The hospital system
where I pick up shifts as an RN recently went through a round of asking nurses
and other staff to take ”voluntary severance packages”, or more accurately early
retirement. They needed more than 200 people to accept this offer or they would
need to start layoffs soon. This is not unusual as many hospitals including one
of the largest systems in the country, Kaiser Permanente, has been recently
been doing the same thing at their 37 hospitals and asking people to take
severance packages and leave.
This is a good
and a bad thing for nursing. Why is getting rid of RN’s a good thing? Because a
lot of these retirement packages were aimed at nurses and staff who were
hanging on, and needed encouragement to leave. I can’t blame them when in the
bay area a nurse can easily make over six figures. But, healthcare is a
business in this country and money will always be a factor in how decisions are
made. It is hard to see some of them go because of the wealth of knowledge they
had for newer nurses. However, maybe in a few years this will open up jobs
again for new grads in this area.
The bad is if there was a nursing shortage do you think they would be
getting rid of nurses, even expensive ones? You can Google nursing shortage
myth or not, and get many reasons for the pros and cons of whether there is a
nursing shortage now or in the future. All I know is around here new grads are
not finding jobs. This may be different other parts of the country, but if you
are going into nursing do some research. Because nursing schools will cry
shortage, but they need students and their money. People need to make sure
nursing is what you want to do and not because it is a job or you can’t think
of anything else.
Floated to a floor with a nurse who was taking early retirement. Her daughter and a friend made two cakes to say goodbye. I had to take a picture and add an appropriate caption.
Preface: Nurses work with body fluids on a daily basis, and most have a sick sense of humor to go along with this type of work. We do not laugh at patients, but we do laugh at some of the things we have to put up with (OK, we do laugh at some patients), it is a pressure valve for a job most could not do.
Anyway, this is one of the cakes. It is a carrot cake with blue fondant icing in the shape of a bedpan, mango syrup in a colostomy bag, and a Baby Ruth candy bar in mango syrup filling the bedpan. Although tasty many could not eat it after the realism.
I have been MIA on this blog for a while getting through the paperwork of both the state and federal government of my NP license. Now that I am an NP and have furnishing privileges , I wonder. No longer about the journey to get here or that I can write scripts. But what should I do now? I need a job and to get experience. A minimum of 2-years if I want to practice in one of the independent states.
I see many independent practice state are trying to lure NPs away from restricted states (as in the article below), but the pay rate is about the same. I would love to be independent but the comfort of a doctor's availability and knowledge is invaluable.
I need to stop thinking about what if's and just get a job.
"New Mexico governor wants to recruit Oklahoma's nurse practitioners by Jaclyn Cosgrove
Governor Martinez wants to market New Mexico beyond its ski vacations, hot air balloons, beautiful desert sunsets and art museums.
Simply put, Martinez wants Oklahoma's nurse practitioners. Unlike Oklahoma, New Mexico allows nurse practitioners to practice
with “full authority,” not requiring them to have a physician sign off
on care in order for them to have prescriptive authority. Martinez specifically mentioned Oklahoma in her recent announcement
of the campaign, adding that she hopes to further reform her state's
laws to remove any barriers that nurse practitioners moving to New
Mexico might face when opening their practices. “The full implementation of (New Mexico's Medicaid program), coupled
with Medicaid expansion, will further increase the demand for highly
trained and qualified health care professionals in New Mexico,” Martinez
said in a news release. “By streamlining the requirements for nurses
seeking to bring their talents and skills to New Mexico, we can further
ensure that more New Mexicans, especially in rural and underserved
areas, will have access to the high quality of health care our families
and communities deserve.” Time to move? Moving to a state like New Mexico was, at least for a moment, in the back of nurse practitioner Damarcus Nelson's mind. Nelson graduated about two years ago and was thinking about where he
wanted to practice medicine. But he had family in Oklahoma and a wife,
pregnant with twins. Moving wasn't an option at the time. “I feel like if we stay here, we can push the envelope better to get
independent practice here, as opposed to trying to run to another
state,” Nelson said. Nelson, who has a doctor of nursing practice degree, works near Yukon
with Toni Pratt-Reid, the first nurse practitioner in Oklahoma to open a
private practice more than 10 years ago. Under Oklahoma law, a nurse practitioner cannot practice medicine
unless he or she has a physician willing to supervise him or her for
