I’m the nurse who called 911 for help with staffing(nurse.org)
nurse.org
I’m the nurse who called 911 for help with staffing
https://nurse.org/articles/nurse-who-called-911-real-story/
173 comments
Note that one of the things they're doing is sign-on bonuses. In other words, a short term wage increase that just encourages nurses to hop to another job as soon as they have worked long enough to qualify for the bonus.
Before the The medical insurance business crew, and before the Johnson administration interfered with the market, many hospitals in the United States were run by religious organizations as a civic duty, not as a money-making venture.
We can see the detritus of those days in the names of Baylor, Baptist, Presbyterian, St Michael's etc.
We can see the detritus of those days in the names of Baylor, Baptist, Presbyterian, St Michael's etc.
Even religious institutions are not immune to corruption. They just have different expectations (charity) surrounding the same motives (growth).
In the same vein, British nurses are going on strike now over pay and understaffing. In UK government sets their salary, so this is like all nurses going on strike - what do you do if you need to gove birth? There will be bodies.
The thing I don't understand - allegedly coservative government is capitalist to the core. So they can't hire enough nurses. Are they going to increase pay to hire more nurses? No. Capitalism for me but not for thee.
https://www.bbc.co.uk/news/health-63561305
The thing I don't understand - allegedly coservative government is capitalist to the core. So they can't hire enough nurses. Are they going to increase pay to hire more nurses? No. Capitalism for me but not for thee.
https://www.bbc.co.uk/news/health-63561305
> what do you do if you need to gove birth? There will be bodies.
Every time I've seen medical strikes, workers organize emergency crews who stay behind to avoid exactly that. People choose medical professions to help others, and especially nurses typically do so despite the working conditions.
Every time I've seen medical strikes, workers organize emergency crews who stay behind to avoid exactly that. People choose medical professions to help others, and especially nurses typically do so despite the working conditions.
>especially nurses typically do so despite the working conditions.
This mentality is what's being exploited. And nurses are getting fed up.
They want to help people. But so much of the decision making is taking that away from them. Even the simple shit like bathing patients is being rushed or removed from them because they're too busy. Simple things like brushing a person's hair helps humanize them. At a certain point they're so overworked with terrible ratios that they can see all the inevitable near miss scenarios that have almost caused harm to patients or themselves/coworkers and without any support from the system to correct these issues they're giving up.
Again, they want to help, but they also can't repeatedly stand back and watch the train wreck in action. Many of them are saving themselves and exiting the profession because the mental and emotional toll they pay each shift is becoming too much.
My wife is an ICU nurse. Most of what I've said here comes from her, or her colleagues who I talk with.
This mentality is what's being exploited. And nurses are getting fed up.
They want to help people. But so much of the decision making is taking that away from them. Even the simple shit like bathing patients is being rushed or removed from them because they're too busy. Simple things like brushing a person's hair helps humanize them. At a certain point they're so overworked with terrible ratios that they can see all the inevitable near miss scenarios that have almost caused harm to patients or themselves/coworkers and without any support from the system to correct these issues they're giving up.
Again, they want to help, but they also can't repeatedly stand back and watch the train wreck in action. Many of them are saving themselves and exiting the profession because the mental and emotional toll they pay each shift is becoming too much.
My wife is an ICU nurse. Most of what I've said here comes from her, or her colleagues who I talk with.
"This mentality is what's being exploited."
There was a BBC article about this recently, titled "The workers leaving their dream jobs"[1]:
"....workers have always hoped for roles that coincide with their interests and passions ... Yet this 'do what you love' narrative comes with drawbacks. Many people find that their dream jobs require more work, under worse conditions. Others discover that the industries they idolise trade on workers' passions to keep pay low..."
[1] - https://www.bbc.com/worklife/article/20221010-the-workers-le...
There was a BBC article about this recently, titled "The workers leaving their dream jobs"[1]:
"....workers have always hoped for roles that coincide with their interests and passions ... Yet this 'do what you love' narrative comes with drawbacks. Many people find that their dream jobs require more work, under worse conditions. Others discover that the industries they idolise trade on workers' passions to keep pay low..."
[1] - https://www.bbc.com/worklife/article/20221010-the-workers-le...
As someone very far from understanding what is going on, what is the rationale that governments are using to justify not increasing salaries/working conditions?
I know it's probably a variation of "there's no money", but, I would imagine nurse care to be something important for everyone.
I know I am being naive as I live in a country where the gov ia about to make significant cuts to health spending... but I always thought "first world" countries such as the UK would make saner choices in areas like this one.
I know it's probably a variation of "there's no money", but, I would imagine nurse care to be something important for everyone.
I know I am being naive as I live in a country where the gov ia about to make significant cuts to health spending... but I always thought "first world" countries such as the UK would make saner choices in areas like this one.
Few people will suffer appreciably from the situation. Everyone will suffer from paying more taxes to fix the situation. Thus the voters will choose to underfund UHC systems. It's the inevitable result of having the same people in charge of spending and deciding if the standard of care is met. The solution that causes the least voter dissatisfaction is to lower the standards.
> . The solution that causes the least voter dissatisfaction is to lower the standards
I believe there is no such consensus in UK, you are just trying to rationalise incompetent governance and ideology.
Last prime minister's best thoughts on Brexit was a 10 minute rant about cheese. Wether honest or corrupt, good or evil, how does a person of such modest ability come to top office? Trully the land of opportunity!
https://youtu.be/UFNRUuBARM4
I believe there is no such consensus in UK, you are just trying to rationalise incompetent governance and ideology.
Last prime minister's best thoughts on Brexit was a 10 minute rant about cheese. Wether honest or corrupt, good or evil, how does a person of such modest ability come to top office? Trully the land of opportunity!
https://youtu.be/UFNRUuBARM4
> This mentality is what's being exploited.
This is one of those things that I find schizophrenic about capitalism: the more you like your job, the less valuable (monetarily) your work becomes. Because, you know, you're being compensated in that warm fuzzy feeling when you do your work.
Except that this is insane! I can see the logic of the system ending up with that reasoning, but if that's the outcome then that system is stupid.
And also, turns out that fuzzy feelings don't feed a family.
And the fuzzy feeling crucially comes mostly when people are able to do their job well, not rushing it because the allocated minute to do it is running out.
This is one of those things that I find schizophrenic about capitalism: the more you like your job, the less valuable (monetarily) your work becomes. Because, you know, you're being compensated in that warm fuzzy feeling when you do your work.
Except that this is insane! I can see the logic of the system ending up with that reasoning, but if that's the outcome then that system is stupid.
And also, turns out that fuzzy feelings don't feed a family.
And the fuzzy feeling crucially comes mostly when people are able to do their job well, not rushing it because the allocated minute to do it is running out.
And salaries in healthcare are far, far lower outside the US.
Like the UK and Europe pay absolute peanuts in comparison, just like in Tech, Law, etc. too.
Like the UK and Europe pay absolute peanuts in comparison, just like in Tech, Law, etc. too.
I'll take my $300k UK tech salary over $400k in the US and not go bankrupt over a medical bill or have my child shot at school, or get beaten to a pulp by a cop for trying to exercise my rights, thank you.
It's depressing but not surprising that everyone in this subthread who said that strong social safety nets are worth a pay cut is getting downvoted. There's a strong thread of social Darwinism among HN readers.
I think it may also be American exceptionalism at play. It shows in the time the downvotes appear on any comment that dares to point out some deep problems that US of A have been struggling with for quite a while.
But then, what can you expect from people indoctrinated from early childhood by, among many other things, being coerced to pledge to the flag every day like it's North Korea.
But then, what can you expect from people indoctrinated from early childhood by, among many other things, being coerced to pledge to the flag every day like it's North Korea.
Anecdotally it is much, much, much easier to get a $400k tech job in the US than a $300k tech job in the UK, so this isn't really a fair comparison
when I moved from a tech job in the UK to a tech job in the US, my salary more than doubled
when I moved from a tech job in the UK to a tech job in the US, my salary more than doubled
95-140 is more correct.
And I'd still take it over the US.
And I'd still take it over the US.
