[HN Gopher] Report: 90% of nurses considering leaving the profes... ___________________________________________________________________ Report: 90% of nurses considering leaving the profession in the next year Author : dr_pardee Score : 889 points Date : 2022-04-27 14:54 UTC (8 hours ago) (HTM) web link (www.healthcareitnews.com) (TXT) w3m dump (www.healthcareitnews.com) | phil21 wrote: | While it's anecdote, every single peer in bedside medical care I | know without exception has either left the field, or has | immediate plans to as soon as student loan debt is repaid. The | few older medical professionals in my family are simply sticking | out the last few years until they can retire early. | | This was generally the case prior to pandemic due to how poor the | work environment has become, but the pandemic seems to have | broken the few remaining folks who still had hopes and dreams. | | How doctors of all professions lost their professional agency to | do-nothing administrators within a generation is quite puzzling | and a bit terrifying to me. | api wrote: | > lost their professional agency to do-nothing administrators | | You just summarized the decline of Western civilization in one | phrase. | | This has happened almost everywhere and efforts to push back | have proven extremely difficult. I personally place a lot of | the blame on the educational system for overproducing | administrative skill sets and underproducing practical skill | sets. There is some role for those things of course but we have | far too many people for the administrative roles we really need | and far too few for many other professions. This combined with | the tendency of people to recruit people like themselves has | oversaturated the market with administrators looking for | reasons to exist. | | The rot is to the point that we have the spectacle of Elon Musk | looking like superman. Why does he look like superman? Because | he actually does things instead of having meetings to discuss | the meeting schedule. He's just a reasonably competent engineer | and business founder with huge resources who... does things... | and this makes him look superhuman by comparison to the hordes | of administrators that only discuss doing things and commission | studies about hypothetically doing things. | hedora wrote: | See also: California's plan to eliminate algebra 2 and | calculus from the highschool curriculum. It is being | spearheaded by someone without a math degree, in the name of | improving marketability of the kids for data science | positions, or something. | | See also (2): Monty Python's bicycle repairman sketch. | tick_tock_tick wrote: | > in the name of improving marketability of the kids for | data science positions, or something. | | They have been very clear and upfront about the goal. They | want to "solve" racial discrepancies in graduation rates so | they've taken the classes often failed and are removing | them. | api wrote: | Yeah that proposal is insane. | | For a while now it feels like the left and the right are | attempting to one-down each other on how stupid they can | get. That proposal seems like an example of the left trying | to out-stupid Trump and the alt-right. Don't worry I'm sure | the right is working on things even dumber than this, and | then those will have to be topped, and so on. In 2024 we | will have Dr. Oz and Marjorie Taylor Greene running against | Oprah Winfrey and Kamala Harris. | | I'm not sure how this downward spiral ties into the | administrative position over saturation problem, but I have | the intuition that it does somehow. Maybe what we have are | a whole ton of people who don't really know how to do | things who vote. Voting is ultimately a hiring decision, so | what we get is a voting process that hires a whole bunch of | either administrators who themselves don't know how to do | things or crackpots because people without practical | knowledge can't spot a crackpot. | selimthegrim wrote: | Oprah would actually not be the worst candidate - | certainly better than Michelle Obama. | api wrote: | https://slate.com/health-and-science/2018/01/oprah- | winfrey-h... | selimthegrim wrote: | My counters are | | a) Forsyth County, GA in 1987 | | b) Michelle Obama's senior thesis at Princeton | hedora wrote: | I think the root problem is that administators without | practical skills are running everything. | | Since they got by without any practical skills, they | don't value such things. Now, they want to eliminate them | entirely from the educational system. | | The managers are at war with the individual contributors, | and they don't understand that someone has to actually do | work, or the system will collapse. | base698 wrote: | https://www.amazon.com/Managerial-Revolution-What- | Happening-... | | > Burnham's claim was that capitalism was dead, but that | it was being replaced not by socialism, but a new | economic system he called "managerialism"; rule by | managers. | | In 1941. | trasz wrote: | It's not about Western civilisation, it's about economic | neoliberalism, replacing every existing metric with a single | one: shareholders' profits. Those do-nothing administrators | _do_ have a marketable skill: they make money for the | company. Or at least appear to, according to (obviously | flawed) criteria that are being used to evaluate ones' work. | tristor wrote: | Pretty much. Unfortunately, we've also created a massive | underclass in the West who have effectively no applicable | skills. They can neither administrate, or do things, and so | they are effectively dead weight on society. Ironically, | considering that administrators are driving us over the | cliff, the underclass is less problematic than the | administrators. At some point we'll hit a critical mass and | there will be so few people left that know how to do things | that we literally will be unable to maintain the basic | infrastructure of civilization. The cracks are already | starting to show. | | The sad thing is that this is so very obvious, and yet such | an intractable problem to solve. The entrenched systems at | every level of society will fight you at every turn when you | try to improve things. | stripline wrote: | I recently saw a good talk about this point. | | Preventing the Collapse of Civilization. | https://www.youtube.com/watch?v=ZSRHeXYDLko | RyEgswuCsn wrote: | That is an interesting observation. I wonder how much of the | advent of "talking over doing" is related to the development | of mass/social media. | | Influence can propagate so easily through mass media, meaning | that it is now possible to generate enough business interest | just through "hyping" (it's difficult to achieve this when | messages have limited reach) --- combined with the fact that | it is often cheaper and less risky to "talk" than to actually | "do", we end up with a culture where hyping is preferred | whenever possible. | bpodgursky wrote: | The shift to EMRs (more-or-less forced by the ACA) has been a | huge quality-of-life loss for doctors. Tons of time spent on | Epic or Cerner checking boxes and selecting drop-downs. | | Turned a "trusted professional" advisory role into a keyboard | role. | notch656a wrote: | There are medical scribes who will do all that for the | physician and for dog-shit wages. Usually these are medical | school-wannabes so they can easily be tricked into working | for minimum wage, and once they're suitably trained the | physician just has to briefly scan the EMR for completeness | and sign off on it. | bpodgursky wrote: | I have not seen this happen extensively, in practice. | ryan93 wrote: | There are like 4 million nurses. Where are they going to go for | even remotely similar wages? | legitster wrote: | > How doctors of all professions lost their professional agency | to do-nothing administrators within a generation is quite | puzzling and a bit terrifying to me | | This should terrify everyone. Large segments of our society are | failing us despite being stuffed to the gills with | administrative staff that don't contribute much to productivity | but rob professions of their independence. We're managing | ourselves to death. | csa wrote: | I frequently say that administrators have killed both the | education (esp. tertiary) and medical fields in the US. | | I'm pretty sure both of these will implode under the | bureaucratic weight at some point -- the financial and social | costs of the excessive administrators is not justified by their | (often minimal or negative) value added. | throwawayboise wrote: | Yes, it's like someone held up a mirror when you look at what | has happened in Higher Ed when the professors stopped running | things, and Health Care when doctors stopped running things. | Costs skyrocketed, outcomes stagnated or declined, | satisfaction plummeted. | salt-thrower wrote: | > How doctors of all professions lost their professional agency | to do-nothing administrators within a generation is quite | puzzling | | The profit model of the U.S. healthcare industry might have | something to do with it. The fact that hospitals are run like | businesses and have shareholders is insane to me. I know other | countries' healthcare systems got hit hard by the pandemic too, | but it seems like the uniquely capitalist nature of healthcare | in the U.S. sets it up to mistreat workers and cut corners for | the benefit of administrators and executives. | toiletfuneral wrote: | theklub wrote: | It's not just that, some hospitals are outsourcing everything | disenfranchising the people that work there. And I mean | everything from the doctors themselves to IT to the cleaning | lady to the food workers and selling the buildings to lease | them back. It's the fleecing of America. | reedjosh wrote: | If they can't throw some medication with pharma kickbacks at | you, they probably won't do much at all. | | My 6 month old son was put on topical steroids for a small | rash on his back and the doctors solution when this turned | into a progressive issue was more and stronger topical | steroids. | | Eventually I learned about topical steroid withdrawal, and | after a hellish withdrawal period, my son has no real skin | conditions. | | https://www.youtube.com/watch?v=PpW4VV2bsD8&t=28s | | And yes, my son at ~1 year old was red and bleeding like that | head to toe. | | When I brought up steroid withdrawal I was rudely dismissed | by multiple doctors including dermatologists. | | Doctors currently have willful blinders on at a minimum, and | some may be a true embodiment of evil. I hope the whole for | profit medical system crashes and burns. | Enginerrrd wrote: | Steroids are so commonplace and old, I really doubt anyone | was getting pharma kickbacks in the case of your son. | | There's just a large range in quality amongst doctors. What | you're calling "willful blinders" or "true embodiment of | evil" is more likely just a failure to adapt out of a | simple paradigm: {Inflammation}->{Treatment = steroids}. | And a failure to recognize when that was causing a loop. | Maybe they forgot about steroid withdrawal. In fact, as | someone with quite an interest in pharmacology and some | background as a paramedic, this is the first I've ever | heard of it, and I love obscure medication issues. | reedjosh wrote: | > Maybe they forgot about steroid withdrawal. | | As I mentioned in my comment I mentioned steroid | withdrawal to many doctors when my son was literally only | sleeping an hour or so a night from itching and I was | dismissed out of hand. | | If its not kickbacks, then its such a terrible arrogance | as to be evil. | | How can a dermatologist not know of my son's condition? | Particularly seeing as steroids have been around for a | while as you've mentioned. Even when I brought the idea | to the dermatologist, after a bit of head nodding his | solution was another two weeks of a yet stronger steroid | to `calm it down`, and then to taper. | | There's a nonprofit trying to get doctors to properly | acknowledge the condition. | | https://www.itsan.org/ | | There's as I linked above about a million videos of | people recovering from TSW as well. | | There's even a study out of Autstralia that followed 10 | children with what was called bad eczema, but after a | withdrawal period every child at max had pruritis on | elbows or knees. | | https://www.medicaljournals.se/acta/content_files/files/p | df/... | | If my job were skin, and topical steroids was one of the | main things I used as a tool, how could I not know about | these issues? You'd have to be such a hack that nobody | would consider you a professional, yet the same | dermatologist that offered yet another round of steroids | had his office on the penthouse suite of a downtown | building with a showcase displaying awards. | | It may seem hyperbolic to you, but you didn't live | through this like I did. You didn't see your young child | in complete misery due to medical authorities you thought | you could trust misguiding you. It's evil of some form. | hedora wrote: | I had some digestive issues, and the specialist's | diagnosis boiled down to: I have the same issue. You're | getting older. | | The correct diagnosis was: That sounds like chronic | inflammation. Hit the gym and lose 20 lbs, fattie. | [deleted] | bitsnbytes wrote: | profit model is not the issue. How the compensation and | rewards are structured is the issue. | defterGoose wrote: | So...we need to _manage_ that better? | orangepurple wrote: | > How doctors of all professions lost their professional agency | to do-nothing administrators within a generation is quite | puzzling and a bit terrifying to me. | | I would bet it's caused by: | | - stifling bureaucracy | | - hostile legal climate | | - massive start up costs | | The only winning move is not to play. Let the system fall apart | and join on the later upswing. The unfortunate part is all the | needless suffering people will endure during this process. | brightball wrote: | Insurance companies. | | Everything is controlled by insurance companies. You can't do | anything unless it's exactly how insurance wants and only for | what insurance will pay. | | It limits everything, including how every profession can be | compensated simply because you can't easily hire somebody for | more than what insurance will pay for their services. You can, | but the funds have to come from somewhere. | slantedview wrote: | Insurance companies are awful and should not exist, sucking | up a lot of doctor time, but when it comes to nursing, | hospitals are particularly awful, cutting staffing levels to | the bone in order to maximize profit. People die as a result, | and nurses are burnt out. | mfer wrote: | In the book _The innovator 's prescription: a disruptive | solution for health care_ by Clayton Christenson, there are | some good analysis of where the complexity and problems come | from in the current US medical system. | | A lot of it has to do with size and the complexity that goes | along with it. So, as hospitals get bigger, do more, and | increase in size and complexity these issues become worse. | | The economics math even mirrors factories... a factory that | can build 100 things compared to one that just produces one | thing. | | The book was enlightening, even though many of the time | frames called out in the book were wrong. Disrupting medicine | is a lot harder than something like technology. | mikkergp wrote: | I think this alludes to it, but it's one thing mentioned in | one of Atul Gawande's book is that in India they have | hospitals that focus on one thing: | | https://www.businessinsider.com/inside-indias-no-frills- | hosp... | | So like a 2000 bed hospital just for heart surgeries. Like | you're saying, the more a heart surgeon specializes, the | better they are at it and the cheaper they can do it. | Better Outcomes for less money. | 2143 wrote: | Yes there are hospitals in India that cater to a specific | aliment. For instance, eye hospitals, cancer centres, | hospitals that cater to pregnancy, childbirth and | neonatology etc. | | > Like you're saying, the more a heart surgeon | specializes, the better they are at it and the cheaper | they can do it. Better Outcomes for less money. | | Not necessarily. | | 1. A heart surgeon is going to be doing heart surgery at | more or less the same frequency regardless of whether the | hospital they're at handles only heart patients or not. | Wouldn't they? | | 2. I doubt if anybody here considers them cheap. Yes it's | probably cheaper than in the US, but still it's rather | expensive. But then again, since life is priceless, ... | mikkergp wrote: | At a 2000 bed facility though, you could specialize in | specific types of heart surgeries. At a general hospital | you're probably more likely to take on a wider variety of | heart procedures. It's not just experience, but | experience in specific procedures that can dictate | outcomes: | | https://www.reuters.com/article/us-healthcare-quality- | surger... | | Maybe cheap is the wrong term, but less expensive? I mean | $800 may be expensive but certainly it's better than | more? | lettergram wrote: | No one wants to hear the truth. | | There's near-infinite demand for healthcare and a constrained | (mostly artificially) supply. | | Insurance, people and government can't solve the problem of | the supply and demand by throwing money on it. | | You either expand supply or remove demand. Given removing | demand is... not desirable. The only alternative to fix the | issue is remove regulation and expand supply. That's it. | | Insurance makes the issue worse by increasing demand and in a | way limiting supply through requirements and procedures. | | Government limits supply through regulation AND expands | demand by paying for procedures. | | An approach is to deregulate, such as removing government | licensing, remove Medicare, etc. | | Imo Prices would drop >95% within a 2-5 years (to India or | Mexico levels). | | I worked in medical billing for a few years and the issues | are beyond obvious. | lefstathiou wrote: | I think there needs to be some new approach to how medical | services are being paid for. My 70yo father fell off a | ladder and drove himself to the hospital in Calhoun Georgia | (2 hours north of Atlanta, a small town) with a bruised eye | and a broken wrist. He got in late afternoon, left the next | day, and the bill to insurance (which of course they won't | pay) was $69,000... more than per capita income in the US. | The system is ridiculous. | | In my opinion, healthcare has reached the state where the | people who receive the benefit are too far removed from the | people who pay for it and given there is no "victim" of | price gauging, the prices will just keep going up up and | way. | | I defer to those wiser than me for the solution. I don't | like complaining without being constructive so here is my | ignorant pass at it. This will require a few key steps: 1) | Yes, we need more supply (by deregulating the profession) | 2) I personally think a more effective solution would be to | gradually eliminate insurance except for catastrophic risk | (like emergency medical care from a car accident). #2 will | shift responsibility to the individual and the system will | be capped at what they can charge based on the average | person's ability to pay for it (which is how it works in | many parts of the world). | ClumsyPilot wrote: | > Yes, we need more supply (by deregulating the | profession) | | So it looks like software development? Are you | comfortable for your life to be in the hands of a rando | who just finished a 6-months bootcamp? | lefstathiou wrote: | I don't think it has to be binary. For situations that | are life threatening, I'll opt for a premium service and | for situations that are not, I may opt for an | alternative. I think almost anyone at our company can be | trained to reliably operate and interpret an x-ray | machine for the vast majority of use cases. | ClumsyPilot wrote: | 'For situations that are life threatening, I'll opt for a | premium service' | | 1 - what does the 'non-premium', i.e. bottomn of the | barrel service look like, is that incompetent people | offering rock bottom prices (resulting in death?). | | 2 - are you sure you can identify a life threatening | situation correctly? Because my father did not. | | 3 - how do you know the 'premium' provider in question | results in better outcomes, rather than being the same | rubbish well presented in fancy packaging? | lettergram wrote: | > left the next day, and the bill to insurance (which of | course they won't pay) was $69,000 | | I agree with you and the quote above is because of | insurance. Medicare will pay 10% of that total and your | father would be charged 2-5%. If he has private insurance | you'll see something different, maybe 15% and your father | would be charged 3-6%. If he's going out of network could | be 100%. Hospitals / practices charge insane bills | because people pay just a small fraction typically. It | really impacts those without insurance or private | insurance the worst. It is insane. | | This is why I have suggested deregulation, particularly | around licensing. It drives down the cost. Insurance may | cover doctor X, but if nurse Y can do it for 5% the | price... well use the nurse. All doctors would have to | reduce prices and insurance would have to raise the | coverage amount to compete. It's what is done elsewhere | in the world. | jodrellblank wrote: | > " _An approach is to deregulate, such as removing | government licensing, remove Medicare, etc._ " | | This worked so well for Rosemary Kennedy when she could be | prescribed an ice pick lobotomy. And so well for Eben Byers | when his doctor prescribed him radioactive water, and he | drank so much his jaw rotted off. It works brilliantly for | this woman[1] and her cheap Turkish dentist work leaving | her in pain. And for, well all of this junk: https://en.wik | ipedia.org/wiki/List_of_unproven_and_disproven... | | Deregulation is what we had when things were terrible. | Regulation and licensing is what we use to block the most | obvious junk 'treatments' and the worst con artists. | | > " _Given removing demand is... not desirable._ " | | Removing demand is enormously desirable. Regulate the shit | out of CocaCola, Marlboro, and all the other health | destroying parasites and their advertising, tax them, | rework town and city planning to remove driving as the | primary transport in life and all the associated exhaust | fumes, rework public schooling and rebuild trust in the | government and medics so people aren't anti-health-advice | on principle, rework employment so that employees have some | rights and aren't stressed out all the time with no sick | breaks. Rework medical access so people can see medical | professionals, and sickness can be caught and treated | early, which reduces demand on seeing much sicker people | later. | | > " _Insurance makes the issue worse by increasing demand | and in a way limiting supply through requirements and | procedures._ " | | Insurance makes the issue worse by driving up costs to | patients and at the same time driving down pay to medical | staff, by insurance taking as much as possible. Without | insurance, supply and demand could remain the same, medical | staff earn more, patients pay less, and services be more | efficient with less time wasted fighting insurance | companies and filling in insurance paperwork. | | [1] https://old.reddit.com/r/northernireland/comments/ua9me | 9/eas... | mola wrote: | You should educate yourself about how most of the western | world manages to have a functioning semi social health care | system. US is broken because of this blind fantaic faith in | _free markets_ _deregulation_ simplifications. | | The problem is a large swath of the population that believe | in all earnestly that squeezing profit is some magical tool | for a functioning economy. | | Too bad US is so good at PR, this mind virus is wreaking | havoc all over the world. | lettergram wrote: | > You should educate yourself about how most of the | western world manages to have a functioning semi social | health care system. US is broken because of this blind | fantaic faith in free markets deregulation | simplifications | | Most healthcare in the west is subsidized by the US. The | US market is far more lucrative, so companies do R&D and | make capital from the US. The US also subsidizes in terms | of both military and energy almost every western country. | Even then, Europe has a higher tax rate and on average is | far poorer. | | I'm well educated on this subject and worked in this area | in the US and spent time in other countries. You have no | idea what you're taking about. | ClumsyPilot wrote: | "The US also subsidizes in terms of .. energy almost | every western country" | | These claims are outrageous and totally unsubstantiated. | How does US subsidise energy of France or Japan? | | "Most healthcare in the west is subsidized by the US." | "The US market is far more lucrative, so companies do R&D | and make capital from the US. " | | You are subsidising the companies, not my healthcare. And | they pay out this money in dividends to shareholders. I | am sure they are very gratefull, maybe you should ask | them for a rebate. | | Stop subsidising them and overpaying - do you think | healthcare costs in Europe will rise? If you do, I've got | a wager. | spaniard89277 wrote: | I would say that most western countries do have both | public and private healthcare. I did have private | insurance here in Spain and it's nothing like in the US, | as far as I can tell. Service was excelent and I didn't | felt everyone was stressed. | | In france your public insurance allows you to walk in a | private clinic or hospital too, as a relative did and | they cover her post-cancer treatment better than in the | public hospital (by her account at least). | | So yeah, "free market deregulation" may be an | oversimplification but you have a problem in the US | that's also far more than just being for-profit. We have | for-profit over here and it works. | | And that includes private & public institution doing | medical R&D and selling their products to the national | health services and private clinics, like quite a bunch | of spanish companies do, for example. I say this becase | it weirdly pops as an argument when it's totally | unrelated, and it may be only a tiny fraction of the | total cost. | onlyrealcuzzo wrote: | Have US hospitals ever had transparent pricing? | | This seems like the root of the problem, and insurance seems | like what "fixes" that but causes tons of downstream unwanted | side-effects. | teeray wrote: | It's always astonishing how I can get a fully itemized vet | bill right after a visit and pay for it. Meanwhile going to | the hospital is like "well gee, let's submit to insurance, | see what they'll pay, we'll readjust prices and then come | back to you in a few months." | lostcolony wrote: | More than that, I can get an estimate upfront, that in | 100% of cases matches the bill unless they find something | additional they need to do, which they'll inform me of | and create a new total estimate for. | | Of note, my vet insurance doesn't negotiate on my behalf; | they just pay X% afterwards. The price the provider | quotes for a given service is the price everyone gets | (probably; some of the smaller vets might modify it if | someone is low income and in need). | MiddleEndian wrote: | Months after my last real procedure in a hospital, even | after the insurance was settled, I could not get them to | tell me how much money I owed them. Even when I went in | person and told them "I want to pay you all of the money | right now" they just shrugged their shoulders and told me | they didn't know how much I owed them. | | They just sent me a bunch of small bills in the mail one | at a time and had a text field online where I could | blindly pay them without indicating whether or not I had | completed my payments. | lostlogin wrote: | Makes you wonder how this works for them. How do they | know if they are in the black or the red if they can't | tell who owes what? | MiddleEndian wrote: | Fucking beats me (although this particular hospital seems | to be very disorganized). I will never understand why | anyone would make it difficult for me to give them money. | brightball wrote: | Yep. Seems ripe for fraud too. | MiddleEndian wrote: | I ended up getting sent to collections for $40-50 for | missing one of the bills. Never in my life have I not | wanted to pay a bill, but god forbid any large | organization just take my money and leave me alone. | lostcolony wrote: | Yes. Prior to insurance. Insurance is the reason prices | aren't transparent; insurance companies demanded discounts, | so providers raised their prices to then say "you're saving | X from list". But not every company had the same bargaining | power, and individuals had none, so the actual desirable | price to offer couldn't be made broadly available. With a | hidden price (so no shopping around), that is discounted at | wildly different rates (so no meaningful way for third | parties to track it), and a necessary service (so no just | avoiding it), in a private for profit industry, of course | it skyrockets. | | Our options are either to mandate publicly available price | lists that are adhered to and hope the market pushes things | downwards, mandate prices, or socialize insurance (so that | the sole representative of everyone can negotiate the price | downwards using the leverage of the provider risking losing | most if not all their clients). Or, you know, keep doing | what we're doing which is working so well ( _/ sarcasm_). | caycep wrote: | Granted, there's a niche for cash pay docs. Example being | psychiatry - it's extremely hard to find a psychiatrist who | takes insurance, even Medicare. The good ones are all cash | pay... | micromacrofoot wrote: | I've heard the same thing from mental health counselors and | therapists. In wealthier areas many will just stop accepting | insurance entirely and make people pay out of pocket to avoid | all the insurance paperwork and requirements (some insurers | require specific diagnosis to continue paying for services). | If an insurer decides to not pay you? good luck. Now you need | to throw hours of unpaid labor at them to get money you're | owed. | | Unsurprisingly, this means many normal people can't afford a | therapist and they're getting harder to find. | UncleOxidant wrote: | This. I had a great doc until a few years back. Best doc I've | ever had by a long ways. He'd spend a good amount of time | with you, actually listen to your concerns and even bring up | recent papers he'd seen on topics related to my health | issues. A few years ago he decided to mostly get out of | doctoring because he was tired of dealing with insurance | companies. For a while he went to a retainer model ($2K/year | up front, $250/visit) and cut the number of patients he was | seeing down significantly. I can't say as I blame him. | brightball wrote: | MDVIP does that model in the US too. | brimble wrote: | Consolidation's a big part of it. The last decade has seen | nearly all the small practices and offices in my city gobbled | up by a couple of huge companies. With that comes the MBAs | and the bureaucracy. | Workaccount2 wrote: | The healthcare in my area is like watching feudal lords | rapidly claiming their territory. With central fortresses | (hospitals) and outposts (smaller treatment centers). | cwbrandsma wrote: | The hospitals themselves are also to blame. There are a | couple court cases where the hospital threw the nurse under | the bus to cover up for their own issues (short staffing, bad | safety procedures, covering up for a doctor, etc), and nurses | are justifiably pissed off right now. | | There was a time when hospitals could have helped the nurses | with the stress and workload, but the admins bungled it at | every possible turn, and now it seems they missed their | window. | polskibus wrote: | It's like that in many countries, also in EU. Average age of | a nurse is rising, richer countries rescue themselves by | importing workforce, because they can't find workers for the | rates they have budgeted at home. | | It's is like that in other professions too if it's only the | tech that gets compensated well. There is a shortage of | skilled labour. | soco wrote: | Errata: there's a shortage of skilled labour _for these | working conditions_. Said budgeting is not set in stone, | and as long nurses and whatever else professions can vote | with their feet (by leaving the profession) no amount of | politics-led finger-pointing can replace a real-world | change in the healthcare policies. | ajross wrote: | > Everything is controlled by insurance companies. You can't | do anything unless it's exactly how insurance wants and only | for what insurance will pay. | | Framed that way, this sounds terrible. But... the truth is | actual health care outcomes for insured patients in the USA | are _extremely good_. This holds in comparison to other | nations, when corrected for GDP and patient income, etc... | | "Insurance companies" are, at least in the narrow sense, | doing what we pay them to do really well. | | They may or may not be making things easier for nurses, which | is a different metric. But nurses aren't their customers, we | are. And we're getting a fairly good[1] product. | | [1] Albeit extremely expensive relative to other nations. | belval wrote: | I doubt that it's as simple as that. Nurses are also leaving | in Canada and we don't have insurance breathing down their | neck. | icelancer wrote: | Insurance / government repayment is mostly the same thing. | A layer of bureaucracy. | tubalcain wrote: | Canada's solution will be to mass-import nurses from the | third world who will do twice as much work for half as much | money. Mark my words. | | It's already happened with low-wage fast food jobs. Health | care is next. Nurses and doctors will be replaced by | poorly-trained third-world counterparts. | alexashka wrote: | Are they? Leaving to do what, exactly? | | For every story of 'X leaves to do Y', there are a thousand | people claiming they'll leave, that never do. | belval wrote: | Some just leave to stay-at-home, some go back to school | and a lot will take early retirement. | klyrs wrote: | Instead, you're left with the diminished quality of care | from people who desperately want to leave but they're | only there because they can't afford to. | reedjosh wrote: | But they have zero autonomy there too I assume? | belval wrote: | Sample size of 1, but my gf blames forced overtime. Being | legally obliged to stay for an 8 hours shift after | finishing one has a way to drive you to depression. | px43 wrote: | I would pay more to go to a hospital where I know people | are actually well rested. My last few hospital stays have | been saturated with clearly agitated staff (doctors, | nurses, reception) who were putting in minimal effort, | and clearly didn't want to be there, and I can't blame | them given the conditions that they're being forced to | work under. | | This is in the US, and I can't figure out why the | Department of Labor hasn't cracked down on the medical | industry yet. It's really horrific, especially because | these are the people we're supposed to be relying on to | keep us healthy and safe. | | How hard is it to enforce 8 hour days 5 days a week? | Every other industry has figured it out. | belval wrote: | To be fair, most industries don't have evening and night | shifts and a supply mismatch, most nurses want to work | the day shift, it's harder to find candidates for evening | and night. | rootusrootus wrote: | At least at my local hospital, it's not just overtime -- | regular shifts are 12 hours even when everything is | normal. That's nuts. | syedkarim wrote: | Why doesn't the American Medical Association start its own | insurance company? | bitsnbytes wrote: | Insurance companies is a symptom of the REAL issue. | | Unfortunately the American public hasn't figured out what the | real issue is yet. They reason why they haven't is mostly | because the Democrat party , Republican party, entertainment | industry , the Main Stream Media, tech industry, and the the | Commission on Presidential Debates (CPD) has them occupied | with the symptoms of the REAL issue in order to keep them | chasing their tails. | | The REAL ISSUE why healthcare isn't getting fixed is because | of Conflict of interest.The American public hasn't figured | out that going to congress who is riddled with conflict of | interest and who designed the existing system that we have in | place and is benefiting from it, might not be the best idea | to fix healthcare. | | In fact the best thing to fix healthcare (and the other 99 | problems)is to STFU about it and focus ONLY On reducing | conflict of interest in congress. Until we reduce conflict of | interest in congress nothing will be fixed. | | The Democrat party ,republican party, CPD and MSM want you | focused on everything but reducing conflict of interest in | congress. In order to fix healthcare and any of the other | issues we must FIRST try to minimize conflict of interest by | implementing the following as a start: | | 1. Term limits | | 2. Closing or reducing revolving doors between private and | public sector. | | 3. No private campaigning contributions. Use tech to overcome | the need of money. | | 4. Reform lobbying by doing away with the money aspect of it | and utilizing technology to get your voice heard. | | 5. Pay congress members more and better benefits, but in | return demand complete transparency from financial | information to limitations in investments , NCA , and make | pay and benefits tied to the general overall approval of | congress by the American tax payers. | | 6.etc | | Both party and the MSM solution to fix healthcare is the | equivalent of going to the MOB and asking them to fix crime | in your neighborhood which the MOB is benefiting from and is | promoting. It just makes no sense to talk solutions with | people riddled with conflict of interest. | | You want to fix healthcare stop talking about healthcare and | get the individual republicans and individual democrats to | put their political ideology on hold and join forces to | demand that their party ONLY focuses on reducing conflict of | interest in congress. | darkerside wrote: | I don't hear it talked about enough, but I think the biggest | problem with insurance is that their profits are pinned to | how much they spend on medical costs. | | https://www.verywellhealth.com/health-insurance-companies- | un.... | | In theory, this sounds like a great way to make sure | insurance companies aren't just taking unreasonable profits, | and that they are spending money on medical care, not | administration, keeping the business lean. | | In _practice_, what it means is that profits are constrained | by medical costs, so the insurance companies are literally | incentivized to pay _more_ for medical services. Originally, | insurance companies were supposed to be an intelligent | negotiator on behalf of their customers. After all, their | experts should know much more than a layperson every will. | | But with the poisoned incentive to raise costs, customers are | basically held hostage by a bag faith negotiator. Not bad | faith as in malicious, but in terms of having an enormous | conflict of interest. | legitster wrote: | I've worked with both, and by far hospitals are much, much | worse actors. | | Hospitals are _legally enforced_ local monopolies (look up | Certificates of Need). Meanwhile, you might have a dozen | choices of insurance companies, but they all suck because | they have to take what the hospital billing departments give | them and take the blame or risk being dumped by the hospital. | at_a_remove wrote: | Previously, that wasn't entirely true. | | In the very early nineties, insurance companies lured doctors | in with promises of referral if they would just accept | certain terms. Originally, this was to the benefit of the | doctor -- more referrals. But only originally: once lock-in | occurred, the insurance companies began to set their own | terms. They couldn't have accomplished this without some | greed on the part of many doctors early on. | Melatonic wrote: | Offer to pay in cash and it is amazing how much better the | customer service and general demeanour is from a medical | office - it always blows me away. They must REALLY hate | dealing all of the insurance BS. | | I had not done an eye appointment in years and years because | my vision is generally very good - I went in expecting to | offer cash, negotiate, and generally play a bit of hardball. | I was amazed when the front desk person IMMEDIATELY perked | up, looked super happy, and started offering massive | discounts before I even threw numbers out. The eye doctors as | well were very enthusiastic. | bakuninsbart wrote: | It is definetely a (big) part of the reason, but if it was | the only one, things wouldn't be in a similarly terrible | situation in other countries. Take the UK as an example which | has a single-payer system, and morale is overall really low, | too, and nursing isn't an enticing career. (On a side-note, | the BBC show "This is going to hurt" is quite good and on | topic) | | Apart from administrators and insurers, I think a large | problem is that the job has become substantially more | difficult and technology intense, while support and pay | hasn't kept pace. At the same time, liability is more serious | these days, which I don't think is a bad thing, but certainly | sucks for the workers who have to constantly justify | themselves and can get crucified for mistakes. | seabrookmx wrote: | +1 very similar story in Canada. | | It blows my mind that super long shifts are the norm for a | job that's generally more exerting/stressful than your | average 9-5. But it's a viscious cycle now because of the | shortages of qualified staff. | | Here in BC we have a full on crisis where family doctors | are retiring at an alarming rate and not being replaced. | andrei_says_ wrote: | Prioritizing profit corrupts the commitment to providing | care. | | Healthcare can be either care or industry. | | Applying corporate values to a healthcare system leads to | maximum wealth extraction from both providers and patients. | | In this context innovation focuses not on the care part but | on the extraction. The care is secondary. | | How can anyone who cares be a proponent or coexist with a | healthcare industry? | DaltonCoffee wrote: | This inefficiency and it's resulting poor working conditions | aren't unique to countries with health insurance and private | healthcare tho, see Canada. | rootusrootus wrote: | > You can't do anything unless it's exactly how insurance | wants and only for what insurance will pay. | | This is the part that makes the whole experience so sadly | ridiculous. Nobody could ever tell patients what something | might cost and let them make choices, it was (and is) "Sign | here to acknowledge you'll ultimately be responsible for all | charges, no matter what they turn out to be." But the | insurance company doesn't operate like that, they say "Want | to be part of our network? Guess what, you have to ask us for | permission or we just won't pay you." | | We need to rip off the bandaid, as it were, and reboot the | damn system. Pick one of any number of good examples from | other modern industrialized nations that have functioning | healthcare, and copy it. Yes, everything will be a zoo for a | while. We'll survive, and maybe even come out the other side | with a better system. And maybe some bankrupt insurance | companies, let me find my handkerchief. | pc86 wrote: | Insurance is the only industry where they agree to pay for | something (in this case, "medical care"), but then _after | service has been rendered_ can decide to pay less, or not pay | at all, or stop paying that provider altogether, etc. This | combined with hospitals being run by non-physicians*, and | people thinking being able to Google and read WebMD qualifies | them to argue with their doctor about treatment plans**, | healthcare in the US is going to absolute shit***. | | * I strongly believe that only physicians should be running | hospitals. Certainly not administrators whose only education | is an MHA and only experience is working for for-profit | health companies. Medical decisions need to be made outside | of cost considerations. The only factors should be medical | science, quality of life, and patient wishes (in that order). | | ** In stark contrast to asking questions and trying to | understand. But I have family members who are the "look | everything up and then try to tell my doctor how they're | going to treat me" ilk and it's crazy. | | *** I don't think the above points are unique to US | healthcare other than cost considerations, but that's all I | have experience with.