that prescriptive authority. However, the law doesn't require physician
supervisors to review patient charts or even practice in the same
building. At Pratt-Reid's office, there is not a medical doctor or doctor of osteopathic medicine who works in the office with them. “We wouldn't practice any differently if we had full autonomy,”
Pratt-Reid said. “Nothing that we did here would be different, other
than we wouldn't have to jump through extra hoops to get the same amount
of care ... . The sooner we get to where New Mexico is, the better.” Many states open to practice Oklahoma is one of about 12 states that requires a nurse practitioner
to have a team leader or management from an outside health discipline —
such as supervision from a medical doctor — in order for that nurse
practitioner to provide care, according to the American Association of
Nurse Practitioners. About 15 states — some that require stringent restrictions and some
that simply curtail one element — have bills in 2014 that would reduce
restrictions, according to the group. No bill has been discussed or announced in Oklahoma. New Mexico and Oklahoma face similar problems, with large shortages of medical professionals across both states. Thirty-two of New Mexico's 33 counties are designated by the federal
government as Health Profession Shortage Areas, according to the
governor's office. Only four of 77 counties in Oklahoma are not designated as Health
Profession Shortage Areas, according to the state Health Department. Rep. Doug Cox, R-Grove, has focused many of his efforts at the Capitol on Oklahoma's doctor shortage. Cox, a medical doctor for more than 30 years, said medical
“extenders” — nurse practitioners or physician assistants who extend the
care medical doctors provide — are a necessary part of the health care
system. Cox is the physician supervisor for a nurse practitioner in Grove, a
city of 6,600 in northeast Oklahoma. More than 1,200 doctors in Oklahoma
are supervising about 1,000 nurse practitioners, according to data from
the state medical board. Cox said he saw a need for a medical professional to help treat
people, and he felt like supervising a nurse practitioner would be a way
of doing his part to address the provider shortage in his area. “The No. 1 reason I see people in the ER is because they can't get
into a doctor's office,” Cox said. “There just aren't health care
providers to serve the need, but our nurse practitioners have liberal
prescribing authority.” Nurse practitioners in Oklahoma are not allowed to prescribe certain
drugs, including oxycodone, a strong pain medication, and Adderall, a
drug prescribed to children with attention deficit hyperactivity
disorder. Tulsa nurse practitioner Mindy Whitten said such restrictions regularly create a problem at her job. Whitten works at an urgent care medical office, a setting where
health care providers regularly prescribe Schedule II drugs like
oxycodone. If a medical doctor isn't at the office when a patient who is
allergic to codeine and hydrocodone comes in suffering pain, there
aren't many other options for her to prescribe. “I don't have a pain medicine I can write for them because the next
one is oxycodone, and that is a Schedule II drug,” Whitten, the
legislative chairwoman of the Oklahoma Nurse Practitioners, said. “I
have to tell them, ‘I'm sorry, I can't write a prescription for you.
You'll have to go over to the ER.'” Another obstacle that nurse practitioners face is in paying physicians for signing off to supervise them, she said. For example, some physicians charge nurse practitioners between
$2,000 and $3,000 each month, she said. It's a charge they wouldn't have
to pay if they lived in states like New Mexico. “Nurse practitioners are starting their own clinics in rural and
underserved communities,” she said. “If I'm going to pay $24,000 a year,
I can live in New Mexico and not worry about it and own my own
practice.” Dr. Gabriel Pitman, a trustee on the board of the Oklahoma
Osteopathic Association, said if a doctor is playing a role and is
available to a nurse practitioner, they deserve compensation for
participating in the nurse practitioner's practice. Under Oklahoma law, a physician supervising a physician assistant is
required to be on site at the clinic for a certain amount of time each
week, whereas with nurse practitioners, a physician isn't required to be
at the clinic. Pitman, an Oklahoma City neurologist, said a physician is necessary
to supervise a nurse practitioner or physician assistant because they
aren't as rigorously trained as medical doctors and doctors of
osteopathic medicine. In Oklahoma, nurse practitioners are required to have a master's
degree along with clinical hours. Requirements are expected to change in
2015 to require a doctorate. The Oklahoma Osteopathic Association supports nurse practitioners and
physician assistants in the roles they serve in the health care system —
just not without supervision, he said. “We feel that a physician must always serve as the team leader, as
they are the only comprehensively trained health care professional
prepared to make a diagnosis and establish a treatment plan,” he said.