Your $300k is extremely rare.
I make <$100k and I'd gladly make half what I do if I never had to worry about a medical bill ruining my life ever again.
[deleted]
Your medical bill concern is valid- the others aren't really. The likelihood of being beaten by a cop or getting injured at school are probably about the same.
It's also much more expensive to become a doctor in the US though right?
So how high are the relative salaries for nurses?
> this is like all nurses going on strike - what do you do if you need to gove birth?
You see a midwife to give birth, not a nurse. I believe they’re also striking, but they’re not nurses and it’s an entirely different strike.
You see a midwife to give birth, not a nurse. I believe they’re also striking, but they’re not nurses and it’s an entirely different strike.
Small point: Here in the US, midwife services can be great for uncomplicated and (mostly) unmedicated births. However, if you have any complications, you likely need to see an MD really really fast.
Yeah most UK maternity wards are run by midwives, but there's an obstetrician on call (on site.)
Thanks for the info! It's always fun to learn about the various medical differences between peoples.
Not really. My sister trained as a midwife and there are extremely few cases where an MD could have possibly done a better job than people who spent their entire careers studying pregnancy and birth.
She spent a lot of that time working with poor Amish communities, not the well-off people you probably imagine hire midwives in the US.
She spent a lot of that time working with poor Amish communities, not the well-off people you probably imagine hire midwives in the US.
I don't see how this is possible. Hospitals can have multiple MD's on site in seconds, perform emergency C-sections, have large amounts of monitoring equipment, and so on.
I looked for some studies, but everything I found was based on poorly designed experiments and aren't worth linking to.
(e.g., excluding all complications after the fact shows similar fetal outcomes, but more cesarians for hospital births; failing to exclude non-credentialed midwives shows more fetal deaths for home birth. Duh?).
I looked for some studies, but everything I found was based on poorly designed experiments and aren't worth linking to.
(e.g., excluding all complications after the fact shows similar fetal outcomes, but more cesarians for hospital births; failing to exclude non-credentialed midwives shows more fetal deaths for home birth. Duh?).
It may depend on state, but I thought that c-sections are MDs only. Given that ~30% of all births in the US are via c-section, I wouldn't agree that such cases are rare.
If my sister is to be believed [0] C-sections are over-utilized by hospitals.
[0] I admit there is perhaps some bias here
[0] I admit there is perhaps some bias here
This is a pretty widespread belief, right? Haven't looked into the actual underlying facts.
Looking at C-section rates:
https://www.statista.com/statistics/283123/cesarean-sections...
If I were a woman I'd probably rather live in some of those low C-section countries than the high ones. But this is "policy analysis by general country vibes," probably not very accurate, haha.
Looking at C-section rates:
https://www.statista.com/statistics/283123/cesarean-sections...
If I were a woman I'd probably rather live in some of those low C-section countries than the high ones. But this is "policy analysis by general country vibes," probably not very accurate, haha.
You've missed the actual question. Giving birth is just one example of many medically dangerous activities. You can replace with auto accident, stroke, whatever.
In my experience, the midwife was hands-on only in the last hour or so of labor. Everything before that was the nurses.
There are several unions, the main ones being the Royal College of Nursing (RCN) and Unison. The former had always been the "no strike" union, they made that their selling point (when recruiting members). Up until this year, this is their first strike in England.
[deleted]
Well, since pregnancy is not a disease or disorder, I think that childbirth will be easily handled in routine ways by midwives. I look forward to fewer instances of induced labour and C-sections due to the obstetrician's tight golf schedule. Or fox-hunting or whatever British pastime gets in the way of collecting insurance monies.
I think it follows from supply/demand that capitalism applies. If the nurses cut supply then demand goes up and eventually the consumer (government) has to pay more, unless they (government) introduce artificial (socialist regulatory authority) to make the strike illegal.
> socialist regulatory authority to make the strike illegal
So the US government of 1920's was socialist, is that why they ordered the military to carpet bomb striking miners?
> Going on strike could—and often did—mean being beaten by strikebreakers, being shot at by National Guardsmen, or even having bombs dropped on you from biplanes.
https://listverse.com/2017/09/14/10-tragic-times-the-us-gove...
The word socialist has meaning, it doesn't mean 'bad guys'. It means siding with workers in their dispute with capital.
There can be times when it's the wrong this to do, but claiming that strike-breaking is socialist is like claiming that French Revolution was monarchist
So the US government of 1920's was socialist, is that why they ordered the military to carpet bomb striking miners?
> Going on strike could—and often did—mean being beaten by strikebreakers, being shot at by National Guardsmen, or even having bombs dropped on you from biplanes.
https://listverse.com/2017/09/14/10-tragic-times-the-us-gove...
The word socialist has meaning, it doesn't mean 'bad guys'. It means siding with workers in their dispute with capital.
There can be times when it's the wrong this to do, but claiming that strike-breaking is socialist is like claiming that French Revolution was monarchist
Heads up, not all price controls are socialist. You can have price controls that serve capitalists goals. They might make it less of a free market, but that doesn't make it socialist. (Capitalism v socialism is not a binary distinction.)
> Are they going to increase pay to hire more nurses? No. Capitalism for me but not for thee.
UK has public healthcare. The primary mechanism how public healthcare keeps costs low is to use its monopsonistic market power to keep prices (including wages) as low as possible.
UK has public healthcare. The primary mechanism how public healthcare keeps costs low is to use its monopsonistic market power to keep prices (including wages) as low as possible.
Three cheers for Tory misrule and Brexit.
> Are they going to increase pay to hire more nurses? No. Capitalism for me but not for thee.
Regardless of whether you think the nurses deserve the pay raise, I have a hard time understanding why you’d think that squeezing suppliers isn’t part of capitalism. For instance, I doubt people would call Apple anti capitalist for refusing to accept TSMC’s price hikes.
Regardless of whether you think the nurses deserve the pay raise, I have a hard time understanding why you’d think that squeezing suppliers isn’t part of capitalism. For instance, I doubt people would call Apple anti capitalist for refusing to accept TSMC’s price hikes.
> I have a hard time understanding why you’d think that squeezing suppliers isn’t part of capitalism.
I have a hard time understanding why healthcare should be capitalistic and have a capitalist class who profit from simply owning healthcare facilities.
I have a hard time understanding why healthcare should be capitalistic and have a capitalist class who profit from simply owning healthcare facilities.
> Capitalism for me but not for thee.
Same with bailouts.
"Oh, you don't have enough money to survive 6 to 12 months without income / did something dumb... wow, that really sucks. Well... bye."
Same with bailouts.
"Oh, you don't have enough money to survive 6 to 12 months without income / did something dumb... wow, that really sucks. Well... bye."
> When I called, the dispatcher sent my request to the local fire chief, who then reached out to me, asked how he could help, and then sent a crew over to help monitor the lobby, retake vitals on patients, and do a roll call to ensure our patient list was accurate. We were all incredibly grateful for their help.
At what point do we acknowledge that there is a systemic market failure and start trying to explore interventions and alternative arrangements? Hospitals are a public good, but hospital executives seem uninterested now in providing that good. So how do we fix that?
It is more likely a regulatory failure, I believe. The market will do what the market does, raise prices for nurses until there are more. If nurses are in high demand, yet wages aren't rising, then there is either collusion among the employers, or some regulatory disfunction (too much, too little, the wrong kind, etc.) preventing it.
It can still be a market failure if it's taking advantage of nurse empathy for patients.
One thought is to have a hospital co-op. I am half joking and have no clue how viable it would be.
The most expensive part would be getting equipment but I am sure you could bait away people with the promise of ethical & responsible healthcare while being paid a fair salary. Something between a local charity clinic and a highly trauma-rated hospital.
For instance, I use a local walk-in clinic like a primary care doctor but they occasionally tell you to go to the hospital. You can basically fit in between a walk-in clinic and a trauma rated hospital.
The most expensive part would be getting equipment but I am sure you could bait away people with the promise of ethical & responsible healthcare while being paid a fair salary. Something between a local charity clinic and a highly trauma-rated hospital.
