to tell you, this really is a thorn in my side. I can swear to you with a clear conscience that I called out sick WAY less than some of my colleagues who had various chronic health issues. I doubt if their lost productivity was studied, or even an issue.
I wonder how many dollars worth of productivity asthmatics or diabetics lose? Oh, OK you want to make it a about self-inflicted negative impacts? Then let's talk about alcohol use. I wonder how many callouts there are due to alcohol consumption or prescription drug use. Particularly on Monday! Both are just as legal as cigarettes, yet some hospitals are even TESTING employees for nicotine use.
I'm glad I'm retired, but I'm telling you, they'd have to be giving everyone a breath-o-lyzer test at the beginning of each shift before I'd let them test me for nicotine. This is just outrageous to discriminate this way, and you non-smokers should agree! But I'm thinking you won't...
I know I've said I don't like EBOS (evidence-based order sets), because I don't believe that a single treatment should be used on every patient with the same diagnosis. Now having said that, I don't mean to imply that I am against the research that brings us to EBOS conclusions. I realize how important medical research is. I wonder though, if the millions of dollars designated for research are being used in the most effective way.
Let's face it, there's some pretty silly research being done. I remember a few years ago, reading a journal that described a several million dollar grant to study the effect of chocolate and salty snacks on pre-menstrual women. Seriously? Yes seriously. Listen, for $100.00 I could have told them everything they needed to know. For good measure I would have offered up the 3-11 staff in the ER as the control group.
As recently as 2 weeks ago, I read a research study that verified doubling up on Tamiflu for severe flu symptoms didn't help improve the outcome or length of illness. Duh. Didn't we know that already without a study? We tell patients all the time more isn't necessarily better with prescriptions.
But here is my all time favorite study. Someone FINALLY listened to me. I have been saying for YEARS that the passageway between the set of double doors to the ER should be like a carwash; the patient on the stretcher should be placed in the center, and then sprayed with soap, water and chlorhexidine, then rinsed, dried, gowned, and only then placed in a exam room. Hospitals aren't clean anymore because the "people we serve" are bringing all sorts of germs in! If we decontaminate them, HAIs will dramatically decrease. And again...Duh!
The social networks among nurse
are all abuzz about the new staffing ratio bill being introduced to congress by
Sen. Barbara Boxer (D-Calif.). Like the cicadas, this attempt rolls around
every few years when someone in power like the good senator tries to get this
Odds are she was recently exposed
to a hospitalization situation and saw some things first hand that didn’t sit
well with her. Maybe a friend couldn’t get to a CCU bed for 16 hours. Or maybe
her daughter had to wait and hour for pain medication, hence the bill. Or maybe
California’s strong nursing union just got to her.
Everybody is happy and
supportive, and naïvely believes this would be the answer to everything. After
all, it’s no secret adding RNs at the bedside improves patient outcomes. The
staffing ratios presented in the bill are every nurse’s dream ratios. Go here
for an easier read of the bill. You can also track the bill’s progress here. You can also see
the projected chance of the bill getting passed at that site: 0%. It’s already
Now if in some other dimension this
bill were to pass, I don’t think everyone would be as happy about it as they
think. In my long career, I have never seen an increase of RNs without a more
severe decrease in other services. Those darn hospitals have to pay all those “extra
RNs” somehow. So you begin to see CNAs and techs disappear, and those left begin
to cross-train as unit secretaries. PT/OT/RT services get cut too. Case
management staff becomes smaller, with openings not filled. Good news for new
grads though, they start getting jobs because they’re cheaper than RNs with
Yeah I know. Here I go again
spreading sunshine and cheer. Listen guys, I REALLY hope I’m wrong. I will lead
a parade if this bill passes. Hell, I’ll donate more money to Nurses House if
it even gets passed through the first committee!
In the meantime, all you
optimists out there, we need you to keep believing. Somebody has to!
My gosh, where does the time go? I almost missed my annual homage to National Nurses Week! I guess it's not on the front burner because I'm retired, but make no mistake...I still consider myself a nurse who can comment on Nurses Week.
Retirement has been interesting. I've slept mostly. (Don't let anyone tell you that you can't catch up on sleep.) I've also been working on the yard, playing with the boat, and oh yeah, I rescued an older dog. Two old gals together.
Anyway, I know I've taught you about the history of Nurses Week, how it relates to Flo, and how interesting and wonderful we are. Enough of all that. I have a slightly different and fun way to celebrate this year. My Facebook colleagues and friends have been joining me in posting photos of ourselves in the workplace since and including graduation. (See below.) The pictures have been wonderful! I urge you and your friends to do the same. You still have until May 12th.
I would also like to plug my favorite charity this week; Nurses House Inc. This should be your favorite charity too. I urge you to donate to them in honor of our profession, and if you can't donate, at least promise me that you will get familiar with this fine organization for Nurses. You will feel very good afterward! I have been donating annually for years, never thinking I would need them, but I did. I became a grateful recipient of their generosity after my hip fracture a year and a half ago. Ya never know...
So play on Facebook, donate to Nurses House, hang in there, and remember that you are an elite group of people. Nurses are simply the best.
A friend and colleague came for a visit recently, and as he read the newspaper, he commented on the fact that a baseball player had renewed his contract for several million dollars. My friend is good at math, and calculated that the ball player would get roughly $130,000.000 each time he got up to bat. I don't know a lot about baseball salaries (or math for that matter) but even my brain recognizes that as a bit excessive. We then began a spirited dialogue regarding this unbelievable salary...Who in the world deserves that kind of money!?!?
I felt really stupid, because my motto has always been that all salaries are negotiable. I never accepted the first salary I was offered when I applied for a job. Never. And if I was to discover that another nurse made more than me, I was glad, because that meant I could negotiate for more. We KNOW what we're worth, and yet we don't demand our worth. I don't understand why we aren't outraged that a ballplayer makes that kind of money, and we don't. I can save a life AND hit a baseball. That should make me worth more. And while I'm at it, I'll add police, firefighters/EMS, and teachers to the more deserving list.
Do you agree?