“We feel direct access to nonphysician health care professionals
endangers patients' health. We feel direct access also puts the patient
in the unfortunate and confusing position of being forced to choose
among the series of health care professionals, not all of whom are
adequately trained to make well-informed diagnoses.”
school a bunch of people I would never have been friends with in the real world,
I now consider friends. However, reality is only a few of us will stay in touch
now that it is over and most go on their way with family and professional life.
Still studying and
jumping through hoops of paperwork, verifications and government regulations so
I can finally sit and write my boards. After a vacation I should be able to
write the boards by the end of October.
helped me get through school and in its current form I think this blog has run
its course. I have other ideas to explore, like Twitter which seemed
interesting for about 2-weeks. However, other sites and platforms will work better for what
I am thinking.
the largest private managed care organization in the U.S. and only second in size to the
Veterans Administration. Over
the past decade Kaiser Permanente has also gone from a reasonably priced
alternative for health care to one of the most expensive in the country. KP offers no explanation for the increased
costs, only that this is part of doing business. Decades ago Kaiser was a
non-profit that helped all people, then they changed to a for profit model, using
wording that still claims non-profit status. Although, KP did reported almost $3 billion in non-taxed profit last
year, and CEO George Halvorson’s annual compensation was $6.7 million.
Here is the problem;
Kaiser Permanente is a private company owned and run by doctors. This is not unusual many hospitals and health systems are owned and run by doctors. But companies like Southwest Airlines are also owned by their employees, but Southwest tries to keep their costs to the customers low. However, at Kaiser it is only the doctors getting annual
profit sharing. So when making a decision about a patient’s medical care does
the doctor also think about saving money, costly procedures, and those
annual profit-sharing checks. Face it, the more profitable the company, the
bigger those bonuses. Sounds like a big conflict of interest when your doctor
is deciding between patient care and their bank account.
Clinicals are completed and my final
project handed in. Which means I am
finally done with school, well unless I go back for my DNP or PhD, and that
will not be happening this year. Board
certification and a resume will be the next projects. Now that I have started looking at jobs, it feels good to see
so many available. I have physicians and NPs that I worked with
willing to give me references. You always want
doctors you worked with for your references, but always wonder what they
really thought about your skills. The medical and nursing models are different
ways of working and caring for patients.
One doctor is trying to get me a job where she works, but I don't know if that is a good fit. I would like to stay here, but the other day Las Vegas sounded good, now that Nevada has passed the bill for NP independence. The only bad thing about Vegas is I do not like the desert climate.
Anyway, maybe for the next chapter in life I should start a new blog. Especially one not connected to the Google platforms. Although nothing is going to happen for a few weeks while I rest first.
Medical Association (AMA) decided, and it is their opinion, that obesity is a
disease. Like every profession the AMA is an association that
can be joined by doctors and medical students, but they have absolutely no
authority to officially classify a disease. The World Health
Organization and CDC can actually
classify a disease, but so far they have not agreed that obesity is a disease.
So, at the AMA’s
annual convention this year, and against their own counsel’s advice, the
majority voted to say obesity is a disease. Even after the AMA Council on
Science and Public Health, which had examined the subject over the last year,
declared that obesity should not be classified as a disease because the
measure that is used to categorize obesity is flawed. However,
at their meeting the majority of physicians voted to say obesity was a disease.
Therefore, it is now their opinion that 78 million or 1/3 of the US
population has a disease.