* | giraffe_lady wrote: | The "only physicians should run hospitals" doesn't make | that much sense to me. Reminds of the technocratic argument | you used to see a lot on the internet that instead of | politicians we should have scientists and engineers in | legislature. | | The issue is if you have someone with a scientific | background doing politics, what you have at the end is | still a politician. Same thing here. An MD doing hospital | administration is an administrator. | | Which is _not_ to devalue specialist expertise in these | roles. I definitely think you want people with these | backgrounds in those roles as well. Just not necessarily | exclusively. A career administrator has different skills | than a physician, you want people with both, and other, | roles working to run a hospital. | | The real problem as I see it is probably the incentives, | constraints, and pressures they work under, or towards. A | physician forced to run a for-profit hospital maximizing | returns is going to make a lot of the same decisions as | someone with a business background in the same situation. | The thing is to change the situation, not put different | people into that role and expect them to do it dramatically | better. | caycep wrote: | The problem with this is that the MBA programs that churn | out hospital administrators tend not to be very | good...focus on mergers, cost cutting, not so much on | optimizing care. The pendulum has swung too much onto the | MBA for MBA's sake hospital administrators and less so on | actual medicine. | slantedview wrote: | > A physician forced to run a for-profit hospital | maximizing returns is going to make a lot of the same | decisions as someone with a business background in the | same situation. | | Indeed! Whereas a doctor might say yes, give that patient | with cancer the treatment they need, the MBA is going to | say no, it costs to much, let them die. If the goal is to | maximize profit, the MBA is doing a better job. If the | goal is to maximize the health of your patients, the | doctor is. We must realize that these two goals are | fundamentally in conflict with one another. | | The question isn't whether a doctor or an MBA should be | running a for profit hospital, it's whether we should | even have for profit hospitals. If we care about people | more than profits, then clearly we should not. | brianwawok wrote: | At some point, you have to put a value on a human life. | | It sucks and no one likes it, but what is the | alternative? | | Each human life is worth infinity? So we should bankrupt | the entire country, spending 10 trillion dollars on a | surgery that has a 1% chance to save a 98 year olds life? | | Obviously that is an extreme example.. but the point is | sound. We only have so many resources, how do they get | divided up? Should be spend millions to give 80 year olds | 1 more year of life? Do we value life on the reverse of | age, so a baby we value at 10 million dollars, but a 90 | year old we value at $20,000? What if that 90 year old is | your Grandpa? | slantedview wrote: | > So we should bankrupt the entire country, spending 10 | trillion dollars on a surgery that has a 1% chance to | save a 98 year olds life? | | This is a pretty wild straw man fallacy, but I'd like to | give a good faith response nonetheless. | | You may not know, but the US spends more per capita on | healthcare than any other country in the world, by a | longshot. Many other countries provide unimpeded | treatment for all of their patients. If a doctor in Japan | wants chemo, the patient gets chemo, and treatment starts | immediately. So how does it make sense that we spend more | on our patients but doctors are still told no, the | patient can't have that treatment? It's because a larger | share of our biggest-in-the-world healthcare spending | goes to for profit companies, like insurance companies, | than anywhere in the world. | | So when an insurance company says no to a treatment, it's | not because we don't collectively spend enough for that | treatment, we do! It's just that the insurance company | wants that spending for themselves. | calvinmorrison wrote: | Let's not be obtuse though. The majority of healthcare | costs are incurred at end of life. Perhaps insurers and | the government should not subsidize any life saving care | for those over the average mortality. | | I know for example, my grandmother who lived in europe | many years ago, had failing kidneys. While today it's | likely she could have subsisted for more years on | dialysis, perhaps that money didn't need to be spent. | | Life is finite, and racking up bills at EOL is a waste. | People need to learn how let others die with grace, | instead of giving chest compressions to a 85 year old | 80lb grandmother. | ClumsyPilot wrote: | If you want to do that, then you have to legalise | euthenasia and dace all the thorny questions that comes | with | nickff wrote: | > _" This is a pretty wild straw man fallacy, but I'd | like to give a good faith response nonetheless."_ | | Your interlocutor was actually using "reductio ad | absurdum", which is a valid style of argumentation. | https://en.wikipedia.org/wiki/Reductio_ad_absurdum | | You didn't address the scenario as presented, or | demonstrate how it violated a principle you had | described. Instead, you shifted to excoriating the | insurers for greed and waste. | | Should the insurance company bankrupt itself on the first | client? If not, how should they decide how much to spend | on each? I should note that non-profit hospitals have | similar results as for-profit hospitals (in the USA), so | there's little evidence of shareholder greed playing a | significant role (though there are many other | stakeholders including employees). | JackFr wrote: | I would recommend the following EconTalk podcast on the | history of the American healthcare system. | | https://www.econtalk.org/christy-ford-chapin-on-the- | evolutio... | | Spoiler alert -- the author being interviewed doesn't | have a solution, quick, easy or otherwise. But the | history is fascinating -- in the end there are a lot | fewer villians than you might imagine. A lot of good | faith decisions seemingly made in the public interest | over the past 150 years have led us into a weird local | minimum that seems inescapable. Where we are was not | inevitable, and as they say if something is unsustainable | it has to end eventually, but before suggesting sweeping | solutions I'd recommend hearing a detailed history. | status_quo69 wrote: | We already have decent (not always great but decent | enough) government provided healthcare for the elderly | through Medicare. So in fact, we've completely avoided | your example already and said "yep, all life has value if | you're eligible for medicare". | | Of course resources are finite, nobody ever argues that | they're infinite. But we treat healthcare as if there's a | constant scarcity of medicine with how much is charged | because there's a constant urge to squeeze even more | profits out of patients who probably have only 2 choices- | pay for the medicine or die. | zip1234 wrote: | The counterpoint is that you have the exact same | decisions being made in systems like the UK. People get | refused cancer treatment because they were too old and | their were younger patients that had a better prognosis. | The fact is both types of systems don't have unlimited | resources. | slantedview wrote: | Yes, care rationing is a thing. But in the UK care is | rationed due to capacity constraints whereas in the US | it's rationed in order to make a profit. These are very, | very different things. It means that people's welfare, | and death, is being traded for profit. | woah wrote: | Works pretty well for lawyers. It's not perfect, but | lawyers have to adhere to a code of legal ethics, and | only lawyers can have equity in law firms. Seems like | this model could be transferred directly to the medical | industry. It would not solve every problem ever, but it | is an interesting thing to look into. | JackFr wrote: | There might be a parallel to a medical group or a | professional corporation, but a law firm is a vastly | simpler operation than a hospital. Orders of magnitude | simpler. | giraffe_lady wrote: | Yeah that sounds fine too if you can do it. Anything that | prevents hospitals from being operated by large profit- | seeking entities with no other stake in them would | probably be a strict improvement over the current system. | | I think the practical issue is those fields that have | similar restrictions basically predate a major societal | shift. We now consider the only valid limits on profit | and ambition to be market forces. I'm not sure | restricting hospitals in this way is less radical than | just nationalizing them, in terms of practical politics. | | Anyway, again, sure. I'm not informed enough on this | subject to know what model would actually work best. I | think the problem is the raw exclusive profit motive | rather than who specifically is running them, but there | are a lot of ways to eliminate that. | legitster wrote: | > after service has been rendered can decide to pay less, | or not pay at all, or stop paying that provider altogether, | etc | | This actually isn't necessarily true when you learn how | billing codes work. Most insurance companies pay out at a | fixed rate per billing code based on your plan. That | doesn't change. What does change is that hospitals can | retroactively apply new additional billing codes. | | This happened to us once for an ER visit where we got 3 | additional surprise bills over 6 months because the | hospital retroactively applied new billing codes to our | visit. | JackFr wrote: | > * I strongly believe that only physicians should be | running hospitals. Certainly not administrators whose only | education is an MHA and only experience is working for for- | profit health companies. | | The skills need to run a hospital are quite different than | those required to be a doctor. I'm not saying hospitals | aren't unique - I believe they are and their adminstration | is highly specialized. Doctors should inform the | administration at every level but it would be a waste of | their training and a bad idea for doctors to run | everything. | | > Medical decisions need to be made outside of cost | considerations. The only factors should be medical science, | quality of life, and patient wishes (in that order). | | Would you be as quick to say "Doctors should work without | pay." ? | DocTomoe wrote: | > The skills need to run a hospital are quite different | than those required to be a doctor. | | And still, in many countries, including highly | industrialized ones, hospitals are run by doctors. So | either US administrators are making their hospitals run a | lot better (which does not seem to be the case), or the | core incentives each group optimizes for are different. | cmorgan31 wrote: | Why would not paying doctors be the natural consequence? | It's a fairly significant jump to go from don't let cost | be a primary decision driver to let's force doctors to | work without pay. | bumby wrote: | Because in reality, there are always tradeoffs and | constraints. In the US, a disproportionate amount of | healthcare costs come at the very, very end of life. | | It's possible to meet the sole criteria of science, | quality, and patient wishes with exploding costs. I think | the OP's point was that money has to come from somewhere. | zeruch wrote: | "a disproportionate amount of healthcare costs come at | the very, very end of life." | | One might ask why that is; while some is surely due to | natural decline in later years, one could likely also | posit that the cost-fears leading up through that period | (decades), and the general inability to get people to do | preventative care throughout adulthood contribute to that | significantly. | _jal wrote: | > One might ask why that is | | Indeed. | | It is one consequence of a highly atomized culture. I | suspect it happens because individuals are expected to | take responsibility for their care (basically, this is | the human side of cost-shifting and corporate planning | around the care gradient available to someone at a given | wealth level). | | To someone at the end of their life, money is usually | less interesting to them than a few more days of | breathing. So the market provides. | bumby wrote: | The explanation I've heard is that it's rooted in the | cultural sanctity of life and how that translates to | trying to preserve life at any costs (even when quality | of life is no longer present). | | To be clear, I'm talking about the absolute twilight of | one's life that's reached regardless of levels of | preventative care. I think there's potentially an | opposite point that could be made: taking care of one's | self can prolong this period and make it cost more. | Someone who drops dead of a heart attack one afternoon | won't have the same end-of-life costs as someone who | gradually becomes enfeebled with age. | ClumsyPilot wrote: | > The skills need to run a hospital are quite different | than those required to be a doctor. | | Why do you think law firms and accountancies are | partnerships? Because the best proffesional for managing | lawyers/accountants/develipers is such a proffeshional | with loads of experience. Thats why we have progression, | you gain management skill as you bevome more senior but | you still know how the industry works and the people you | manage | scarface74 wrote: | That's the definition of the "Peter Principle". Just | because you are good at your profession doesn't mean that | you are good at management. | ClumsyPilot wrote: | Is it impissible to select those who are good at | management from the pool of thousands of people who are | good at that proffeshion? | scarface74 wrote: | No, you first find people who want to go into management, | then you give them management responsibilities without | promoting them until they prove they can handle it. | towaway15463 wrote: | It should still be doctors. Just makes administration a | career path that a doctor can choose to move into. There | would be plenty of takers from the ranks of those burnt | out on patient care. They could even find new meaning in | being able to help people without going through the | bedside wringer. If professional administrators have a | place in the system it's in positions under experienced | physicians where they can help with implementation of | policy, not shape it. | Spooky23 wrote: | Doctor pay is high because supply is constrained. | | We're "fixing" this by flooding the market with less | trained nurse practitioners and PE. Doctors are being | gobbled up by regional medical cartels and put where they | can maximize billing. | ejb999 wrote: | >>We're "fixing" this by flooding the market with less | trained nurse practitioners and PE. | | In reality though, the overwhelming majority of cases | that walk into a doctors office on any given day do not | require an actual MD - NP and PA's are more than capable | of handling many, many things that a typical patient | needs. | | Everybody tends to think they need a 'real doctor', they | usually don't. Its good they are there when they are | really needed, but do you really need an MD to diagnose a | sore throat, adjust your BP meds or many other routine | things that are people are seen for everyday? | Spooky23 wrote: | True, but which ones? | scarface74 wrote: | Opposite anecdote: For done reason about 10 years ago my | asthma that had just been a minor nuisance and didn't stop | me from running, teaching fitness classes part time, etc. | for a decade, sent me to the hospital and kept me coughing | for nearly a year. | | The doctors and specialists gave me every treatment under | the son to no avail. | | Then I did my own research and read I should try OTC | psuedophredrine. It worked like a charm. Now every time I | catch a cold (and when I got Covid), I pop psuedophredrine | for a few days and I am good. | | Yes, psuedophredrine is suggested to treat Covid if you | have virus induced asthma. | | Second anecdote: I have relatively mild cerebral palsy. As | I've gotten older, my affected foot tightens up especially | in the winter. My neurologist said it was physical and not | neurological. I went on vacation and was drinking more | alcohol than I usual do. I noticed I was walking without | pain. I did my research when I got home and found a | prescription muscle relaxant with the fewest side effects | and ask my doctor about it. He prescribed it to me. | | He didn't bother telling me that I should get blood work | done to check for liver problems. I had to bring it up to | him. | | I can now walk without pain and run when properly | conditioned. | umvi wrote: | > * I strongly believe that only physicians should be | running hospitals. | | Strong disagree. This same attitude pervades the military | ("only pilots should run the air force") and really all it | does is that lower representation of the interests of the | other non-pilot 90% of your organization and put a pilot | bias on every decision being made. | advael wrote: | Those are extremely different situations and you've not | really justified why they're being compared. A "doctor | bias" in every decision being made would ideally | prioritize health outcomes over decisions made for profit | or convenience. It's possible that doctors will make poor | decisions too, but on balance our expectation based on | their training is that decisions made because of | healthcare outcomes would be more likely in this scenario | than the current state of affairs, which prioritizes | economic considerations as administrators in every | context currently tend to | bumby wrote: | I think the point is that "doctor bias" will not take a | balanced approach to the other systemic factors. I'd | argue it's the same with the pilots. If you asked pilots, | they'd likely say the same thing: their priorities are | going to align with the mission better than anyone | else's. | | Anecdotally, this has been true in my experience on | complex engineering projects. When the project manager is | a mechanical engineer, guess which systems get the most | time, money, and priority? Mechanical. And when it's an | electrical engineer, the electrical system gets the | priority. When it's a software engineer, the software | etc. They all recognize the other systems, but | availability bias skews their worldview and priorities to | the neglect of others. | hinkley wrote: | > insurance is the only industry where they agree to pay | for something (in this case, "medical care"), but then | after service has been rendered can decide to pay less | | That's not always the case. The reason I stopped writing | mobile applications long ago was because the mobile | carriers were doing exactly this, and not even providing | enough paperwork for you to argue with them about it. | | People like to lambast the Apple App Store for being | greedy, but the fact of the matter is that people netted 3x | as much off Apple that they did from the carriers. They are | asking too much money _now_ but their rates were absolutely | defensible at the time. It 's not a coincidence that we had | a gold rush that started almost exactly when the App Store | became a viable target. | | One might ask what would happen if we joined the rest of | the 1st World in providing medical care and marginalized | private health insurance. Would it be a similar watershed | moment? | towaway15463 wrote: | The only gold rush in medicine where I'm from involves | moving to the US to get away from a nationalized health | care system. | ejb999 wrote: | curious - where is that? | slantedview wrote: | > I strongly believe that only physicians should be running | hospitals. | | More than that - hands on healthcare should not be a for | profit industry. The need to make profit is fundamentally | opposed to providing the best care. As the push for profit | increases, more people get sick and die. This goes for long | term care as well, which is facing a similar staffing | crisis for similar reasons. | legitster wrote: | Your local hospital is likely a non-profit. Your health | insurance company might even be a non-profit. But they | don't do any better. Corporate profit motive doesn't seem | to be at play here. | candiddevmike wrote: | It's executive/board/administrative compensation that's | more of a problem than profits for most | hospitals/insurance companies. | scythe wrote: | >Medical decisions need to be made outside of cost | considerations. | | It's really jarring to read an otherwise reasonable comment | that drops a whopper like this. _Nothing_ exists outside of | cost considerations. The NSA has cost considerations. The | Space Shuttle had cost considerations (obviously, not great | ones!). The design of nuclear submarines involves cost | considerations, however unsettling that may seem. You 're | telling me that my broken hand needs to be judged _outside | of cost considerations_? Give me a break. | | The problem is that there is a lack of "trustworthy" | parties to evaluate cost expectations in medicine. The | patient often doesn't understand their condition _or_ its | treatments, the doctor has a clear perverse incentive to | inflate costs, and the insurance company may actually be | _better off_ if the patient _dies_. At least that 's the | conventional picture. Leftist pundits often complain that | the American economy is based on "greed", but a more | precise criticism is that there has recently been a trend | away from expecting benevolence and for-its-own-sake | honesty from anyone under any circumstances, or | equivalently an increasing cynicism about human | motivations. It remains to be seen whether a medical system | can function when nobody expects to trust anyone. | inglor_cz wrote: | "The Space Shuttle had cost considerations (obviously, | not great ones!)." | | It absolutely did, and great ones too. The program was | too costly and never lived up to the original | expectations of fast and easy access to orbit. | | Falcon 9 + Dragon is the first American human-rated | launcher and ship that can be labeled as somewhat cost | effective. | [deleted] | ipaddr wrote: | * In this day and age not being your own doctor/advocate | will produce unwanted unnecessary results. | | If you look up possible treatments /side effects and your | personal history you will be in a better position to engage | and weight options. If you blindly accept everything you | will end up on the most profitable treatment plan plan | insurance allowed. | bumby wrote: | > _I strongly believe that only physicians should be | running hospitals._ | | Can you elaborate on your rationale? I ask because I've | worked in hospitals run by a cadre of physicians and it was | not run well. Anecdotal, obviously, so I'm curious on your | thoughts on what they provide. | | My worry is that it can lead to an unbalanced technocracy. | It's like saying a politician needs to come from [industry | x] to govern [industry x]. Technical competence is a | necessary, but insufficient criteria when managing a | multifaceted problem. The risk is that the front-line | physician priorities would always become the organization's | top priority. In reality, a hospital administrator has to | manage competing priorities across many different domains. | adolph wrote: | > Medical decisions need to be made outside of cost | considerations. | | A common attitude which may cause: | | _Health care is extremely costly in the United States. | Although the rate of growth in spending has attenuated in | recent years, per capita spending on health care is | estimated to be 50 to 200 percent greater in the United | States than in other economically developed countries. | Despite leading the world in costs, however, the United | States ranks twenty-sixth in the world for life expectancy | and ranks poorly on other indicators of quality._ | | https://journalofethics.ama-assn.org/article/complex- | relatio... | inglor_cz wrote: | Looking at the levels of obesity in the U.S., I consider | the 26th place a true miracle of American medicine. If it | can prevent people who devastate their bodies with junk | food for decades from dying at 50 ... | | On the other hand, imagine the world where Coca-Cola | makes billions on healthy drinks, people are slim and fit | until they die, and half of the money spent on treatment | of chronic diseases of excess can be used for something | else. | rootusrootus wrote: | > Looking at the levels of obesity in the U.S., | | This is not unique to the US. Can't really say "but we | only have 25% obesity here" and call that any kind of | win. Maybe the US leads in this regards (though it varies | by region, some areas have European-level obesity rates), | but obesity is a worldwide problem. | ryanbrunner wrote: | > * In stark contrast to asking questions and trying to | understand. But I have family members who are the "look | everything up and then try to tell my doctor how they're | going to treat me" ilk and it's crazy. | | I think this is exacerbated by doctors a lot of the time. | I'm in Canada so it's obviously a very different system, | but visits to a GP often have strict time limits and "one | issue only" rules. When you can only talk about one | symptom, and you only have 5 minutes to explain it, it's | natural to try and do homework first to see what you're | going to use your limited time on. | 93po wrote: | > people thinking being able to Google and read WebMD | qualifies them to argue with their doctor about treatment | plans | | In my experience, I have had: | | 1. Doctors that know nothing about a really basic ailment | and not have any meaningful guidance or treatment to | suggest | | 2. Doctors that Google something literally in front of me, | things that I have already Googled myself, and draw the | wrong conclusion because they're looking at results at a | glance - when I had searched myself earlier and dug deeper | though, it was clear to me the result he was looking at was | just plain wrong | | 3. Doctors that provide very little to no guidance about a | wide selection of medications available to treat a problem, | leaving me to essentially guess which option of a dozen or | more I should go with | | 4. Doctors that force me to advocate for myself and my | condition before they agree to help treat it - so much so | that I had to visit 4 different doctors to find one that | would, wasting nearly a thousand dollars of office visits | with nothing to show for it. | | It's no wonder people do their own research and dare to | advocate for themselves. Most doctors are fucking | worthless. | 77pt77 wrote: | You forgot one. | | Doctors that blatantly lie to your face because they want | to push some procedure. | hallway_monitor wrote: | I cannot agree enough. I think anyone who has dealt with | a puzzling condition quickly learns how limited the | "expertise" of these supposed authorities is. Sure, | insurance companies are terrible, but so are most | doctors. Great, quit, you probably sucked anyway. | aqfamnzc wrote: | It also probably doesn't help that doctors are jacks-of- | all-trades medically - there are simply too much | complexity to thoroughly understand the nuances of every | obscure condition and interaction. | | However, I think acknowledging when one doesn't know | something is a skill many could benefit from improving... | momirlan wrote: | just adding a case when a doctor prescribed double the | quantity for an infant. i spotted it right away, he | panicked, asked to have the prescription back and | promptly destroyed it. | ClumsyPilot wrote: | Indeed, there have been mutiple instances where, if I had | not put my foot down,i would be left untreated and | undiagnosed. | | Doctors are not like other proffeshions, they cannot put | things right if the opportunity for treatment is missed | Melatonic wrote: | I felt the same way until I started being more active in | choosing quality doctors. Doctors are no different than | any other profession - there are the ones at the bottom | of their league that are just going through the motions | and there are the superstars working for some of the best | institutions in the world. The key I have found is to | specifically look for doctors that are either actively | involved in academic research pertaining to your ailment | or are working at quality institutions that are engaging | in research that is at least tangentially related to your | issue. | | Keep in mind they also have to do a stupid amount of | paperwork these days for every patient and the place they | work for may be overscheduling the crap out of them - | generally (unfortunately) I always consider my first | appointment to be sort of a wash due to this and assume I | am not going to really get anywhere until the second time | I see them. | Djvacto wrote: | As a quick counter-point to *, there is another sub-problem | with healthcare/doctors in the US, where often patients | with chronic illnesses or not-easily-testable conditions | have to fight hard for doctors to take them seriously. The | why of this varies a lot from what I've seen, but includes: | | - an attitude of "most patients are just trying to wring | medications out of you" - an ego-hit of "if I didn't make | the diagnosis, I don't want to help" (this applies to both | patients coming in with a suspicion of what they have, or | getting a diagnosis from another doctor) - burn- | out/overworking, where doctors have a hard time managing | all the different cases coming at them without dropping the | ball here and there | | It's not a simple, single-cause problem at all, but just | want to provide an alternative point of view about patients | who look things up or come in asking about a specific | condition or diagnosis. | | When I got my ADHD diagnosis after a quarter-century, I | went in specifically asking about ADHD because I had seen | some flags that made me think I might have ADHD. Contrast | that with the people doctors screen out who are trying to | get a stimulant prescription despite not needing it, and | you have a situation where it's hard for doctors to tell | who does or doesn't need meds, and where patients with | actual conditions have to fight hard for those to be | diagnosed. | | Even in cases like POTS, which has no medication involved | in treatment, just lifestyle changes, and yet people close | to me who have POTS all had an uphill battle getting it | recognized by anyone, especially doctors who could diagnose | (disclaimer: sample size = 3). | argc wrote: | > When I got my ADHD diagnosis after a quarter-century, I | went in specifically asking about ADHD because I had seen | some flags that made me think I might have ADHD. Contrast | that with the people doctors screen out who are trying to | get a stimulant prescription despite not needing it, and | you have a situation where it's hard for doctors to tell | who does or doesn't need meds, and where patients with | actual conditions have to fight hard for those to be | diagnosed. | | I told my doctor I had already been diagnosed with ADHD | because I had a strong suspicion I had it and wanted to | see for myself if the medication helped (it helped | massively). I think medicine should be accessible for | patients who need it but I don't know how to avoid large | amounts of patients then taking medications for the wrong | thing, which would probably happen if it was a free-for- | all. It kinda comes down to the question of having the | personal freedom to hurt yourself doing something stupid, | which is a balance (a little of that freedom is good, too | much probably bad). All-in-all I lean toward the current | system of using on experts to make the final decision. | Still, I would be really pissed if a doctor prevented me | from getting stimulants for something I believe I need, | so I am not 100% satisfied with the current system | either. | suchire wrote: | Another wrinkle to the problem with that gatekeeping | structure is that it is so prone to bias against women | and people of color, who are much more likely to be | undiagnosed and ignored or dismissed. | tomrod wrote: | I'm not sure why this is being downvoted. This is a | legitimate issue, divorced from politics completely | (politics usually result in downvotes). | | [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638275/ | | [1] https://www.medicalnewstoday.com/articles/gender- | bias-in-hea... | lostlogin wrote: | Could someone explain what's inaccurate here? | | Edit: It originally appears to be getting heavily | downvoted. | clankyclanker wrote: | Nothing is inaccurate. Here's a few primary and secondary | sources. | | https://www.health.harvard.edu/blog/women-and-pain- | dispariti... | | > a 2000 study[0] published in The New England Journal of | Medicine found that women are seven times more likely | than men to be misdiagnosed and discharged in the middle | of having a heart attack. | | 0: | http://www.nejm.org/doi/full/10.1056/NEJM200008243430809 | | https://www.independent.co.uk/life-style/health-and- | families... | | > women with chronic pain conditions are more likely to | be wrongly diagnosed with mental health conditions than | men and prescribed psychotropic drugs, as doctors dismiss | their symptoms as hysterics [1]. | | 1: https://psycnet.apa.org/record/1990-98104-000 | | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/ | | > racial bias in pain perception is associated with | racial bias in pain treatment recommendations... Black | Americans are systematically undertreated for pain | relative to white Americans. | advael wrote: | I view drug enforcement policy meant to prevent | individuals from making decisions for themselves as | always doing more harm than good. The place for | regulation in this space is controlling what claims | profit-motivated entities can make about drugs, enforcing | quality and safety standards in manufacturing, and | honestly tying the hands of insurance companies as much | as possible, if not just gutting them altogether | Melatonic wrote: | The counterpoint to your last thing is that there are | also many ailments that we literally just do not have | enough info about yet to have proper treatments. And if | we are studying such things many doctors are not going to | always be up on the latest research for that specific | condition. | | I have found it helpful to approach it in more of a | teamwork-like mentality. Don't just read WebMD and try to | diagnose yourself - journal your symptoms, observe the | trends, record data. If it seems like it points to a | specific condition hop on Google Scholar and look for | some legitimate new research the average doctor may not | have heard about. Print that out and then when you go in | show them and ask questions without attempting to | specifically diagnose yourself. | | You could be totally wrong but with some background info | your doctor is much more likely to accurately diagnose | and take you seriously. | drc500free wrote: | I'm more and more convinced that POTS/EDS/MCAS aren't | rare diseases, they're just criminally under-diagnosed | because they tend to affect women. FWIW, POTS is much | more manageable with medication (e.g. Midodrine and | Florinef). | 77pt77 wrote: | > criminally under-diagnosed because they tend to effect | women | | I just can't understand this argument. Women already live | 5 years longer than men on average. You mean to tell me | if the system didn't discriminate so strongly against | their best interest they'd live even longer than men? | ejb999 wrote: | nurses are 91% female and doctors are about 37% female - | are they also 'criminally under-diagnosing'? Seems there | are quite a few more women in healthcare than men these | days. | thewebcount wrote: | Yeah, I've witnessed this first hand with my spouse. | She's been told she just needs to exercise more (she was | a professional dancer when it hit her), that it's all in | her head (actual psychiatrist said otherwise), that it | will resolve in 6-18 months (it didn't), etc., etc. It's | pretty appalling. | | Thanks for mentioning POTS, btw. Despite how many people | have it, it's still fairly poorly known about even within | the medical community. | wolf550e wrote: | re: "Medical decisions need to be made outside of cost | considerations." | | In the end, labor hours of professionals are finite. Even | if you don't need to pay doctors, you only have so many, | they can only work so many hours, you will need to | prioritize who to help in what way, which procedures to do. | Same with all the other personnel, the consumable stuff, | the devices/scanners/equipment, etc. So someone is going to | have to prioritize. It can be just "how much quality of | life can we save using the resources we have", regardless | of the patient's ability to pay/insurance/citizenship, but | some prioritization will need to happen. The policy of the | death panels can be changed, but their existence is | inevitable. | slantedview wrote: | > labor hours of professionals are finite. | | This is why it makes no sense to have doctors and nurses | waste time battling insurance companies over treatments, | and hospitals over staffing. Their time is indeed too | valuable. | wing-_-nuts wrote: | This is exactly why we should simply just expand medicare | to be an option for everyone. If it's good enough for | everyone over 65, it's good enough for everyone under it | too. I'm ok with paying a reasonable premium to have | access to the largest insurance network in the nation. | elhudy wrote: | Simply? It is not so simple. Medicare reimbursement rates | are way below commercial rates and hospitals wouldn't | survive just from medicare reimbursement alone. | | Let's stop trying to come up with "simple" solutions to | the healthcare catastrophe in the US because the reality | is more complex. | wing-_-nuts wrote: | So raise the reimbursement rates to the point where | hospitals can survive, or cut the fat. See? Simple. | | Every time someone makes an argument like this, it's | always to say that somehow, medical treatment in the USA | is _special_ compared to other countries. We couldn 't | _possibly_ have universal healthcare work here. Please. | bumby wrote: | Possibly misattributed, but usually given to HL Mencken: | | "For every problem, there is a solution that is simple, | neat, and wrong." | | Don't kid yourself into thinking a complex system that | makes up 20% of GDP is going to have a simple solution. | Just a couple examples you'd have to contend with: | | 1) Insurance companies get a say too, according to the | Constitution. That means they get to lobby in their own | interests. That political problem itself is a boondoggle. | | 2) The US funds a disproportionate amount of medical R&D. | Some of that fat is going to be cut from research. You | need to have a plan on how that will effect long term | quality of care and innovation. | | 3) Physician licensures are limited by the AMA. If you | expand coverage, you will need to expand supply because | any time something becomes "free", people will consume | more of it. That's not a necessarily bad thing in | healthcare, but needs to be addressed. The AMA also gets | to defend their political interests. | | There's lots and lots of other issues. I'm not claiming | the US healthcare system is great. But pretending it has | a simple fix is naive. | wing-_-nuts wrote: | Again, I point to the fact that nearly every other | industrialized nation does it better than us, with a | fraction of the resources. I find it highly suspect when | people say the problem is so complex we can't possibly | fix it. Every other major western (and some asian) | economy has addressed this. We are not exceptional. We | can fix this too. | bumby wrote: | Yes, but that is, in part, because the US effectively | subsidizes other countries medical R&D. Similar when | other countries cap their drug costs while the profits | are made up within the US. That means we subsidize other | countries healthcare costs at the expense of our own. A | country-to-country comparison is incomplete without | understanding those systemic issues. | | It's like when people point out how much the US spends on | the military compared to other Western industrialized | nations. Part of that discrepancy is due to the fact that | the US disproportionately funds organizations like NATO. | Other countries reap the benefit without footing the | bill. There was a lot of outrage in Europe when the US | tried to enforce the NATO GDP spend that other countries | _already agreed to._ | | The US can do better, but I would argue we can't unless | we fully understand the complexities of the system. That | means not getting enamored by the idea that there are | simple fixes. The first step IMO is getting the political | will to do so (and to understand the tradeoffs within a | complex system), because many of the potentially | solutions are stymied at Congress. | bumby wrote: | But this is exactly why administrative roles are created | to help alleviate that dilemma, so primary care providers | can focus more time on patients. | [deleted] | samstave wrote: | > _I strongly believe that only physicians should be | running hospitals._ | | _(Disclaimer: I have been on the design team for several | hospitals, including El Camino and San Francisco General, | in the bay area - and I have a family of doctors and nurses | in my family - my brother was head of the Veteran | Administration for the state of Alaska, and is currently | CMO for a large health provider (he is a doctor)_ | | --- | | That said, the "running" of a hospital isa hell of a lot | more than medicine (when we are specifically talking to the | _running of_ -- but this comment was made in relation to | costs /efficiencies as far as outcomes, patient treatment, | insurance etc...) | | Hospitals are really complex ecosystems and should be | thought of more like an aircraft carrier than an other form | of business. | | The costs within the realm of a hospital are ridiculous - | as are the methods and manner in which hospitals raise | money. | | Insurance is cancer to be sure, but there are so many other | factors that go into the operational costs of a hospital - | and I don't just mean ngoing care and operations - systems | and technology and medicine evolve. People are people and | regardless have the same hierachy of needs in any | environment. | | You have every single actor as an enemy of the hospital | bottom line: | | New tech, $$ | | Older nursing pop $$ | | Current nursing/doctor market salaries $$ | | Maintenance for existing systems $$ | | Insurance billing code lock-in $$ | | Competing hospitals for doctors and nursing staff $$ | | California $$ | | Corruption $$ | | Utilities and related redundant infra to ensure life | systems | | The ridiculous cost to upgrade | | The list goes on and on... | | (The cheapest hospital project I worked on was hundreds of | millions of dollars) | | etc... | | Hospitals are really expensive to run, and it requires a | hell of a lot more skills than simply being a "doctor" to | run one. | dr_ wrote: | Let me add two more payment scenarios: 1) Pay in the form | of a credit card number, where the provider ends up paying | CC processing fees to process the payment. 