> 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.
We can see the detritus of those days in the names of Baylor, Baptist, Presbyterian, St Michael's etc.
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.
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.
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.
Like the UK and Europe pay absolute peanuts in comparison, just like in Tech, Law, etc. too.
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.
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
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.
Nope. See the OP.
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 healthcare should be capitalistic and have a capitalist class who profit from simply owning healthcare facilities.
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."
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.
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.
> 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.
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.
https://www.tennessean.com/story/news/crime/2022/03/25/radon...
Do other countries merge firefighting and ambulance functions or is it a US only thing?
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.
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.
Great response.
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 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.
I don't have an answer but in your case I'm not sure more government is the right thing to do.
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.
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'm not trying to make a point, just provide some context.
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.
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.
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'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.
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.
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.
https://www.nolo.com/legal-encyclopedia/what-patient-abandon...
We group fire and rescue together because you sometimes have to get trapped people away from a fire.
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.
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.
Different wording, but same message though. It sounds like the two options are fundamentally the same, regardless of the wording.
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).
Also for climate change specifically there's a huge hangover effect from already emitted greenhouse gases and carbon extraction is extremely difficult.
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...
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 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!
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.
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.
> 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?
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.
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.
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.
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).
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.
when I moved from a tech job in the UK to a tech job in the US, my salary more than doubled
And I'd still take it over the US.
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)
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 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?).
[0] I admit there is perhaps some bias here
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.
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.
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.
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.
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 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?
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.
(Paramedics do _way_ more than just provide a taxi service, but that's the bit that's relevant to the analogy)
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.
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.
Note that "declining staffing" is exactly the complaint here, and evidently it has gone unaddressed.
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.
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.
You mean, the way the admin chose to address this dispute. The admin is the one cost-cutting.
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.
And therein lies the problem with Hospitals.
Money for suffering, pay me to if you want to live.
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 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).
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.
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.
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.
Nursing is a really tough career.
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?
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.