Is calling a
disease less of a stigma than telling a patient they have a serious risk factor
they can influence.
doctors pushing for lifestyle changes does this open the door to more surgery, medications,
and insurance reimbursement for obesity treatment?
For many years
the CDC has recognized that the two biggest preventable causes of death are
using tobacco products and obesity. Obesity
is not a disease, but a risk factor for other diseases, like cardiovascular disease,
diabetes, hypertension, metabolic syndrome, etc.
Should we now
say smoking is a disease or is it still the cause of a disease?
I am waiting for my first primary care patient to tell me they have the disease obesity.
Yes obesity is
serious, but instead of running for the knife lets first try:
And if needed prescription
week, but that does not mean the work is done. In grad school you can still
walk, even though they give you a little extra time to finish some
requirements. Like a 30 page paper and clinicals until the end of the month. I will miss my primary care clinical site. However,
it is starting to feel strange that this school part of my NP journey is over
in 3-4 weeks.
But come mid-July
it will be time for me to mentally and physically clean my house and mind after
years of school dictating life.
So many stacks
of papers, references, Power-points and lecture materials that I thought I might
need one day, will be placed with love in the recycling bin. I will keep the
important books and notes, but literally there are stacks of paper feet deep. Yes, I still prefer taking notes on paper and reading books with pages instead of e-books. So much easier to write in the margins and highlight in a book.
Then I will need to take care of, boxes that are rarely opened and need to be evaluated and items tossed or donated.
cell phones not used for years need to be recycled.
with tags that I will never wear. They were gifts from my Mother, and sometimes her
taste is good and at other times it is not my style, but I still love her for sending
them and so will the Goodwill.
After a good mind
and house cleaning the rest of the summer will be studying for boards and
working on a resume. Although, no hurry in looking for work yet before September.
of people don’t know that if you are insured you should not be paying a
co-payment, deductible or anything for any of these services. But the doctor’s office or
insurance company will not tell you that.
Services Covered Under the Affordable Care Act
If you have a new health insurance plan or insurance policy beginning on or
after September 23, 2010, the following preventive services must be covered
without your having to pay a co-payment or co-insurance or meet your deductible.
This applies only when these services are delivered by a network
15 Covered Preventive Services for Adults
Abdominal Aortic Aneurysm one-time screening for
men of specified ages who have ever smoked
First, I live
in one of the medical marijuana states. I believe for a few individuals it
could be a useful medicine. It helps cancer patients, glaucoma patients and
some others. But let’s get real most people who claim they use it for medical
purposes are just getting stoned.
I was thinking about this again today because I heard on the radio that San Jose had 70 pot
club or medical marijuana dispensaries and only 41 Starbucks. They want to regulate and close many of them. So a quick Google search revealed this is
common in many big cities like Denver and LA, where medical marijuana is legal. They also have almost twice as many pot clubs or
medical marijuana dispensaries as Starbucks. Funny they use Starbucks as a gauge, because we all know they are everywhere.
If you have
ever seen or been in a pot club or medical marijuana dispensary then you know 95% of them
are a joke pretending to be clinics selling medicine. Remember the Speakeasy’s
during prohibition or the 1800’s traveling snake oil salesman, that sold alcohol
tinctures to cure everything from your libido to the mother-in-law visiting. Well probably cured both of those at times.
Anyway, most of
these medical marijuana clinics and pot clubs are nothing more than bars with
pot instead of booze. They have
counters, menus of different way to smoke or eat your marijuana, and tables to
hang-out with your friends. Does this
sound like a clinic or an Applebee's.
Two states have
now legalized marijuana and a bunch more pretend that it is only distributed as medicine. In addition more than twenty states will fine you less than $100 for getting
caught with less than an ounce or growing a few plants. Not even a slap on the wrist.
Outside of a few cases, people need to stop pretending it is some kind of wonder drug for everything from hangnails to gonorrhea, and the states need to just legalize and tax the shit out of it, like alcohol.