2) Ask for the | money back, months later. | dan_quixote wrote: | > Insurance is the only industry where they agree to pay | for something (in this case, "medical care"), but then | after service has been rendered can decide to pay less, or | not pay at all, or stop paying that provider altogether | | This is precisely why I think we will never be able to | effectively treat healthcare as a "free market" with tools | like HSAs, posted price sheet, etc. The end user can never | know the true cost of their procedure until it's long over | (sometimes years later) and often don't get to choose at | all. | mminer237 wrote: | > I strongly believe that only physicians should be running | hospitals. | | This is how it is for other professional industries. As an | attorney, you can lose your license for sharing any profits | with someone who isn't a lawyer. I believe states typically | require accounting and engineering firms to either be | wholly or two-thirds owned by such professionals as well. | scarface74 wrote: | What does that even mean? All lawyers have support staff | where the lawyers "share" their billable votes with non | lawyers | brianwawok wrote: | > I believe states typically require accounting and | engineering firms to either be wholly or two-thirds owned | by such professionals as well. | | What states are these, Canadian states? | | In the US, many many many SaaS shops are wholly owned by | businessmen / bean counters. It's like, weird, to be an | engineer who runs a software company. | nawgz wrote: | > engineering firm | | > SaaS shop | | Now, I get we like to refer to ourselves as Software | Engineers, but surely you understand he means actual | certified engineering firms, not groups of code monkeys, | right? Software is virtually never engineering, you'd | have to get to a situation like flight control software | before you're doing anything legit | brianwawok wrote: | I am a software engineer and do not consider myself a | code monkey. Do not speak for all of us. | nawgz wrote: | If you have never stepped into a domain where you have to | formally verify your software, I think you should | probably not take too much offense to such a comment. | While I admit it may be slightly negatively connoted, I | primarily used it to illustrate that the kind of | engineering going into making a bridge differs greatly | from making your UI widget pixel-perfect or your SQL | query from being too polynomial | scarface74 wrote: | I'm sure "sales engineers" feel the same way... | chrisux wrote: | I feel like the person you are responding to was not | meaning software engineering. Electrical engineering, | Chemical engineering, Civil engineering, Mechanical | engineering, etc are all more likely: especially as what | you say about software engineering is definitely well | known. | [deleted] | Workaccount2 wrote: | They are talking about the "applied physics" engineering | fields. | kllvql wrote: | I believe this is in reference to Professional | Engineering firms, which often requires PEs either as | owners or in certain roles. As far as I'm aware software | engineers are not required to be Professional Engineers | in the US for most tasks, nor are SaaS shops required to | be licensed as Engineering firms. | | [1] | https://www.harborcompliance.com/information/engineering- | fir... | bumby wrote: | NCEES did toy with the idea of a software engineer | Professional Engineer license, but it went away due to | too little interest. I think it was in part that industry | didn't want it because it would give more leverage to | SEs. IMO the only way that will become commonplace is if | it is forced by regulation. | zip1234 wrote: | From what I can tell, this is just to keep money in the | hands of lawyers and keep prices high. | | There are plenty of things that could be done better now | by non-lawyers with the help of lawyers (look at Rocket | law). | j-krieger wrote: | Why _shouldn't_ money from law be kept in the hands of | lawyers? It's a grueling education with an even more | grueling exam and even now a lot of law graduates can | barely afford to keep a roof over their head | bumby wrote: | Because the profession is meant to serve the public | interests and not just be a money grab. According to | government data, the median lawyer is in the top 10% of | income earners. | scarface74 wrote: | To put numbers on it. To get to the top 10% of income you | only have to make around $120K. | bumby wrote: | Correct. ONet data puts the median lawyer at about $127k. | From what I could find, 90th percentile of income is | around $126k. | | While I know HN is probably SV and software biased, | saying "only" $120k comes across as out-of-touch for the | way most people live. For comparison, the median SF | lawyer makes $191k according to BLS data. I could not | quickly find 90 percentile data for the area. | scarface74 wrote: | Your average Enterprise CRUD developer in any major city | in the US can hit that number within 3-5 years and a job | hop. It's not exclusively a SV thing. | | And your number is correct according to Census data. | | https://dqydj.com/average-median-top-individual-income- | perce... | bumby wrote: | I agree, but it's still out of touch. (not a knock on | you, we are all subjectively influenced by what we come | into contact with the most and interpreting it as | 'normal'. It's also why something like 90% of people | consider themselves middle class.) The fact that you have | to narrow it down to software development and major | cities should tell you that much. That's also why my | original comment included both SV and software as biasing | factors. | | The average person does not develop software and does not | live in a major city. If somebody is making double the | median wage and 2.5x the average wage and complaining | about keeping a roof over their head, they can probably | expect some sideways glances. It's like when people | complain about the difficulty of making ends meet once | they make their Lexus payment and pay their kids private | tuition bill. The subjective struggle may be legitimate | but it's still out of touch with the experience of most | people. | WoahNoun wrote: | Many states of laws regulating the "corporate practice of | medicine." But it seems like that leads to a hospital | just being bunch of loosely held together independent | businesses/contractors. | travisjungroth wrote: | > * In stark contrast to asking questions and trying to | understand. But I have family members who are the "look | everything up and then try to tell my doctor how they're | going to treat me" ilk and it's crazy. | | I still think it's better than the other extreme of just | showing up and trusting the professionals. That should work | in theory, but my experience for myself and those around me | is it's incredibly ineffective. If what you're dealing with | requires the least bit of thought, odds are you're getting | brushed off to the extent you allow. | | The _real_ model of US healthcare is essentially apprentice | /master, with the patient as apprentice. Apprentice does a | lot of the work, not all, some needs to be approved by the | master and the apprentice better know how to learn from the | master, when to push back, and how to make it seem like it | was their idea all along. You can imagine how this falls | apart for mental health. | AlphaOne1 wrote: | I also think the complete implosion of family medicine | has made this worse. In the past, you would keep the same | family medicine doctor for decades and trust them. They | in turn would know what your values and priorities are. | Moreover, they would be able to guide you through | difficult healthcare decisions that inevitably come up | (cancer diagnosis, mental health etc.). We have lost the | human connection aspect of medicine and those few | physicians that are able to hang on to it are burning out | due to the massive amounts of paperwork they need to | accomplish. From the hospital perspective, (which many | physicians now work for) good paperwork=good patient | care. Paperwork is measurable. Relationships (other than | in the abstract) are not. | kurthr wrote: | Having worked in Tech for many years at corporations large and | small, I have seen companies run by Founders, by Sales, by | Marketing, by Finance, by Engineering, and by Legal. Each had | their plusses an minuses. | | Until I saw hospital nursing, I had never seen a company run by | HR. | | Every decision starts and ends with HR. From hiring, to wages, | to discipline and promotion, to IT and pay-roll, to | reorganization and spending priorities, there is a rule for | that. Maybe that rule originally came from the CEO or the CNO, | but they say things like "may" and get interpreted as "shall" | (or the manager faces a bad review and/or termination) or they | are interpreted beyond any rational meaning. My best | explanation is that it comes from a fear of litigation and a | lack of leadership at the top. The final hilarious story is the | CEO negotiating a big deal with lawyers and VPs shaking | hands... and then saying without joking, "but I'll have to get | HR's approval". The meeting wasn't important enough for HR to | show up, but they had the last say. | beezlebroxxxxxx wrote: | If you follow the history of HR departments in a lot of | modern corporations you often see them operating as private | in-house legal firms, and aggressively expanding their | purview to include even actions at the executive level. The | only thing most HR departments look out for is HR. Everything | they do resolves around continuing or expanding the power of | the HR department. | | Your comment on lack of leadership is spot on. No one wants | to be accountable. Instead HR departments put in place | bureaucracy that works to deny individual fallibility in the | name of a "system of human resource management". They want to | treat people like a cog in a machine instead of as people. | inetknght wrote: | > _No one wants to be accountable._ | | That is American corporations in a nutshell. Outsource | everything, put layers upon layers, and insulate yourself. | Then when fecal matter hits the rotary you can put the | blame on others and, at worst, you get fired and there's | little to no worry about any sort of legal reprecussion | because... well you weren't accountable for the problems in | the first place! | | It's a massive problem created from little cuts here and | there with a few big lawsuits mixed in. | kickout wrote: | Agree with you, but people on HN and other places tend to | flame/heckle companies that don't do this too, aka Elon | Musk. Love him or hate him he does things 'his' way | without all the seemingly built-in middle layers. I like | it as opposed to the HR led office space cosplay, but | people seem to want their cake and eat it too. | smoe wrote: | Both my mother and sister were nurses and disenchanted with the | profession (in Switzerland) long before the pandemic hit, as | the hospitals got completely mba'd during their careers. | Whereas in the past they could actually take time interacting | with patients, now everything needs to be Lean and it's just | about shoveling people through the system with minimum | resources while extracting ever more money. I don't see how | this can end well. | | My mother switched to an administrative role internally, 10 | years before she got retired and my sister went from nurse to | anesthetist and now in the progress of moving to IT as a domain | expert for medical software so she can work from home. | Spooky23 wrote: | Yes. The system is gross. When my dad suffered from a stroke | (pre-COVID), the level of neglect and poor care he received was | startling. He died before he should have after making | substantial recovery due to the side-effects of being in a | hospital. | | My mom was a long-retired medical director of a hospital and | even she was shocked at poor quality of care, compassion and | competence. Even in the ER of a recognized trauma center, | things were pretty meh. Some specialist floors and ICU were | good, but when an infection caused by poor hospital hygiene | struck, he was relegated to the "medical" floor, where he was | not fed, medicated, turned or treated with respect. Ultimately | we maintained a 24x7 staffing of family volunteers for over 6 | weeks. | | Many of the staff frankly sucked. But it was easy to see why - | the staffing levels were so poor _pre-COVID_ , that any RN | risks license every day by virtue of being there. The smart | ones GTFO. You can't care for 15 patients. | dsugarman wrote: | My frame of reference on this topic is that my family is mainly | medical doctors and I started and run a yc backed Series A | stage startup. | | In my experience, the administrators are often doctors at | hospitals and people all the way to the top have to have strong | medical backgrounds. That's not to say there aren't do-nothing | administrators, but those do-nothing administrators are often | doctors. They tend to adhere to the way things are and always | were as an orthodoxy, like 1st year residency is the worst and | at these points quality of life improve, but it's almost like a | fraternity hazing justifying the insane hours, complete loss of | work life balance just because this is how it is. Candidly, | there does seem to be a guilty pleasure there. | | There is little to no real discussion on how to improve not | only the work conditions but also the user experience of | medical care. In my view, it starts at the top; | organizationally, they are lacking an entire skillset to make | any improvements what-so-ever. | archhn wrote: | See "The Managerial Revolution" by James Burnham. | m_ke wrote: | My SO is a healthcare worker as well, she just graduated 2 | years ago and has major regrets about her decision. She'd leave | and try and do something else but she has mid 6 figure debt, to | make things worse she was rear-ended her last year of school | and has back issues that make it hard for her to handle the 12 | hours shifts. | | She's looking to switch jobs now and her first offer expected | her to travel to locations deep in queens, manhattan and | brooklyn, seeing on average 50 patients a day. She currently | works at one of the largest hospital chains in NY and is now | negotiating an offer from the other largest chain, initially | she was told to not worry about salary and that they'd be able | to match her previous offer, then HR called her and told her | she had 1 and not 2 years of experience so the best offer they | can offer her is lower than expected, she said she wouldn't be | able to do it so the HR people went to check again to see what | they can do and it turns out they called up the hospital that | my SO works at now and checked their pay tiers and said they | can only match the number that they were told. The new position | was close to where we live so she considered taking it anyways | but they just called her again and asked her if she'd be | willing to travel to other locations multiple times a week to | help fill in gaps (but weren't even able to tell her which | locations before accepting the offer). | | TLDR: don't let your friends and family go into healthcare | anon23anon wrote: | I'm sure this is the top comment b/c we as developers have | basically lost our professional agency to do do nothings roles | like project manager/project owner/"business people". It's | frustrating. I've been in the game a long time. It was way more | fun when the web was still new and for the most part didn't | care a whole lot about tech. | zeruch wrote: | "is quite puzzling" | | Is it? | | The financialization of every aspect of life, in this case with | for-profit hospitals through multiple layers of insurance | middle-men, the exodus you describe would seem one of the | natural byproducts from miles away. | PragmaticPulp wrote: | > How doctors of all professions lost their professional agency | to do-nothing administrators within a generation is quite | puzzling and a bit terrifying to me. | | I have a lot of friends at various levels of healthcare, from | nursing up through low and mid-level administrative positions. | | The one thing they all seem to agree on is that patient | satisfaction surveys have been terrible for healthcare. | | Once the emphasis shifted to patient satisfaction, everything | became more of a game of catering to what the patient _thinks_ | they want. With the spread of rampant medical misinformation on | the internet and the rise of alternative-medicine podcasts | /blogs/influencers masquerading as informed medical | professionals they have a constant influx of patients who show | up believing they have a certain condition or need a certain | medication. If you disagree too much or refuse to give them the | medication they want, you risk a negative review. Too many | negative reviews could negatively impact your compensation or | even cost you your job. | | Even at offices that don't perform patient satisfaction | surveys, providers are at the mercy of negative online reviews. | Again, if you don't do exactly what the patient thinks they | want, you risk scathing online reviews. | | This is terrifyingly problematic given the trend of people to | self-diagnose with anxiety or infections who show up demanding | Xanax or antibiotics. Puts doctors in a situation where they | don't really think prescribing those medications is a good | idea, but they also feel like they can't deny too many patients | or they risk their reputation/bonus/reviews. | | It's also a huge problem with conditions like obesity or | alcoholism or smoking, where the doctors can see obvious | patient-induced health issues but the patient really doesn't | want to hear the truth from their doctor. | CityOfThrowaway wrote: | Patient satisfaction surveys are the legible feedback | mechanism showing that something is deeply broken, but not | the _source_ of the problem itself. | | It's clear from your comment that the _source_ of the problem | is the increasingly sharp divide between what the | credentialed medical professionals believe and what lay | people believe. The satisfaction survey is simply uncovering | that fact. | | It would be vastly worse if patients were being treated and | had no recourse when they felt their health was mismanaged. | It may well be the case that the patients are _wrong_ , but | it is extremely dystopian to imagine a world where | individuals are not empowered to make decisions about their | own bodies. | pc86 wrote: | Patients have always been entitled to make decisions about | their bodies. You can decline procedures, and treatment, | and you can get second, third, fourth, fifth opinions. | Satisfaction surveys do nothing to increase that autonomy. | The dystopian world you speak of is a straw man. | | The problems stems from people believing they are consumers | of healthcare, on equal footing with the practitioner they | are seeing. They're not, objectively. A 45 minute Google | search doesn't equal 4 years of college (usually in | something like biochem but not always), 4 years of medical | school, 3-7 years of residency training and potentially | another 1-4 years of fellowship training. If you're seeing | anyone above a family doctor/PCP, they 100% know more about | your condition than you do, whether you've been living with | it for a decade or not. | | That doesn't mean you don't have autonomy, or that you | shouldn't question your doctor's decisions and ask for | explanations, but it does mean you should err on the side | of thinking the person whose spent at least a decade, but | probably closer to two, educating themselves to get where | they are probably knows what they're talking about. | PaulDavisThe1st wrote: | > they 100% know more about your condition than you do, | whether you've been living with it for a decade or not. | | I was with you up until this point. Part of the problem | is that this cannot be true in all cases, unless either | (a) your condition is commonplace (b) the doctor | specializes in your condition. | | Yes, doctors know more than you in almost every way about | bodies about medicine, about drugs. However, people with | relatively uncommon conditions have been enabled (largely | by the internet) to create communities of fellow | condition-sufferers, and the collections of anecdata that | result represent a resource that generalist doctors do | not have access to. The good specialists, in some cases, | will take occasional dips in to augment their own | knowledge and expertise. | | Case in point: my daughter has had two major hip | surgeries. While there is no way anyone in their right | minds would have chosen someone who had not performed | these surgeries previously (preferably, many times), and | while it was completely clear that the surgeons really | really really knew what they were doing, it was also the | case that various online communities made up of people | who have been through this procedure were able to provide | lots of information that the surgeons could/would not. | This was particularly true of the recovery process, where | there were a number of common oddities that most people | who have the procedure experience, and they're really not | a problem. They are scary however, and the actual medical | professionals really had nothing useful to say about | them. | | There's another issue with the blanket "doc knows best" | rule. If you've had a GP for many years, or a specialist | helping you with a condition for many years, then it's | probably a great rule of thumb. On the other hand, if | you've moved, or for any other reason switched doctors, | and you're the kind of person who does _pay attention_ to | their body, there 's a reasonable chance that you're | going to know things about yourself/your body that the | new doc(s) will likely not be aware of. They can (and | will) learn, of course, and there's no reason to be | aggressive or patronizing about it. But for example, you | may understand the way you typically recover from | antibiotic treatments, or the consequences of lack of | sleep, or your tendency to always pull a lower back | muscle given certain movements, etc. etc. in ways that | your (newish) doctor may not yet be wise to. | Buttons840 wrote: | > The problems stems from people believing they are | consumers of healthcare, on equal footing with the | practitioner they are seeing. They're not, objectively. | | Objectively, the patient is the only one who has 500,000 | hours of experience with the unique and very complicated | system we call a body, and is objectively the only one | who comprehends what they're feeling. They're also the | one who experiences the consequences, they're the only | ones with literal skin in the game. How much is all of | this worth? | | It's a difficult thing. The answer is some mix of giving | the doctor and patient power. | pc86 wrote: | The patient already has absolute power. They don't have | to accept any treatment they don't want to. | | The patient may be comprehending how they _feel_ but that | absolutely doesn 't mean that they understand the complex | interactions within their body, which the physician does | know. | PragmaticPulp wrote: | That's the theory - That patient satisfaction surveys will | uncover the bad providers. | | But in the real world, if someone is receiving bad care | they don't continue making followup appointments with that | doctor. Nobody continues going back to the same bad doctor | over and over again and writing negative reviews. It's | really easy to calculate churn rate for individual | providers. | | The hot topic now is tracking outcomes: The idea is that | with enough data collection and crunching, we can | eventually start tracking which providers have better | outcomes among their patients. This is one of those things | that sounds great on paper but has a lot of challenges in | the real world. It's also prone to gaming, as we've seen | from surgeons who have learned to avoid difficult cases so | they can avoid the risk of another patient death statistic. | hedora wrote: | That reminds me. I have one laying around to fill out. | | 10/10 plan to get sick again. | bitsnbytes wrote: | "The one thing they all seem to agree on is that patient | satisfaction surveys have been terrible for healthcare." | | My Wife is an ER nurse manager and while you have many self | entitled idiotic patients that think they are staying in a | resort versus visiting an ER, the patient satisfaction | surveys is not very high in regards to the issue and why | nurses are leaving. | | My wife actually had a person complain that the ER did not | have cow bells to call for a nurse (She claimed to be a | retired nurse and they always had that for back up, lol) and | they constantly complain how come they came in first for a | stubbed toe, but another patient with a gunshot wound or | heart attack is being seen first. | | The bigger issue as why nurses are leaving the field from | what she has seen and experienced is: | | 1. wages: The wages are beyond inadequate in certain nursing | specialties and many have left to become traveling nurses or | contracted nurses that get paid double the standard nurse | pay. | | 2. Burn out: Besides covid, Hospitals Patient to nurse ratio | is often exceeded and no accountability for the hospital to | break those ratios. Nor any consideration for a high demand | patient versus a low demand patient. Then when something goes | wrong the hospital looks to pin it on the nurses. This was an | issue before covid . but covid just added fuel to the fire. | | 3. BS. nurses get bs from ALL sides. They get bs from the | patients and even more bs from upper management who set | unrealistic process in place that is more concerned by hiding | accountability and making things look good on paper than | actual patient care. Then you had that whole BS covid | movement crap calling nurses hero but besides lip service | they did absolutely nothing for them. In fact they did the | opposite. I know my wife had to fight the executives because | they wanted to make nurses use their vacation time for sick | time if they got covid. Their explanation for this that if | the nurses got covid it was not likely from the hospital as | the hospital takes extreme precautions to prevent it. The | funny thing was that the same hospital spewing that BS also | wanted nurses to not wear mask due to possible shortages at | the beginning of covid. Insert the BS is to DAMN High meme | here. | | 4. RaDonda Vaught's conviction. This is certainly not helping | the case to get more nurses. | PragmaticPulp wrote: | > My Wife is an ER nurse manager and while you have many | self entitled idiotic patients that think they are staying | in a resort versus visiting an ER, the patient satisfaction | surveys is not very high in regards to the issue and why | nurses are leaving. | | ER is definitely a different ballgame. Thanks for the | additional perspective. | | The patient satisfaction surveys apply more to domains | where repeat visits are the norm: Family doctor, nurse | practitioners, and so on. (Ideally, none of us becomes a | frequent customer of the ER nurses!) | ev0lv wrote: | >>4. RaDonda Vaught's conviction. This is certainly not | helping the case to get more nurses. | | The precedent RaDonda's conviction set is far from | favorable to a profession which is already very difficult | and taxing. This is a BIG reason. | [deleted] | mikkergp wrote: | I get what you're saying, but the promise of the medical | system and the implementation of the medical system aren't | really aligned. Sure 50% of problems are naive patients, but | the other 50% are doctors or a system that doesn't know how | to talk to you or treat you, or there's just an ocean of | uncertainty in how to operate. You show the negative side | from the doctor perspective, but on the other hand. Doctor's | aren't really trained in 'health' they're trained in | pathology. If you're really sick they can provide help, but | if you want to optimize or you're kind of sick, or your | numbers are borderline. Medicine is just sort of not a hard | science, there's way too much uncertainty. You mention people | demanding antibiotics, but the doctor's are just as bad -- | last time I tried to have a nuanced discussion about it with | a practitioner, the answer was a simple "x days is the | standard of care". Not to mention that the doctors would have | to be up to date on the latest versions of research in a ton | of different areas to have some of those answers anyway. I'm | not going to leave terrible reviews about it, but I rarely | leave a medical office feeling satisfied that there are firm | answers on anything. | 77pt77 wrote: | > How doctors of all professions lost their professional agency | to do-nothing administrators within a generation is quite | puzzling and a bit terrifying to me. | | Same thing with professors. | birdmanjeremy wrote: | I'm friends with quite a few nurses, primarily travel nurses, | and not a single one is considering a change in career that I | am aware of. Simply an anecdotal counterpoint and nothing more. | pc86 wrote: | Travel nurses are compensated quite a bit more in my | understanding. And the travel aspect means they can leave the | more toxic locations more easily. | phkahler wrote: | They're paid a shit ton more. And because of that, more | nurses are quitting to do the travel thing, which worsens | the shortage and increases demand for travel nurses ;-) | never seen an industry fuck itself over so bad. That's | really the issue - healthcare has become an industry, not a | profession. | lotsofpulp wrote: | As you noted at the beginning of your comment, the issue | is the pay to quality of life at work ratio being too | low. | s1artibartfast wrote: | AT some point you hit diminishing returns on the pay/QAL | ratio. | | IF the tradeoff is bad at 200k/yr, it wont be better at | 225k/yr or 250k/yr | lotsofpulp wrote: | Then increase the pay even more or increase the quality | of life at work. | | Instead of $250k, halve the work load somehow and make it | two $125k. | | If there is no number, then society cannot afford it. | | But this is nursing, not trying to find ways around the | 2nd law of thermodynamics. If nurses received $300k/year | income, then there probably would not be a shortage since | the barrier to entry is not that high. | | If we really want to get down to the nitty gritty of it, | most people cannot afford quality nurse care (or doctors | or hospitals). So the question really comes down to how | much wealth is society willing to redistribute to those | who need it in the form of healthcare? | s1artibartfast wrote: | Totally agree. With lowering wages and cranking out more | nurses. I think this is a more sustainable solution. | [deleted] | t-3 wrote: | Sure, but nurses are more like 30-40k/yr. Plenty of room | for improvement. | ejb999 wrote: | >>Sure, but nurses are more like 30-40k/yr. | | Not even close if you are talking about the USA (and | actual nurses, not CNA's or MAs) - starting pay for 2 | year RN degrees near me are about 55-65K, and you easily | go over 100K in a few years. | s1artibartfast wrote: | The point is that I know nurses that make 200k a year and | still complain about the workload. More nurses and better | hours is the solution. Meanwhile the trend is to make it | more and more difficult to become a nurse and higher and | higher for hospitals to have nurses | dragonwriter wrote: | > Sure, but nurses are more like 30-40k/yr. Plenty of | room for improvement. | | "Nurses" can be used to mean many things (CNAs, | LVNs/LPNs, RNs) but this is specifically RNs, who, make | much more than that, generally (median $77.6k/yr) | https://www.bls.gov/ooh/healthcare/mobile/registered- | nurses.... | JumpCrisscross wrote: | > _median $77.6k /yr_ | | Given the amount of school a nurse must have, that's low. | ejb999 wrote: | 2 years of school to be an RN, 4 for BSN - it's not a lot | of school, it's an average amount of school at most. | BobbyJo wrote: | The market... finds a way. | joshgel wrote: | It's really amazing to see travel nurses come back to | work at a place they just left. They are now doing the | same job as before, are getting paid almost twice as much | with better schedules and are working next to people that | they know and are friends with. | | It's honestly surprising that more haven't taken the jump | and is really shocking that hospitals aren't doing more | to retain critical staff. | TecoAndJix wrote: | The hospitals have been asking Biden to put a stop to it: | https://www.npr.org/2022/02/02/1077710203/hospitals-ask- | bide... | pc86 wrote: | It sounds nurses just need to be paid more, or travel | nurses need to be paid less. Equilibrium is probably | somewhere between the two extremes. | | Apropos of nothing but why is the knee jerk reaction "we | need executive action to fix this _staffing problem_? " | lotsofpulp wrote: | Why would travel nurses need to be paid less? | pc86 wrote: | If wages equalized, it's unlikely they would all equalize | to the top of the range. It's more likely to be somewhere | in the top quartile or quintile. | lotsofpulp wrote: | Why would they equalize? I assume there is a premium | required for not going back to one's own home everyday. | Sohcahtoa82 wrote: | I can only react with this face: https://i.kym- | cdn.com/photos/images/original/000/112/480/Opo... | | Help me understand this. Make it make sense... | | 1. Hospitals pay their nurses $X, which is way too low | | 2. Nurses quit because they're underpaid and overworked | | 3. Hospitals have a nurse staffing crisis and so pay | travel nurses 2 * $X (or more!) | | 4. Hospitals are in a panic over the cost of travel | nurses, yet instead of paying their nurses more to keep | them around and eliminate the need for travel nurses, | they ask the government to cap the cost of travel nurses | | My mind is exploding over the ridiculousness of it. | zaptheimpaler wrote: | Its hilarious that nursing shares this problem with the | tech industry and probably with most other industries. | Every company is extremely allergic to giving raises and | is happy to let their workforce churn constantly. You | would think they believe that experience has no value. | | But on the hiring side, experience is one of the most | widely accepted signals of value. | ProAm wrote: | A travel nurse means you just have to work across town you | dont have to travel out of state, out of country, or to | middle of nowhere. And these people are bringing in 5k a | week currently. None of them are leaving. | Eric_WVGG wrote: | Funny you should mention that... reading all of this, I was | thinking of a podcast interview with a nurse who was retiring | from hospital work. His primary reason for leaving was being | tired of fighting with hospital ownership and administration, | and was planning on switching to travel nursing which appears | to be more of a "gig" space. | | He did consider that a career change, I think in the same | sort of way that a computer programmer like (presumably) most | of us would consider quitting Google to work on an indie app | or videogame development would be a career change. | | The larger point is, medical professionals are bailing from | the hospital system, which looks pretty busted. | tubalcain wrote: | Travel nurses make six figures and get to sample choice cuts | from the local Tinder menu every time they take on a new job. | muh_gradle wrote: | I can add another data point. One of my mother's friends | works as a travel nurse. I don't envy her lifestyle, but she | seems to find that the compensation makes it worth her time. | drnonsense42 wrote: | The other responder said the same thing, but to add, a | traveling nurse I'm friends with , in Texas, gets paid 5k a | week if he chooses to work and chooses where he wants to | work. So again, this is like making a judgment about software | development working conditions by using people rest and | vesting at FAANG as an example. | rdtwo wrote: | A lot of nurses are becoming travel nurses because they will | get paid market rate | mfer wrote: | The travel nurse market is growing due to supply and demand | problems. | | The demand for nurses is increasing as people are leaving and | there are more from the boomer generation hitting an age | where they need more care. | | The supply has stayed the same. Schools local to me have not | increased output for various reasons (lack of instructors, | lack of space in local hospitals where nurses train, etc). | The supply is too low. | | So, we have a supply and demand problem. Travel nurses get | paid a lot more because of this. | | The solution is to produce more nurses. Something few are | talking about. | | One of the local schools, to me, turned away half of | applicants because the program isn't increasing capacity. | jwagenet wrote: | No, the solution is to pay nurses better. There are already | tons of high quality nurses who don't want to do it anymore | because of poor pay in the face of demanding hospitals and | patients. | mfer wrote: | Pay is a problem. I don't disagree with that. | | But, before COVID there was already a supply problem. The | supply problem has been slowly getting worse for years | and then COVID accelerated it. If every nurse came back | to working as a nurse who wanted to work there would | still be a supply problem. | | Supply has not been growing to meet the demand growth for | years. | rightbyte wrote: | Poor pay? Judging by the nurses I have talked too in big | proper hospitals stress and scheduling are their main | concerns, not pay. | | Obviously higher pay would increase their abuse | tolerance, but I think it is only part of the problem and | a short term solution since no amount of pay will offset | stress problems. | | County level nurses seem to have much better work | conditions than hospital nurses. | sixothree wrote: | Nurses in outpatient offices haven't seen many of the pay | perks related to covid that hospital staff get, even | though they are still facing risk. | s1artibartfast wrote: | Strong disagree. | | Nurses are generally payed very well. This is a supply | problem driven by increasing restrictions on nursing | degrees and insurance. | | Not enough nurses and high cost leaves hospitals | understaffed and nurses overworked, leading to a feedback | cycle. | vkou wrote: | Travel nurses are paid well. Full-time nurses are not, | considering the amount of education they need, and the | difficulty of their work. | llbeansandrice wrote: | pay, benefits, and hours | | I suppose you could just pay people more money to make it | worth it but the long hours take a toll in other ways as | well and contribute to burnout no matter how much you get | paid. | hedora wrote: | Also anecdotal, but we're looking for home healthcare for a | parent. There are zero in a 50+ mile radius. | | One of their neighbors used to work for a home healthcare | company in the area. | agumonkey wrote: | I'm surprised how long and deep the medical bleeding has been | going. You'd think a vital organ bleeding would cause faster | reaction.. | vonnik wrote: | I work at a startup* trying to tackle nurse burnout, and two of | my family members are nurses. Here are a few things I've learned: | | - Nurses were getting burned out before the pandemic, and the US | has a nursing shortage that's been going on for about 90 years | (it started with an infrastructure buildout in the 1930s).