Moving Day

I had previously hosted my blog on Wordpress. Today, I have decided to move it here as blogger has more of the features I am looking for. It seems to be much more open to my own personal touches, so here I am. I will move all of my old posts here as well. That will take a bit of time, then I will be on to new posts. I promise to post more regularly, as least every few days.

Docs vs Nurses vs Docs

Notice I put nurses in the middle in the title? There is a reason for it. This is how things work at the hospital I am currently working at. We have our ICU docs who run things in the ICU. We also have the cardiologists and the cardiac surgeons. The problem comes in when they don’t seem to communicate with each other. I had a patient the other day that illustrated this the best.

They were in town on vacation and their daughter had a congenital heart condition that had been repaired surgically in their hometown. She was having some complications and was admitted to our ICU to manage. The cardiologist on-call was the one in the group with the largest ego. He was in the room discussing things with the family when the patients home cardiologist called, the one who had treated the child since birth. When Dr. M, as I’ll call our cardiologist, was asked if he wanted to speak with him, guess what his answer was? “No, just tell them to send the records.” Here begins the problems as this was stated in front of the family.

Later on that evening, the parents asked why he wouldn’t speak with their doc, the one they trusted totally. Let me also add that these parents were very knowledgeable about their daughters condition and very involved in her treatment. The kind of parents we love to have around. I had to honestly answer that I didn’t know. They had a few questions concerning what we were doing as far as treatment was concerned,so since it was a Sunday evening, I asked our ICU doc to speak with them as Dr. M had gone home. His answer to quite a few of their questions was that cardiology had to make that decision. So he had us page Dr. M at home and put him on the phone with the parents. Dr. M, from home, told the parents that the ICU docs should make those decisions. According to the parents, he seemed like he just wanted to get off the phone and get back to dinner with his family. He may have even said so, I don’t know why else they would have thought this.

In case you’re wondering, the big question was why was their child not receiving their home medications. I have to side with the ICU doc on this one as most of the home medications were cardiac medications. Something I think the cardiologist should be deciding. But then again, I’m just a nurse. What do I know. These medications were never ordered even though they were on all 3 medication reconciliation forms we had filled out, a subject for another post.

Bottom line is that I had a patient and family that had good, important questions concerning their child’s care at 5PM that were not addressed until the next morning. Not at all acceptable in my book. This is a facility that is totally run and controlled by the physicians for their comfort and convenience. I have yet to see anything done which in any way involves nursing at any point. Worse yet, many of their practices, in my opinion, endanger their patients. We can have patients being treated by 5 or 6+ specialties, all of whom can write orders and none of whom are ultimately managing the care.

Change is a good thing

I started this blog to make clear my feelings about the health care system, it’s reform and how to repair it. Those feelings have not changed, however I find there is a lack of new subject material. As I have been reading and following other nursing and medical blogs, I have decided to change the focus of this blog to my experiences as an RN. I work only PICU, Pediatric Intensive Care, for those non-medical types reading this. I also work as a traveller, so I move from city to city every 3-6 months. I will still post on political topics as the motivation strikes me, but no longer wish to restrict my writing to only those topics. I hope this new direction is a change for the better. I think it will be as I feel I will now be able to post more regularly and more generally about whatever may be on my mind on any given day. With that in mind, I am off to work on my next post. I cannot promise everyday as I have a full life with work, a wife and a two sons, 4 and 5, but will promise to do better than every 2 months. (where the h*ll did that time go).

My Absence

I have been AWOL for a few weeks. Just having started at a new hospital in a new city (Phoenix, AZ), I have had to spend some time acclimating to my new position. I will be back and posting soon. Sorry for seemingly disappearing.

Everone looks, no one types

I find it interesting that a link to my blog posted on the daily kos site

FULL STORY

generated almost 120 “hits” to my blog, but not one single comment. How is it that these many people visited but not one had the courage to directly address my points/concerns? It seems that those with an agenda have no interest in intelligent dialog.I have no idea how to make something an actual link. You may have to copy/paste for the above link to work. If anyone can help me in this regard, I’d greatly appreciate it.