For instance, I use a local walk-in clinic like a primary care doctor but they occasionally tell you to go to the hospital. You can basically fit in between a walk-in clinic and a trauma rated hospital.
>Hospitals are a public good
Hospitals are emphatically not a public good. From wikipedia
>In economics, a public good (also referred to as a social good or collective good)[1] is a good that is both non-excludable and non-rivalrous. For such goods, users cannot be barred from accessing or using them for failing to pay for them. Also, use by one person neither prevents access of other people nor does it reduce availability to others.[1] Therefore, the good can be used simultaneously by more than one person.[2]
Hospitals definitely turn away patients who can't pay (non-emergencies), and a patient occupying a hospital bed prevents others from using it.
Hospitals are emphatically not a public good. From wikipedia
>In economics, a public good (also referred to as a social good or collective good)[1] is a good that is both non-excludable and non-rivalrous. For such goods, users cannot be barred from accessing or using them for failing to pay for them. Also, use by one person neither prevents access of other people nor does it reduce availability to others.[1] Therefore, the good can be used simultaneously by more than one person.[2]
Hospitals definitely turn away patients who can't pay (non-emergencies), and a patient occupying a hospital bed prevents others from using it.
You're completely right, I misused the term and I should've known better. I don't know why you are being downvoted.
For what it's worth we have the same problem in France where everything is managed by the government.
I don't have an answer but in your case I'm not sure more government is the right thing to do.
I don't have an answer but in your case I'm not sure more government is the right thing to do.
What's needed is the government to mandate what is required. Make it more expensive (via fines or the like) to understaff than it would cost to hire the staff.
And I'd like to see all liability for tiredness-caused mistakes to flow upstream to the first person who had the authority and ability to improve the situation and didn't do so. Understaffing is a form of medical malpractice in my book.
And I'd like to see all liability for tiredness-caused mistakes to flow upstream to the first person who had the authority and ability to improve the situation and didn't do so. Understaffing is a form of medical malpractice in my book.
As soon as we can defeat the medical provider, drug, and "insurance" lobbies. Given that legislation in the US only gets passed when it empowers some lobby, good luck.
The main source of our dysfunction is this "HMO" fallacy that a 10kft-view insurance company can somehow create the intelligence to administer effective care. Rather, what we've gotten is more opaqueness, more market inefficiency, onerous and arbitrary approval/denials for arbitrary procedures, and every incentive for doctors to kick the can down the road as each visit is a billable event.
To me, the obvious market based solution is based around making medical providers provide straightforward prices or rate schedules, like every other industry, as a requirement of forming a binding contract to bill against. Regulate that prices are all the same no matter who is paying, and regulate that every medical insurance plan must pay any provider. The sheer majority of care happens very slowly - not the emergency "car crash" example some healthy person with little experience with the medical system will inevitably throw out as an argument.
Regulate the insurance industry such that coverage must be purely in financial terms. If an insurance company wants to set some cutoff on what they think a given serrvice should cost, they can do so in a transparent manner that can be easily checked against all provider quotes. Otherwise the default dynamic is to reimburse some percentage of all expenses.
Emergency service costs get limited statutorily, similar to how the state regulates towing rates (when the police call to get a car towed, etc). Due to lobbying, these costs generally end up higher the open market, so there is no problem with constraining the market.
Public health insurance plans continue to exist in the new framework, for those of limited means and those without access to insurance. Ideally we work towards unbundling insurance from employment over time, but that's not a necessary component.
Of course I realize this is all a pipe dream given the aforementioned lobbies, despite the little bit of recent noise towards price "transparency". I'm not opposed to single payer (basically using two of the lobbies to kill the third), but the rot in our system goes far beyond the mere billing nonsense that makes much of the news and I don't think single payer would be enough to reform the deeper problem of providing effective care.
The main source of our dysfunction is this "HMO" fallacy that a 10kft-view insurance company can somehow create the intelligence to administer effective care. Rather, what we've gotten is more opaqueness, more market inefficiency, onerous and arbitrary approval/denials for arbitrary procedures, and every incentive for doctors to kick the can down the road as each visit is a billable event.
To me, the obvious market based solution is based around making medical providers provide straightforward prices or rate schedules, like every other industry, as a requirement of forming a binding contract to bill against. Regulate that prices are all the same no matter who is paying, and regulate that every medical insurance plan must pay any provider. The sheer majority of care happens very slowly - not the emergency "car crash" example some healthy person with little experience with the medical system will inevitably throw out as an argument.
Regulate the insurance industry such that coverage must be purely in financial terms. If an insurance company wants to set some cutoff on what they think a given serrvice should cost, they can do so in a transparent manner that can be easily checked against all provider quotes. Otherwise the default dynamic is to reimburse some percentage of all expenses.
Emergency service costs get limited statutorily, similar to how the state regulates towing rates (when the police call to get a car towed, etc). Due to lobbying, these costs generally end up higher the open market, so there is no problem with constraining the market.
Public health insurance plans continue to exist in the new framework, for those of limited means and those without access to insurance. Ideally we work towards unbundling insurance from employment over time, but that's not a necessary component.
Of course I realize this is all a pipe dream given the aforementioned lobbies, despite the little bit of recent noise towards price "transparency". I'm not opposed to single payer (basically using two of the lobbies to kill the third), but the rot in our system goes far beyond the mere billing nonsense that makes much of the news and I don't think single payer would be enough to reform the deeper problem of providing effective care.
I like how this comment acknowledges acute horrific care incidents that essentially makes market based solutions horribly preditatory, but continue describing it anyway as if it's an afterthought
If you had bothered to read my entire comment instead of jumping on one sentence in isolation, you would have gotten to the part where I addressed that in terms of statutorily limiting emergency prices.
When your car is towed involuntarily, the cost can certainly be described as predatory. And yet it's still probably within a factor of two of what you could negotiate on the open market for a planned tow. That's much better than the blowups on medical prices. And the "huge bill" thing is fixed by wider access to insurance, both private and public plans, as well as making it so that insurance companies can't easily cancel or deny coverage. Furthermore, there can be a public payment plan as a backstop for everyone, such that if you do fall through the cracks and get stuck with a huge bill, you're still only expected to pay a certain percentage of your income per year.
For the issue described in the article, single payer would only change the billing bureaucracy from that of health "insurance" companies to the government. The same incentive for hospitals to play the minimum staffing blame game will be there. Only the market dynamic of patients choosing to go elsewhere can raise the standard of care to favor places that employ more than the legally minimum staff. That requires removing barriers to patient choice.
If you're hangry, you can walk into any random grocery store or restaurant and still expect sane prices, because the sheer majority of their business is done less urgently.
When your car is towed involuntarily, the cost can certainly be described as predatory. And yet it's still probably within a factor of two of what you could negotiate on the open market for a planned tow. That's much better than the blowups on medical prices. And the "huge bill" thing is fixed by wider access to insurance, both private and public plans, as well as making it so that insurance companies can't easily cancel or deny coverage. Furthermore, there can be a public payment plan as a backstop for everyone, such that if you do fall through the cracks and get stuck with a huge bill, you're still only expected to pay a certain percentage of your income per year.
For the issue described in the article, single payer would only change the billing bureaucracy from that of health "insurance" companies to the government. The same incentive for hospitals to play the minimum staffing blame game will be there. Only the market dynamic of patients choosing to go elsewhere can raise the standard of care to favor places that employ more than the legally minimum staff. That requires removing barriers to patient choice.
If you're hangry, you can walk into any random grocery store or restaurant and still expect sane prices, because the sheer majority of their business is done less urgently.
It seems the quote marks might be there because 911 wasn't really called, but it was still very serious...
If you work in walk-in emergency health care you tend to take calling actual 911 way more seriously than most people do from what I understand, even though some would say there's not a huge difference between calling emergency services (911) and calling emergency services (non-emergency line). It's a point of nuance and a lot of people will tell you--911 is for the big and bad, usually near-deadly situations.
Anyway it's interesting that there really was a legitimately deadly serious situation in multiple ways, and this person who represents the circumspect nursing community seemingly took even more additional circumspect care in phoning it in. When a lot of people in such a situation would have probably given up much earlier and perhaps even lost their composure & ability to work completely.