Even if they
have a doctorate or PhD, a nurse practitioner, chiropractor, physician
assistant or psychologists is not a medical doctor. If you are treating someone
in my family I want to know your background. I am proud to be a nurse
practitioner and we have a lot of
power as NPs. We perform physical examinations, diagnose and treat illnesses,
order and interpret tests, prescribe medications in most states, and plan and
implement therapeutic interventions.
On the other
hand, I am not foolish enough to put myself in a class with most medical
doctors, and patients should not guess who is wearing the white coat. I have
met only one NP who was narcissistic and insisted she be called doctor by staff. Beside setting herself up for a lawsuit, I
won’t tell you what the staff called her behind her back.
This is a relevant
topic because to be blunt, many patients are not educated enough, and have no
clue to know the difference between the people in white coats. I wear a white
coat now, but even in my nursing scrubs with my RN badge on, patients regularly
call me doctor, and probably only because I am a male. Talk about confused.
with a PhD or doctorate can call themselves a doctor, but that does not make
them a medical doctor. In fact there are a lot of people out there in the world
with PhDs and doctorates who like to be called doctor, and that is fine.
However, I would never have them touch or get close to a real human being. Thousands of people have Honorary Doctorate
degrees like Stephen Colbert or Bill Cosby and can call themselves doctors. Do
you really want them, a psychologist like Dr. Phil or the guy at the gas
station with a PhD diagnosing your intracranial bleeding or cardiovascular
Thank God I know
some doctors well enough to ask them medical questions, and I do so often. I am not
a fool and will not pretend that I have the same education as a medical doctor.
MD's learn the
medical model and as medical students they spend 10-15 years in higher
education, medical schools and residency, and if they specialize add more years
practitioner learns the nursing model and may spend 6-8 years in school.
However, nurse practitioners are better and
more equipped to deal with patients in several ways. We were trained to treat
people more holistically and not just in a narrow allopathic or western form of
medicine. We communicate better with patients and their families. We see the
big picture more often. In most hospitals I have worked and research papers I
have read, nurse practitioners consistently have a higher overall patient satisfaction
Most docs love us and as NPs and PAs we
are part of the solution to the primary care shortage. But a few bad apples can
ruin it for a lot of people when it comes to trust and working together.
NP's scope of practice varies widely from state to state. I know where I live and many states have current bills trying to improve NP scope of practice. Primarily because of the new Affordable Care Act, the shortage of primary care doctors and an aging population.
The state ranking below are from the Pearson Report. The most interesting thing I found was that only 24 states restrict Doctorate and PhD NP's from calling themselves Doctors. This is a pet peeve of mine, because as an NP you should never imply to a patient that you are a doctor without clarifying you are a NP. (more on that another time)
Hopefully change happens sooner rather than later in more of these states.
Alabama: F Alaska: A Arizona: A Arkansas: D
California: C Colorado: A- Connecticut: B Delaware: C
Florida: F Georgia: F Hawaii: B Idaho: B
Illinois: D Indiana: D Iowa: B Kansas: C
Kentucky: B Louisiana: D Maine: A- Maryland: A-
Massachusetts: D Michigan: F Minnesota: C Mississippi: C
Missouri: F+ Montana: A Nebraska: D+ Nevada: C
New Hampshire: A+ New Jersey: B New Mexico: A New York: B
North Carolina: F North Dakota: A Ohio: C Oklahoma: C
Oregon: A+ Pennsylvania: C Rhode Island: A South Carolina: F
South Dakota: D Tennessee: C Texas: D Utah: B
Vermont: C Virginia: D Washington: A+ West Virginia: C
Washington DC: A Wisconsin: C Wyoming: A
In early 2009 when the economy tanked and
unemployment was over 10% I decided this was a good time to go back to school
while things recover. The plan then was to graduate, get experience and settle
down. Now the economy is recovering and I will be graduating, but I do not know
where I want to settle. I am torn because I like my current location and
everything about it. On the other hand my mother is getting older and I do want
to be closer to her.
I'm attracted to the west coast and it feels like I still have unfinished business here. But in the end I guess any job offers will still be the
biggest influence of where I end up. Hopefully it does not take as long for me to recover from school as it has the economy.