On the Road Again

The life of a travel nurse. I am currently sitting in a hotel en route from the DC area to Phoenix, AZ. I have to report to work in Phoenix next Monday and can move in to my apartment on Friday. My goal is to be there on Friday. It will be nice to spend the winter in Phoenix, though travelling cross country, 2300 miles, with my 2 sons, 4 and 5 yrs old, is a challenge in and of itself. Also just shipped 12 boxes of clothes, etc. to myself as we have more than our poor little Camry can carry. What an adventure this will be. This time, instead of the county hospital in Phoenix, I will instead be working at the children’s hospital. It will be interesting to see if there is much difference. I started out traveling for many reasons, one being that having worked at Duke Hospital for my entire nursing career, I wanted to see if their ego was deserved. To some degree, it is, but it mostly has to do with volume and experience. We, my wife and I, also felt that with our children being the age they are, that now is the ideal time to do this. They are old enough to appreciate what is happening, yet young enough to not have all the ‘I don’t want to leave my friends’ concerns. For all the stress that moving every 13 weeks causes, I wouldn’t trade it for the world. From a nursing perspective, it is heaven. I do not get involved in the ‘politics’ of the hospital or unit I am working on. I go to work, do my job and go home. There is the downside of having to learn new systems, processes, etc. every place I go, but I treat it as a learning experience. So, all in all, I come in, help fill staffing holes, ignore the pettiness of politics and have fun doing what I do. All this and I, unfortunately, get paid more than the full-time employees. Through all of it, my agency is my employer, so in a resume sense, I am not changing jobs at all. I will continue to update on the ups and downs of traveling as time allows.

Universal Healthcare Won’t Work

I am an RN who works in a Pediatric ICU, so I see first hand the internal workings of our healthcare system. I work as what is known as a traveling nurse. I work in a location for 13 weeks and then move on to a new location, so I also have experience in more than one area of the country as well as different types of hospitals. I have worked at Duke University and also at the county hospital in Phoenix, AZ. Currently, I work at a hospital just outside Washington, DC. Throughout all these experiences, I have gained pretty strong opinions about what is wrong with the system and what it will take to fix it.

First, what I believe to be wrong with the system. In a nutshell: insurance companies, including government programs. Actually, the medicare/medicaid system is probably the biggest offender here. Every hospital I’ve ever worked at has had to have a number of people on staff whose full-time job it was to “deal with” insurance issues. I am not referring to the accounting and billing people, these are clinical people (nurses, social workers, etc), who spend their entire day talking to insurance companies about why a patient is still in the hospital, why they’re still in ICU, etc. We have insurance adjusters picking apart the patients medical condition and attempting to micro-manage their medical care. On a daily basis, the nurses and physicians involved in the patients care are asked to explain and justify why we’re doing what we’re doing. I understand the need for accountability, however, when physicians are spending a couple of hours everyday justifying their actions to an insurance adjuster, how are they compensated for this time? Further, how can a nurse provide appropriate care when they know that every action is going to be torn apart for billing purposes? People often wonder why a visit to the doctor costs hundreds of dollars yet they only see the doctor for 5-10 minutes. Because that 5-10 minute visit results in 1-2 hours of additional work for the doctor, the nurses and the office staff. Some of this time is due to legal paperwork having to do with licensing requirements in the sense of “we may need to defend a complaint over this visit to keep my license”. Even greater is making sure paperwork is in order enough to withstand being torn apart by an attorney in a malpractice suit, justified or not. I have experienced this same problem in my own family. When I made the decision to step down from a staff position as a nurse and begin to travel, it resulted in a change in employer, hence a change in insurance. My 3 year old son is on a couple of different medications for severe allergies. We were unable to keep him on his established medicines because the insurance would not pay for one until another, cheaper, alternative had been tried. Of course, we had already done this previously, but this documentation wasn’t good enough. He had to spend 3 months in agony ‘trying’ this other medication because the insurance would not pay for the one that we had already established worked for him. In speaking with the insurance company myself, I asked the adjuster I was speaking to (who had the power to approve the correct medication) what type of college degree she held. I was shocked to learn that she had no degree at all. I have since asked this question anytime I have had to deal with an insurance company professionally and found that commonly, the people at insurance companies deciding whether to approve or deny coverage either have no degree at all or have a degree in business or accounting. In my opinion, these people are making medical decisions with no medical training whatsoever. My question regarding insurance companies is this: Why should someone with no medical training or background at all decide what medical care someone should receive? We have people with no more than a high school education second guessing medical specialists in their care of their patients. Does this make any sense at all? I have witnessed this and can tell many more stories in great detail if you would be interested in listening.