If you work in walk-in emergency health care you tend to take calling actual 911 way more seriously than most people do from what I understand, even though some would say there's not a huge difference between calling emergency services (911) and calling emergency services (non-emergency line). It's a point of nuance and a lot of people will tell you--911 is for the big and bad, usually near-deadly situations.
Anyway it's interesting that there really was a legitimately deadly serious situation in multiple ways, and this person who represents the circumspect nursing community seemingly took even more additional circumspect care in phoning it in. When a lot of people in such a situation would have probably given up much earlier and perhaps even lost their composure & ability to work completely.
> this person who represents the circumspect nursing community seemingly took even more additional circumspect care in phoning it in. When a lot of people in such a situation would have probably given up much earlier and perhaps even lost their composure & ability to work completely.
Remember y'all, every single nurse must be a superhuman who can deal with an infinite amount of stress of they're not a "real nurse". If only owners who didn't staff enough people in their medical facilities weren't "real owners" of said facilities, I think that would fix a lot of our issues.
Remember y'all, every single nurse must be a superhuman who can deal with an infinite amount of stress of they're not a "real nurse". If only owners who didn't staff enough people in their medical facilities weren't "real owners" of said facilities, I think that would fix a lot of our issues.
Can nurses unionize? It seems like they need it very badly. They get the short end of the stick with everything in medicine.
Yes they can unionize, and no it won't solve anything - most hospitals near me are unionized and they are still running critically short on nurses - you can't hire (or schedule) people that don't exist or don't work for you.
The real problem is there are not enough nurses, and a big reason for that is there are not enough nursing schools or slots in the existing nursing schools and it is extremely competitive to get into these schools - even with outstanding grades.
Just checked, the biggest hospital near me (in a medium-ish sized city) currently has 350+/- open nursing positions they are trying to hire for.
The real problem is there are not enough nurses, and a big reason for that is there are not enough nursing schools or slots in the existing nursing schools and it is extremely competitive to get into these schools - even with outstanding grades.
Just checked, the biggest hospital near me (in a medium-ish sized city) currently has 350+/- open nursing positions they are trying to hire for.
As the husband of a nurse who left the profession ~a year pre pandemic, it's not entirely that there aren't enough nurses. It's more that there are not enough nurses because healthcare administration tries to pile on too many patients, and too few CNAs. Nurses are treated like cannon fodder.
This will, indeed, lead to having open nursing positions, but may not be as indicative of a lack of nurses as you think. It's entirely likely that those 350 open positions are currently filled by "travel nurses", making 3-5x the base salary, in which case it's more a case of those 350 positions being for people looking to take drastic pay cuts.
It's a situation the healthcare industry has fostered and it's coming home to roost, meanwhile politicians are getting involved to try to cap the nurses salaries.
And I'd put a tenner on much of the problems being rooted in the undervaluing of women's work.
This will, indeed, lead to having open nursing positions, but may not be as indicative of a lack of nurses as you think. It's entirely likely that those 350 open positions are currently filled by "travel nurses", making 3-5x the base salary, in which case it's more a case of those 350 positions being for people looking to take drastic pay cuts.
It's a situation the healthcare industry has fostered and it's coming home to roost, meanwhile politicians are getting involved to try to cap the nurses salaries.
And I'd put a tenner on much of the problems being rooted in the undervaluing of women's work.
Traveling nurses are definitely part of the problem, (why wouldn't someone go for the much higher salary) - but more nurses causes that problem to go away - simple supply and demand.
From the The American Association of Colleges of Nursing (AACN) website:
>>>According to AACN’s report on 2021-2022 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 91,938 qualified applications (not applicants) from baccalaureate and graduate nursing programs in 2021 due to insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints. <<<
Thats almost 100K potential nurses that were qualified to enroll, but there we no slots available for them.
From the The American Association of Colleges of Nursing (AACN) website:
>>>According to AACN’s report on 2021-2022 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 91,938 qualified applications (not applicants) from baccalaureate and graduate nursing programs in 2021 due to insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints. <<<
Thats almost 100K potential nurses that were qualified to enroll, but there we no slots available for them.
> Traveling nurses are definitely part of the problem, (why wouldn't someone go for the much higher salary)
Sounds more like being part of the solution. More traveling nurses equal more pay.
Eventually things will reach an equilibrium where base pay will rise enough to either attract more nurses back to the profession and/or make it profitable to train more nurses.
Sounds more like being part of the solution. More traveling nurses equal more pay.
Eventually things will reach an equilibrium where base pay will rise enough to either attract more nurses back to the profession and/or make it profitable to train more nurses.
I understand you are saying that nurses are overworked because of there aren't enough nurses.
I don't think you are understanding that I'm saying that health care administration tends to staff at a level that overworks and undersupports nurses. Which causes many qualified nurses to leave the front-lines for nursing adjacent (one nurse friend is doing CPAP equipment rental) or leaving nursing entirely (my wife).
I don't think you are understanding that I'm saying that health care administration tends to staff at a level that overworks and undersupports nurses. Which causes many qualified nurses to leave the front-lines for nursing adjacent (one nurse friend is doing CPAP equipment rental) or leaving nursing entirely (my wife).
Why aren’t more nurses opting to become traveling nurses?
A lot of them are. And those that are are making $125-175K/year. It does mean relocating, or adding 1-2 hours commute on top off a 12 hour shift (that typically takes more like 14 hours once you add shift handoff and finishing paperwork that you don't have time to do during your shift because you have double the optimal patient load and half the CNA support...
Nursing is a really tough career.
Nursing is a really tough career.
Let me rephrase, why aren’t nurses quitting en masse to become traveling nurses?
If you are going to be miserable at work, at least be miserable and well paid.
Why is there a need to relocate or commute as a traveling nurse?
If there is a national nurse shortage, why cannot you be a traveling nurse locally?
If you are going to be miserable at work, at least be miserable and well paid.
Why is there a need to relocate or commute as a traveling nurse?
If there is a national nurse shortage, why cannot you be a traveling nurse locally?
>>why aren’t nurses quitting en masse to become traveling nurses?
because by definition, traveling nurse...travel. Yes you might get a gig for a while in your local hospital, but what happens when that ends? If you are young and/or single and don't own a house or locked into a 12-month lease, sure you can just pickup and move to the next place across the state or across the country - but if you are like most people, perhaps own a home, have a spouse with a local job and perhaps more importantly, kids in a local school system - it is very hard to just keep packing up and moving 2-3 times a year.
It is not for everyone.
because by definition, traveling nurse...travel. Yes you might get a gig for a while in your local hospital, but what happens when that ends? If you are young and/or single and don't own a house or locked into a 12-month lease, sure you can just pickup and move to the next place across the state or across the country - but if you are like most people, perhaps own a home, have a spouse with a local job and perhaps more importantly, kids in a local school system - it is very hard to just keep packing up and moving 2-3 times a year.
It is not for everyone.
That seems an awful lot to me like the "medical guild" is preventing enough people from being able to enter this profession to meet demand, which otherwise would be met at prevailing wage. I never once thought of nursing school spots as competitive when I was a student, you needed good grades but class ranking wouldn't come into it.
I'm aware I'm not an expert here, and I'd love to understand what the actual barrier to training more nurses is.
I'm aware I'm not an expert here, and I'd love to understand what the actual barrier to training more nurses is.
You called it.
I have family looking to become a doctor in Canada, a country desperate for doctors.
There is so much demand to get into the limited slots you can have a near-perfect score and still not get admitted.
Canada's solution to this problem? Introduce a new test (CASPER) to further limit those who can apply.
One of my daughters friends scored very well on the MCAT (Medical College Admission Test) but failed CASPER (????).
These systems seemed "rigged" to artificially limit supply and drive up wages.
She's now looking to the US so in the end, does Canada win by sending its medical professionals elsewhere?
The unions are great, and had a place but now they work against the public's best interest by limiting supply to drive up wages. Cant be a nurse in Canada without joining the union.