I’m assuming most NP programs are similar to
this one and that we meet weekly with our instructor to discuss patients,
clinicals and any concerns. For our primary care we are all located in
different large busy clinics throughout the metropolitan area. These clinics
are not in any way upscale or suburban; they provide services to the inner-city
and underserved populations. But this is also where we get the best experience,
because many of these patients are train wrecks with extensive problem lists.
dropped out, so my cohort remains the same ten people after 18 months. We now know each other all too well. These weekly sessions lead by
our instructor is a chance for us to decompress from the stresses of everything
going on. Of course our favorite topic is patients and their comorbidities.
talk about is confidential. But we laugh at our patients, we feel for our patients,
we get frustrated with our patients and we really care about them. It helps
because we know we are not alone in the decisions and mistakes that we make. They
are learning points. Our instructor with her decades of experience has
some of the best and funny stories about patients and mistakes from her past.
I want to blog about some of my patient
encounters, but it still feels uncomfortable to post anything outside of the classroom for fear of being recognized. Even without identifying points
in a post, all those confidentiality, HIPAA and ADA laws make me overly cautious while still in school.
As I continue
to walk the bigger path of life, it is hard not to look back at the smaller paths
and exit ramps taken along the way. People, places and experiences are what shape
And many times
I have wondered how one decision, made years ago, along one of the numerous side
paths, would have changed everything.
Would I be walking
this current path of life to become a nurse practitioner, probably not. And who knows where
I would be if one of a thousand decisions had been made differently. Honestly, life’s little
journeys can have positive and negative effects, but they are only part of the
aspects that make you who you are.
As easy as it
is to look back at paths not taken and decisions that could have been made
differently, so it is with looking forward on my current path. Sometimes I
think that I should never be here, but yet the path is still beneath my feet.
Even though the
end is close and I think I will see it just around the next ridge. There waiting
for me is another creek to cross or hill to climb. So I will keep walking. Sometimes
on a smooth trail, sometimes on a path that is overgrown and strewed with
hazards. Life is just that way, and there will be a day when I will look back
and wonder if I should have made different choices I have yet to make.
Sick for 10 days or
so, but since then I have been unbelievably tired. After
school and clinicals all I wanted to do is sleep. So now it is
catch-up mode for presentations and papers due.
But it made me think, why
don’t nurses get sick more often?
My sister the teacher
always says she gets sick from being around the kids, and granted kids can be like little Petri dishes of germs. And at the clinic patients often say they must have caught something at work. Maybe that is true.
But what other profession depends on a
business model that involves their staff having direct contact with sick, infectious
and injured people. Clinics and hospitals rely on and persuade the sick to
visit them. In fact they relish the various and obscure contagious diseases. Nurses
and healthcare professionals must be hardy, because we get exposed to this
daily. Next time I hear my sister talking about catching something at work I'll have to bite my tongue.
Tried to avoid it, but to
no avail. Some little virus or bacteria found its way inside of me and then kicked
my ass, and left me wandering between my couch and bed for three days. Most of it was in my respiratory system with accompanying
throat pain, coughing and phlegm. The occasional headaches and muscle pains were just
The generic OTC cold and flu medication in
my cupboard that expired six months ago can attest that I do not get sick often.
Probably not the flu, but I will never know. Because like any good nurse I will try to avoid a doctor or urgent care visit, and self treat first. FYI, hermetically
sealed expired medications still work fine. So I prescribed alternating acetaminophen,
NSAIDS and Robitussin DM that seemed to keep things tolerable.
However let’s be honest, the true secret
weapon was gargling with warm salt water. Why does this always work so well on a
throat that feels and probably looks like ground beef?
approach is still the best, because besides my salt water gargling, drinking hot tea
with fresh lemon and honey was a good thing. Sympathy from others was appreciated,
but not as much as a comforter on the couch, time and the occasional bowl of warm chicken soup with saltine
crackers. Those things probably helped me as much as any over the counter medications. Chicken soup and saltine crackers no lack of sodium there.
is a term coined by George Ritzer, when he wrote about the McDonaldization of Society. Basically, you
rationalize a task and break it down into smaller parts to make it more
efficient, faster and cheaper. Think of a time when a craftsman took time to
manufacture a piece of furniture from start to finish. He would take a piece of
oak and measure, cut, plain, chisel, border, stain and a dozen other step to
make something of quality. Or a chef making something as simple as a good hamburger,
there are a lot of steps. Start with good quality meat you have to grind, form
and fry or grill properly. Fresh tomatoes, lettuce, onions and other produce to
selected, washed and sliced. And fresh baked buns. Now think the opposite,
McDonald's and IKEA.