I work in an ICU where split-second life or death decisions are made. i.e. the patient is dying and we must save them…do something in the next 15 seconds or they are dead. If you have ever watched an episode of ER when they are scrambling to save someone and doing many things very quickly, remember that all those actions must be documented to defend against an insurance company’s examination days later, calmly sitting at a desk somewhere with all the time in the world to sit and think. Worse yet, to defend against a lawsuit up to 10 years later being microscopically examined by attorneys with all the time in the world. I am sure you have seen episodes of different attorney shows where the attorneys are dissecting a physician’s action on the witness stand. Keep in mind the statute of limitations for malpractice suits is 10 years, longer if the patient is a child. They have until they turn 28 to file a suit. We as healthcare professionals always must keep in mind as we do our “charting” that we must write enough information so we can confidently defend our actions 10 or 20 years and hundreds to thousands of patients later. I make a point of remembering my patient’s names while I am caring for them, but I am just not good enough to remember them all by name forever. Even a few months later, I am sorry to say I remember them better by their medical course than by name. Therefore, in addition to changes in how insurance operates, the court system as relates to malpractice must be changed. You do realize that malpractice insurance costs more for physicians than a lot of people make in a year? For physicians that I work with, their malpractice insurance costs up to $100,000/year. This money must come out of their billing rates. Hence another reason why your 5-10 minute visit costs hundreds of dollars. People tend to think of doctors as rich. Nothing could be further from the truth. Yes, they make a good living, but they literally make life and death decisions on a daily basis. Remember, I work in a Pediatric ICU, so if your child were critically ill or injured, how much is it worth to you for the doctors and nurses who save your child’s life? Thinking about it from that perspective, how much should they make? And keep in mind, the doctors to make quite a bit more than us nurses. Add to this equation that most of the doctor’s decisions are made based upon information they receive from the nurses and we get into a whole other argument regarding nursing salaries.

I could ramble on more and more about the problems, but it does not fix anything. Solutions are needed and I have a few thoughts in that area as well. You may think I would be in favor of nationalized healthcare. Actually, I think nationalized healthcare would be even worse than what we already have. As I stated earlier, the government programs are the worst offenders when it comes to what I call insurance meddling in medical care. They say no the most often and have no avenue to make a more detailed argument to attempt to prove the necessity of a needed treatment. Talk to anyone, especially someone in the medical field, who has emigrated from Canada and they will tell you how poor the healthcare is in Canada. Sure, everyone is covered and all healthcare is essentially free, but what level of healthcare do they have. I have worked with many nurses from Canada who have stated without reservation that the medical care provided in Canada is vastly inferior to that of the care here. The principle of free enterprise and competition improving the quality of a product applies in healthcare as much as it does anywhere else.

I sincerely feel and believe with all my being that the insurance industry as it exists is the very foundation of the problems in the healthcare system. How to fix that? Somehow create a system whereby decisions on coverage are made based on sound medical grounds, not financial considerations. Perhaps a law requiring physicians in the appropriate specialty making decisions regarding coverage and authorizations without regard to costs. Insurance companies always complain about the high cost of healthcare, yet they are the primary reason for it. Perhaps a standard form whereby the physician can state “this is the patients condition, this is what we need to do”, and then get a yes or no without multiple requests for more information. This would result in the physician performing much more efficiently, thus enabling the billing rate to be more reasonable. There are other ways to address this as well.

In combination with this must be some kind of reform of the malpractice laws. There are much too many frivolous lawsuits being filed and making it all the way to trial. There has to be a way to hold attorneys accountable for clogging the system with cases that should not even see the light of day. I have encountered respected attorneys who have medical personnel on their staff who research cases for merit before deciding to even take a case. The burden in medical malpractice is “acceptable medical practice”. This perhaps needs a more specific definition. Also, not to put a value on a life, but is “uncle john”, who dies at 85 due to complications after surgery really worth $100 million? This seems outrageous to me. The constitution states “a jury of peers” in criminal cases. Should a doctor or nurse in a malpractice case not be afforded the same protection? Perhaps a jury composed of doctors or nurses who actually have the training and experience to judge the actions taken in the case?

I do not claim to have all the answers to this problem, but I do feel I am extremely qualified to pinpoint the causes of the problem. I would be happy to answer any questions and/or discuss further with anyone who is interested in discussing this issue with an open mind. Bottom line is this: show me a government run program in ANY AREA that works, and I may rethink my position somewhat.