Everyone knows Salary is driven by salary/demand. Limit the supply what happens the price?
I have family looking to become a doctor in Canada, a country desperate for doctors.
There is so much demand to get into the limited slots you can have a near-perfect score and still not get admitted.
Canada's solution to this problem? Introduce a new test (CASPER) to further limit those who can apply.
One of my daughters friends scored very well on the MCAT (Medical College Admission Test) but failed CASPER (????).
These systems seemed "rigged" to artificially limit supply and drive up wages.
She's now looking to the US so in the end, does Canada win by sending its medical professionals elsewhere?
The unions are great, and had a place but now they work against the public's best interest by limiting supply to drive up wages. Cant be a nurse in Canada without joining the union.
Everyone knows Salary is driven by salary/demand. Limit the supply what happens the price?
Thinking about this more.. here's a classic example:
https://www.cbc.ca/news/canada/newfoundland-labrador/dr-paul...
An American doctor volunteers three months of FREE service and is denied a license?
Normally they would use "lacks Canadian experience" but in this case he was Canadian trained.
Not to worry, the licensing group found an excuse to deny his license.
Because of COVID he was seeing patients virtually or over the phone. They managed to dig up some obscure ruling that doctors need to see patients in person, so license denied.
And the general public, could they not have benefitted from 3 months of free service? This area is absolutely DESPERATE for a doctor, but the barriers to entry must be protected at all costs.
https://www.cbc.ca/news/canada/newfoundland-labrador/dr-paul...
An American doctor volunteers three months of FREE service and is denied a license?
Normally they would use "lacks Canadian experience" but in this case he was Canadian trained.
Not to worry, the licensing group found an excuse to deny his license.
Because of COVID he was seeing patients virtually or over the phone. They managed to dig up some obscure ruling that doctors need to see patients in person, so license denied.
And the general public, could they not have benefitted from 3 months of free service? This area is absolutely DESPERATE for a doctor, but the barriers to entry must be protected at all costs.
There are many former nurses who have the academic qualifications but have since left the profession. Some of those could be drawn back in with better pay and working conditions.
They still have current licenses??
One of the main places nurses tend to go to leave the fray is the medical billing / "insurance" industry. Who else has extensive experience with ICD billing codes? So not only does the financial cancer strangle the people supplying actual healthcare, it shrinks the supply of them as well.
That's really not what happens. Most nurses doing clinical work aren't experts on the CPT and ICD-10 codes used in billing. Medical coders attend specialized courses to learn the detailed coding rules, and then pass a certification test. They get paid much less than an RN.
Some nurses do go to work for payers, mainly doing case reviews and utilization management. This is absolutely necessary to prevent waste, fraud, and abuse. Even in socialized medical systems they have people doing similar oversight work.
Some nurses do go to work for payers, mainly doing case reviews and utilization management. This is absolutely necessary to prevent waste, fraud, and abuse. Even in socialized medical systems they have people doing similar oversight work.
Sure, I agree the "insurance" industry employs people that aren't nurses, too.
The "oversight" function provided by "insurance" companies is terrible and hostile. It does nothing to stop every day waste, like rushed appointments, doctors telling you to come back in a few weeks for another billable event, repeated tests, etc. Meanwhile it creates administrative hoops based around rejustifying treatments that have already been justified by the front line doctors, to the point that many providers employ "nurse navigators" to wade through the hassle - care-providing potential is wasted on both sides of this pointless adversarial setup.
The "oversight" function provided by "insurance" companies is terrible and hostile. It does nothing to stop every day waste, like rushed appointments, doctors telling you to come back in a few weeks for another billable event, repeated tests, etc. Meanwhile it creates administrative hoops based around rejustifying treatments that have already been justified by the front line doctors, to the point that many providers employ "nurse navigators" to wade through the hassle - care-providing potential is wasted on both sides of this pointless adversarial setup.
There are plenty of facilities where nurses are unionized (and it is almost universally a net benefit to both the staff and patients).
Interesting read on the impact of consolidation on the healthcare labor market: https://www.competitionpolicyinternational.com/wp-content/up...
> deploying innovative ways to attract and retain team members
> Sign-on bonuses and loan forgiveness programs
> Staffing incentives and shift premiums
> Increasing investments in professional development and career pathways
Doing everything except what is really needed, Real Pay Raises. All Sign-on bonuses do is incentive people to job hop. If you pay enough, people will stay.
> Sign-on bonuses and loan forgiveness programs
> Staffing incentives and shift premiums
> Increasing investments in professional development and career pathways
Doing everything except what is really needed, Real Pay Raises. All Sign-on bonuses do is incentive people to job hop. If you pay enough, people will stay.
> If you pay enough, people will stay.
This is absolutely not true. Study after study have proven that there is a limit to the number of hours someone is willing to work.
The real solution is to increase the NUMBER of nurses. This means removing the artificial barriers to entry.
Their issue is BURNOUT and this is caused by staffing shortages and partly this is caused by artificial barriers to entry.
Train more nurses, alleviate the shortages.
This is absolutely not true. Study after study have proven that there is a limit to the number of hours someone is willing to work.
The real solution is to increase the NUMBER of nurses. This means removing the artificial barriers to entry.
Their issue is BURNOUT and this is caused by staffing shortages and partly this is caused by artificial barriers to entry.
Train more nurses, alleviate the shortages.
If you pay enough you can attract enough nurses that they aren't overworked and thus aren't prone to leaving.
> ... the fatigue and moral distress that is caused by working in a state of chronic crisis staffing levels, for a corporation that seems completely out of touch and apathetic to what is really happening in their beautiful new hospital.
Did I miss the part where the hospital was billed for the firefighters time? It's would be insanity to let them get away with this for free.
Do firefighters normally pay hospitals to take responsibility for the patients the firefighters drop off at the hospital?
The hospital billed every single person they treated that night. They aren't a charity. They also bill the customers the firefighters kindly transport to their store free of charge for them.
And the firefighters either got paid by the local government, or they are a charity and work as volunteers.
But my point is that if hospitals help firefighters treat patients without charging the firefighters, then why should the firefighters charge the hospital to help the hospital treat patients? That's not reciprocal.
But my point is that if hospitals help firefighters treat patients without charging the firefighters, then why should the firefighters charge the hospital to help the hospital treat patients? That's not reciprocal.
Hospitals don't "help treat patients" without charging the patient for it. The guys charging $100 for a box of tissues don't get to become collectivists all of the sudden.
Two things:
Hospitals do consult on EMS calls at times, often without billing for it.
Not all hospitals bill for every little thing, that really depends on the hospital and how they are funded. For example there are a number of children's hospitals that are funded by grants, donations and endowments. And some hospitals like the VA hospital system are funded by the government to serve specific segments of the population.
Hospitals do consult on EMS calls at times, often without billing for it.
Not all hospitals bill for every little thing, that really depends on the hospital and how they are funded. For example there are a number of children's hospitals that are funded by grants, donations and endowments. And some hospitals like the VA hospital system are funded by the government to serve specific segments of the population.
> Hospitals do consult on EMS calls at times, often without billing for it.
They don't bill on a per-call basis, but you can be sure that if a hospital is providing medical control services to an EMS agency there is a contract in place and they are being compensated for it (either a flat annual fee, or by some other means)
They don't bill on a per-call basis, but you can be sure that if a hospital is providing medical control services to an EMS agency there is a contract in place and they are being compensated for it (either a flat annual fee, or by some other means)
Hospitals help not only the patients, but also the firefighters who are responsible for those patients before handing them off to the hospitals. And they provide that service to the firefighters without charging the firefighters.
> The guys charging $100 for a box of tissues don't get to become collectivists all of the sudden.
When you say "don't get to be", do you mean shouldn't get to be? Are you sure the firefighters did actually charge the hospital for this?
> The guys charging $100 for a box of tissues don't get to become collectivists all of the sudden.
When you say "don't get to be", do you mean shouldn't get to be? Are you sure the firefighters did actually charge the hospital for this?
They don't provide the service to the firefighters, they provide it to the patient at a massively inflated cost.