To increase production and profits companies turned
to the McDonald's or assembly line method. A product comes down the line and a
person does one thing. No thinking involved. Most
fast-food places operate this way. Frozen preformed burger, fries and food is
delivered from a large factory somewhere. On the same truck comes, pre-chopped
lettuce, tomatoes and onions in something that looks like a clear garbage bag. No
real cooking going on, only the timers and beeps that tell the worker when everything
is ready. One person takes your order and money, one person drops the fries,
one person flips the burgers, one person assembles the food, and one person
puts it in a bag and gives it to you. Efficiency without deviation or thinking.
They even figured out how to have the customers work free, by filling their own
drinks and clearing their own tables. IKEA has you pull and assemble you own
Yes assembly lines have their place and make
things cheaper. Can’t imagine making millions of a cars or computers without an
assembly line. Healthcare has been McDonaldized. CEOs and
bean counters see patients and care as products to streamline. Get them in and get
them out. Like a fancy restaurant, the more times they can turn over a table during a shift, the more money made. Hospitals use beds instead tables. Healthcare has
been broken down into small parts, like an assembly line of care.
In any hospital, on any unit, you cannot
avoid hearing the charge nurse, staffing and the shift manager referring to and
arguing about the Bed Board. It keeps track of all the hospitals beds and who
is in them. We shuffle patients in the hospital 24/7. A doctor orders a bed on
a particular full unit, or a new patient needs a bed on the already full specialty
unit. The shuffle begins. The people ordering the patients to be moved at
midnight never see the patients. The shift manager says take the 35-year-old
male on B5 to CVPCU. Then take the new admit to A3, because we are moving a
patient from there to the med/surg floor. The ER patient on hold can then go to
the neuro ICU, and the semi-stable ICU patient from neuro ICU can go to B5. . . checkmate.
In the hospital, you will see every
specialist there is because nobody deals with the whole person anymore. Chest
pain cardiologist, a little confused neurologist and trouble peeing, a urologist
or nephrologists will see you. They all specialize, one flips, one assembles
and one hands you the order. Try to get a patient discharged and you need 3
different specialists to agree and sign off.
In the hospital, like Target, everything is
computerized and bar coded, and we will scan patients, medications, supplies, equipment and
I am in a large clinic now and it is the
same. A person will check in, see a nurse for triage, see a practitioner and then
the discharge person. If they need labs, pharm, x-rays or behavioral health, they
can see from 4-8 people during their visit.
In some clinics the provider has a set schedule and every 15-minutes
they have to see a patient; 10:00, 10:15, 10:30, etc. Unless you are a new patient
and I am doing a complete history and physical, but those are only on Tuesdays.
A regularly scheduled visit and you are limited to one problem. If you have
another problem, you will need to make another appointment. You came in for a cough
I will treat that. So the sore leg or mole you want me to evaluate. Sorry, no
time. I will make sure it is not life threatening and can refer you to
dermatology or orthopedics. In my
surgical rotations to observe, they have their own unique spins on assembly
lines to make things quick and efficient.
Yes, again there are times when it is
productive and makes sense to use some of these methods. However, people are
not products to be flipped and hurried along to the next station in the
I do not have the solutions, but just about everyone in healthcare
knows there are problems, and we will not be fixing them anytime soon. One of
my clinical rotations has me working with many homeless and uninsured individuals.
Another clinical rotation has me working with an upscale rural population. None
of that is the problem. The problem in this country is we do a horrible job
educating and preventing disease in the first place, e.g., Primary Care.