* So | it's a secular problem, with chronic as well as acute causal | factors. | | - There is a ladder of nursing credentials, and the shortage | effects them differently. Hiring for roles like CNA and LPN/LVN | has exploded because of the shortage of RNs and above. CNAs get | trained in 4-12 weeks to do the heavy lifting of care; RNs get ~3 | year degrees to perform much more complicated tasks. | | - Burnout, and the nursing shortage, are in a positive feedback | loop/downward spiral. That is, the more nurses burn out, the more | they cause other nurses to burn out. Short-staffed facilities | have a very hard time pulling back to normal staffing, because | nobody wants to join a skeleton crew. (I know of long-term care | facilities where the scheduling nurses (the bosses) are working | the graveyard shift because they can't fill it.) | | - Many nurses work rigid schedules on 12-14 shifts, and a lot of | medical errors happen at the end of those shifts. ** | | - The hot US job market (Great resignation, great reshuffle) is | hitting nursing especially hard; it is very sensitive to external | shocks. There are paths to easier work and higher pay. | | - Many healthcare facilities and systems don't give nurses | flexibility or the possibility of advancement. (One family member | will need to quit her current job and come back in a year or two | to her current employer if she wants to move up a pay grade -- | which is like some tech companies -- but slower moving and lower | paying.) | | - Many facilities are run entirely on foreign staff (the H2-B | visa allows that). And many nurses are imported from the | Philippines. | | * https://clipboardhealth.com | | * https://www.nursing.upenn.edu/nhhc/workforce-issues/where-di... | | ** | https://www.nytimes.com/video/opinion/100000008158650/covid-... | | (plug: if you're interested in this problem, we're hiring: | https://culture.clipboardhealth.com) | xkbarkar wrote: | Find it a bit amazing that so many here act as if the past two | years are the sole reason. | | Few people have been as relentlessly toxic and unforgiving on | social media as nurses. | | As a child of a nurse, that job has sucked for at least the past | 40 years. The pay is average. Workplace is a cesspool of gossip | and toxic work culture. Management is generally terrible. Also, | the pandemic has exposed how many in the profession really are | just narcissists. | | The amount of facebook posts from indignant nurses spreading the | most horrible comments , just to receive likes and be perceived | as heroes, these past two years have made my stomach turn. | | Its about time we cleaned up in healthcare. Not just aduquate | pay, making sure we properly manage healthcare professionals and | evolve healthcare management to grow where its needed. | | I am 100% positive a flexible healthcare system that expands and | shrinks after societal need is possible. | | Not this crazy old fashioned fixed set of beds for x or y, that | gets cut in some wave when they are needed less. Only to cause | havoc in years when they are needed more. | | Make sure the good nurses dont burn out and quit leaving the | narcissist and ego maniacs behind. | | There are amazing nurses out there, but we need to face that many | of them are absolute shit at their jobs. And should seek other | venues. This exodus may be a good thing in the end. | asdfasgasdgasdg wrote: | > This exodus may be a good thing in the end. | | Hrmmm. Pretty sure if 90% of nurses actually left the | profession it would be a serious problem. | | That being said, I would be surprised if this actually | happened. If even 5% left the profession would probably become | more lucrative, since pay would have to rise to retain those | who remain. Meanwhile, although nursing is not super highly | compensated, the alternatives for someone who has only a | nursing education and skillset will likely be worse. That may | lead to a gap in ideation about leaving vs actually leaving, | because the fact of the matter is that we all still have to put | food on the table. | everhard_ wrote: | This seems like a world-wide pattern, and it was already an issue | even before covid.[1] I'm curious about what alternatives they | have, may be joining newer tech-enabled companies with nursing | services, or going fully independent and work solely by their own | terms with some patreon-like app... ?? Or is it the case that | they are really sick of nursing and might prefer changing | professions or even unemployment? | | [1] | https://www.icn.ch/system/files/2021-07/ICN%20Policy%20Brief... | andrewclunn wrote: | Meaningful Use, ICD-10, more and more top down "big data" | standards and approaches, that focus on qualitative data entry AS | care. I mean this literally: thanks Obama. | oversocialized wrote: | thenerdhead wrote: | My sister is a RN training to be a NP. Caring for others has | always been in her blood. But I can tell she's not happy over the | last few years (even prior to covid). | | This survey has such a low number of responses to make any | meaningful conclusion from. 200 people surveyed. Non surprising | stats like 71% of respondents having 15+ years of experience | wanting to quit. | | What really should be the lesson here is that capitalism does | what capitalism does best: | | It cuts costs. | | - More patients to nurse ratio (Simply unsafe given most medical | professionals already lack sleep) | | - Little to no compensation relief on the way. (Huge boom of | travel nursing during pandemic) | | - Excess job responsibilities (More paperwork/aid duties, less | actual nursing) | | - New talent / old talent challenges (Larger incentive to switch | jobs, hard to properly train) | | We better figure out something soon. The medical field feels like | it's holding on by a thread. Insurance companies run rampant with | no end in sight. Health care continues to increase in costs and | fail patients to the point of walking out or even dying to get | care. | | While I think generally speaking, nurses like my sister just want | to feel appreciated like other jobs people are burning out in. | You can do that in many different ways: | | - Don't overwork them. | | - Don't underpay them. | | - Don't give them unwanted responsibilities. | | - Most importantly, listen to them. | | I think you may find that people actually do love the profession | as it's one of the most noble professions out there, just that | they are being forced out of doing something they love because of | greed. Greed is not good. | adventured wrote: | Report: 90% of people want to stop working. | uf00lme wrote: | Poor pay, shift work, bad working conditions and multiple chances | of catching all kinds of diseases. Most nurses I know have above | average intelligence with an excellent work ethic. Just one | bootcamp away from a much better life. | | So much sacrifice for the greater good, we the public are not | worth it. | | Another profession I always think of are math teachers, they are | good people. | SomeCallMeTim wrote: | A bootcamp doesn't guarantee anything; without the right | aptitude and temperament the tech industry is just as | miserable, with a side of failure if you can't keep your jobs. | | And no, "excellent work ethic" isn't enough. | germinalphrase wrote: | What non-technical bootcamps provide actual on-ramps into the | industry? | lexwraith wrote: | My wife was/is both an RN and a DNP in NYC during the entirety of | the pandemic. I'm an Iraq infantry veteran. Our experiences are | remarkably similar and there are major trends as to why there is | unsustainable turnover. | | 1. Everyone pays lip service. People stand at airports and say | thank you for your service the same way they open their windows | at 7PM and start clapping and cheering during shift turnover. | Sometimes they'll say they know people who are veterans or | 'frontline healthcare workers' as a sign of solidarity | | 2. Nobody actually wants to hear what you went through. Hearing | people die or knowing people are about to die in sometimes | painful, unfortunate ways is too raw for people to try to seek | out and understand, despite the fact that for a significant | portion of the population that's how we're going to go out, in a | hospital with all sorts of drugs pumped into our system | | 3. There's a constant barrage of emotional/mental harm. Believe | it or not, you don't magically 'harden up' immediately. | Absorbing/witnessing drastic outcomes gets easier, but the burden | doesn't get lighter. This isn't to mention physical harm. People | do all sorts of things out of desperation and frustration. | | 4. The systems that manage you are byzantine if not kafkaesque. | You're never sure how the decisions are made, yet you're the one | that will be paying the most for it. You know deep down that | you're just a number on a spreadsheet, and the only reason that | keeps you going is internal motivation to do what you think is | right, so you push on | | 5. The people who can help rarely think about you. Very few | politicians will mention your name or your union that is doing | its best to get some kind of safe nurse:patient ratios or even | get the hospital to pay for your scrubs that they mandate. Very | few billionaires have mentioned healthcare workers or veterans at | all. As a whole, until someone has an emergency that threatens | their physical or financial status, healthcare and security is | treated as a black box with unreal expectations and extra | sensitivity to deviations from said expectations, despite a | complete lack of introspection and information on how those | expectations came to be | | I don't know what the solution is. In healthcare, every system is | so deeply connected to the rest that destroying one or even | refactoring takes down everything else, and we need it to stay | online. The same applies to the continuation of geopolitics by | other means. You can give every IC the best EMR system, the best | rifle and radio, the best monitor/laptop/keyboard, but it's all | for nothing if the system as a whole is a dumpster fire. Her | frustration is palpable every time she finishes a rough shift | (probably 2 out of 3), and the best I can do is lend my ear and | pour a glass of wine. | | That being said, I am grateful that she is continuing on the | path. Our shared experiences have brought us closer than ever. | springsprint wrote: | My wife works as a floater pharmacist in retail, can confirm, the | situation is quite similar and very dire. She cannot even get a | couple of days of UNPAID time-off when needed. The scheduler and | the management are quite abusive with the way how they treat | their staff. There is no such thing as a work-life balance. | civilized wrote: | This is a PR firm plant http://www.paulgraham.com/submarine.html | | In fact the entire website is probably a PR plant. | pbuzbee wrote: | Is this a shock? | | - Demanding work: 12 hour shifts, irregular schedules, night | shifts, physically exhausting, limited breaks (including | bathroom/water!) | | - High responsibility with unsafe conditions. You're literally | responsible for people's lives. Poor staffing ratios stretch you | thin and make you more likely to make mistakes. And if you make a | mistake, you're at huge risk for litigation... and now criminal | consequences too. Responsibilities, resources, and staffing | stretched even thinner due to the pandemic. | | - Administration that treats you as something to be optimized and | does the absolute bare minimum to support you. Instead they tack | on additional tasks, expectations, and requirements ("no water at | a nurse's station!"). They encourage a culture where nurses | provide a concierge service to 'guests' instead of critical care | to patients. | | - Hostile/entitled patients. I'd guess many/most patients are not | an issue, but it only takes a couple of difficult/combative | patients to really ruin your conditions. | | - Low pay given the responsibility and working conditions for | non-travel nurses. https://nurseslabs.com/nurse- | salary/#nurse_salaries_by_state Like many others pointed out | here, in tech I make way more than a nurse for a job that's less | demanding, has far lower stakes, and is of far less value to | society. | | To me the blame lies mainly in middle/upper management, whose | role is to build and empower an effective workforce. If 90% of | your workers are considering leaving, you blew it. | tsol wrote: | The pay was good enough last year, what changed? In my opinon | nursing has always been a difficult job, yet they've always had | people lining up to become nurses. So it must be more than just | 'the job is too demanding'. | anonporridge wrote: | Pure speculation, but if I had to hazard a guess, it's | because the job is becoming increasingly inhumane. | | More and more, nurses have to act like robots to remain in | compliance, and that's not what any of them signed up for, | and the increasing lack of intangible reward that comes from | caring for people and creating a human connection, means they | demand more explicit monetary reward for temporarily | suppressing their humanity to do the job. | goodpoint wrote: | Can we stop posting posting US-related stuff without a clear tag | in the title? | [deleted] | fumeux_fume wrote: | Of course the answer to this problem is more optimization and AI. | Lol, wtf website is this? | johndhi wrote: | I've worked in healthcare law for a few years and I think the | problem boils down to how it's regulated. | | It's super, duper complex with lots of paperwork. The complexity | is too great to run a small practice, the Medicare/Medicaid fees | are too small to make up for it, and it increases the importance | of administrators in the hospital system. | | If I had a bunch of time I'd love to go through and write up a | proposed alternative approach, and congressional bill -- but I | have to imagine even if I did that, no one would listen to it. | artur_makly wrote: | I'm sure Elon has a solution for this in 2023. | nameless912 wrote: | Anecdotally, many of my partner's coworkers have been on the | school setting therapist -> hospital setting therapist -> burnt | out craft store employee pipeline over the last couple of years, | and my partner is desperate to join them once we have enough | savings to allow her to quit her job. This is within the | Speech/Language, Physical, and Occupational Therapist realm, so | not nurses exactly, but it's similarly bad for a lot of medical- | adjacent jobs right now. | nfriedly wrote: | My mom was a RN (Registered Nurse) for 30+ years. She quit doing | what most people think of as "being a nurse" about 10-15 years | ago and switched to related work (home checkups, teaching, | medical billing, etc.) because of how stressful and demanding | working the floor in a hospital was. | | Last year she retired from the profession entirely, a few years | ahead of "normal retirement age", and now she works part-time at | a local farm/fruit stand. The main things that drove her to | retire early was management insisting on 12 hour shifts and not | hiring enough staff. | tssva wrote: | 12 hour shifts have long been the standard for nurses in a | hospital setting. A full-time hospital nurse usually works 3 12 | hour shifts in a week. | nfriedly wrote: | Yes, you're right, and there are some reasonable arguments | for it. But I'm not convinced that it's the optimal solution | for all situations. | | I my mom's case, she was mostly doing paperwork, so many of | the arguments weren't as applicable. She had done 8 or 10 | hour shifts for a while and found that she really preferred | it (and was staying on top of her work), but then a different | manager was brought in that forced everyone back onto the | "standard" 12 hour shifts. | geocrasher wrote: | Nurses have an extremely hard job. Before my wife died, she spent | days to weeks at at time in hospitals over and over again. She | went out of her way to show them kindness despite her suffering, | and they always thanked her for it. Most patients treat them like | _slaves_ and are even abusive toward them- at the very least, | thankless. COVID only made this worse. It 's no wonder they are | leaving in droves. | jmyeet wrote: | The number of people in the US who continue to defend the | abhorrent health insurance system is absolutely mind-boggling. | The level of brainwashing that pervades discourse about single- | payer health insurance being some sort of communist plot is | testament to some of th emost successful propaganda of all time. | | What's worse is it belies an ugly aspect of human nature | (particularly pervasive in the US IME) that people absolutely do | not give a fuck about anyone else when it comes down to it. As | long as someone is fortunate enough to have decent health | insurance through their job, people who don't are lazy. | | The big picture here is that the wealthy want people dependent on | jobs and to be in debt (eg student debt) because it makes them | compliant. | | So I'm not surprised nurses are leaving. Insurance companies make | providing healthcare an absolutely miserable business and | deliberately killing people ("prior authorizations", "pre- | existing conditions", etc) should not be the basis for commercial | enterprise. Denying someone life-saving or life-changing care | should not be a profit motive. | | What's worse is that a lot of the burnout is effectively caused | by people who are profoundly selfish and are voluntarily choosing | to get sick and die of what is now a highly preventible disease. | | It's a hard situation because people depend on nurses so | collectively they're torn. Teachers OTOH aren't life-critical | (but still obviously important) so I'd actually like to see them | make a mass exodus over all the right-wing censorship they're | facing in most states. | fundad wrote: | Yeah it's wild how well the grift works. My coworkers want | private insurance (because we get it) and oppose universal | healthcare. I think generally people in the states are ok with | a grift if it hurts poor people worse. Because of that | literally everyone expects they are getting grifted at all | times and trusts no one. | Ericson2314 wrote: | There should be strikes until we get medicare for all. Simple as | that. | lucidone wrote: | I have family members who work in health care here in Canada. The | fact that their wages are subject to regulation (e.g., they are | effectively getting a paycut this year with inflation), they | realistically cannot strike to improve their working conditions | (people will die), and that their work is very demanding | (physical labour, emotional labour, shift work, constantly | understaffed) makes this an unsurprising statistic from my | anecdotal experience. | Footkerchief wrote: | Is that 90% figure new, or has it been the case in past years? | gagan2020 wrote: | Why no one talking about survey size of 200 nurses of particular | area only | AviationAtom wrote: | How are more people not sounding alarms about the future of our | society with more bleak headlines like this? I fear we have | become far too reactive to many problems that should have been | anticipated, and planned for. | Zeetah wrote: | Wonder if this is a US phenomenon or a global phenomenon? | thg wrote: | It's about the same here in Germany. | | Source: Got nurses in the family. | bezospen15 wrote: | How do we reduce the cost of health care while simultaneously | paying nurses more? | jmugan wrote: | A lot of us are saying we need to increase the pay of nurses, but | we also believe that medical care is too expensive. So, where is | all that money going? There are a lot of flippant answers but | they never seem to lead anywhere actionable. | eksx wrote: | One example is drug waste. Insulin for example is charged per | vial to the patient but usually only a minimal fraction is | actually used and the remainder is disposed of. | jeffrallen wrote: | And then the patient is charged a disposal fee. | jrochkind1 wrote: | I am not sure, and I'm not saying this is the WHOLE problem (in | fact I am confident it is not), but... in 2017 (first hit I got | googling) 7.9% of all healthcare expenditure in the USA ($275 | billion) went to insurance overhead, vs 2.8% in Canada. | | But yeah, in general, this is a problem (healthcare in general, | healthcare expenses, nurse job experience) where almost all | other countries with similar wealth are doing so much better | than us, it shouldn't be _that_ mysterious to solve it, right? | It 's not like, who knows if it's even possible to do better! | Like, we know it is... figuring out what the difference between | them and us isn't trivial, but it should be easier than | something there isn't a model for. | | The most obvious difference would seem to be how insurance (and | universal coverage thereof) is handled. | orwin wrote: | In France, 18% to 22% of the money given to our public | insurance is used for administrative stuff, which i thought | was a lot. Then I learned that 31% of what my company pays | for my private insurance is used for administrative purpose. | So either private companies are way less efficient than | public service, or i should immediately buy shares from | Swisslife and others. | | Guess what my first major investment was? | ciphol wrote: | It goes to treating crises (expensive) rather than preventing | them (cheap) | shantnutiwari wrote: | The article seems to focus too much on : How can IT fix this | problem? | | Ugggh, maybe it can't? As the main problems seem to be political, | not tech related? | | You might as well ask how IT can be used to fix homelessness or | police brutality? | bell-cot wrote: | My last experience in a hospital was Dec'21. ICU, at an old | friend's bedside, in a large (500+ beds, "teaching") hospital | that is part of a big (50+ hospitals) chain. | | The nurses seemed excellent...but the amount of time and | emotional energy they had to put into dealing with multiple | computerized systems - just within my friend's room, to replace | an empty IV bag - was staggering. The "smart" IV pump was the | worst - a crappy little display, a minimized number of flaky | buttons as the only interface, and the nurse had to drill down | into multiple sub-sub-sub menu's to do even basic stuff. | | My first thought was that you could triple nurse productivity | (as in "care given to sick humans") if you had two IT tech's | following each nurse around, tasked with doing all the "re- | redundant data entry & dealing with computerized shit" that had | obviously become the nurse's primary job. | | My second thought was that interfaces which the nurse had to | deal with should be restricted to 1950's-industrial-control- | panel style - nothing but well-labeled, single-purpose physical | buttons, switches, & dials. And the data entry that they had to | do was restricted to wax pencils on well-laminated paper - | which could be fed to a scanner, to update the patient records | database. ( _Displays_ , say of vital signs & such, could be | fancy. But the "50's control panel" rule could put an end to | "oh, that information is hidden down in a sub-sub-sub-menu | here..." shit.) | ed_balls wrote: | The average ago of nurses went from 46 to 55 in my country. The | current retirement age is 60. | detcader wrote: | because the headline can never be "90% of nurses' employers fail | their employees this year" | TOMDM wrote: | Well yeah, because it's reporting on a survery of nurses which | included a question about whether they're considering leaving | the profession. | | I think your would be headline is a fair inference to come to, | though not the sole cause. | | With how over sensationalised our media is, can we avoid | complaining when headlines actually directly match the thing | they're reporting on for once? | fitba72 wrote: | In my experience, most nurses come in, socialise and cheer you | up, take your blood pressure and temperature with automated | devices, that one can buy for home use, and give you medicines | that a doctor has prescribed (someone can also can do at home if | they are feeling up to it). This is a wonderful profession and | they should be highly paid but do they really need a bachelor's | degree or master's degree to do this job? Some specialised nurses | can even draw blood but, again in my experience, many of those | were unable to "find a vein" and had to call on someone more | experienced or a doctor. Pretty sure some experienced heroin | users could do a better job at this. Just my experience. | [deleted] | shadowofneptune wrote: | Where a less credentialed person can do the job it has already | been done. Here's how it breaks down: | | Registered Nurse (RN): The 'specialized nurses' you talk of, | and what this article is mainly about. Requires at least an | associate's degree to be licensed, but increasingly an | bachelor's is expected. Only they can administer any medication | a doctor prescribes, and only they can assess your condition. | | Licensed Practical Nurse (LPN): If they are certified they can | also do blood draws. Requires graduation from an LPN program | (usually about one year) to be licensed. They perform easily | predicted tasks like a dressing change that do not require | assessment. They can also administer some drugs based on the | situation. | | Unlicensed Assistive Personnel (UAP): In a big hospital, these | are who are checking your temperature most of the time. They | can only do basic tasks that do not require any medical | training, even if their experience is larger than the RNs and | LPNs they're under. | | There are also many different technicians. In a big hospital, | an RN acts as a middle manager delegating their work to these | many different tiers. In an ICU, or in a small hospital, it | will be done much more by themselves. | theguyovrthere wrote: | Nurses leaving the field is only part of the larger problem. | | Nursing educators aren't exactly a dime a dozen. The average age | of a masters prepared nursing educator in the us ranges between | 56-62. Doctorally prepared is higher. The country is facing a | nursing shortage, and a nursing educator shortage. | | Now my doctor has an interesting theory that some of the pain | points for nurses is being created by the hospital systems and | industry themselves as an excuse to say we dont have enough | nurses and bring in nurses from other countries like the | Philippines, as they'll be glad to come to the US and work for | less, and will be so grateful for the opportunity that they'll go | along with whatever the hospital says they need to do. (This was | in the context of vaccines.) | | The other thing that has nurses worked up is recently is this | case: https://www.cbsnews.com/news/radonda-vaught-nurse-guilty- | dea... | jrochkind1 wrote: | There's even more in here beyond the headline about nurse | satisfaction. | | USA healthcare pretty broken, and sliding into catastrophe. Nurse | dissatisfaction is just the tip of the iceberg, or the canary in | the coalmine. | | > Eighty-four percent of emergency room nurses and 96% of | intensive care or critical care nurses have a 4:1 ratio, which is | double the optimal target of 2:1. | | > Thirty-six percent of nurses said they've seen patients with | acute health conditions walk out of the ER because of the wait | times for an inpatient bed. And 37% said that surgeries had to be | rescheduled because of bed shortages. | sujitjadhav wrote: | Time to bring Robots faster. | [deleted] | djohnston wrote: | I would expect robots to replace physicians before nurses for | the same reason I'd expect them to replace architects before | plumbers. | manuelabeledo wrote: | So my Roomba still gets stuck under the sofa, and robots still | cannot make a full lunch, but they will replace nurses? Yeah, | good luck with that. | fallingfrog wrote: | Never seen an industry that needed unions more. | susrev wrote: | They surveyed "more than 200 hospital registered nurses based in | the U.S.". Does this small of a sample size truly reflect the | feelings of the ~2.4 million (2019) registered RN's in the US? | | That is 0.00008 % of all RN's in the US. | stakkur wrote: | I work for a major healthcare provider (thousands of nurses) and | while there's a lot of unhappiness, nowhere near '90%' are | considering leaving. | | And really, this is a red herring; the real problem started long | before COVID. This video essay nails it (or so care practitioners | at my workplace say, anyway): | https://www.nytimes.com/video/opinion/100000008158650/covid-... | [deleted] | sllewe wrote: | Using an anecdotal source - My Wife (ICU RN) this is sounds | right. | | Outside of the existing issues with Bedside nursing (long days, | physically demanding) - the primary issue is staffing. Pre- | pandemic the ratios were already bad but now many are leaving for | travel contracts which carry significantly better wages. It | quickly becomes a loop where employees leave for Travel | Contracts, and then can only be backfilled with Travel Contracts. | The remaining FT staff nurses are left making much less money, | and have to assist "training" with the outside Travel nurses. And | while this is nothing against them - The travel RNs also often | have a different "vibe" as they are much less focused on long | term improvement or problem solving within the Unit. | | Also ICU/PCU/ER nursing throughout the pandemic was a terribly | depressing place to be. Leaving many of my Wifes colleagues | (including herself) with what is essentially PTSD with little or | no support from the Hospital System. | durrden wrote: | My wife (ER/Trauma RN) feels the same way. They will need to | double the pay of non-travel nurses to get through this. | alostpuppy wrote: | The existence of travel nurses should really be indicative of | a problem. | pmulard wrote: | Travel nurses serve a need, like if another nurse gets | injured or has a child, and they will need to be | temporarily replaced. | solenoidalslide wrote: | Shouldn't travel positions exist for every other | profession? | | The reason why it's expected for nursing in particular is | the indicator that something here is very wrong. | InitialLastName wrote: | Should it? The market for medical care has a base rate (and | appears to be clearly under-staffed for that rate), but | (especially in a pandemic) it's rather peaky and the basic | skills appear to be VERY transferable from location to | location. If there are people with the skills that are | willing to travel, it seems that a system that maintained | maximum capacity in all locations would be a very wasteful | one. | alimov wrote: | Yes, it should be indicative of a problem. The fact that | nurses are overworked, and underpaid is a big issue. | | > If there are people with the skills that are willing to | travel, it seems that a system that maintained maximum | capacity in all locations would be a very wasteful one. | | The general idea here is that more and more nurses are | willing to do this because they are underpaid and | overworked in their regular (non-Travel Nurse) positions. | I didn't see anyone arguing for "maximum capacity" | either... just better wages and working conditions. | | > basic skills appear to be VERY transferable from | location to location | | If you read the parent comment by sllewe you will see | that there are other costs and concerns around this which | do more to stress existing nurses at whatever hospital is | being filled with travel nurses. Imagine training a new | someone every week (or however often new travel nurses | pop up) while also having to do your own job... | especially when you are already being overworked and when | a miscalculation on your part could result in loss of | life. All the while knowing that the travel nurse is | making significantly more money than you, negotiated | their hours of availability and doesn't have to care | about the unit beyond whatever contract length they | signed up for.. | mansilladev wrote: | As the son of a retired nurse, I can tell you that this has been | true since the dawn of the nursing profession. | sonicggg wrote: | Nurses complain about their work conditions, but I don't | understand them. They had this massive leverage during the | pandemic to discuss improvements. Some people may say "Oh but it | is illegal for nurses to strike in country X", but what will | governments and companies realistically do if all nurses decide | to stop, arrest everyone and let the health system collapse? Not | a reasonable option. | | There's just something masochist about their profession. | d4mi3n wrote: | Legalities aside, how would you feel about refusing to work for | poor pay/conditions if you knew for a fact that said decision | would result in many deaths? | | Not a chance, not a speculation, but absolute awareness of the | number of patients that will not receive care and likewise will | die as a result. | | I don't think it's fair to blame nurses for poor treatment when | they have a multitude of terrible options to pursue in order to | improve their working conditions. | belval wrote: | It's unfortunate to see this downvoted because I've heard this | sentiment echo'ed a lot and I think it's worth explaining. | | It's not about the illegality, it's really just about people | dying. Yes you can go on a strike but your patient that's in | critical condition won't survive on principle. You could say | "just don't care about the patient and strike anyway", but | that's extremely hard to do. | | Striking when it hurts some millionaire owner is one thing, you | wouldn't feel bad about yourself. Striking when it hurts | someone post-op who did nothing wrong aside from being sick | isn't noble, you get to live with the fact that as an | individual you could have saved them, yet you didn't because | you wanted money. | sonzohan wrote: | It seems like your comment would be better directed towards | weak or absent nurse unions, instead of individuals. I had | countless nurse and physician friends go to their hospital | directors/HR/managers during the pandemic "I need a raise | because I have absorbed the load of 3 other workers and am | working harder than ever." Not only were they refused, many | instead received 10-33% pay cuts, with hospitals citing | increased Opex costs despite decreased staffing, significant | government assistance, and increased volunteer (0-cost) help. | | It'd also be enlightening for people in this thread to have | hospital executives explain how they have some of the highest | patient numbers in history yet they're hemorrhaging so much | money their physicians had to take pay cuts. | | Nurses, due to their profession having relatively low barriers | to entry yet requiring years of operational knowledge to truly | be effective, need collective bargaining. Nurses do strike, and | nurse strikes are actively occurring on the U.S. West Coast. | However, the unions they represent are small and have little | power overall. For a strike to be successful you need | solidarity from a majority of workers in the area you want to | impact. You also need buy-in from the hospital/region that | union nurses will provide superior care to non-union nurses. | Something that's hard to do when your average executive thinks | that the most complicated thing a nurse does is sticking a | patient. | Ensorceled wrote: | It's more a lack of psychopathy in the profession. If nurses in | Ontario had gone on strike two months ago, a lot of extra | people would have died. | sonicggg wrote: | I know Ontario all too well. The same people that depend on | nurses won't do more than needlessly beat pots and pans for | their "heros". They do not even support them with their | votes, which put in power the nefarious Conservative party. | Who exactly are the nurses standing for? People that won't | have their back. | TOMDM wrote: | I think there's some middle ground between "Hey, we need | some more support, our conditions suck" and "Fuck it, we'll | let the sick die I guess" | bsedlm wrote: | at some point, somehow, medical care stopped revolving about | 'healing' and medicine became all about 'treating'. | | the health of the patient became subordinate to the economic | incentives of the hospitals and the other involved institutions | (insurance providers, pharmaceutical corporations, etc...) | | and so I have the hypothesis that this happened because people | (young adults) going into medicine because of a vocation to help | and heal others become disheartened when they find out it's all | about institutional profit; only them who get into this becuase | "doctors make good money" really make it to the end (which is not | terrible, as they usually do learn the methods and techniques of | medicine, but that in the long run prioritize money over health). | | health care should have never been allowed to become a capitalist | marketplace. | screye wrote: | Not to be mean, but 'leave nursing' and then what ? | | Nursing is a well paying middle-class job without a lot of | transferable skills to other professions. Don't say programming. | It isn't the solution to everything. Other low-entry-barrier jobs | pay much less and have exploitation problems of their own. For a | lot of middle class families, dual income is essential to | maintain their lifestyle. So SAHM is not an option. Nursing has | clearly gone through a rough 2 years, but I suspect that things | are going back to normal now. Why leave now ? | | > High patient-to-nurse staffing ratios | | This bit is confusing me. If supply-demand is in the Nurse's | favor, then don't they get more leverage on what QOL and wages | they can demand ? It is not like they can fire a senior nurse on | low pay, when new nurses are harder to find and demand higher | wages. I know that the nurses refusing work and resulting deaths | has bad optics, but it doesn't look like hospitals have a lot of | leverage right now. | | > Administrative burden and manual tasks | | Sounds like an opportunity for a startup to disrupt the space. | But, the jaded side of me thinks that the startup will fail due | to insufficient political leverage with hospitals/insurance/law- | makers. | | > health IT | | Keep calling it health IT and the problems will never be solved. | Solving hard problems needs reframing of the resources dedicated | to it. When tech workers are seen as assets and not cost-centers, | these problems will solve themselves. | kerbs wrote: | > 'leave nursing' and then what | | When we got married, my wife (Physicians Assistant) made | handily more than I did. $140k to my $82k midwest, software | development job. | | 10 years later, she makes $130k (after cutting hours back) and | I make $4-500k as a software engineer in the midwest. The two | markets crossed _drastically_ | | Where are they going? | | For us, home. | screye wrote: | > I make $4-500k as a software engineer in the midwest | | This is a massive outlier though. In your case, the exception | proves the rule. | | The rule: "The 1% of Nurses that found a partner in the US | top 1 percentile will be able to quit their job." | jewayne wrote: | $500K as a software engineer? That's the very tip of the | unicorn's horn. My friend works as a CEO of a (smallish) | software company and makes half that. | peanuty1 wrote: | This forum almost certainly skews heavily towards people in | Silicon Valley or working at Bay Area companies. AKA the | very highest earning people in tech. | titanomachy wrote: | "If supply-demand is in the Nurse's favor, then don't they get | more leverage on what QOL and wages they can demand?" | | I have a family member who works in public health and is trying | to staff nursing positions. She has something like a $400k | budget to hire 4 nurses at $100k each (let's say). She is | unable to fill the positions because cost of living in her area | has gone up so much. She'd rather have 2 nurses at $200k each | instead of zero nurses, but she's simply not allowed to do | that. She's trying to change policy but it's a massive uphill | battle. | | Power's concentrated very high up in health care, and it's | exercised through the use of rigid policies. It certainly seems | like nurses should command higher wages, but the bureaucracy | has become very effective at preventing basically anything from | changing quickly. | warner25 wrote: | I was thinking the same as your first point. I'm a career | military officer and know a lot of military families[1]. My | observation is that the spouses who are doctors and nurses are | the only ones who can reliably find middle-class employment. | Becoming a nurse is much easier than becoming a doctor, and | pays much better than other common things like retail, food | service, house cleaning, and photography (probably more of a | hobby). | | [1] The labor participation and employment rates for military | spouses (especially when adjusted for age and education) are so | low that they're almost off the charts. The causes are frequent | cross-country moves to economically struggling locations, and | an extreme need for flexible schedules (e.g. for when service | members get deployed and spouses become de facto single | parents). Medicine seems to be unique in that it's everywhere, | always hiring, and often allows for part-time employment. | raydev wrote: | > Nursing is a well paying | | Only in a vaccuum. It pays far worse than other jobs at the | same rate given the effort and stress the job entails. | | > don't they get more leverage on what QOL and wages they can | demand ? | | Sure, but it needs to get far worse. The hospitals are only | going to budge once walkouts are organized. But that can't | happen without strong unions, most nurses just need to pay the | bills which is why they continue to put up with it. | | I'm not sure you understand who has the leverage. The hospitals | can let healthcare deteriorate far beyond current expectations. | They still get paid in the end. The environment for patients | and nurses will only get worse. | BeetleB wrote: | > It pays far worse than other jobs at the same rate given | the effort and stress the job entails. | | Depends on location. Most professions I know with that much | effort and stress get paid a lot less than $100K, which is | the median nurse pay in my area. Amazon pays a lot less. | kerbs wrote: | > don't they get more leverage on what QOL and wages they can | demand ? | | Following up on this apart from my reply above, my | observation is instead of raising pay they simply let roles | languish. It's bizarre. | | But then again it feels like that's what happens when | nursing/AP care is treated as a cost center. It seems like | they aren't concerned with addressing a market as much as | keeping cost/income the same as it has always been. | eftychis wrote: | What I read here instead is that the American people is fine | with deteriorating healthcare, and will not regulate the | industry, nor burst into a walkout of their own. | | I find it cheaper to fly back to Europe and pay out of pocket | (uninsured) for anything non-trivial along with my flight | ticket than pay for California services. Only two things I | miss: a) nicely decorated clinics and nurses taking my vitals | and information instead of the doctor b) heart attack or | stroke chance while reading the bill. | | (Of course, I have the advantage of having people to stay | with. Perhaps, Airbnb will start offering health services | that way soon.) | | /s | | Seriously, we need to start looking as health care for its | value as health care and not a money grab; we pay enough | taxes to have a hospital running without the fear of | profitability I believe -- in California at least. | jewayne wrote: | Honestly, unless they're not in the midst of fighting a | serious illness, most Americans just want to be sure that | they have access to better healthcare than the people below | them in the socioeconomic ladder. They're fine with | healthcare deteriorating, as long as it deteriorates at | least as much for the guy below them. | | Now, if a serious illness comes along, some people do wake | up and realize it's not a f*cking game. But certainly not | all. | sebow wrote: | No surprise at all. A lot of unnecessary stress (yes, more than | enough, even for a pandemic) and the top-down approach of the | institutions really broke the trust of the public in many | healthcare systems worldwide. I think the sentiment would be the | same even if wages would be raised (and in many cases they have | been). | | Considering it was bothersome for both healthcare workers and the | public, in my opinion the friction is more between the healthcare | workers and management/government entities (& their policies) | rather than "some patient bothered me" cases. | TYPE_FASTER wrote: | I'm a software engineer. My wife is a RN. It's been interesting | over the past 20+ years to see the parallels in two different | markets. Temporary staffing is used to fill vacant reqs. Gradual | erosion of employer provided benefits. | giantg2 wrote: | "... poor processes, along with inefficient operational workflows | and administrative burden are key drivers of frustration and | burnout among ..." [insert job here] | | This is pretty much universal in my experience. As a dev, it | always seems to boil down to these. It's amazing how the business | doesn't know their processes, can't document them accurately, or | simply don't care to analyze and document them. Garbage | requirements become a garbage system. | Blackstone4 wrote: | Might be similar for teachers...I know many have cut back hours | to part time where they can or are considering leaving. They are | having to fill in for staff absenses and are stressed. | mattmaroon wrote: | It's a lot easier to say you will leave your profession than to | actually do it, so I don't expect anywhere near 90% to be true. | But it won't take that many to leave before it becomes a severe | problem. The industry will be forced to reckon with this. We | can't not have nurses and healthcare is basically an infinitely | large industry (people will spend all of their money to stay | alive) so I'm sure it will be improved. | t_mann wrote: | If there ever was a contrarian move then it'd be for an 18-year- | old to start nurse training now. Probably one of the last | professions at all to be hit by automation, practically | guaranteed demand for skilled labour and a hefty shortage thereof | in the making. | retr0nerd wrote: | Get ready for another dark age. The destruction of education and | medicine in this country means plague doctors will be making a | return. Better check with your HMO to make sure your policy | covers them. | ubermonkey wrote: | A good friend of mine was a nurse practitioner in cancer care | here for 17 years, and quit last year to do contract work in | interesting places. She's unmarried, no kids, etc., so I think | it's a little bit of a "shake things up" thing but also a little | bit "make hay while the sun shines." | | Her most recent gig was in Antarctica. I mean, cool, right? | post-it wrote: | I would love to spend a winter at the south pole station. The | biggest downside of being able to do my job remotely means I'll | never get sent to cool places. :( | pmulard wrote: | It's even better. You can send yourself to cool places :) | jimmar wrote: | A family member just quit her nursing job because she refused to | learn yet another system. She was great with patients but could | not stand the computer systems she had to use. | brimble wrote: | I feel like quitting _receiving healthcare_ when a provider | switches their records systems or adds a new one and I have to | input all the same shit _yet again_ (what the _fuck_ is even | the point of digital medical records? They can 't keep even the | most basic info straight anyway!), so I can only imagine what | that's like for the people who have to work with it daily. | throw8383833jj wrote: | Here's my naive understanding of the situation: | | It sounds like they're just being overworked. So, just have the | nurses take a 20 minute break every 2 hours, to go out and take a | walk. The hospital can require it if it comes to that but why | wouldn't they just want to do it? and if the hospital doesn't | want to do it, then the nurses should insist on it and walk off | the job if not given their breaks. I would imagine the hospital | would rather agree to 20 min breaks every 2 hours rather than | loosing 90% of their workforce forever: they don't have a choice, | they have to agree. | defterGoose wrote: | Well, at least you're aware that it's a naive understanding... | throw8383833jj wrote: | why doesn't collective bargaining work in this scenario? if | the demand for nurse labor is so incredibly high, they should | have a lot more bargaining power, no? | airstrike wrote: | Compared to what % historically? If you don't give me historical | trends, I don't know what to make of this one data point. | mberning wrote: | My wife worked bedside at a nationally ranked childrens hospital | for 5+ years. She left recently for private practice and loves | it. More money, less stress, better management. The list goes on. | Bedside nurses are often not paid very well, are treated poorly | by patients, and even more poorly by administrators. The | hospital's motto should be "anything for the patient, nothing for | our employees". | saos wrote: | Not surprised. Cost of living is at an all time high whilst wages | have stagnated. Atleast thats the problem in the UK. | mfer wrote: | I've spent a fair amount of time talking with nurses about the | problems. I'm related to a bunch of people who are nurses across | disciplines (ER, ICU, med/surg, etc). It's been enlightening | hearing them talk about the problems... | | 1. Many new nurses make the same or more and long time nurses. | It's frustrating when the nurse in charge with the most | experience is making less than new nurses. Some hospitals are | even trying to stop nurses from talking about pay. | | 2. Patients in COVID have become downright mean. Add this to the | problems nurses have management and doctors (who are often rude | and arrogant) and it's a poor culture. The quality of the | environment, from a mental health standpoint, is on the decline. | | 3. IT systems that they have to use were designed by people who | have not talked with the workers who use them. They may have been | designed with laws and compliance in mind. Nurses aren't the | people who choose or pay for these systems. But, they use them a | lot (maybe the most) and it's obvious they weren't taken into | account when designing the UX. It's maddening for them. | | This one is big for product designers. Often we listen to the | people who pay for it and miss out on the people who actually | have to use it. | | 4. Nurses are the catch all for jobs. Not enough aides? Nurses do | the work. Food service workers don't want to take food into a | patients room... nurses will do it. Not only do they have higher | ratios of patients but they fill in the work when other areas | have shortages, too. So, the work per patient goes up. Pay | doesn't go up, though. | abeppu wrote: | > Many new nurses make the same or more and long time nurses. | | Is it mainly lack of information (and exhaustion) that prevents | these more experienced nurses from negotiating for what they're | worth? | causality0 wrote: | _3. IT systems that they have to use were designed by people | who have not talked with the workers who use them._ | | You couldn't be more right about that. Last week a nurse had to | use a computer in my wife's hospital room to log that she'd | given her a painkiller. The IT staff had failed to configure | the hospital computers to disable windows updates or restrict | them to off-hours and the nurse was forced to stand there for | ten solid minutes while Update churned, the pc restarted, and | Update churned some more. | zdragnar wrote: | Back in the days before cell phones, my mom would wind up being | on call for overnight labor & delivery. The final straw | (certainly not the first) was that they got a call in the | middle of the night that a woman came in in labor, and she had | to drive in to work (a half hour drive). This woke up my dad, | who also happened to be a light sleeper and worked a day shift. | | 20 minutes later (while my mom was well on her way into work) | the phone rang again- it was a false alarm, she didn't need to | come in anymore. Naturally, it was my (not so happy) dad who | answered. | | By the time she got in, they didn't have anything for her, so | sent her back home. | | At the time, there wasn't quite such a crunch in nursing, so | the pay part wasn't accurate yet, but everything else you | listed (substitute COVID for %50+ of patients) was already true | 30 years ago. | odysseus wrote: | I would think some hospitals have rooms dedicated for the on- | call nurse(s) to sleep in. Especially with something as | common and false alarm prone as overnight labor & delivery. | Pretty sure the midwifery I went to had this. | thepasswordis wrote: | >Patients in COVID have become downright mean. | | Maybe, but nurses have also used "because covid" as an excuse | to engage in some pretty awful behavior. Fathers have only very | recently been allowed in the room during ultrasounds, for | instance. NICUs only recently started allowing both parents to | visit at the same time. | majewsky wrote: | Is this because of the whims of individual nurses, or because | of policies put forth by the hospital administration? | [deleted] | tristor wrote: | > This one is big for product designers. | | You're right that there are definitely opportunities for | improvement here. As a Product person that has worked in | EMR/Healthcare IT systems, I can tell you the biggest challenge | is most of the decisions are driven by legally-required | compliance. In many cases, you literally cannot make it better | because the brokenness is /by design/ to comply with the law. | | Nearly across the board, especially in the US, our legal and | regulatory climate has not kept up with technology and often | actively works to the detriment of technical innovation and | improving our systems. | primedteam wrote: | HITRUST certification is the most demoralizing thing I've | done in my life. You need a policy, a procedure and evidence | of things like this: | | _Shared system resources (e.g., registers, main memory, | secondary storage) are released back to the system, protected | from disclosure to other systems /applications/users, and | users cannot intentionally or unintentionally access | information remnants._ | bawolff wrote: | I mean, if it was really a very high security system, | ensuring that confidential info in memory cannot be written | unencrypted to a swap file, does seem like a reasonable | requirement. | seanp2k2 wrote: | Yep, try doing that in an electron context and you quickly | learn why a lot of this software still runs on mainframes | with UX from the 80s, hard T1 lines (if they're lucky | enough to be off ISDNs), faxing things all around since | that's considered "secure", etc etc. A lot of startups | can't touch this stuff due to regulatory hurdles. When the | first step is "go change the law", it's a non-starter. | tristor wrote: | I understand exactly what you mean, but having done HITRUST | CSF certification for a system, I will say that it is not | as bad as some others, because at least HITRUST is /very/ | clear in its requirements, so there's not as much vagaries | and back and forth with auditors after the fact, or rushed | changes. It's truly a nightmare to meet, but once done you | can be assured you will pass the audit fairly. | artful-hacker wrote: | I'm in this business too, and it's not just the direct | features supporting the law, its the law driving out time and | talent trying to make things better. We don't have time to | improve systems because we are all too concerned with meeting | the latest regulatory pipe dream of interoperable systems. | | Systems that nobody has ever asked us to use. Entire APIs | with full access to key data, that nobody uses. | tristor wrote: | Yes, this is probably the bigger impact, to be honest. | Teams have limited resources and more and more of it is | cannibalized by regulatory compliance work. | giantg2 wrote: | We've created so much regulation that no one person can | know it all - not the legislators, not the | agents/bureaucrats, not the judges, and certainly not the | workers or patients who would be most affected by them. | jimmydddd wrote: | Steve jobs mentioned this as a reason he never wanted to do | enterprise sales. The user and the purchaser are two | different people. | m463 wrote: | I wonder how this is handled inside apple? Are apple | internal tools good or terrible? | JaimeThompson wrote: | Doctors and hospitals control some of the more powerful | lobbying groups in the United States making it a bit strange | they haven't worked on those issues. | namelessoracle wrote: | "Doctors and hospitals" are not nurses and do not seem | themselves as akin to nurses. | | It's like asking why most software devs don't go to bat for | technical support people. | dragonwriter wrote: | > Doctors and hospitals control some of the more powerful | lobbying groups in the United States making it a bit | strange they haven't worked on those issues. | | Doctors and hospitals are not necessarily aligned groups | (either with each other or with nurses) on the issues, and | private insurers, state governments (as market participants | themselves, via operating public insurers such as Medicaid | agencies), and other players are also very powerful | lobbies. | asdff wrote: | It seems the byzantine regulatory compliance software lobby | is even more powerful then | lazide wrote: | Why when they get paid/further protected by it? | asdff wrote: | There is a reason why these things are like this. Someone | with influence is making money hand over fist with the | current state of affairs, so it says. Regulation are always | penned by those in industry they are set to regulate with | government connections. Politicians don't do anything unless | there is a push for it by lobbyists or donors because that's | where the incentives are. | tristor wrote: | For healthcare the regulations mostly entrench the big | players in insurance. It's regulatory capture 101. | asdff wrote: | And what sucks about this entire situation is even if you | today fixed healthcare, because you havent fixed | regulatory capture it will end up screwed up in some | other direction as soon as the grifters finish planning | out their graft and ringing personal phone numbers in | washington DC and state capitols. Fixing regulatory | capture is therefore required to solve the big problems | we have, like climate change, housing, and healthcare, | otherwise no fix will ever be long term and meaningful. | The incentive structures with regulatory capture favor | personal profit over public good every time. | Terry_Roll wrote: | >3. IT systems that they have to use were designed by people | who have not talked with the workers who use them. They may | have been designed with laws and compliance in mind. Nurses | aren't the people who choose or pay for these systems. But, | they use them a lot (maybe the most) and it's obvious they | weren't taken into account when designing the UX. It's | maddening for them. | | >This one is big for product designers. Often we listen to the | people who pay for it and miss out on the people who actually | have to use it. | | Thats an interesting comment because I know the main developer | for one of the most popular hospital systems used throughout | Europe and its popular because its good. | | Saying that, I also know there are medical consultants at a | world famous hospital who dont really know how to program but | because of their position have got their software in use when | it perhaps shouldnt be. | | I know alot of US programmers doing various medical systems for | local hospitals and health care regions with various standards | of programming skills. | | Like you I also know of people in various roles, from world | famous multi millionaire consultants to nurses on the front | line. Every team & dept is different. Sometimes its a | managerial problem at the top of the health trust, other times | its just the team and low level management. | | Saying that there is a culture of taking a sicky probably | because they see consultants putting private work before NHS | work and they see the wages some of these consultants get paid | and Google Scholar, PubMed, DrugBank etc keeps highlighting the | inadequacies of the teaching, ie they dont keep up to date, | some areas appear to be decades behind the science other areas | are within a few years of the latest research. | | Too much reliance on drug companies when superior non | patentable solutions already exist. | meatsauce wrote: | How, in your opinion, did the Affordable Care Act affect | nursing? Were you in a position to observe then? | peoplefromibiza wrote: | preface: my parents are retired nurses and a big chunk of my | family works in healthcare. | | It sounds like the issues nurses face are global and do not | significantly change across different systems (the system in my | country is completely different from USA) | | It probably comes down to the fact that this is a human problem | and to solve it we must radically change the expectations | around care and primarily being taken care of. | | There's no technological deus ex machina or amount of training | that can change the situation without shifting the POV. | | IMO people working in HC are subject to a lot of stress and | must be protected at the cost of making it a bit unpleasant for | the patients to be cured. | | It's such a fundamental foundation of our lives that the system | should be calibrated to create the best possible working | environment for those who are working instead of moving it | toward a customer reviewd activity that focuses on their | satisfaction. | | I know it can sound unpopular, but receiving the best medical | care possible is not a right, it's a goal that more often than | not it's almost impossible to achieve, so let's improve the | working conditions so that the workers can give their best | without questioning too much all the sacrifices that the job | requires. | lazide wrote: | Well, first you'd need to get over the idea it's oriented | around customer satisfaction or outcomes, which it doesn't | seem to be here in the US. | peoplefromibiza wrote: | I don't know the US system so well to argue, I can only | expand on what I meant: the job of healthcare is not to | make people comfortable or make their wishes come true, HC, | unfortunately, it's not a democracy. | | What I've seen in the past 30 years is a gradual shift | towards becoming some sort of wellness centers for disease: | patients that complain about other patients, patients that | complain about their accomodations, patients that complain | about therapies, most of all patients relatives that want | to have a say on everything that's going on up to the point | that doctors simply do what asked to not waste too much | time with them. | | And to add insult to injury, all the legalities that made | taking a decision virtually impossible without risking too | much. | | Of course there are situations were malpractice causes more | damages than the illness itself and those must be | reprimanded, we can't afford to disrupt trust in medicine | in any way, but the results should be taken into higher | consideration than the opinions. | | ER, intensive care and other kinds of "hardcore" department | should also be judged differently, just like it happens to | military personnel who are not subject to regular justice | while on duty. | safdahfslh23s wrote: | My partner is a physician in an ICU and a lot of her colleagues | have talked about leaving the field as well. Their complaints | are #2 & #3 along with: | | 5. Pay cuts - Most of the critical doctor specialties (ER, ICU, | primary) that were the backbone of the pandemic got "raises" | that were less than inflation (hers was 1.5%) while profitable | elective specialties got big raises. The root cause is the | billing system where elective surgeries bill pay out more than | critical roles. Still, it's extremely demoralizing to be called | a "pandemic hero" and have your pay get cut. | | 6. Criminal and Financial Liablity - Healthcare is delivered by | a team yet the financial and criminal penalties for mistakes | are assessed at the individual level. Recently a nurse was | given a criminal sentence for a drug mistake which many believe | was systematic failure (bad UI / IT systems, bad hospital | practices, AND negligence on the nurse). Imagine getting sued | or jail time as an engineer for dropping a production database. | The few malpractice cases my partner has been involved in, it | was very clear that the issues were systematic and perpetuated | by hospital practices. However, if they had gone to trial, an | arbitrary worked would d have been sued and the hospital | wouldn't change its crappy practices. Institutions have | effectively dodged liability in many cases. | | 7. Chronic understaffing and burnout - most ICUs have been | understaffed throughout the pandemic. From an economics POV it | seems crazy that their is a labor shortage but salaries are | effectively dropping. | vonnik wrote: | I work at a startup* trying to tackle nurse burnout, and two of | my family members are nurses. Here are a few things I've | learned: - Nurses were getting burned out before the pandemic, | and the US has a nursing shortage that's been going on for | about 90 years (it started with an infrastructure buildout in | the 1930s).* So it's a secular problem, with chronic as well as | acute causal factors. | | - There is a ladder of nursing credentials, and the shortage | effects them differently. Hiring for roles like CNA and LPN/LVN | has exploded because of the shortage of RNs and above. CNAs get | trained in 4-12 weeks to do the heavy lifting of care; RNs get | ~3 year degrees to perform much more complicated tasks. | | - Burnout, and the nursing shortage, are in a positive feedback | loop/downward spiral. That is, the more nurses burn out, the | more they cause other nurses to burn out. Short-staffed | facilities have a very hard time pulling back to normal | staffing, because nobody wants to join a skeleton crew. (I know | of long-term care facilities where the scheduling nurses (the | bosses) are working the graveyard shift because they can't fill | it.) | | - Many nurses work rigid schedules on 12-14 shifts, and a lot | of medical errors happen at the end of those shifts. * | | - The hot US job market (Great resignation, great reshuffle) is | hitting nursing especially hard; it is very sensitive to | external shocks. There are paths to easier work and higher pay. | | - Many healthcare facilities and systems don't give nurses | flexibility or the possibility of advancement. (One family | member will need to quit her current job and come back in a | year or two to her current employer if she wants to move up a | pay grade -- which is like some tech companies -- but slower | moving and lower paying.) | | - Many facilities are run entirely on foreign staff (the H2-B | visa allows that). And many nurses are imported from the | Philippines. | | * https://clipboardhealth.com | | * https://www.nursing.upenn.edu/nhhc/workforce-issues/where- | di... | | * | https://www.nytimes.com/video/opinion/100000008158650/covid-... | | (plug: if you're interested in this problem, we're hiring: | https://culture.clipboardhealth.com) | clumsysmurf wrote: | > Many facilities are run entirely on foreign staff (the H2-B | visa allows that). And many nurses are imported from the | Philippines. | | I'm curious what the consequences of this are, how does this | impact the profession in the US? | pvarangot wrote: | I have training similar to a WFR that I got in Argentina. I | wanted to certify as an EMT in California because why not? It's | 160 hours of classes plus 24 hours or practical or something | like that for the national exam and then it's the state | requirements. Private training is around 2000 dollars. Ok I'm | cool with that. | | There's no way to get a certification with online learning or | with any kind of in person time schedule compatible with my | job... ok... maybe I can get time off? I have to re-get all | sorts of immunizations I already have and re-do medical checks | that I already had to get for my green card, like a year ago... | ok... that's a lot more time off. Oh, they drug check me! | well... I guess even I would work on healthcare more for | vocational reasons I'm not doing it while I'm in California. | It's just too much of a hassle and with the staff shortages I | feel I'm just being taken advantage off. | | In Nevada it's only take the course, pass the exam and you can | already go on an ambulance, so are most other states. | strangattractor wrote: | I always want to quit my job and I'm not a nurse. I think it is | a growing trend. I spend more time typing in Slack than typing | in code:) | ihodes wrote: | I think this is a great summary of some of the main challenges | nurses are facing. | | I'd add to #1 that travel (temp) nurses are making 4x+ more | than staff nurses, I've heard as high as $13-17k per week in | high-demand areas. This exacerbates the problem, as staff | nurses hear this, and if they can, they leave. Travel nurses | can be great, but they won't know the facility and workflows | and people as well as staff nurses: staff nurses now pick up | more slack, all while getting paid 1/10th what their new | colleagues are. This is more than most doctors. | | For #3, this problem is made worse by additional compliance | burden. Nurses need to document more and more, click more and | more, read more and more... with less and less time. And on | systems that are unpleasant to use. Among other issues, this | leads to problems like these[0], which drive more and more | nurses away. | | I'm working with a badass team on solving some parts of these | problems, particularly relating to technology and workflows. If | you're interested (across basically any role, but product | designers, engineers, product managers are top of mind right | now), let me know (email in bio)! | | [0]: https://www.cbsnews.com/news/radonda-vaught-nurse-guilty- | dea... | luckydata wrote: | about #3 that ain't a design issue, it's a policy issue. Until | healthcare in the US is about maximizing profit extraction by | every party involved things will not change. | | For profit healthcare is an abomination and a blight on the | very soul of this country. If I believed in religion I would | say God will judge us very harshly for allowing this system to | stay in place for so long. | elhudy wrote: | Don't forget that nurses can now legally be thrown under the | bus with criminal charges for malpractice while hospitals walk | away scotch-free [1]. This is huge in the nursing community | right now. | | [1]https://www.npr.org/sections/health- | shots/2022/03/24/1088397... | Wistar wrote: | And, alas, found guilty: | | https://www.npr.org/sections/health- | shots/2022/03/25/1088902... | gruez wrote: | Discussed on HN with counter-argument: | https://news.ycombinator.com/item?id=30778376 | aiisjustanif wrote: | Jfc that is terrible. | rectang wrote: | But the electorate continues to reward "tough on crime" | prosecutors. Their incentives are all towards maxing out | the savagery towards defendants, systemic repercussions | be damned. | | From the article: | | > _Janie Harvey Garner, the founder of Show Me Your | Stethoscope, a nursing group on Facebook with more than | 600,000 members, worries the conviction will have a | chilling effect on nurses disclosing their own errors or | near errors, which could have a detrimental effect on the | quality of patient care._ | | > _" Health care just changed forever," she said after | the verdict. "You can no longer trust people to tell the | truth because they will be incriminating themselves."