They do both, they are related but distinct services.
What service do they provide to firefighters? That's like saying a concert hall provides a service to the taxi cab driver who drops off a patron.
(Paramedics do _way_ more than just provide a taxi service, but that's the bit that's relevant to the analogy)
(Paramedics do _way_ more than just provide a taxi service, but that's the bit that's relevant to the analogy)
Do you get billed by the fire brigade if they have to put out a fire at your house?
You do if you ask them to fill up a swimming pool or a similar non firefighting activity. Was a discount provided to the patients because the hospital was able to cheap out on labor? I'll bet not, why should the executive team keep that surplus that was created due to their mismanagement?
I guess all the matters is that the patients were supported - they're the tax payers and the ones who matter.
If the local fire brigade is funded through municipal taxes, for example, then lots of people are getting billed anyway even when the fire brigade never comes to their houses.
To be fair people in the waiting room aren't under the care/responsibility of the hospital. It's a public area.
The response by the hospital is gold. You couldn’t get it any more perfectly meaningless if it was a layoff notice from Mark Zuckerberg.
To add more context to the nursing profession, this case is in the back of the back of the mind of every single nurse:
https://www.tennessean.com/story/news/crime/2022/03/25/radon...
https://www.tennessean.com/story/news/crime/2022/03/25/radon...
Seems so weird to me to read that a request for extra medial staff would go to firefighters. Intellectually I know the US has a combined Firefighter/Paramedic crew, but it's still jarring to read it.
Do other countries merge firefighting and ambulance functions or is it a US only thing?
Do other countries merge firefighting and ambulance functions or is it a US only thing?
There's a good reason firefighters are cross trained, so it probably does happen in other places too. Go look at the dispatch log for your local fire department. For every fire they put out, there are probably 100 or more medical emergencies, car accidents, etc. They may go for days at a time without seeing anything that even looks like a fire. If the only thing they were allowed to do was fight fires, they'd be idle most of the time.
I think it’s pretty unique to the US. In most places you have a police service, a fire service, and an ambulance service, all separate but working together. Makes sense they’re separate - different roles to specialise in and they move between different locations and leave the scene at different times.
But you actually need police, fire, rescue, and ambulance.
We group fire and rescue together because you sometimes have to get trapped people away from a fire.
We group fire and rescue together because you sometimes have to get trapped people away from a fire.
The US is largely the same but fire services are sent out to a lot of those because they also have the tools to deal with getting access to patients and making the scene safe for ambulance crews. Sending them out immediately means you don't have to wait for them if the patient's door is locked or their car is all smashed up and you need fire services to peel the car apart to get to them.
Incidentally, from my experience helping to manage a fire department payroll and being the son of a nurse, firefighters and nurses are paid about the same for a given area.
I'm not trying to make a point, just provide some context.
I'm not trying to make a point, just provide some context.
Firefighters yes, paramedics, no...
It's not uncommon for the firefighter/paramedic on the engine who shows up and treats the patient for a few minutes before the ambulance arrives to be making _significantly_ more than the paramedic on the ambulance they hand care over to.
Outside of unionized, municipal departments, paramedic pay in the US is generally pretty abysmal (and well below that of nurses).
It's not uncommon for the firefighter/paramedic on the engine who shows up and treats the patient for a few minutes before the ambulance arrives to be making _significantly_ more than the paramedic on the ambulance they hand care over to.
Outside of unionized, municipal departments, paramedic pay in the US is generally pretty abysmal (and well below that of nurses).
The suggestion that other countries don't do this seems weird. Are paramedics in other countries trained and equipped to cut open wrecked and burning cars? Many sorts of accidents will require both firefighters and paramedics, so you may as well encourage firefighters to be trained paramedics as well (not all American firefighters are, but many of them are.)
> Many sorts of accidents will require both firefighters and paramedics
Yeah so both attend. Makes sense they're separate vehicles as the ambulance would ideally leave while the fire brigade are still sorting out the scene. And normally the police as well, for a road accident. If you can understand the police being separate you can understand the fire and ambulance being separate.
Yeah so both attend. Makes sense they're separate vehicles as the ambulance would ideally leave while the fire brigade are still sorting out the scene. And normally the police as well, for a road accident. If you can understand the police being separate you can understand the fire and ambulance being separate.
Police in America often have paramedic training as well, for a reason. You say "both attend" but somebody gets there first. Sometimes police get there first, sometimes firefighters get there first. All should be encouraged to get trained.
All three would receive firefighter training too, if not for the obvious issue of their vehicles and equipment being specialized and expensive. But all of them can be trained to render first aid, so that is encouraged.
All three would receive firefighter training too, if not for the obvious issue of their vehicles and equipment being specialized and expensive. But all of them can be trained to render first aid, so that is encouraged.
Maybe it's different in the US but in the UK 'paramedic' is a full-time thing, professionally registered and monitored. You'd seriously struggle to combine that with any other full-time profession. They do it in the military is the only place I know that combines it. I can't see it as being realistic to train everyone as a paramedic for our definition of it. I doubt most people could pass the training.
Obviously paramedics are registered and obviously not everybody is cut out for it. That should go without saying. There are grades of paramedic and I think most firefighting paramedics are likely not the most specialized of all of them, but I feel confident in asserting that nearly any paramedic firefighter in America is qualified to monitor patients in the waiting room of a hospital.
As for the rest, I have a lot of gripes with the American system of healthcare, but the quality of first responders is not among them. If I ever have a heart attack while driving and crash into a tree, I'll be very happy if the volunteer firefighter who cuts me out of my car is also a paramedic. My complaints about the American system will be reserved for the private for-profit doctors they bring me to.
As for the rest, I have a lot of gripes with the American system of healthcare, but the quality of first responders is not among them. If I ever have a heart attack while driving and crash into a tree, I'll be very happy if the volunteer firefighter who cuts me out of my car is also a paramedic. My complaints about the American system will be reserved for the private for-profit doctors they bring me to.
Ah right maybe we in the UK only use the word 'paramedic' to mean the most specialised, advanced trauma life-support level and you use it more broadly. I'm sure all police and firefighters here do get advanced first-aid training.
We definitely don't use it more broadly (in the industry, anyway... the public certainly mixes them up at times). Paramedics are ALS level care providers in the US.
"Paramedic" means roughly the same thing in the US and UK. UK training standards are a bit higher, but in both cases they are professional roles, with ongoing training requirements, etc. They have a very similar scope of practice, both providing advanced level care.
In the US it's pretty common for fire departments to require EMT level training, with some folks then going on to get their Paramedic certification. Agencies that require everyone to be a paramedic are rare (but they do exist).
In the US it's pretty common for fire departments to require EMT level training, with some folks then going on to get their Paramedic certification. Agencies that require everyone to be a paramedic are rare (but they do exist).
The US is a little unique in the extent to which "firefighter/paramedic" is a common role, but it's very typical for firefighting personal to have at least some level of medical training, even if it's just the "first responder" level.
It's not clear to me from the story if the personnel sent over by the fire department were paramedics at all. The actions described would be well within the scope of a BLS first responder.
If I had to guess, the chief sent a BLS engine company, which would typically consist of 3-4 people, all trained to the EMT/FR level.
It's not clear to me from the story if the personnel sent over by the fire department were paramedics at all. The actions described would be well within the scope of a BLS first responder.
If I had to guess, the chief sent a BLS engine company, which would typically consist of 3-4 people, all trained to the EMT/FR level.
That's my impression, also. It doesn't compromise their primary job because if they're actually needed at a fire they can roll from the hospital rather than the station.
I've seen plenty of fire/paramedic/ambulance crews doing various things while awaiting a call. So long as they're ready to jump on the truck and roll quickly dispatch simply needs to know where they are so as to determine what unit is closest.
I've seen plenty of fire/paramedic/ambulance crews doing various things while awaiting a call. So long as they're ready to jump on the truck and roll quickly dispatch simply needs to know where they are so as to determine what unit is closest.
The US doesn't, we have dedicated EMTs. But firefighters might have first aid training too, and are more likely to be available on a random night.
The US absolutely does, it just depends on the agency.
I'm a firefighter/paramedic who sometimes rides a fire truck, sometimes rides an ambulance, and sometimes switches from one to the other mid-call as the situation warrants.
I'm a firefighter/paramedic who sometimes rides a fire truck, sometimes rides an ambulance, and sometimes switches from one to the other mid-call as the situation warrants.
Yes the US does - it varies by state and even by town/city.
Many of the towns near me you need to actually be a paramedic to become a firefighter and vice-versa - can't be one without the other in some areas.
Not sure I necessarily agree with this, but it does happen. I see the benefit, but also think there are a lot of people that would be good firefighters, but may not have the willingness or ability to do the classroom and testing required to be pass a full paramedic course.
Many of the towns near me you need to actually be a paramedic to become a firefighter and vice-versa - can't be one without the other in some areas.
Not sure I necessarily agree with this, but it does happen. I see the benefit, but also think there are a lot of people that would be good firefighters, but may not have the willingness or ability to do the classroom and testing required to be pass a full paramedic course.
We have firefighters cross-trained to handle first aid so there are more people available in spread out areas. Often a fire truck is on scene faster than the ambulance. Once the ambulance is on scene, firefighters can assist paramedics.
Modern firefighters are far far more than just for fighting fires.
In my region EMS is separate but the firefighters still have plenty of first aid training and would be able to provide the response they did in this article.
In my region EMS is separate but the firefighters still have plenty of first aid training and would be able to provide the response they did in this article.
It totally depends on where you are -- some municipalities have their own EMTs, some are attached to fire, etc.
So the hospital's plan is to do everything they can, other than raising wages?
I'm not criticizing for calling 911 for help, but wouldn't have calling another local hospital been a better option? The fire chief sending over his staff potentially leaves him short staffed. I can't imagine that a local fire department has that many people to spare.
Just to be clear she called the non emergency number and spoke with dispatcher. The chief prioritized and made the correct call.
> I'm not criticizing for calling 911 for help, but wouldn't have calling another local hospital been a better option?
There aren't any other local hospitals. The nearest other hospitals are in Seattle. Her hospital is in Silverdale. Silverdale and Seattle are separated by Puget Sound, so even though they are only maybe 15 miles apart, you either have to drive the long way around Puget Sound or you have to take a ferry.
Without crossing Puget Sound the nearest other hospitals would be in Tacoma which is around a 40 mile drive away.
There aren't any other local hospitals. The nearest other hospitals are in Seattle. Her hospital is in Silverdale. Silverdale and Seattle are separated by Puget Sound, so even though they are only maybe 15 miles apart, you either have to drive the long way around Puget Sound or you have to take a ferry.
Without crossing Puget Sound the nearest other hospitals would be in Tacoma which is around a 40 mile drive away.
All of the hospitals are in the same situation. Every hospital is understaffed due to large amounts of the nurses in America getting burned out from the Covid epidemic.
Hospitals were understaffed prior to Covid (because managers were being cheap and refusing to have sufficient staff) and with many anti-vaxxers assaulting and threatening healthcare workers, many nurses quit the industry.
Hospitals were understaffed prior to Covid (because managers were being cheap and refusing to have sufficient staff) and with many anti-vaxxers assaulting and threatening healthcare workers, many nurses quit the industry.
Let's not result to hyperbole. 99%+ of nurses quitting had absolutely nothing with threats of violence from antivaxxers.
Unhinged capitalism will be the cause of the most devastating global crisis that is just around the corner. You can see it very easily on a simplex plot, you cannot solve for anything useful, like global quality of life, when there are parameters that have infinites, ie infinite 'growth' bullshit. It's a closed system, limited planet. We need to find a better metric, and forget about 'getting rich, work all your life' crap, when you are dead you take few cubic meters of space including ground, all your real estate 'investing' and stress, they just end 6ft under.
> We’re told, "You make good money. You chose this career. If you don’t like it, why don’t you just quit?" [...] My response to them was, "Do you REALLY want nurses to 'just quit' if they don’t like their jobs? Think that one through a little further."
Great response.
Great response.
I don't think it is, since it doesn't answer the question. What the person who asks the question thinks and why a nurse who doesn't like their job doesn't quit are not obviously connected. Such a response is for a hospital administrator, not for someone who has no power to do anything about their working situation.
It reads "I'm not exploited quite to the breaking point yet, there is room for more optimization, Mr. Corpo."
It does not answer the surface level question, but I think it answers the implicit ask to stop whining.
If that question was in good faith, I think your response might be the right one. But I very much doubt that question was in good faith - it sounds more to me like "suck it up or get out, princess".
Regardless of the intent, the response is incongruous to the prompt.
A: This is the job; take it or leave it.
B: You don't really want me to leave it.
Maybe A does or doesn't want that, but how does that have any bearing on B's decision-making? Let's call a spade a spade. The nurses who are not quitting are doing so because (they think) the job is still good; it's just not as good as it was a few years ago. The nurses quit did so because (they thought) they could get a better deal doing something else.
A: This is the job; take it or leave it.
B: You don't really want me to leave it.
Maybe A does or doesn't want that, but how does that have any bearing on B's decision-making? Let's call a spade a spade. The nurses who are not quitting are doing so because (they think) the job is still good; it's just not as good as it was a few years ago. The nurses quit did so because (they thought) they could get a better deal doing something else.
> more to me like "suck it up or get out, princess".
Different wording, but same message though. It sounds like the two options are fundamentally the same, regardless of the wording.
Different wording, but same message though. It sounds like the two options are fundamentally the same, regardless of the wording.
It's a great response within some filter bubbles but among the general public there's no shortage of people who think that nothing will change until there are bodies that need to be explained away and that getting it over with sooner rather than later will result in less bad things overall.
I have the same feelings about climate change. Nothing's going to change until shit gets much, much worse. Too bad to ignore.
The big issue with accelerationism like that is in a crisis like climate change by the time the issues are so bad they're non-ignorable resources will be so tied up addressing the symptoms there won't be slack left for addressing the underlying issues.
Also for climate change specifically there's a huge hangover effect from already emitted greenhouse gases and carbon extraction is extremely difficult.
Also for climate change specifically there's a huge hangover effect from already emitted greenhouse gases and carbon extraction is extremely difficult.
[deleted]
"Bodies that need to be explained away" ? It's a hospital, that's literally one of their core functions. The death certificate reads "cardiac arrest" due to "$underlying_disease", not "nurse responded to call 30 minutes too late" due to "MBAs optimizing away every bit of margin and then some".
What happens is that the capitalists threaten or actually them to compel them to stay at work and to prevent them from taking other jobs, claiming they the unpaid nurse (but not the capitalist!) has a legal obligation to care for patients.
One of the threats frequently used against nurses is to report them to the state licensing agency for "patient abandonment". This threat is frequently made whenever a nurse tries to resign - even with 2 week's notice (even though state licensing agencies say that resignation is not patient abandonment). This threat is also made whenever a nurse is forced to work overtime.
https://www.nolo.com/legal-encyclopedia/what-patient-abandon...
https://www.nolo.com/legal-encyclopedia/what-patient-abandon...
Do not such threats amount to libel or slander?
Yes, yes i do.
Yeah, the system won't get fixed until it is broken. As far as hospital administration cares to understand, the hospital is still running, there's still money coming in the door. If nurses are really worried about losing their licenses from the corner cutting they need to do, then they absolutely should quit and let all the patient deaths that ensue be entirely the fault of admin.
That makes sense logically in our heads that such a course of action might save lives in the long run, a triage of sorts. But the nurses know the patients that would die if they quit, and they know the other nurses they would be heaping the work on, including watching those patients die. Nurses are taught triage, but when that takes the form of walking away from patients you could save to save more you have never met, I think that goes against what draws many to the profession in the first place.
> they absolutely should quit and let all the patient deaths that ensue be entirely the fault of admin.
Letting people die as a negotiation tactic with your bosses is horribly unethical. You can handwave and say it's the admin's fault, but that won't change the reality of those people being dead because of the way you chose to address a dispute with other people.