_ | | That's the exact opposite of how the NTSB operates. It | satisfies the infantile urge to blame and shame a | supposed evildoer, to the great detriment of everybody in | the long run. | PaulDavisThe1st wrote: | > That's the exact opposite of how the NTSB operates. | | Bingo! I have a friend in the UK who organizes "post- | mortem" (no pun intended) workshops and process training | for hospital staff, precisely to do the NTSB-like thing | after medical procedure errors occur. Rather than trying | to point fingers and identify scapegoats, the central | question is: "what went wrong here, and how do we reduce | the chances of that happening again?" | | Of course, occasionally the answer might be "We hired the | wrong person, and we should fire them", but that seems to | be only _very_ rarely true. | ethbr0 wrote: | An an organizational ethos, it's hard to argue with a | default of " _We_ fail, _you_ succeed. " | | When failures happen, it's usually the organization | rather than the individual that's key to changing. | evil-olive wrote: | this is fairly common in the medical field, the usual | name for it is "morbidity and mortality" [0] | | > The objectives of a well-run M&M conference are to | identify adverse outcomes associated with medical error, | to modify behavior and judgment based on previous | experiences, and to prevent repetition of errors leading | to complications. Conferences are non-punitive and focus | on the goal of improved patient care. | | 0: https://en.wikipedia.org/wiki/Morbidity_and_mortality_ | confer... | dolni wrote: | > But the electorate continues to reward "tough on crime" | prosecutors. | | Do you believe that people who vote for "tough on crime" | prosecutors are seeking harsh punishment of mistakes? | | Or do they want criminals acting in malice to have the | book thrown at them so other people aren't needless | victims? | rectang wrote: | I don't think "tough on crime" voters strongly | differentiate, based on the behaviors of the prosecutors | themselves. The biggest resume priority seems to be | maintaining a ludicrously high conviction percentage, | which is awful for different reasons (innocent defendants | forced into plea bargains). | | Only a small subset of prosecutors elected in the most | liberal districts are rewarded by their constituencies | for exercising prosecutorial discretion. I say that | without making any judgment as to whether they're using | that discretion well -- I'm just observing that very few | prosecutors work that way. | dolni wrote: | > I don't think "tough on crime" voters strongly | differentiate, based on the behaviors of the prosecutors | themselves. The biggest resume priority seems to be | maintaining a ludicrously high conviction percentage, | which is awful for different reasons (innocent defendants | forced into plea bargains). | | Well, I think your position is probably one of ignorance. | Plenty of people I talk to are for tough prosecution on | things like violent crime and against tough prosecution | for simple drug possession. | | > Only a small subset of prosecutors elected in the most | liberal districts are rewarded by their constituencies | for exercising prosecutorial discretion. I say that | without making any judgment as to whether they're using | that discretion well -- I'm just observing that very few | prosecutors work that way. | | Yes, that does seem to be a trend. Prosecutorial | discretion is actually important, but it doesn't mean you | let crime run rampant, either. | gruez wrote: | > The biggest resume priority seems to be maintaining a | ludicrously high conviction percentage, which is awful | for different reasons (innocent defendants forced into | plea bargains). | | I don't live in a jurisdiction that elect prosecutors, | but is this actually a thing? Do candidates/incumbents | run campaign ads on their conviction rate? Are voters | researching/talking about the conviction rate of the | candidates like it's a pissing contest? | rectang wrote: | Yes. It was true for our current US Vice President, | Kamala Harris for example -- but she's not an outlier, | this happens all the time. | | https://theintercept.com/2019/02/07/kamala-harris-san- | franci... | | > _If the conviction rate had been measured by actual | cases pursued, rather than all cases referred by police, | Hallinan said, his office would have had a conviction | rate that was relatively similar to Los Angeles and other | major cities._ | | > _And Hallinan was getting results. Overall, crime rates | were plummeting. Violent crime had gone down close to 60 | percent in San Francisco since Hallinan took office._ | | > _Still, the low conviction rate resulted in headline | after headline about San Francisco's permissive attitude | toward crime, a media environment harnessed by the Harris | campaign._ | [deleted] | anonporridge wrote: | Worse, the family of the victim had apparently forgiven | the nurse for her mistake and didn't want criminal | prosecution. | | This was driven purely by the state prosecutor. | HarryHirsch wrote: | Consider this: someone drives without paying proper | attention and kills someone. It's time for victim impact | statements, and relative after relative asks the court | for lenience on the driver because the victim was a drunk | and a wifebeater, the world is better off without him. | | Not sure that that is a good idea, justice is about more | than just those immediately affected by a crime | wonderwonder wrote: | Do we really want to live in a society where people are | not prosecuted because the family of the victim forgave | them? So if two people commit the same offence, Person A | is not prosecuted because the victim's family forgave him | but Person B is because the victims family did not? Was | offender B just unlucky on victim selection? The rule and | application of law should not be based on the feelings of | the victims family. Did the dead person forgive them? | ethbr0 wrote: | We certainly don't want to ignore them, given they have | the most immediate understanding of the situation and | entitlement to guilt. | | We don't allow plaintiffs to sue without standing. Why do | we allow DAs to prosecute without a victim? | | The state has a justification to pursue crime, but it | seems like that should be limited when there's (no | victim) or (victim who disagrees with prosecution). | wonderwonder wrote: | Is the dead person not a victim? If someone is murdered | and their family is like good I hated them anyway does | that nullify the existence of a crime? Are we basing | prosecution now on the character of the victim? That's a | pretty quick path to deciding that certain victims have | no value in society. | graywh wrote: | it was the county DA and he's up for reelection this year | wonderwonder wrote: | Is it though? Should a cop be prosecuted for accidentally | killing an innocent civilian in the course of duty during | a non violent traffic stop? I would argue that they | should be. How many chances should a nurse get to | accidentally kill someone? Do they only get prosecuted | the second time? Third? | | If you are responsible for the death of another person | due to your own negligence then you should be prosecuted | for a crime and be removed from any scenario where you | are able to repeat that mistake. | Jiro wrote: | A cop killing an innocent civilian at a nonviolent | traffic stop can pretty much happen only because of | malice or negligence. We use the word "accident", but | it's never really an accident. If a nurse accidentally | kills someone, it may really be an accident. | | Furthermore, the nurse is in a profession where people | die all the time due to reasons beyond the nurse's | control, and surviving relatives are not always rational | in who they blame. So nurses will be falsely accused much | more often than police. | ethbr0 wrote: | > _A cop killing an innocent civilian at a nonviolent | traffic stop can pretty much happen only because of | malice or negligence._ | | I'm not sure this is true, specifically because the | difference between a nonviolent traffic stop and a lethal | (to the officer) traffic stop can be a split second. | | If my keyboard had a 0.01% chance of lethally shocking | me... I'm pretty sure that would alter my typing | behavior. | wonderwonder wrote: | "can pretty much happen only because of malice or | negligence" | | Negligence means "failure to take proper care in doing | something", which is often just called an accident. | | That is exactly what the nurse did, she failed to take | proper care and someone died. The nice thing about the | law is that what the relatives feel should not matter at | all, that's why we are supposed to have impartial | prosecutors that review the facts and determine if | charges are warranted. | | Bottom line, no matter the profession if you fail to take | proper care and someone dies as a result, you should be | prosecuted and prevented from getting the opportunity to | do it again. | Jiro wrote: | >Negligence means "failure to take proper care in doing | something", which is often just called an accident. | | This is not true, because you're equivocating on the word | "proper". An accident is failure to take proper care, | where proper care means "care that follows the rules". | Negligence is failure to take proper care, where "proper" | means "can reasonably be expected". They are not the same | thing. | wonderwonder wrote: | Not really sure where you are getting those definitions | from. Proper means proper. The nurse did not follow the | rules. The nurse did not provide any of the care that | could have been reasonably expected. Fail to see a | difference, she failed both of your definitions. | Jiro wrote: | It is possible for there to be rules that someone cannot | be reasonably expected to follow. | HarryHirsch wrote: | The solution isn't that Radonda Vought, who killed a | patient through a string of crassly negligent actions | should walk free - one would like to see the whole chain of | command be given serious prison time. It's clear that | patient safety at Vanderbilt isn't a priority - training | and safety culture reflects that. | | Strange to see that HN, which is generally suspicious of | copaganda, falls for very transparent nursepaganda. | Sakos wrote: | Imagine if aviation functioned like health care in the | US. We'd have a magnitude more crashes and deaths. | hawaiianbrah wrote: | Just one magnitude... ? | ethbr0 wrote: | > _one would like to see the whole chain of command be | given serious prison time_ | | Absolutely. To each according to their authority. | | RaDonda Vaught made a mistake, and admitted it, | repeatedly, in multiple interviews. | | But that mistake was only partly because of her free | will. Vanderbilt University Medical Center incentivized | her to make that choice, for their own profit, and with | control over her employment. | | RaDonda Vaught goes to prison. | | VUMC pays a fine and nobody goes to prison. | | I think HN takes a dim view of a company holding | someone's contract in their hands, saying "Do something | illegal or I tear this up," and then blaming the employee | when everything explodes. | | They're playing chicken with patients' lives, and passing | off the charges to their employees when they lose. | ikiris wrote: | Its the strong libertarian vibe. They think consequences | shouldn't exist, and the dead guy can take his money | elsewhere. | LanceH wrote: | The strong libertarian vibe of npr saying she's being | scapegoated? | | When you have millions of drugs being issued, there will | be some legitimate mistakes happening -- some will even | cause death. If you want people to actual work in | healthcare, they shouldn't be fearing for their lives for | being less than perfect. | ikiris wrote: | please cite where an npr report gives the impression | she's been scapegoated in such a way that she doesn't | deserve the consequences she's been given. I'd love to | read it honestly. | | From what I've seen there's been a lot of reporting on | her case, and how Vandy rightfully deserves a lot of | pain, and a lot on how a subset of nurses feel she's been | railroaded, but I've not seen what you claim and would | like to know where I missed it. | | I'll also re note that pharmacists have carried this | burden for over a hundred years, and their removal from | the process is part of how this chain of mistakes | happened to begin with. | dragonwriter wrote: | > Don't forget that nurses can now legally be thrown under | the bus with criminal charges for malpractice while hospitals | walk away scotch-free | | The nurse in that case was prosecuted for criminal reckless | homicide (not malpractice, which is civil negligence.) The | characterization of the hospitals direct responsibility is | negligence not arising to criminal (gross) negligence (as the | principal of _respondeat superior_ doesn 't apply in criminal | law, the employees recklessness would not be imputed to the | employer the way it would in a civil case.) | | As for civil liability if the hospital, that was settled out | of court with the victims family, the hospital did not get | off scot free. | | This... isn't a new thing that deserves the "now" label like | it is a change. Criminal wrongdoing by employees (including | in healthcare) very often does not rise to a level of | criminality for the employer, and that's been true for a long | time. | anonporridge wrote: | This kind of thing is going to further disassociate nurses | from interacting like a human with their patients. If you | risk criminal prosecution and prison time from making a | mistake, everyone starts walking on eggshells and become | afraid of doing anything beyond box ticking. They'll start | turning a blind eye to things they know are wrong, because | the system doesn't see them. All work will align towards pure | compliance with the law and the hospital system at the | expense of intimate connection with patients. | | And of course, a lot of nurses are in the job for the human | connection, and will consequently be burned out at an | increasing rate. | | To some degree this might actually be good long term, because | it will be that much harder for hospitals to manipulate | nurses into working around the limitations of the system to | provide real care, which allows the administration to turn a | blind eye to their own flaws. There's going to be a surge of | malicious compliance that ends up shining a bright spotlight | on just how abusive and dysfunctional hospital systems really | are. | | And patients will ultimately be the ones who suffer. | [deleted] | [deleted] | Soulsbane wrote: | Food service workers don't want to take food into a patients | room? | | My mom worked in food service for several years at a hospital | and took the food into the rooms. Is this not the norm? | mikewarot wrote: | >3. IT systems that they have to use were designed by people | who have not talked with the workers who use them. | | Every time the computers went down at a friends ER, the waiting | room emptied out as the staff were able to use paper forms and | just get their jobs done, instead of being forced through | thousands of menu clicks and choices that made no sense. | | EVERY SINGLE TIME -- Epic or as I call it... the Epic Failure. | I always give my condolences to staff forced to use it. | sli wrote: | > IT systems that they have to use were designed by people who | have not talked with the workers who use them. | | This was exactly my experience when I worked for a medical | software startup. Our (very unfinished) software got deployed | in a hospital with no training, no orientation, no nothing, and | it was such a disaster that it was a patient safety issue. Mind | you, the engineering team had no say in any of this, not that | we were even given the chance, and we weren't even aware that | the deployment was for real. We were under the impression that | the deployment was for testing purposes, because we were aware | that the software was unfinished. | | It was a breathtakingly poor decision purely on the part of | managers (and, frankly, sales) on both sides of that deal and | it was doctors and patients who suffered because of it. An | absolute nightmare all around and I'm glad to no longer be | there. | mikemac wrote: | Agree with all of this, and just to add one thing: liability. | | Look at the RaDonda Vaught case or the Michelle Heughins case; | terrifying to be looking at jail time for a med error. | | Many nurses are watching these cases more closely and deciding | that since staffing isn't getting any better and they won't be | protected, it's not worth the risk. | sfteus wrote: | Married to an RN and absolutely sympathetic to the | staffing/pay plight they're currently facing. I'm | unfortunately not very familiar with the case of Michelle | Heughins, but I've heard a lot of the RaDonda Vaught case. | The high points of the case as I understand them: | | * Vaught stated her department was not understaffed, nor was | she tired. The incident also occurred in 2017, so pre- | pandemic | | * Vaught went to dispense Versed (generic name midazolam) by | the brand name, instead of the generic name as they're | trained to do. This led to her selecting vercuronium bromide | instead | | * Vaught stated she had dispensed midazolam several times | before, which would have had to have been by the generic name | | * Vaught ignored several warnings from the dispensing machine | stating the patient was not prescribed vercuronium bromide | | * Vaught ignored the red cap on the vial dispensed that | stated it was a paralytic agent | | * Vaught ignored that vercuronium bromide needed to be | reconstituted with sterile water (unlike midazolam, which | comes as a liquid). She stated she thought it was odd that | she didn't have to reconstitute it before when dispensing the | correct medicine | | * Vaught did not scan in the medication before or after | giving it to the patient, which would have likely prompted | another warning about it not being prescribed | | * Vaught could not recall exactly how much she gave to the | patient | | * Vaught immediately left the room after injection, and did | not wait to observe the patient for any side-effects | | All of this information is available in the DA discovery | documents | (https://www.documentcloud.org/documents/6785652-RaDonda- | Vaug...) and the CMS report | (https://www.documentcloud.org/documents/5346023-CMS- | Report.h...). | | The opinions on the case I've observed have been nurses who | aren't aware of this and saying she should not have been | convicted, and the nurses who are aware who think the | conviction is fair ...ish. The latter is at least unanimous | she should have her license revoked. | | Most agree that Vanderbilt should be held responsible for | negligence as well. My wife's hospital for instance does not | stock _any_ paralytics within machines, to prevent it being | accidentally dispensed without involving the pharmacy. | There's also evidence that Vanderbilt tried to cover the | incident up. | | I've made a point of stressing to any RN I've talked about it | with the importance of having a lawyer with you when talking | with investigators. Vaught straight up incriminated herself | multiple times during her initial interview. | hermitdev wrote: | I'm not familiar with the case, but assuming what you've | outlined above is accurate, I have no doubt a jury would | convict. Negligence actually sounds like too nice of a word | for that train wreck of events. | michael1999 wrote: | There's a big difference from revoking her license, and | locking her in a cage for 3 years. | ikiris wrote: | Yeah usually that difference is causing someone to die by | being criminally negligent. Which she was. | giantg2 wrote: | I believe you can even be personally liable for HIPPA | security violations as a user or dev of a healthcare system. | That seems a bit scary. I agree that regulation persuades | people not to do things out of fear of breaking the law. We | see this in it's intentional form with regulation of other | things such as abortion, guns, etc. Put so many laws in place | that risk of accidentally breaking one and receiving an | extensive punishment isn't worth it. | Sohcahtoa82 wrote: | > HIPPA | | *HIPAA | throwawayboise wrote: | > I believe you can even be personally liable for HIPPA | security violations as a user or dev of a healthcare | system. | | Welcome to being an engineer, if that's what you want to | call yourself. The engineer who approves a bridge design | can be held liable if it collapses due to a design fault. | labcomputer wrote: | One difference is that HIPAA has a bunch of statutory | penalties for "technical violations" that might or might | not harm anyone. For example, if a call center staff | discloses patient information to, say, the child or | parent of a patient, that comes with an automatic fine | and (potentially) jail time. | | Another aspect is that certain HIPAA allowances for data | usage require a lawyer's expertise, not an engineer's. | For example, can a health insurer use patient data to | train a model w/o first obtaining patient consent? If the | model will be used for "healthcare operations" (i.e., | adjudicating claims), you might argue that the answer is | yes. If the same model will be used for suggesting | treatment options to doctors, you might argue that the | answer is no. If you answer wrongly, you are hit with a | statutory fine. | | It's like having a fine for painting the bridge the wrong | color because there is a law that bridges must be green, | but you used lime. Not because you're worried about the | bridge collapsing, but because the law says so. | | Generally, civil engineers don't need to worry about | fines or jail as long as things stay up. | initplus wrote: | Lot's of better paid gigs with better working conditions | where you aren't personally legally liable if you write a | bug. I don't especially care about what job title some | board thinks I'm allowed to use. | giantg2 wrote: | Generally the firm's insurance will cover an engineer | since they are a "professional". Software "engineers" | generally have not been individually liable for bugs. | Usually the software user agreements don't allow for this | sort of thing. | | Basically, contracts can control the liability in most | cases, but HIPPA prevents that by explicitly defining | liability under the statute. | | Here's some info on the engineer portion. | | https://www.nspe.org/resources/professional- | liability/liabil... | Shuang1 wrote: | That case goes far beyond med error and I don't understand | why people keep bringing it up as an example. | | She pulled the wrong med, and then injected it and walked out | of the room rather than observing for effects. Also the med | she pulled had warnings on all sides of the bottle and on the | top saying very clearly that it's fatal to administer without | ventilation. This went beyond a mistake to negligence. | rvba wrote: | > She pulled the wrong med, and then injected it and walked | out of the room rather than observing for effects | | With staff shortages nurses dont have the time for that. | | Hire 2x more nurses - so there is 2x more time for each | patient. | cyberlurker wrote: | Right, when I first read the summary it didn't adequately | cover how careless the nurse was. It wasn't just a small | mistake. | | Edit: I should say that doesn't mean I think it makes any | sense the hospital isn't liable and jail time for the nurse | seems odd | sithlord wrote: | Literally every medication has warnings slapped all over | it. My partner worked at Vanderbilt (on a different floor) | around this time, and one constant complaint I heard (prior | to the incident) was how there was hardly any controls | around anything there. | ikiris wrote: | Yeah, there's no doubt that this is a shitshow from how | Vandy is described (and nursing in general especially | with these automated pharm boxes), but that should be | additional consequences, not this nurse avoiding hers. | js2 wrote: | Janie Harvey Garner, a St. Louis registered nurse: | | "In response to a story like this one, there are two kinds | of nurses," Garner said. "You have the nurses who assume | they would never make a mistake like that, and usually it's | because they don't realize they could. And the second kind | are the ones who know this could happen, any day, no matter | how careful they are. This could be me. I could be | RaDonda." | | https://khn.org/news/article/radonda-vaught-nurse-error- | medi... | | HN readers can look at this case filing: | | https://www.documentcloud.org/documents/6785652-RaDonda- | Vaug... | | > Also the med she pulled had warnings on all sides of the | bottle and on the top saying very clearly that it's fatal | to administer without ventilation. | | The linked PDF includes images of medicine in question. | There's a single warning on top that reads "WARNING: | PARALYZING AGENT" and a red cap. I don't see any warnings | on the side. The vial appears to be tiny, smaller than my | thumb. | | But yes, she made a series of mistakes, listed on the last | two pages of the PDF. | | I am not a nurse, but I can easily imagine how someone | could make the errors she did in an overworked and high- | stress environment. It's a cascading series of errors that | starts with overriding the medicine cabinet when she can't | find the medicine she's looking for. But according to her | defense, overriding the cabinet had become almost standard | operating procedure at Vanderbilt at that timeframe. Once | she starts down this path, she's operating on automatic and | almost blind to what she's doing. | | I agree she was negligent. I don't think she should go to | prison for it. In the bigger picture, this is causing more | nurses to quit, likely leading to more medical errors and | deaths, not fewer. | ikiris wrote: | If nurses quit over criminal liability for killing | someone by being that careless, everyone is better off by | them not being in the field. Pharmacy has had the same | rules for over a hundred years. A great example is even | in the movie a wonderful life. | | edit: minor grammar fix | kenjackson wrote: | If you don't go to jail for this, do you do so for any | sort of negligence? What about an Uber driver that runs a | red light and kills a pedistrian walking? Or is drunk and | kills someone? That worries me a lot more than this | story. | gruez wrote: | >I agree she was negligent. I don't think she should go | to prison for it. | | but we literally have a law for "negligent homicide"? | js2 wrote: | Yes we do, but we also give DAs discretion over when to | enforce it. Given the extenuating circumstances, I don't | think it should have been enforced here. | | Her employer, by not creating a culture of safety, set | her up for failure. | | I just don't see how in the long term this prosecution | reduces medical errors and generally disagree with | criminalizing mistakes; even ones such as this. | ikiris wrote: | Enforcing criminal liability for homicidal negligence is | how you force respect of even basic safety requirements | that already existed. | | I'm not arguing that hospitals aren't currently a | shitshow, I'm aware I've worked in them. That doesn't | excuse this nurse's complete lack of respect for the | risks she took. | Sakos wrote: | As I've said before, if aviation insisted on criminal | punishment for pilots, we'd be _far_ worse off. Many | accidents are caused by fear of punishment. Culture of | safety can only be implemented and enforced top-down. Why | punish the nurses when they 're not the ones responsible | for what kind of culture exists at their institution? | js2 wrote: | "The beatings will continue until moral improves." | | We cannot prosecute our way out of medical errors, and | what you claim is at odds with the opinions of medical | professionals. | | https://www.nytimes.com/2022/04/15/opinion/radonda- | vaught-me... | | https://pubmed.ncbi.nlm.nih.gov/25077248/ | chrischen wrote: | That enforcement causes nurses to not want to work, as | the nurses aren't the decision makers in making a culture | of safety. The administrators bear that responsibility so | maybe we should enforce it on them. | [deleted] | ikiris wrote: | This nurse was the decision maker in whether she bothered | to check the label on the vial for what she was injecting | to the patient, and / or bothering to scan it _as | required_ before leaving them to die in terror. | | I'm not sure what world you live in, but I'd like to live | in the one where criminal negligence resulting in | avoidable death is prosecuted. | xyzzyz wrote: | > 2. Patients in COVID have become downright mean. Add this to | the problems nurses have management and doctors (who are often | rude and arrogant) and it's a poor culture. The quality of the | environment, from a mental health standpoint, is on the | decline. | | Mean customers, and rude coworkers? I sympathize, but this is a | reality in a lot of industries. I have no reason to believe | that healthcare here is worse than average. | woodruffw wrote: | Most industries are neither tasked with restoring health nor | with being the bearer of hard truths about a person's health. | I think it stands to reason that healthcare can be a | particularly toxic environment for those reasons. | mfer wrote: | Half of the toxic problem is from the people being treated. | The other half (and sometimes more than half) is from | management and co-workers (i.e. doctors). Not all doctors | are bad but enough of them are to make an impact. | | There's a culture problem there. | woodruffw wrote: | Absolutely. In case it wasn't clear: I was saying that | just _dealing_ with peoples ' health makes for a | fundamentally stressful and potentially toxic | environment, even if each individual in question is | perfectly kind and reasonable. | | Mistreatment by doctors and management isn't excused by | that, but I think it can be seen (partially) through that | lens. | titzer wrote: | fundad wrote: | Health care seems to be part of the institutions that are | of no use to certain cults. It's part of the effort to | dismantle the administrative state and reserve health care | for the 1%. | LordDragonfang wrote: | All customer-facing positions have to deal with rude | customers. Very few of those positions specifically _select | for_ customers with a high correlation to selfish and /or | antisocial conspiratorial behavior. Almost all COVID | hospitalizations are unvaccinated, and there's a very large | (if not majority) portion among that population that chose | not to vaccinate for entirely selfish reasons, and another | large portion who have been actively consuming media telling | them the members of the medical profession are the enemy. | You'd be hard pressed to select for a more adversarial | customer base. | nostrebored wrote: | This isn't particularly reasonable analysis. A large chunk | of the unvaccinated population is elderly and | contraindicated for vaccination or in hospice care. From | talking with nurses, the elderly population has its own set | of problems and frustrations. Imagine trying to administer | care to someone who has no idea why they're in a hospital | setting. Similarly, vaccination status in American COVID- | hospitalization research classifies people of unknown | vaccination status as unvaccinated. These people are often | homeless, isolated and elderly, or mentally unwell and | unable to provide reliable information to caregivers. | Again, likely unpleasant to work with. | | Grouping these people as conspiratorial is unfair and seems | politically motivated. While you definitely have some | overlap with conspiratorial people, people have a right to | be skeptical of medical care, which is often incorrect and | potentially life threatening. Being able to explain things | concisely and with evidence is a core skill for a nurse, | much like being able to explain to someone why their | technical decisions are setting them up for failure is a | core skill for a software architect. | | But from talking to nurses, this isn't the drive for | negative workplace satisfaction. Patients who are | hospitalized are less likely to be mentally stable: many | pathways to hospitalization come from extremely poor | decision making, and many of these people are repeatedly | hospitalized. Combine this with the fact that it's a very | physical job, primarily handled by women, and you have a | multi-faceted problem that's not as easy to solve as just | giving people right-think. | | Personally I think the pathway to fixing this is | appropriately valuing nursing care, what is often a highly- | skilled profession with large physical, legal, and | downstream risk, and compensating people appropriately. | While nursing is a disproportionately paid job relative to | educational requirements, current compensation really | doesn't accurately account for just how demanding a job it | is. | | The amount of nurses you see who become addicted to | painkillers, benzos, etc., is truly sad. Much like | teaching, it's an area where I feel that society is | inaccurately evaluating what the overall impact could be if | the role functioned well. | throttledagain2 wrote: | mfer wrote: | I've spoken with nurses who've had a variety of other jobs at | other types of places. They are consistent in telling me that | working as a nurse is a worse environment in the way they are | treated. | | The example stories they have shared are the type of thing I | can't relate to and I've worked in software, general | engineering, food service, construction, and tech support (I | answered calls for 3 years). | omegaham wrote: | This is also my experience being married to a nurse. Any | story I have about a boss, coworker, or client being a | jerk, she has about five stories about someone being bad | enough that I'd already be shooting resumes toward anyone | who will take me. | | She's been punched in the face by a patient, she's had | coworkers who sabotage each other due to personal | vendettas, she's had bosses go on racist tirades in | meetings, and on and on and on. As I remind my wife | whenever she has a particularly awful day, there's a reason | why the classic NP-hard CS problem is literally named the | Nurse Scheduling Problem[1]. And yes, she's considering a | career change. | | [1] https://en.wikipedia.org/wiki/Nurse_scheduling_problem | bagels wrote: | Yes, my wife has also been punched working in the | hospital. She now does nursing by phone where people are | still really awful to her, but at least they can't | assault her. | literallyWTF wrote: | Yeah I don't know about that bud. Try telling the spouse of a | dying person that their half baked ideas they read on | Facebook aren't valid and tell me their meltdowns are | comparable to working retail. | | All jobs suck donkey dick, but jobs directly dealing with | sick and dying people are on a different level. | germinalphrase wrote: | People who are sick, in pain, or possibly dying might be | slightly less emotionally regulated than your typical | customer. | brimble wrote: | It doesn't help that hospital systems tend to be garbage at | customer service, so the person's been told to wait an | indefinite (but always very long) period without any | indication of how long it'll be, and asked to tediously | fill out the same information five different times on five | different pieces of paper and iPads, all while feeling | terrible, before they finally snap at a poor nurse who | isn't to blame for their hospital being an uncaring money- | making machine with little regard for humanity. | alostpuppy wrote: | You didn't even mention the anxiety patients are enduring | over the billing the entire time. | MomoXenosaga wrote: | And now they will be billed even more because nobody | wants to do the job anymore! | | Healthcare workers are not slaves they can quit after | all. | robertlagrant wrote: | We make really usable software for nurses, and they absolutely | love it. I think the effort we go to is totally unnecessary to | achieve that, as - just as you say - most medical software is | so bad from a user perspective. | | Anyway, it's nice to make software like that :-) | tmp_anon_22 wrote: | > This one is big for product designers. | | I think this is looking at the problem wrong. The problem is | that implementing positive change in these systems is | impossible for reasons far outside the control of any product | designer or developer currently on the team. | | This software is old, has byzantine requirements, probably cut | costs all over the place, and conceived in a board room without | the benefit of an adequate development lifecycle or | stakeholders advocating for the users. | | It probably takes 3 months to move a button around, and instead | of moving that button executives are having them push a feature | that earns a few more million, or a feature that the customers | want more then a UX improvement. | citizenpaul wrote: | >executives are having them push a feature that earns a few | more million | | I've worked here before... Half our customers are complaining | about feature X that doesn't work right/ is inconvenient. | Exec: we don't care they are already paying us on a 3 year | contract. Hack this new feature into the program that a | potential new customer wants. | | Horrible places to work they are. Thats why I avoid using any | long term contracts like the plague. The second I see call | for pricing I close the window. | mfer wrote: | > I think this is looking at the problem wrong. The problem | is that implementing positive change in these systems is | impossible for reasons far outside the control of any product | designer or developer currently on the team. | | A developer working on something is different from a product | designer. For product designer I don't mean a UI/UX | developer. I mean someone empowered to design the thing. This | is often a leader or product manager. | | Product design isn't something taught well in most schools. | It's often out of sight and mind. An engineer who was good at | building hardware or writing code didn't learn the skills | needed for product design through that. Product design | requires looking at the whole system differently. | | > It probably takes 3 months to move a button around, and | instead of moving that button executives are having them push | a feature that earns a few more million, or a feature that | the customers want more then a UX improvement. | | A better UX would reduce the amount of time nurses spend | using these systems. That productivity could be used to do | more other work (like taking on more patients). I don't like | this argument but it's easy to make in terms of cost | effectiveness. | | I don't think the cost effective conversations are happening. | I expect there isn't that level of depth to these. It's hard | to do when a purchasing organization (like a hospital) only | have a few options and they are all bad. | | This is an opportunity. To build software that is both | compliant and has a good UX. There's an opportunity to | disrupt all the crap software here. | tmp_anon_22 wrote: | I think what you're describing as the Product Designer who | can get shit done would need to be at the VP or C level to | actually accomplish this within an enterprise organization. | | > I don't think the cost effective conversations are | happening. | | I think it would take years to overhaul these products and | the conversations on that and how the price would roll down | hill to the healthcare organizations have happened, and | been summarily shut down. | | I also think startups have tried to sell software via this | value prop but have not managed anything close to feature | parity or sales-org-maturity as the dominant enterprise | players. | | > This is an opportunity. | | I think various startups and other organizations are | _trying_ but there is a reason enterprise-style | organizations exist and dominant their various verticals. | | Its not only about a good product, its about navigating | painfully expensive sales cycles of multi-year or even | near-decade, political wheeling and dealing at the | municipal, state, and federal levels, dealing with | compliance and legal liabilities etc. | | > This is an opportunity. | | Is it though? Hospitals still run. Yeah its expensive as | hell, nurses are quitting, but I don't see the horsemen of | the apocalypse quite yet. Healthcare outcomes are ok-ish. | Young people are still entering the medical field as a | viable profession. | ajmurmann wrote: | I think this might be more of a symptom of administration | being detached from the work on the ground. Even if one app | had UX that was significantly better (within the realm | what's possible within regulation. Others here make the | point that the laws and regulations make the UX | unregenerate bad), the sale might highly likely go to the | solution that has more checkboxes filled in the feature | table. | histriosum wrote: | > This is an opportunity. To build software that is both | compliant and has a good UX. There's an opportunity to | disrupt all the crap software here. | | The thing that everyone is overlooking here is that EMR | software is not designed with patient outcomes as the top | priority. Every single EMR software I've seen in the field | has been designed with BILLING as the top priority -- | everything is organized around making sure that you can | bill for the maximum number of services. | | I don't think this can possibly change without regulation. | The incentives are all wrong at every other layer. | rectang wrote: | It is true that billing is a priority and there are | profit incentives at work. _That 's exactly why it's | worth it for hospitals to improve the data entry user | experience!_ | | Better documentation means more revenue. If your doctors | and nurses are not filling in the forms because the | interface isn't user friendly, you're losing money. | histriosum wrote: | > Better documentation means more revenue. | | This is not actually the way the system works, as | currently designed, and so correspondingly this is not | how EMR systems are designed. The documentation that | matters is capturing the procedure codes and inventory | codes for billing -- and EMR systems and the associated | hospital workflows and security mechanisms are designed | around making sure that those billing codes must be | entered in order to do anything else. | rectang wrote: | I asked one of my Smarter Dx colleagues who's an expert | on this subject to clarify, and he had this to say: | | > _There are 2 types of billing, even for hospitalized | patients. FFS and DRG based payments. Fee For Service | does depend on capturing those billing codes correctly. | But DRG based payments depend solely on documentation and | the billing codes are irrelevant. FFS is 2 /3s of US | health care spend currently ($2.6T) while DRG is $1.3T._ | wtetzner wrote: | > A better UX would reduce the amount of time nurses spend | using these systems. That productivity could be used to do | more other work (like taking on more patients). I don't | like this argument but it's easy to make in terms of cost | effectiveness. | | I don't think the companies developing the software care, | because they're getting paid either way. | redwall_hp wrote: | > Patients in COVID have become downright mean. Add this to the | problems nurses have management and doctors (who are often rude | and arrogant) and it's a poor culture. | | So...this is also the biggest reason (besides lack of pay or | basic human dignity) that restaurants and retailers are having | a lot more trouble finding employees. Rude (and sometimes | violent) customers were already an issue, but they've become | absolute animals lately. It's increasingly bad for your own | health, mentally and physically, to have any public-facing job. | In the last few years, we've let go any pretense of expecting | people to be civil and reasonable, and adult children are | rewarded for their behavior instead of being trespassed. | | Teachers are also quitting in droves (and in the middle of the | school year, in some cases) for the same reason. Children are | awful and the parents are worse. You risk sickness and | violence, and are constantly harassed by parents. Then there's | the whole attack on the curricula and book banning... | | The FAA reported 1099 incidents with unruly passengers last | year, up from a normal 100-300 in prior years. Because some | sorts of people simply won't do what they're told...and | disobeying flight crew instructions is generally a federal | crime. | | Everyone's increasingly overworked and underpaid, and they have | to deal with degenerates like that daily. Of course they want | out. | | We're having a societal implosion. | kenjackson wrote: | Everyone thinks that their belligerence makes them Sam Adams | or Gandhi rather than just the jerk they likely are. I see | this every weekend at youth sporting events. I'm just like, | "it doesn't matter why -- if the ump says you need to leave, | just leave -- this isn't Game 7 of the World Series". | balozi wrote: | _> 4. Nurses are the catch all for jobs. Not enough aides? | Nurses do the work.... _ | | The nurses aides would argue that they do the majority of the | frontline work while getting paid a fraction of what the nurses | make, and get even less credit. | mfer wrote: | Most of the nurses I talk with speak about a lack of nurse | aides. When there isn't a nurse aide the nurses have to do | that work. When I speak of a lack of them I know nurses who | can go multiple consecutive shifts without an aide working | the floor. When they do work there is 1 aide to a floor and | can't cover everyone so the nurses do that work. | MomoXenosaga wrote: | Dont forget the sexual harassment. Twenty two year old nurse | and boomer men don't mix. | maestroia wrote: | Someone I dated last year has worked on the administrative | side of hospitals for years. Her statement was "everyone is | hooking up in them, and it's typically ignored. Unless they | use a patient bed, then all hell breaks loose." | ikiris wrote: | No one cares about ux in hospital purchasing _at all_ unless | it's an admin app. | e40 wrote: | On (3), Kaiser seems to be the exception to this. Their | systems, on the nurse/Dr side seem very easy to use and the | connections between different departments work seamlessly. At | least, from what I've noticed as a 10+ yr Kaiser patient in the | Bay Area. | rectang wrote: | > _3. IT systems that they have to use were designed by people | who have not talked with the workers who use them. They may | have been designed with laws and compliance in mind. Nurses | aren 't the people who choose or pay for these systems. But, | they use them a lot (maybe the most) and it's obvious they | weren't taken into account when designing the UX. It's | maddening for them._ | | > _This one is big for product designers. Often we listen to | the people who pay for it and miss out on the people who | actually have to use it._ | | This resonates with me strongly for two reasons. First my | mother is a retired RN, and the electronic record keeping was | her biggest frustration. It is hilarious to me how much my | mother hates computers, while I make a living in software. | | Second, I'm now working for a startup, Smarter Dx (we're | hiring: https://angel.co/company/smarterdx/jobs ) that works | with these records and tries to make better use of them. To the | extent that we're successful, incentives are created for the | hospital to improve them, conceivably including improving the | UX that nurses see. I don't mean to underestimate the | difficulty of the problem, but I think it's possible to at | least push in the right direction. | woodruffw wrote: | This is a good summary, and it corresponds to what I've heard | from friends and acquaintances that are currently nurses (or | left recently). | | (2) is a really perverse statistical phenomenon, and it's | unfortunate that nurses are bearing the brunt of our civic and | public information failures. It must be particularly soul- | draining to heal someone who resents the single thing that | would have protected them the most from needing hospitalization | in the first place. | cogman10 wrote: | The one I think you are missing is that nurses are and have | been overworked for a WHILE now. (that's what I get from | /r/nursing) | | Hospitals have made sure they hire JUST ENOUGH nurses to cover | shifts and no more. With covid hitting, this blew out the | number of nurses needed resulting in a lot of "I know you've | already worked 60 hours, but can you do another 20? we are | short!". | | Rather than hiring permanent people or upping salary, Hospitals | have instead elected to just use travel nurses and an extreme | premium so as to avoid any salary increases. | | The fix is one that Hospital admins don't want. Pay your nurses | more and hire more than the minimum to cover shifts so a nurse | being out sick doesn't result in another working a 80 hour | week. | | So, instead it's been day old pizza with superhero stickers. | jonlucc wrote: | I would add that travel nurses are treated better in a lot of | ways. Staff nurses must attend certain meetings and training | aimed at standardizing care and improving outcomes. The | travelers don't have to attend. Travelers can take off pretty | much any time they want as long as they know before they sign | the contract. Sure, they're considered "outsiders" by some | staff and sometimes get the less enticing patient | assignments, but for those drawbacks, they get paid 4x (I've | seen 3-8x staff rates, but 4x seems common) plus a housing | stipend as long as their location is more than some distance | (I think 40 miles iirc) from their "home" location. Why would | anyone be a staff nurse? | | Anecdotally, I know a travel nurse who works in pediatric | ICUs (PICUs). One shift a couple months ago, the overnight | staff on her unit was >80% travelers. And this is in peds | units that aren't as affected by COVID, because ~1/2 of the | patients are cardiac babies with congenital heart issues. The | _only_ case I can see for not paying staff more to increase | retention is that they can respond to a dip in cases over the | summer, but that can 't possibly be an 80% decrease in | patients. Maybe they're waiting until travel rates come down | to offer an increase in pay so their 1.2x salary offer is | more enticing in comparison to the travel rates, but the | current system is ridiculous financially. I did mention that | we've seen first-hand that hospitals can afford to pay nurses | $4k/week, though, and I'm sure I'm not the only one who | noticed. | bumby wrote: | > _The fix is one that Hospital admins don 't want. Pay your | nurses more and hire more_ | | As someone who worked in hospitals to help redesign their | processes, this one piqued my interest. | | For every project I worked on (and I mean literally every | one), the team lead wanted to jump to the solution that they | just need the ability to hire more people. In the rare | instances where they were able to convince hospital admins to | do so, it never fixed the problem. Not once. | | Why? Because it never addressed the root causes. They needed | to take a process-oriented approach. There's a saying that | adding more people to a broken process makes things worse. | You can hide a lot of quality issues with inventory; if you | have a requirements for 100 widgets a day and you have a crap | process that only makes 10 quality widgets, you can meet your | goal by increasing throughput 10x, but nobody thinks that | would be a good approach. It's the same with injecting more | staff onto a broken system. If the system causes nurses to | spend disproportionate amounts of time on admin work and not | on direct patient care, it may be better to look at your | admin processes rather than just hire more nurses. | | It's natural when people to feel overwhelmed to think the | solution is to just hire more people, but it's almost always | better to hold off on hiring until the system/process is | fixed. | | Edit: I'm curious about the downvoting. I think it would help | illuminate the conversation if you could explain where your | disagreement lies. I'm basing my statements on actually | tracking when hiring was increased to the levels desired and | metrics did not improve. | ben0x539 wrote: | i think that argument works a lot better in a field where | they arent bullying people into working overtime near | constantly | bumby wrote: | Perhaps. But again, why is the overtime needed? | | If it's because it provides more patient care beyond what | a nurse can provide in a good system, it might be a valid | point. But if it's because the system is fundamentally | broken, I'm skeptical that hiring more people will | actually fix anything. From personal experience, it will | only create a lag that will require the same need for | more hires down the road. | ben0x539 wrote: | if the overtime isnt needed let people go home after 6 | hours each day | bumby wrote: | I think you're missing the point. Yes, if overtime isn't | needed people should be sent home. Hospitals agree on | this; they don't want to pay overtime if it's not needed. | | The issue I'm pointing to is that sometimes it's "needed" | because of a bad process, like when there is redundant | work. Sometimes it's needed because the system needs | slack to compensate for disruptions in system dynamics. | Sometimes it's "needed" because "that's how we've always | done things." Point being, if it's needed, it should be | because it contributes directly to better patient | outcomes. | kedean wrote: | You're describing Brook's Law from The Mythical Man-Month. | It was an observation of collaboration in software | engineering specifically, and it cannot be applied | universally to every industry. Really, anything that is | highly parallel (medicine, teaching, stocking shelves, | waitstaff, deliveries) can benefit from hiring more people | until you reach saturation, and medicine isn't there or we | wouldn't be having the conversation. | | The problems are caused by a "just in time" approach to | staffing, where you have exactly enough people to cover the | shifts at bare minimum. What solution would you suggest | _other_ than more people? They are not saying to throw more | nurses at patients simultaneously, they are saying to hire | more nurses so existing ones aren 't bound to spent the | entire week stretching themselves across the hospital. | | Also, I think you are being downvoted because you are | applying software engineering rules to medicine. | bumby wrote: | It's interesting because they aren't software engineering | rules. If anything, they are industrial engineering rules | that pre-date software and certainly older than the | mentioned book from 1975. The approach I was using was | developed specifically for healthcare and with great | effect in some organizations. I know this is HN, but I | think it's an error to assume everyone is coming at a | problem from a software perspective. | | > _What solution would you suggest other than more | people?_ | | It obviously depends on the situation but most of the | time it comes down to reducing process waste. That may be | automation through software where a nurse was hired | specifically to only generate reports 40 hours a week, to | re-designing a layout that minimizes travel time for | nurses when they are delivering to patients. My | experience with the staffing situation is that managers | did not know how to staff to meet the needs of their | patient loads and just revert to simple heuristics that | left them understaffed at some times while being | overstaffed at others. | phil21 wrote: | > re-designing a layout that minimizes travel time for | nurses when they are delivering to patients. | | I think talking about micro-optimizations like this | misses the forest through the trees. | | It's neat and cool. Fun to wring out those last bits of | efficiency. But the fact you even need to discuss it | shows how hiring adequate amount of bedside staff is the | absolute last thing any medical system will do. | | > revert to simple heuristics that left them understaffed | at some times while being overstaffed at others | | Showing that they were better than modern day automated | shift planning. | | I will submit that if your hospital floor staff is not | 50% idle on your average given fully-staffed boring day, | you are understaffed. Only extremely exceptional events | should cause your staff to be booked 100%. When it | happens it should be root cause analyzed and be immediate | cause for executive concern. | | The trope of card playing nurses _should_ be true, | because of all industries there are - you want surge | capacity in healthcare. Both physically speaking in terms | of warm bodies available, as well as mentally speaking in | brains not being stressed to their max the entire shift. | stdgy wrote: | The rules nurses have to deal with around things as asinine | as taking PTO are AMAZING. They're required to put in PTO | requests months in advance and the hospital can and will say | "Sorry, denied. We don't have enough people..." As they are | intentionally creating skeleton crews of nurses to wring | every ounce of profit out of the business. | | My mom was a nurse, my aunt was a nurse, my sister is a nurse | and my best friend's mom is a nurse. I really can't believe | anyone continues to be a nurse given the insane working | conditions these folks have to put up with. Twelve hour | shifts, overflowing with patients, watching newcomers earn | more than seasoned veterans... When I compare it to my laid | back software engineering job it's like I'm living in an | entirely different universe. The hospital industry is a | hugely demoralizing place. | a2tech wrote: | The hospital I work at requires physicians to file their | schedules 8 months in advance. The only deviation from that | is for emergencies. Unofficially there's a lot of flex for | them, but that's the official administration line. | cogman10 wrote: | Yeah, my mom was a small town nurse it was the same even | there. I gave them a bit more slack because it was a | hospital serving like 2000 people (so not really a high | profit place) but even there, there was a lot of last | minute "Oh no! People didn't show up for their christmas | shifts, could you come in please!" | ayngg wrote: | I actually think that this is just one example of many across | a ton of disciplines where people like Nurses basically are | forced to deal with costs and responsibilities offloaded onto | them from above the responsibility chain. Resources are eaten | up at the top of the chain to their benefit and costs are | offloaded down the chain until it reaches people like Nurses | at the end of the line who have to deal with it because there | is nobody else to offload it to. There is no shortage of | people wanting to be nurses (in some places it is extremely | competitive), and there is a huge demand for nurses based on | shortages everywhere, but somehow we are in a situation where | nurses are overworked because they are short staffed. | | I look at academia which is rife with money sloshing around, | and see undergraduate classes are taught by grad students who | make ~30k a year who are basically the Nurses of the academic | world and treated like garbage. The justice system is | dysfunctional, courts systems are overwhelmed and | understaffed so criminals just enter and exit like a | revolving door, and police is basically useless because the | best they can do is taxi criminals into the system that | automatically spits them out again, while they take the brunt | of public criticism for how they are forced to deal with a | problem that is mostly beyond their scope. | | In all of these cases it seems like the bottom if falling out | of these institutions, and the responsibilities have fallen | on their respective janitors to deal with it when the | solutions need to come from places that have been | incentivized to create the mess in the first place. | WalterBright wrote: | And yet the government budgets rise dramatically year after | year. | munk-a wrote: | The government is one of the few places where you can get | a job in your twenties and retire comfortably in your 60s | having made a decent, but certainly not outstanding, | amount of money with consistent raises and cost of living | adjustments. | | What some people will call government waste - other | people will call ethical employee treatment... sure there | are a lot of other sources of inefficiency outside of | your comment - but complaining about overpaid government | bureaucrats is essentially advocating for the same race- | to-the-bottom that has stagnated wages in large parts of | the labour pool. | fallingknife wrote: | It's not that they're paid too much. It's that they do | too little useful work. | munk-a wrote: | A relative of mine works for a state level LEO targeting | financial crimes - they've spoken often about how | "smaller government" advocating politicians have | repeatedly hamstrung the organization when it tries to go | after large corporations. They've still managed to do | good work going after smaller scale offenders that fleece | investors - but I wouldn't put the blame on those | employees for doing work you don't find useful... it's | mostly up to politics. | andybak wrote: | I've worked public and private sector and know plenty of | people in both and I've not noticed a huge difference in | the number of people just coasting vs those who really | try to make a difference. | | What makes you think government is that much worse than | the private sector in this regard? | johnnyanmac wrote: | > There is no shortage of people wanting to be nurses (in | some places it is extremely competitive), and there is a | huge demand for nurses based on shortages everywhere, but | somehow we are in a situation where nurses are overworked | because they are short staffed. | | why is this such a common story across pretty much every | single industry? There's more people in the country than | 10, 20, 30 years ago. More customers, more money. Why do | they think they can handle more work with less workers | whose salary is less when adjusting for inflation? | heavyset_go wrote: | Owners and operators have learned that they can keep the | lights on by running their businesses with skeleton crews | and, at the same time, reap the rewards of lower costs as | profits. | chiefofgxbxl wrote: | They don't think they can handle more work with fewer | workers. It's just a profit squeeze, and someone else | pays the price. | TomSwirly wrote: | > courts systems are overwhelmed and understaffed so | criminals just enter and exit like a revolving door, | | You're delusional. America has more people in jail, serving | longer sentences, than _any country in history_. | triska wrote: | I think this is due to Pournelle's _Iron Law of | Bureaucracy_ : | | https://www.jerrypournelle.com/reports/jerryp/iron.html | | "In any bureaucratic organization there will be two kinds | of people: | | First, there will be those who are devoted to the goals of | the organization. Examples are dedicated classroom teachers | in an educational bureaucracy, many of the engineers and | launch technicians and scientists at NASA, even some | agricultural scientists and advisors in the former Soviet | Union collective farming administration. | | Secondly, there will be those dedicated to the organization | itself. Examples are many of the administrators in the | education system, many professors of education, many | teachers union officials, much of the NASA headquarters | staff, etc. | | The Iron Law states that in every case the second group | will gain and keep control of the organization. It will | write the rules, and control promotions within the | organization." | TomSwirly wrote: | I had no idea that Pournelle was claiming credit for | that! | | He nicked it from Robert Michels, who wrote about the | Iron Law of Oligarchies in 1911: | https://en.wikipedia.org/wiki/Iron_law_of_oligarchy | | I was reading some old Analog magazines the other day, | and man, Pournelle was one deranged man in his "non- | fiction". | tomrod wrote: | You just explained something I saw on many establishing | subreddits! | TomSwirly wrote: | Here's the original author: | https://en.wikipedia.org/wiki/Iron_law_of_oligarchy | [deleted] | ayngg wrote: | Thanks for the link, I'll check it out. | bumby wrote: | As somebody with experience at NASA, this made me | chortle. I would NOT characterize the average civil | servant that I worked with as "devoted to the goals of | the organization." That includes the lowest level field | organizations. Unfortunately, for the average employee, | it eventually gets treated like any other job. | | It's possible this dichotomy works in theory only. Being | generous, it's possible they just disagree about the | goals of the organization. | avianlyric wrote: | That's the point. The second group, those who only care | about the existence of the organisation, and the | power/money it provides to them, have taken over at NASA. | | As a result only those who act to increase the | power/wealth at the expense of all else, such as the | original goals of the organisation, get promoted and hang | around. The end result, an organisation that achieves | very little, and consumes huge amounts of resources, full | of people who really don't care about the fundamental | goals of the organisation. | bumby wrote: | Ok, I see your point and think you're right. The quote | distinguished between scientists/technicians and | management. I met many in the former group who cared | little about the goals of the organization, but to your | point, they had been within the organization a long time. | armchairhacker wrote: | Nurses, teachers, charity workers, IEPs, game devs. | | These are all jobs where people sign up _for the job_. | Whether it's altruism or genuine passion. They're willing | to compromise and put up with less pay and harder working | conditions. | | But because they're willing to compromise, these people | are _pushed to their limit_. With not only low pay and | shit conditions, but higher-ups which actively exploit | their altruism and passion. "If you don't work, patients | / children are going to suffer!" coming from the same | beaurocracy which created the situation where a) they | suffer or b) you work extra hours. | | They're being pushed past the limit in fact, which is why | there's now a nursing and teaching shortage despite these | actually being popular fields. A lot of people want to | work these professions, they just don't want the jobs. | HWR_14 wrote: | This is the same reason why startups often phrase what | they are trying to do as "change the world" and not | "become filthy rich" to their employees. | n0on3 wrote: | This. So much this. In so many fields, it's actually hard | to find one where this is not the case. | notch656a wrote: | I don't disagree nurses DESERVE to be paid more (I'm not | sure if the economics bear out but they're certainly as | WORTHY as many other professions), but wouldn't the fact | that these nurses continue to work in nursing despite | considering leaving bolster the argument even further that | they are receiving adequate compensation? | | Staying when you want to leave indicates there's enough | compensation to 'make it worth it' at least versus whatever | shitty alternatives you have. Leaving when you want to | stay, to me, would be a much bigger indicator that nurses | who want to stay in the profession can't because of | wage/benefits/conditions issues. | alexashka wrote: | That's not how the real world works. | | People don't 'switch careers' when they've spent years | getting good at it. What they do instead is sit around | posting on HackerNews and fucking the dog in all sorts of | other ways. | | Do you realize the irony of it all? This place gets like | 1/10th the traffic on weekends. That's not a coincidence. | tetraca wrote: | > Staying when you want to leave indicates there's enough | compensation to 'make it worth it' at least versus | whatever shitty alternatives you have. Leaving when you | want to stay, to me, would be a much bigger indicator | that nurses who want to stay in the profession can't | because of wage/benefits/conditions issues. | | I think the conclusion of this sort of economic thinking | is basically: Give your employees just enough money that | they can keep they keep their head above the water but | not enough to flourish, and just enough | pressure/responsibility that they don't have energy to do | anything else, but not too much that they have a complete | mental breakdown that leaves them with the conclusion | that they should leave your industry at any cost. | | When you spent a lot of time and money into a specialized | and demanding career, I imagine it practically very | difficult to actually change your career, even if it's | killing you. It's probably even worse if you have | familial obligations. You likely do not have time or | energy to better your situation after hours, and if you | quit, you potentially resign yourself (perhaps) to many | years of destitution while you accumulate the necessary | knowledge to do something else. I would not be surprised | if many people just bear bad conditions because the cost | to do anything else worth one's time is simply too high. | nradov wrote: | Employers are going to pay the minimum wages they can in | order to retain sufficient workers. They obviously aren't | going to voluntarily pay extra just so that employees can | flourish. | | There are a lot of jobs openings available to someone | with an RN certificate and some experience. Unemployment | in that group is close to zero. They don't all work in | direct patient care roles. | landemva wrote: | Many can't afford to not work due to debt/rent/child | support payments. If you don't pay rent you lose the | apartment and the weekend parenting time. Miss the child | support payments which were being taken from paycheck and | child support enforcement takes driver license and starts | process to take the car that is in your name. | | Many people don't have even a little optionality. | notch656a wrote: | That's actually my point. IF they are able to meet their | obligations in nursing and their job is literally such a | superior option to all the alternatives that they don't | have 'optionality' then it's a weird flex to be angry at | your one best(least bad) option that actually pays your | rent and child support. Be angry that the alternatives | aren't as good as the nursing gig you have. | | I definitely feel for those paying child support, because | 'imputed income' means you must pay at whatever rate the | judge thinks you can make the best money at. You can | never take a more relaxing lower paying job, because it | will result in your imprisonment. Those people really | have no future in the US -- their only option to throttle | back their income is suicide, leave the country, or wait | to go to jail. I blame society for the existence of these | debtor's prisons, not nursing employers. | landemva wrote: | Seems you understand the more income -> more support | trap. Mandatory overtime is considered in support | calculations. That sets high water mark so going back to | 40/hours week does not lower payments. I learned the hard | way, and last employer I regularly sent email to boss | thanking them for opportunity to work voluntary overtime. | I would subpoena the boss's response of 'yes' for | evidence in child support hearing to only use 40/hours | week. The courts and county child support enforcement are | wicked and liars. | notch656a wrote: | Yes that never made the slightest sense to me. As someone | married with a kid, when I get a raise or bonus it goes | to my retirement -- not as a change in quality of life | for a child who already has food/shelter/education. The | kid still gets the same amount now as when I made | significantly less. The idea that a kid needs more money | because you worked overtime is quite possibly one of the | dumbest ideas I've ever heard. | Sakos wrote: | Are you familiar with the US? I don't see how you can in | good faith argue that if people don't like what they have | to do and/or what they get paid for it, they can just go | do something else. | ayngg wrote: | I am not really specifically making an argument on their | salaries, I guess I am saying that Nurses are in the | position where they have the least leverage in the system | so they end up bearing a lot of the responsibilities that | should be held elsewhere while having a disproportionate | amount of resources allocated to them. | | In healthcare I get the feeling that a lot of workers | feel stuck in that there are many patients and people | depending on them, and to leave would sort of be like | abandoning them while increasing the burden on ex- | cowoerkers. | pojzon wrote: | Most of those ppl cannot leave due to various | obligations. | | If you want to see an indocator of terrible compensation | - check why pretty much noone (at least here) wants to be | a nurse. | | Profession is rapidly aging because new ppl are not | joining. And they are not joining because work is hard | and pay is terrible. | | The whole Healthcare system if we dont get robots in | place fast is going to crumble soon like a house of | cards. | maxerickson wrote: | The US has lots of people interested in nursing and not | enough infrastructure to turn them into nurses: | | https://www.npr.org/sections/health- | shots/2021/10/25/1047290... | | The work is hard, but the pay is well above many other | jobs and there are jobs everywhere. | KarlKemp wrote: | This reads too much like a generalization of the standard | complaints about management and their stupid meetings, the | basic thesis of that web comic that was neither funny nor | true, Dilbert. | | The criminal justice system may be overwhelmed, but its | reaction certainly isn't to just let criminals "exit like a | revolving door". The US is still incarcerating people at | 10x the rate of other wealthy countries. | | Nurses being overworked is simply due to there not being | enough nurses. It matters little if there's too much | bureaucracy somewhere, or if too much money is spent on | pharmaceuticals (about twice as expensive as anywhere else) | or if doctors make too much money or if the US has a | uniquely unhealthy population. | johnnyanmac wrote: | >Nurses being overworked is simply due to there not being | enough nurses. | | yes but this begs the obvious question of "why?", which | either leads to the immediate thoughts of | | 1. not enough people want to be nurses 2. companies don't | want to hire more nurses | | I'm assuming #1 is false, so #2 is the go-to conclusion, | at least on the high level. I'm sure I'm missing some | more nuanced #3/4/5 explanations, but it does seem to | ultimately come down to money that isn't being spent (be | it maliciously or simply due to not having the budget). | pessimizer wrote: | Dilbert wasn't a webcomic, it was in the paper. | linsomniac wrote: | In cases I'm familiar with, they aren't hiring JUST ENOUGH | nurses, they are hiring AS FEW NURSES as they can get away | with. More like half as many as they should. IIRC, nurse-to- | patient ratio should be around 1:5, but it can often be more | like 1:10 or worse. | | On top of that, they also hire as few orderlies and nursing | assistants as possible, so the nurse doesn't even have anyone | to offload things to, and ends up having to do more work on | more patients. | | This has been a problem well before the pandemic. | | It's a trope among nurses that they are so busy they don't | have time to use the bathroom, let alone eat lunch. | | Source: My wife is a nurse, most of her friends are nurses, | and she left the profession ~a year before the pandemic | because of exactly these issues. | eigen wrote: | and now nurses are apparently solely responsible for medical | errors and will not be supported by their employer. the cause | of which appears to be related to #3 in GP above where | overrides are a regular occurrence and quickly loose meaning | if you have to do it multiple times per day. | | https://khn.org/news/article/radonda-vaught-fatal-drug- | error... | tom-thistime wrote: | Yeah, anecdotally, experienced nurses were fed up in the | mid-1980s. | HWR_14 wrote: | Do you have anything I can see about that, or did you just | know people who were fed up and retired then. | conductr wrote: | Yes and No. | | On an individual basis, nurses are overworked because they | choose to be and their employers allow for it. The standard | work week is 3 12 hour shifts, which is much less than most | professionals work. Like a retail or warehouse worker, they | are expected to clock out as soon as possible and leave when | the shift ends. Those of us with salary jobs knows how | difficult that can be in our arrangements and how much "free" | work we end up performing. They get paid premiums for | everything; night, weekend, etc. And since they're hourly, | they typically LIKE the overtime and signup for it as much as | possible. They also might work FT at one hospital and pull | extra shifts at another hospital on a PRN basis. These things | are very common. Just like in a retail environment, people | typically LIKE to work holidays so long as it's voluntary | because it's 1.5x pay (or more?). | | > Rather than hiring permanent people or upping salary, | Hospitals have instead elected to just use travel nurses and | an extreme premium so as to avoid any salary increases. | | This makes no sense. Capacity is the problem, paying more for | the same capacity does not solve the problem. Hospitals try | very hard to avoid overtime and the travel nurses due to the | cost. It's also a very elastic model to balance and a lot of | flex (non Full Time) folks are needed to fill the gaps and | manage cost somewhat. | | > The fix is one that Hospital admins don't want. Pay your | nurses more and hire more than the minimum to cover shifts so | a nurse being out sick doesn't result in another working a 80 | hour week. | | That is the current system. The problem is usually time. If | someone calls in sick, they do it an hour before their shift | starts. They usually can solve for this. Either they call | from their roster or a supervisor level person with an active | RN license steps into the clinical side that day. Staffing at | 2x just in case everyone calls in makes no sense. Staffing at | 5x just in case a pandemic hits makes no sense. | | Hospitals barely make money as it is, I don't see how this is | a sustainable solution. Paying more does not create capacity | in this industry. | | It's also important to note that "nurse" is a very generic | term. For example, ICU nurses is a very distinct type of | nurse that has been dealing with COVID first hand (caring for | vent patients). They are the ones you hear about making | $150-200/hour in COVID times. It is difficult to become an | ICU nurse. It hasn't been possible for a surgical nurse to | pivot to ICU nurse in these times so the labor pool has been | rather fixed, or shrinking due to natural churn and inability | to onboard new folks. It would be akin to suggesting why does | some [insert super specific domain expertise] developer make | $1M/year at FAANG when they could hire a PHP coder for | $15/hour on a freelance website. There is no immediate/cheap | substitute for the experience and knowledge that the | expensive developer has, so they cost more. This is happening | in nursing where some are thriving while many actually got | furloughed early on in the pandemic. | | My personal opinion on the matter, is one only has to look at | the demographics of an average nurse. It's become quite "old" | and like other industries, the boomer's retiring is causing a | labor issue. The handful of nurses that made 5-10 years of | salary since Q1.2020 are now ready to retire early as well. I | don't blame them. | robonerd wrote: | > _Capacity is the problem_ | | Capacity is generally limited by staffing, not space or | actual beds. When hospitals report how many "beds" they | have available, they're generally not talking about the | furniture. | conductr wrote: | They are absolutely talking about actual physical beds. | The bed is licensed by the state and inspected by a | regulator and is an indication of how many patients can | stay in the hospital. As as been shown these years, they | can and will pay what is needed, finding qualified people | is the hardest part. | robonerd wrote: | If a hospital has 200 beds but only enough nurses to | staff 100 of them, they have "100 beds". | conductr wrote: | Maybe to you, but officially you have 200 beds at 50% | occupancy. If needed, nurses can be added by other means. | For example, the army, FEMA, etc. will ship in nurses and | just need to know if the bed is physically there and | certified for use. | robonerd wrote: | > For example, the army, FEMA, etc. will ship in nurses | | _Might_ ship in more nurses, and until they do, the beds | that can 't be staffed don't count towards capacity. | | > _50% occupancy_ | | Having the capacity to staff those beds is not the same | as the beds being occupied. Beds are occupied by | patients, not nurses. | thebradbain wrote: | "Hospitals barely make money as it is, I don't see how this | is a sustainable solution. Paying more does not create | capacity in this industry." | | The problem is - and this may be very bizarre in a society | as capitalistic as the US - healthcare should not be | beholden to making a profit. | | Rehabilitating people is clearly "valuable" to the economy | in that without people to participate in the economic | system, a debt-based economy collapses; I'd argue that | healthcare is much more valuable to capitalism than is | reflected on a balance sheet of paper | costs/revenues/profits, and yet a system such as ours has | absolutely no way in its current form to price that in | (sure, in an academic defense you could wave hands that | "positive externalities" such as these should be priced in | to the model, but it's clear with the racket the medical | industry has found itself in that will never happen | practically). | | The main issue profit-seeking conflicts with is that whole | rehabilitating/healing/saving people is an intrinsically | good thing to do, and that letting people who have full | lives to live die or suffer is an intrinsically bad thing | to do. | | What's not sustainable is that healthcare has to survive | within the confines of a system that is many times in | complete opposition to it. Other otherwise-capitalist | countries have at least _tried_ to insulate their | healthcare industry from market forces, meanwhile the US | has just wrapped it in another layer of capitalism with its | insurance market. | landemva wrote: | It makes sense to the $250k/year hospital chief bureaucrat | (not a medical person) and the Pres. and board accept that | the extra contractor pay is just short term. | conductr wrote: | So are pandemics if you look at it that way | landemva wrote: | It was great for revenue. Hospitals got paid for using | Remdesivir, which has no approved medical use anywhere | worldwide and had a test on Ebola virus patients halted | because it was killing faster than the Ebola virus. | https://www.cms.gov/medicare/covid-19/new- | covid-19-treatment... | | ' October 22, 2020, the FDA approved remdesivir (Veklury) | for the treatment of COVID-19 for adults and certain | pediatric patients requiring hospitalization ' | | That stuff is lethal. | https://www.fiercebiotech.com/biotech/gilead-mulls- | repositio... | nradov wrote: | Hospitals receive very little revenue for administering | remdesivir. It's not a material item on their financial | statements. | BeetleB wrote: | > Rather than hiring permanent people or upping salary, | Hospitals have instead elected to just use travel nurses and | an extreme premium so as to avoid any salary increases. | | In case people want an idea of what travel nurses made during | COVID... | | https://khn.org/news/highly-paid-traveling-nurses-fill- | staff... | | > In April, she packed her bags for a two-month contract in | then-COVID hot spot New Jersey, as part of what she called a | "mass exodus" of nurses leaving the suburban Denver hospital | to become traveling nurses. Her new pay? About $5,200 a week, | and with a contract that required adequate protective gear. | | > Months later, the offerings -- and the stakes -- are even | higher for nurses willing to move. In Sioux Falls, South | Dakota, nurses can make more than $6,200 a week. A recent | posting for a job in Fargo, North Dakota, offered more than | $8,000 a week. Some can get as much as $10,000. | jonlucc wrote: | These contracts are likely emergency contracts, which pay | outrageously but often require a full week of 12-hour | shifts or something similar with the expectation the nurse | will only do one week then recover. I've seen this for | COVID peaks and when a hospital's entire nursing staff is | planning to strike. The $5200/wk rate is more likely 3 or 4 | 12-hour shifts. | BeetleB wrote: | I'm not sure I follow: | | > The $5200/wk rate is more likely 3 or 4 12-hour shifts | | 3 or 4 12 hour shifts a week is normal for salaried | nurses. $5200/wk isn't. It's over double. | | > which pay outrageously but often require a full week of | 12-hour shifts or something similar with the expectation | the nurse will only do one week then recover. | | I'm not sure what you're trying to say. Yes, it may be a | full week of 12 hour shifts, but it's still a much higher | pay. And if you get the next week off, it's a _fantastic_ | deal. | | For context, pre-pandemic, I knew a nurse who often would | do this schedule for her salaried job - she requested it | as she liked having a full week off. | | What I mentioned elsewhere: Travel nurses have a lot more | control over the contracts they take. They can work fewer | hours per year and still make significantly more. They | may have stretches of long hours in a given contract, but | annually they work less. | jonlucc wrote: | > 3 or 4 12 hour shifts a week is normal for salaried | nurses. $5200/wk isn't. It's over double. | | It's a normal shift schedule, and they pay travel nurses | much more than staff nurses to work the same shift | schedule. These are typically 3 month contracts, but not | always. | | > I'm not sure what you're trying to say. Yes, it may be | a full week of 12 hour shifts, but it's still a much | higher pay. And if you get the next week off, it's a | fantastic deal. | | I don't disagree, but a lot of people do not want to work | (or feel like they can't provide good care for) 12 hours | every day for a week. | BeetleB wrote: | Ah I see - we're in agreement! | ben0x539 wrote: | How many working hours are in those weeks? | jonlucc wrote: | I replied to the parent, but the highest quotes are | probably emergency contracts for 5 or 7 shifts of 12 | hours but only for a week. Longer contracts are often 3 | months at 3 or 4 shifts per week. | BeetleB wrote: | I haven't found concrete figures, but from what I've | read, they do often work more hours during the contract. | However, travel nurses in general have far more control | over their schedule than regular salaried nurses. A | salaried nurse cannot refuse to work, but travel nurses | routinely say "No" to contracts if they don't like the | pay or the hours. | | What happens is they'll accept a few weeks (or 2 months) | of long hours, and then take a month off and relax. As | you can imagine, if they're getting paid $6000/week, they | can easily take a lot of time off and still get paid more | annually than their salaried counterparts (while overall | working fewer hours per year). | pbuzbee