Letting people die as a negotiation tactic with your bosses is horribly unethical. You can handwave and say it's the admin's fault, but that won't change the reality of those people being dead because of the way you chose to address a dispute with other people.
Putting nurses in situations where they feel like quitting a crappy job means people will die is even more unethical. Don't blame the nurse who's put in the trolley problem, blame the guy who's tied a bunch of people to the trolley tracks.
Take it to the extreme: if you were enslaved, forced to care for critically ill people, would you be acting wrongly to run away if you could? I don't think so. The difference is a matter of degree, not of kind.
More practically, not every nurse's threshold is in the same place; each nurse decides they've had enough at a different point. It's not as though — barring coordinated effort — every nurse is going to quit the same day. The problem will manifest itself as declining staffing, not a sudden depopulation of the hospital, and it will not go unaddressed.
More practically, not every nurse's threshold is in the same place; each nurse decides they've had enough at a different point. It's not as though — barring coordinated effort — every nurse is going to quit the same day. The problem will manifest itself as declining staffing, not a sudden depopulation of the hospital, and it will not go unaddressed.
> The problem will manifest itself as declining staffing, not a sudden depopulation of the hospital, and it will not go unaddressed.
Note that "declining staffing" is exactly the complaint here, and evidently it has gone unaddressed.
Note that "declining staffing" is exactly the complaint here, and evidently it has gone unaddressed.
People could die because nurses have to cut corners to keep up. It's better to not be involved in unethical behavior than to contribute to it continuing to limp along.
And to be clear, I don't think of this as a "negotiation tactic with the bosses". I see this as a tactic to get the bosses evicted completely.
And to be clear, I don't think of this as a "negotiation tactic with the bosses". I see this as a tactic to get the bosses evicted completely.
That's a much easier thing to say as the person who's not the one who has to actually do it. Actively choosing to do identifiable harm now to prevent future diffuse harm is a more difficult version of the 'Trolley Problem' that already gives people trouble when the numbers are direct.
> Actively choosing to do identifiable harm
No, it's actively choosing to not do identifiable harm. Whatever harm comes to patients when you are not there, not even an employee anymore, can in no way be blamed on you.
Why does nursing licensing exist? Probably in no small part to ensure a minimum standard of care. Therefore staying and cutting corners in violation of your licensing terms is the active choice to do identifiable harm. To stay and cut corners is allowing management to shift the blame on you.
I've been on the difficult side of this problem, where safety and people's lives are at stake. Management never says "cut corners". It's always "you're expected to get through the work load." If you ask them if you're supposed to cut corners to make it happen, you get greeted with silence. They will stonewall you on every corner. You can tell them it's impossible and they will just ignore you and repeat their "expectations".
They'll hang your job over your head. They'll tell you they will just get someone else to do it. They'll tell you they'll blackball you. It's a bluff. Any place that is cutting corners is already in dire straights. They can't fire you because they'd be in an even worse position. They can't find anyone else to do the job because they wouldn't be in this situation if they paid enough to hire enough people to do the job. They can't blackball you if they themselves become persona non grata because they were at the helm when a hospital had to shut down because they refused to pay enough for nurses.
The only play, as a bottom rung worker, is to not play at all. It's War Games and WOPR.
Quit and the situation gets resolved very quickly. The org is on its last legs. It's only life support is the people who bend over backwards to keep it running. One hospital guess down, it's nightly news. Two and it's a national emergency.
No, it's actively choosing to not do identifiable harm. Whatever harm comes to patients when you are not there, not even an employee anymore, can in no way be blamed on you.
Why does nursing licensing exist? Probably in no small part to ensure a minimum standard of care. Therefore staying and cutting corners in violation of your licensing terms is the active choice to do identifiable harm. To stay and cut corners is allowing management to shift the blame on you.
I've been on the difficult side of this problem, where safety and people's lives are at stake. Management never says "cut corners". It's always "you're expected to get through the work load." If you ask them if you're supposed to cut corners to make it happen, you get greeted with silence. They will stonewall you on every corner. You can tell them it's impossible and they will just ignore you and repeat their "expectations".
They'll hang your job over your head. They'll tell you they will just get someone else to do it. They'll tell you they'll blackball you. It's a bluff. Any place that is cutting corners is already in dire straights. They can't fire you because they'd be in an even worse position. They can't find anyone else to do the job because they wouldn't be in this situation if they paid enough to hire enough people to do the job. They can't blackball you if they themselves become persona non grata because they were at the helm when a hospital had to shut down because they refused to pay enough for nurses.
The only play, as a bottom rung worker, is to not play at all. It's War Games and WOPR.
Quit and the situation gets resolved very quickly. The org is on its last legs. It's only life support is the people who bend over backwards to keep it running. One hospital guess down, it's nightly news. Two and it's a national emergency.
GP said quitting, which is obviously not unethical (given some notice and not quitting at a time designed to cause maximum injury), even if people do die as a consequence.
Depends on how you quit. If a nurse or doctor gives appropriate notice before quitting or striking, so that innocent patients can be rerouted first, then there's no problem. But if they're walking out of an ER room and abandoning a patient on the table with their rib cage splayed open, that's basically murder.
In this case, the nurse who "called 911" was faced with a situation where the waiting room was packed with people who needed emergency care. For her to walk away from her job in that moment would be like leaving somebody on the ER table. At the very least, a nurse in that situation should persist through their shift and quit afterwards, not quit on the spot.
In this case, the nurse who "called 911" was faced with a situation where the waiting room was packed with people who needed emergency care. For her to walk away from her job in that moment would be like leaving somebody on the ER table. At the very least, a nurse in that situation should persist through their shift and quit afterwards, not quit on the spot.
Rerouted to where? The bosses want the patients $$ but not to pay the staff.
Another hospital, or to scab nurses the administration has to scramble to call in. But to walk out without notice in the middle of a crisis because you want a stack of dead bodies to blame on your boss is basically murder.
Excuse me? Threatening to kill patients as a negotiating tactic with your employees is what is horribly unethical.
> You can handwave and say it's the admin's fault, but that won't change the reality of those people being dead because of the way you chose to address a dispute with other people.
You mean, the way the admin chose to address this dispute. The admin is the one cost-cutting.
You mean, the way the admin chose to address this dispute. The admin is the one cost-cutting.
Then quit when you're not on duty. Not when you're on duty and the situation is perilous. The first is eminently reasonable, but the second is tantamount to murder.
Easily said. Doing so puts your colleagues in much more stress, and in a time where there's more demand than supply for a profession it means people will suffer. And its a profession by people who try to lessen or end suffering, like many service jobs including teacher, police, etc. These professions will always lose because corporate psychopaths know their calling is to not leave society hanging.
And that thinking is exploited by the sociopaths who don't give a flying fuck who is suffering and dying because they insist on extracting a profit from every facet of society.
I'm kind of sick of looking at problems like this and having people like you saying that the only solution is to continue to let sociopaths ruin everything for the rest of us.
I'm kind of sick of looking at problems like this and having people like you saying that the only solution is to continue to let sociopaths ruin everything for the rest of us.
> there's still money coming in the door
And therein lies the problem with Hospitals.
Money for suffering, pay me to if you want to live.
And therein lies the problem with Hospitals.
Money for suffering, pay me to if you want to live.
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> We’re told, “You make good money. You chose this career. If you don’t like it, why don’t you just quit?”
That's the only question they can think to ask. The only way a nurse can make any impact in the institution is to walk away. The institution has turned a deaf ear to literally everything else.
Anyone with half a brain can see how to fix this problem. Give nurses a stable and manageable job, and they will take it. It's not complicated.
But the institution knows that they don't have to. Nurses will go through hell for their patients. So naturally, the institution will hold patients hostage to essentially blackmail nurses into maximum productivity.
We can't expect nurses to go on strike. That's asking people who pursued a career of empathy and literal healing to abandon their patients. Sure, we are in a desperate enough situation that strikes are happening, but as soon as they get the minimum amount of progress, collective action will stop.
It's glaringly obvious what we need: regulation. Nurses must be free to step away from work without fear for their patients' health. Only then will they have a voice.