wrote: | Travel nursing is definitely a great way to turn the tables | if you can do it. The money you can make is clearly quite | high! I fully support those nurses using travel nursing to | get greater pay. | | But it also isn't an option for everyone. Many don't have | the flexibility to switch to travel nursing. For example, | you may not be able to get a nearby contract and may not be | able to travel (e.g. because you have children). Plus, | traveling isn't an option for new nurses without | experience, who now have to work in hospitals that are | hemorrhaging experienced nurses to traveling AND have worse | staffing ratios than ever. | ARandomerDude wrote: | > Hospitals have made sure they hire JUST ENOUGH nurses to | cover shifts and no more. | | This is a two-edged sword. If you hire more than you need, | the nurses' hours will be cut during normal situations and | they won't make enough money. If hospitals don't cut extra | hours and instead keep the staff on the clock, a public | scandal will erupt surrounding well-paid medical | professionals sitting around doing nothing. | runnerup wrote: | You can pay people fixed monthly salary + overtime hours. | You don't need to cut their hours and their pay, though | that's often the choice that employers make. | munk-a wrote: | Exactly, choosing to cut hours or pay due to a lull in | business is a choice made by the employer. It's not like | these hospitals are sputtering along right at the fringe | of solvency and one bad choice will bankrupt them - | private health providers tend to make pretty comfortable | profit margins and the fact that they can pay such | outrageous surge prices for travel nurses is a pretty | clear proof of how much they have to spare. | nradov wrote: | Many hospitals literally are sputtering along right at | the fringe of solvency. This is particularly a problem | with non-profit hospitals in poor and rural areas. Summer | have shut down in recent years, and the pandemic is | accelerating that trend. | | https://www.beckershospitalreview.com/finance/12-latest- | hosp... | munk-a wrote: | _Some_ hospitals are sputtering right along, and a list | of 12 isn 't a great piece of evidence that those | hospitals (many of which are run by regional | organizations which are essentially consolidating patient | pools into a central location) are being run effectively | - especially if these hospitals are paying 10k/week for | travel nurses. | | If there's a location that isn't profitable to operate a | hospital in then the hospital will probably fail. America | is the country still clinging to market-driven healthcare | services and the market can be a cruel mistress. | | And all that doesn't at all erode the fact that nurses | are paid pauper's wages at extremely profitable hospitals | - some tech companies are going out of business, some | probably closed their doors today... that doesn't mean | that all engineers are expected to work for 60hrs/week at | $15/hr. | nradov wrote: | That article was just a recent example. If you search | around you can find many other hospitals which have | closed down or gone through bankruptcy in recent years. | | https://www.gpb.org/news/2022/04/08/wellstar-closing-er- | hosp... | | https://www.post- | gazette.com/opinion/editorials/2022/04/04/c... | | In 2020 the US median salary for an RN was $75K. That was | well above the median household income. Hardly pauper's | wages. | | Most hospitals are not extremely profitable. In fact the | majority are run by governments or non-profit | organizations. | | https://www.kff.org/other/state-indicator/hospitals-by- | owner... | | Tech companies will pay engineers as little as they can | get away with. Expectations have nothing to do with it. | Wages are set by the market. | tinco wrote: | > a public scandal will erupt surrounding well-paid medical | professionals sitting around doing nothing | | I don't think that's true. Increasing the amount of nurses | means simply increasing the amount of care. If you have | twice as many nurses, you'll have twice as much care for | your patients. No way nurses would be sitting around doing | nothing. | coryrc wrote: | That's not how healthcare works. That it is does not | function that way is why free-at-point-of-use public | healthcare systems are capable of working. | bumby wrote: | Not sure why you're being downvoted, but the idea that | doubling nurses doubles the amount of patient care shows | an ignorance of the healthcare system. "Patient care" is | a nebulous term and needs to be further defined in that | statement. Do you now get two catheters instead of one? | Or get your vitals taken twice as often? Both double | patient care but only one is relevant. | Firmwarrior wrote: | I could definitely imagine nurses having twice as much | time to carefully read my charts, or twice as much time | to sleep at night and be well rested so they don't fuck | things up, or being able to come by and help with | something twice as quickly | bumby wrote: | That would provide better patient outcomes, I agree. | Whether hiring more nurses translates to actually | doubling that, is another question. To be clear, I'm not | saying that increased staff is not part of the solution; | it's just been my experience that it's rarely the sole | part (or often even the majority part) of the solution. | ikiris wrote: | It's because it would actually double the amount of care | on most floors, because they're usually at 60% of the | staffing they need as a start because they've been able | to get away with that for years. | bumby wrote: | That doesn't really answer the question. "it would | actually double the amount of care". It would double the | amount of staff hours. How those staff hours are used is | a measure of patient care and not all hours are equally | relevant to the patient. | | As an example, if we assume you are a software engineer | and you double your work hours, will you double your code | output? Probably not, just like it's not a 1:1 | translation of nurse hours to patient care. | [deleted] | ikiris wrote: | Comments like this are showing just how much you don't | understand maintaining a service level based care, and | are stuck in thinking in terms of producing a product. | | Combined with willfully ignoring that basically all | floors are intentionally understaffed and have been for | _years_. | bumby wrote: | I can tell you from my years in healthcare that many of | the people who think they know how the system works only | have a very myopic understanding and they usually are the | one's who have the most confidence that their simple | solution will fix the problem. Unfortunately, there's a | lot of nuance in complex systems like healthcare. | | We probably agree about the staffing levels to an extent, | but I would be curious to hear the staffing estimation | methodologies used in your experience. | ikiris wrote: | Yeah, I agree. You sound like many healthcare admins I've | worked with and for. | | I'm not sure its the flex in this argument you think it | is. | bumby wrote: | I wasn't healthcare admin and most of my department was | staffed with nurses. But we were very data oriented and | it helped buffer us from emotional responses to problems. | tomc1985 wrote: | At the rate that healthcare charges in the US, hospitals | can more than afford to keep X+1 or +2 needed nurses around | in three 8-hour shifts. They just don't. | conductr wrote: | Not even close. Most hospitals have trouble staying | afloat as is. And there are disciplines within nursing, | so you'd have to overstaff by quite a bit more such that | closer to 2x is a backup but leads back to the GP's | point. | | They employ on-call, PRN, contract nurses, etc to fill in | the gaps which mostly works in non-pandemic situations. | a2tech wrote: | Reading threads like this really hammers home most of HN | have never worked in health care. Hospitals BARELY make | their budget. 1% over cost of doing business is | considered a really good year for my institution. | | Also if I never have to hear people complain about | bloated admin budgets in education and healthcare ever | again it'll be too soon. Those admins aren't sitting | around on their thumbs--they're dealing with the | ridiculous legal and administrative system the insurance | companies and government have created. Those people are | absolutely critical for the institution to exist. | jonlucc wrote: | Hospitals have been paying 4x staff rates for travel | nurses for multiple years now, though. | bri3d wrote: | This seems to be highly bifurcated, like so much in the | US, between the haves and the have-nots. But overall I | don't think it's fair to say "Hospitals BARELY make their | budget." As usual, the whole system is broken. There are | some hospitals with a wealthy customer base with full- | ride insurance who can bill obscene amounts and profit | massively, and then there are some hospital systems with | uninsured and underinsured customer bases who are just | scraping by. | | I looked up my local hospital network, UCHealth | (Colorado, there are many UCHealths it would seem), and | their EBITDA in 2021 was 16.6%. Mayo Clinic posted 1.2 | billion dollars in _operating profit_ in 2021, and also | have a gigantic investing arm with several billion | dollars under management. | | Then we look at networks like Spectrum in Michigan, who | posted only a 3.6% margin, or Henry Ford, with a negative | operating margin offset by investment income, and it | becomes clear that _some_ hospitals barely make their | budget while _others_ rake in dollars. | tomc1985 wrote: | How badly is the entire industry mismanaged if hospitals | have to charge thousands-to-millions of dolllars for | treatments? There is no possible way that is just barely | supporting facilities+medical staff+reasonable | administration+liabilities if other countries can do it | at tiny fractions of our price. | | Instead, the story as I've heard it seems to be similar | to education: massive administrative overhead permitted | by fundamentally broken insurance billing. | | Sure I may not know healthcare but they really need to | fix their shit. | mgr86 wrote: | My Daughter was born on the winter solstice this year. We had | a broken sink in our hospital room and someone came by to fix | it. He had a trainee with him. Who was mentioning that he was | scheduled to work New Years Eve and then again the next day | on New years day. A 3rd shift followed by an immediate 1st | shift. He was casually talking to the guy training him and | mentioned that had to be a mistake. The guy in charge said | something like "what did I tell you. _They_ don 't care about | you". I sure felt angry for both of them at that moment. | nradov wrote: | Hospitals operate 24x7. Someone has to work those shifts. | Usually it ends up being the employee with the least | seniority. What's the alternative? | krisoft wrote: | The problem is not that they had to work on those days. | | The problem is that they had two consecutive shifts. | | The alternative is that the hospital hires enough people | so they can schedule them such that everybody has time to | go home relax and sleep after they are done with a shift. | dham wrote: | My first year at the movie theater I had to work | Christmas Eve, Day, New years eve and day, all for | minimum wage. People are just more entitled now a days. | krisoft wrote: | Did you go home and sleep between working on on new years | eve and new years day? If yes then what you had is not | what the complaint is about. | ikiris wrote: | for those that aren't aware, a while here reads as at least | 40 years, and it gets worse every year, especially the last | 10 or so. | | With additional nuance that this kind of thing used to be | protected a bit by the additional guard of a pharmacist. The | automated dispensary changed those criminally liable people | into a checkbox bypass that this nurse (and from the sounds | of it, the rest of them by effect of policy) regularly | bypassed. | Sohcahtoa82 wrote: | This ended up being the last straw for one of my friends who | was a nurse. | | He kept getting vacation requests denied due to lack of | staffing, yet if he asked if they were looking to hire, the | answer was always No. | | He was super lucky and had some early cryptocurrency | investments pay off big, so he decided he was done with it | retired. He said that he loved helping people as a nurse, but | not at the cost of his own physical and mental health, having | to work 60-80 hours/week. If he ever gets back into it, he | would establish at the interview phase that he works 50 | hours/week tops, and that vacation "requests" are not | requests, but notices. | landemva wrote: | That describes me, though in tech. Trying to step back in | to tech and recently had interview. After I explained | parenting time schedule, HR guy said everbody works 60 hour | weeks every week so there is not a role for me. | notch656a wrote: | That sounds perfectly fair actually. You explained you | can't work 60 hours a week and he explained it's not the | role for you. Complete honesty and the choice was made | not to do the deal. You shouldn't get special hours or | treatment for being a parent. | landemva wrote: | I agree with you, and I wanted them to know my needs so | we all succeed. Hilariously the guy never asked my pay | needs (low) and talked to me about the top of the pay | range. I didn't care to correct him since the expectation | was overtime all the time for everybody. Looks like a | management culture I don't want to struggle against, so I | can look elsewhere. | ikiris wrote: | Yeah the incredulous looks I get when I turn down gigs at | "unlimited" PTO positions are just wild. | | Like what did you expect to happen? We're not stupid. | Sohcahtoa82 wrote: | "Unlimited" gets a bad rap. | | At the place I'm at right now, we have an unlimited | policy and I've got 25 days of PTO planned over the | course of the year that's all been approved. | | But yeah...I do know not every place is that good about | it. | ikiris wrote: | Its just corpspeak for "we don't want to commit to you | getting time off or a possible slight payout" | taurath wrote: | A good friend of mine couldn't get a single 3 day weekend | approved (so one day of PTO) several months in advance. | | Then I open my recruiter inbox and I see like 20 new B2C | healthcare startups. | | It really feels like the entire economy is designed to | prevent problems being solved. Some people in healthcare are | making massive amounts of money and the quality of life of | everyone that performs the actual work has taken a nosedive | when it was already a really crappy situation. | 14 wrote: | From a Canadian stand point you American nurses are already | highly paid. My brother works in the US and was recently | thinking of coming back to work closer to where he grew up. | The best deal he could get here was $20usd less then what he | makes there. So on top of making $20 more then a nurse here | he is also making it in USD. He is making huge amounts of | cash as a nurse down there. How much more do nurses need? | gruez wrote: | >you American nurses are already highly paid. [...] How | much more do nurses need? | | This seems perfectly consistent with econ101. Prices for | something is high, so we need more supply. | callmeal wrote: | >How much more do nurses need? | | Something something freemarket no longer applies when it | comes to paying peons? | sophacles wrote: | > Something something freemarket no longer applies when | it comes to paying peons? | | It never did. | conductr wrote: | The nursing labor market is so fluid, so much turnover, | it operates much more like a commodity exchange where | prices are concerned. This doesn't apply to people to | refuse to change employers so incentivizes short term | rate chasing | Melatonic wrote: | Apparently quite a bit if 90% hate their jobs | freeflight wrote: | Nursing, just like many other social oriented | professions, attract a lot of people for the right | reasons, like wanting to help other people, yet too often | that well-meaning motivation is then exploited to the | maximum by overworking and underpaying these people. | | They will bear a lot of that, because these people care | for their patients and leaving a job because of bad | circumstances also means leaving their patients behind | _with_ those bad circumstances. | | Which is not something that comes easy to everybody who | makes "helping others" such a big part of their work | motivation. | ethbr0 wrote: | It's the game developer of health care. | | People get into it because they love it, and then have | their love exploited for profit by businesses | masquerading as social charities. | | Some hospitals and clinics do great philanthropic work. | There are also a lot that don't, but have the same cross | over their door. | soared wrote: | Without starting values and locations (COL) you can't | compare values in this way. | tenpies wrote: | Canada is generally more expensive and taxes more | (especially when you factor in sales taxes and such). | | To be honest, I am amazed that Canada has a healthcare | system left. | | Decades of mismanagement and underinvestment aside, | almost any Canadian healthcare worker can cross the | border and instantly see a substantial pay bump and | increase in QoL. | | I do imagine within the next 20 years, Canadian | healthcare is going to look vastly different. Like | something from an emerging market, where sure there is | universal healthcare, but you generally avoid it if you | have the means. | GoodJokes wrote: | psychlops wrote: | They use the extra money here to pay for healthcare. | cogman10 wrote: | > How much more do nurses need? | | What you need to realize is that nursing salaries in the US | are NOT uniform. From what I've seen in past discussions | about it is they range anywhere from $20/hr -> $100k/year. | The $100k/year are usually achieved only in cities and | generally only by travel nurses. | | The majority of nurses, that I've seen, are clocking in at | 50->60k yearly salary. | | Sort of like saying "Oh, that google dev makes $300k a | year. How much more do devs in the US need?" | ethbr0 wrote: | "Nurse" is a pretty broad title when popularly thrown | about, given that it spans from LPN to DNP and med- | surg/clinic to ICU. | | "Sysadmin" seems the most readily comparable title in IT, | going from "I push software to Windows PCs" to "I manage | supercomputer clusters." | [deleted] | BeetleB wrote: | > The $100k/year are usually achieved only in cities and | generally only by travel nurses. | | While $100K/year is not the norm throughout the country, | it is normal in my city (non-SV). Travel nurses made a | _lot_ more during COVID. | | From my conversations, pay is not the reason they are | considering leaving. Working conditions are. | 14 wrote: | He was an icu nurse not a travelling nurse and not in a | big city. Washington state I forget the city but it | wasn't a big city like Seattle. | redwall_hp wrote: | > Sort of like saying "Oh, that google dev makes $300k a | year. How much more do devs in the US need?" | | And the answer to that is "how much is Google worth?" If | your business relies on the efforts of software engineers | to design and build your primary products, they should | have the primary equity in the company. So no, even | Google developers aren't paid nearly enough...and they're | certainly overworked, regardless of how much they make. | davidgay wrote: | https://www.sfgate.com/news/article/Highest-paying-jobs- | in-S... reports Registered Nurses as getting $150k/year | in San Francisco, and $83k nationally. | bratwurst3000 wrote: | here in germany nurses make 15EUR And in switzerland nearly | the double. I can understand their frustration and those | who can leave or get new jobs. | MomoXenosaga wrote: | They are looking into getting nurses from the Philippines | and Africa. Works for the UK maybe but there's a huge | language barrier for the rest of Europe. | | Besides they need their health workers too. | cogman10 wrote: | Something that should always be considered is US | healthcare is an expensive nightmare. Public healthcare | is a HUGE benefit that I think a lot of outside of US | people underestimate. (And no, nurses don't get free | healthcare from their hospitals. They have the same | terrible insurance everyone else gets). | | For example, I have to pay $9000 a year BEFORE my | insurance starts covering healthcare costs. (at $5000 my | insurance starts paying out and I owe 10% of the bill). | My insurance does not cover medicine costs at all. | [deleted] | munk-a wrote: | In Germany's defense, at least, Switzerland has some of | the most insane wages in the world, and the cost of | living there is equally high. | noTooMooch wrote: | boringg wrote: | Executive hospital pay is ridiculous AND the executives are | often times just some MBA type without any real value add. | How about you chop up their comp between the nurses - would | be a start. Nurses are the lifeblood of the hospitals for | anyone who has had the unfortunate circumstances of having to | spend any time there. | AussieWog93 wrote: | >1. Many new nurses make the same or more and long time nurses. | It's frustrating when the nurse in charge with the most | experience is making less than new nurses. Some hospitals are | even trying to stop nurses from talking about pay. | | I think non-performance-based pay is something endemic to many | female-dominated professions. My wife used to work in | childcare, and it did her head in that she was paid less than | complete idiots who'd been working there longer than she had. | hadlock wrote: | Not only are nurses talking about leaving the industry, in the | "newbie programmer" groups I help mentor in, there is an alarming | number of people who were _considering_ going in to health care | /nursing, who are now seriously reconsidering their options, or | changing majors in college mid-way through to move into | technology/programming. | | I guess my point is, not only is the current healthcare labor | market at stake, but hiring/pay/working conditions now are having | upstream impacts on the labor pipeline of people coming into the | market, or evaluating entering healthcare. Having recently gone | to the ER with my toddler, I can tell you this is not an area you | want the market going for lowest bidder when you do have to use | healthcare services. | dukeofdoom wrote: | I have a nurse friend that was fired because she did not want to | take the vaccine. She had covid before, and strongly believes in | bodily autonomy. She did not want to be forced to put something | in her body against her will. She's started a business cleaning | houses now, and says is making same money. Except now she isn't | pressured to be rushing from patient to patient like crazy. She's | choosing her hours, works during the day at her pace and doesn't | bring home the emotional stress of dying people. She worked as a | nurse for 7 years and in that time she had thousands of patients. | She said in all that time she only discharged 3 patients after | chemo therapy. She's kind of convinced both are billion dollar | scams by medical industry. | LatteLazy wrote: | You see these numbers come out of nursing and teaching regularly. | But they both have very high retention rates. Because in both | cases, people stay because they would feel bad if they left. | They're not there for the money. This is why they're so badly | paid. This is why I didn't go into teaching: you cannot compete | with people who will work for emotional rewards instead of cash. | pkaye wrote: | A couple changes I've heard from nurses would be helpful: | | 1. Safe mandated staffing ratios. California is one that does | this and many nurses seem happy with the ratios. | | 2. Safe harbor laws. If the nurse feels they are pushed into a | risky situation, they should have a right to notify management | which will take on liability if they do not resolve it. A few | states have this but hospitals bully nurses not to invoking it. | | 3. Better pay for the liability they take. Unlike management, | they could go to prison for mistakes they make. There was a | recent case nurses were outraged about. | | 4. Unions are beneficial. In California the nurses union is | pretty strong to negotiate better terms and conditions. | xyzzy123 wrote: | Canberra flagged, Tasmania exempted, Sydney and Melbourne | upvoted. | honkycat wrote: | Greed is destabilizing society everywhere you look. | | 1. Hire more nurses to spread the load around | | 2. Pay existing nurses more | | 3. Incentivize people to get the technical training required to | become a nurse. | | "But what about my boss's 4th home?" I know. I am worried about | that too. i pay 1500/mo to live there, and the costs will | probably trickle down to me. we will have to figure something | out. | | "But we don't have the money! Who is going to pay for it?" Well. | Then I guess the goose is cooked. We no longer have the resources | to run a functioning society. I want you to think about that, and | maybe think if we could get the funding from somewhere. | | We are out of trained workers. The money diet our overlords put | us on has officially starved us. Welcome to the 3rd world. Hope | you saved up enough money for a ticket to Elysium. | | Nobody wants to take out student loan debt anymore. If you are | over 30, let me fill you in: cost of college has gotten even more | insane than when we were in school. | | we are seeing the same thing in our courts. Everyone is mad at | the PDX DA for turning people loose all the time, but the secret | is: there are not enough public defenders, and we can't hold | people indefinitely without cause. There are literally not enough | lawyers graduating from law school/graduated in the past to fill | these spots. | | Our society is falling apart and all anyone can talk about is how | lazy the homeless are and obsess over what genitals people are | born with. | fallingfrog wrote: | "Well. Then I guess the goose is cooked. We no longer have the | resources to run a functioning society. I want you to think | about that, and maybe think if we could get the funding from | somewhere." | | Absolutely! Thanks, this made me laugh out loud. It's almost as | if the people in charge of society don't have the same | interests as the rest of us.. | dcchambers wrote: | The burnout in healthcare is unreal and is a problem we should | all be worried about. | tedmcory77 wrote: | My partner works in the healthcare industry; the Radonda Vaught | ruling and outcomes are going to echo through that industry in a | very significant way. | qclibre22 wrote: | These "nursing crisis" articles are a semi-annual feature, likely | a PR stunt by the hospitals for more subsidies and guest nurses. | | The nursing crisis is 57 years old now: | https://pubmed.ncbi.nlm.nih.gov/14252064/ (1965) | | Similar articles WHY THE NURSING SHORTAGE | PERSISTS. HALE T. N Engl J Med. 1964 May 21;270:1092-7. | doi: 10.1056/NEJM196405212702105. PMID: 14121489 No abstract | available. STUDENTS' DISAPPOINTMENTS IN PUBLIC | HEALTH NURSING. HANSEN AC, THOMAS DB. Nurs Outlook. 1965 | May;13:68-72. PMID: 14291737 No abstract available. | chillingeffect wrote: | A good path to explore, but requires more data points than two | from 60 years ago... Let's try this approach: [0] steady with | huge uptick since the pandemic [1] steady decline with uptick | in July 2021 [2] sparse, but slow incline since July 2021 [3] | shallow dip ~2013, slow include since | | [0] | https://trends.google.com/trends/explore?date=all&geo=US&q=n... | [1] | https://trends.google.com/trends/explore?date=all&geo=US&q=n... | [2] | https://trends.google.com/trends/explore?date=all&geo=US&q=n... | [3] | https://trends.google.com/trends/explore?date=all&geo=US&q=n... | gjsman-1000 wrote: | A family friend was talking to a doctor who was considering | quitting. | | The reason why, at least for that doctor, wasn't really the | stress from patients. It was all the damned paperwork and the | stress that created. | pavon wrote: | Agreed. This article is so off the mark, trying to talk all the | ways technology can help this problem without a single sentence | retrospecting about any of the problems that shitty EMRs have | caused or at least facilitated. The massive increase in | charting, and the fact that nurses spend more time on CYA than | providing care these days is the number one reason I've heard | from nurses who are trying to get out. High patient-to-staff | ratios is the second, which wouldn't be quite as bad if it | weren't for all the charting. | christophilus wrote: | I've known a few nurses, doctors, and PTs who expressed exactly | this sentiment. It's such a stupid problem, too. There's no | reason they should have such an onerous burden, and yet they | all do. | | One of the PTs I know spent at least as much time filling out | paperwork as he did with patients. This was partly due to the | volume of paperwork required by govt / insurance / lawyers / | whatever, and partly due to absolutely awful software. | treeman79 wrote: | I got badly injured. Everyone refused to do paperwork. Every | doctor said it was every others job. I had great disability | coverage. (In theory) | | Result. Spent 2 years trying to work when I couldn't get out | of bed and was mostly blind. | | All because doctors didn't want to spend 20 minutes filling | out forms. Plus Disability companies lie constantly until | various deadlines pass. | gbear605 wrote: | Obviously the doctors should have done the paperwork and | you shouldn't have had to deal with that. But it seems like | the root cause isn't that doctors don't want to do | paperwork, it's that the insurance is introducing too much | paperwork. | bkjelden wrote: | My partner is an NP, not only is there an astounding amount of | paperwork, usually it's done outside of working hours because | management took the chunks of the work day that were previously | blocked off for doing paperwork and turned them into more | patient visits so they could make more money. | henchore wrote: | During my last physical, the doctor was trying to listen to my | symptoms while getting frantically pinged from the hospital or | something. I don't blame him at all, but this trend of always- | on + interruptions at work is disastrous, I imagine especially | so for people like doctors doing extremely high level | intellectual work. | nittanymount wrote: | this is more correct, the medical fields have to do a lot of | paperwork to follow rules and avoid issues (legal?) almost half | of their time are on charting instead of taking care of | patients, paperwork is needed, but in most facilities, it takes | too much time, and the workflows are not optimized enough as | well... | hateful wrote: | I've always wondered why they don't hire an assistant that | JUST does the paperwork/coding for the doctor. They could | follow them into room and just take notes (and leave at times | when it is appropriate). | | How much could it cost to pay someone else to do this? Surely | less than a doctor makes doing it... It can become its own | profession. It's a separate skill - separate from what a | doctor should be focusing on. | | On a side note, it seems that a lot of professions would | benefit from having an assistant - a thing that seems to have | disappeared - if what I've seen in old movies in shows is to | be believed. Another side-case of this is the fact that | technical people tend to be promoted into management roles | and have to deal with attendance and time-sheets - why not | have someone else do it? The work only suffers. | pomian wrote: | Brilliant suggestion. Some of us still remember the days | when we were paid to be creative engineers, solid creative | engineers, designing elegant solutions. Didn't know or need | to know how to type, design layout of reports, kerning and | fonts, didn't keep track of bills and accounts: Just | engineering. (Of course report presentation, review and | editing were still necessary, not not the actual technical | aspects.) | opwieurposiu wrote: | My kid's pediatrician has a guy that does this. The job | title was "Scribe." A little bit crowded in the exam room | but you get used to it. | | The Scribe had a laptop and could look up whatever info was | needed while the doc was doing his thing. If a scrip is | needed the scribe types it in to the system and then the | doc had to read it and approve. | | Just keeping the docs hands clean from not having to touch | a dirty laptop/iPad all the time has a health benefit I | bet. | hateful wrote: | My wife is a PA - here are a few things we've (anecdotally) | noticed: | | 1. A few doctors left practices after they got taken over by a | bigger entity and the hoops they had to jump trough weren't | worth it, so they retired. | | 2. The insurance companies - they control EVERYTHING. One thing | that happens a lot is that they don't allow her to order an MRI | unless she orders an X-Ray first - even if what they're testing | for wouldn't show up on an X-Ray. And this slows down the | process of diagnosis by days. There are more examples of things | like this - things that should be up to the provider, but end | up being up to the insurance company (what drug to prescribe or | what treatment to pursue first) - it makes no sense (at least | from what I hear from her). | gadflyinyoureye wrote: | The software in this space is terrible. The system is designed | for admins not practitioners. For example blood pressure entry | is odd with two boxes. Note capture is slow due to needing it | be typed rather than written. Sharing out of the core system is | onerous. | | FHIR would be a good idea, but in practice its hard to | correlate a patient across the systems. Few hospitals and | doctors setup a push notification for when they change a | patient's record. | | Essentially all of the software needs to be redone with a focus | on a centralized record tracking system. The rewrite needs | practitioners (all of them, not just Docs, but the lowly CNA | too) to drive the requirements. Admins should be included, but | not the target of day to day UI. | [deleted] | BouffantJoe wrote: | I've heard a lot of the same from teachers. | ghaff wrote: | My primary care doctor dropped me a few years back. He said his | solo practice couldn't handle the paperwork of having so many | patients so he went to just seeing patients for his specialty. | | He was admittedly older and had never particularly embraced | computers and so forth. | | (And then my new PCP retired during the pandemic.) | dt3ft wrote: | Isn't there any software for solo practices out there? | JshWright wrote: | Obvious bias, since I work there, but Elation Health is | very focused on building EHR software that makes it | possible for independent primary care providers to be | successful and not have to spend hours per day doing | paperwork. | | https://www.elationhealth.com/ | | Speaking from personal experience, moonlighting as a | paramedic, paperwork is a universal challenge in healthcare | (I often spend more time documenting a call than the call | itself took from patient contact to transfer of care to the | ER). It is shockingly rare for EHRs (regardless of the | speciality they focus on) to actively try to make life | better for the clinician. That's a large part of why I'm at | Elation for my day job; the founders (and therefore the | whole company) have a ton of empathy for the doctors (and | staff) we serve. | ghaff wrote: | He was part of a hospital system so he used their software. | I know nothing about medical software but my impression is | that there is a huge amount of paperwork regardless | involving insurance, prescriptions, testing, etc. Stuff is | more integrated and electronic than it used to be but | there's still a lot of manual interactions, phone calls, | faxes, etc. | pavon wrote: | In the 20 years since I've graduated college, the longest | I've had the same PCP is 3 years, about half of the remainder | I had for 2 years, and the rest I only saw once before they | left and I had to change again. Even if they do stay, they | have to see so many patients (~1000 per PCP is what I've | heard) that they won't remember anything about me, and will | be no better at treating me than a doctor pulled at random. | | For people with chronic conditions a PCP makes sense, for the | rest of us it is just another pointless loop you have to jump | through. | mistrial9 wrote: | almost every single general/primary care Medical Doctor's | office in this area of California closed doors after the year | 2000 or so.. Paperwork related to insurance billing, and | inability to compete with Big Managed Care (Kaiser Health) | for work conditions and benefits, is what I heard as | reasons.. the offices were empty commercial space, it was | noticeable how many there were... | crawfordcomeaux wrote: | I'm so excited about the idea of creating an anarchic healing | network of former medical industry workers looking to create a | new system oriented toward meeting all the needs, not just some & | also not for profit. | next_xibalba wrote: | Sometimes the only way to recognize and solve problems is to go | through a crisis. I hope all of these nurses quit and the rest of | us wise up to how important they are. | | (I have a nurse in my family) | dijonman2 wrote: | Maybe we shouldn't have fired a bunch of them. | kxyvr wrote: | My wife is an ICU physician, so I've been watching this from the | sidelines. I can't emphasize enough on how badly COVID broke the | system. There's always been problem with staffing and burnout. | However, COVID really brought out the worst in people. The | patient population became far more abusive than it had in the | past and this was during a period where all healthcare providers | were working extremely hard, not seeing their families, and | sacrificing their personal health to help people. Then, a large | part of society decided that COVID wasn't an issue, refused to | mask, and refused to vaccinate. At some point, a large portion of | providers decided enough was enough and quit: | | https://www.beckershospitalreview.com/workforce/if-1-in-5-he... | | Now, the problem is that when people started quitting, there were | fewer nurses to take care of the patients and their ratios went | up. During normal times, a floor nurse might be 6-8 patients to | one nurse, a step down unit might be 4-1, and an ICU might be 1-1 | or 1-2. It depends on the level of care required. Now, they're | doing more than double this on a regular basis. And, frankly, | they can't do it, at least safely. There's a number that a nurse | can call if they believe they have an unsafe number of patients | in order to get some kind of legal protection, but they still | have to see that number of patients. And, frankly, it's | incredibly stressful because they really, truly can't take care | of that many patients, so they quit. A friend of my wife is a | nurse trainer at a large hospital. They're having 80% of new | nurses quit during their onboarding process because the ratios | are absurd. A good portion of my wife's time is spent figuring | out who's the least sick patient to discharge from the ICU | because they don't have the staff. | | Unfortunately, I don't think we're even close for this to being | over either. The constant refrain is that COVID is the new normal | and we need to adjust. I would contend that a new normal would | imply a stable operating point and I do not believe this to be | the case. It's going to take a really long time to restaff | appropriately where the patient ratios and stress level | manageable. Long time means years because, really, hospitals want | and need BSNs and not just associates level training. In the mean | time, every time we have a COVID surge, the hospital gets | flooded, everyone gets overworked and abused, and more people | quit. | tomohawk wrote: | What I've seen: health insurance companies and large medical | companies were able to get everything they wanted. The result was | Obamacare. It's been down hill from there. | | I have family members in medicine, and they see the same thing. | There was a really good opportunity at that time to address some | glaring issues with healthcare, and we ended up with this thing | that did not address those issues and created a lot more issues. | Kharvok wrote: | Hospital consolidation into major for-profit networks is largely | to blame | mikewarot wrote: | This is the direct and extremely unalterable consequence of one | decision, to base our medical system on profit, instead of | results, or capabilities. We've left a matter of national | security in the hands of accountants. | | The tragic insertion of a middle layer, the insurance industry | (AKA Death Panels), makes it even more tragic and inefficient. | | You can not seek profits in a competitive environment without | reducing every cost to the bare minimum. Until recently, it | happened slowly, but the public health emergency is a forcing | function that will not be ignored. | | This wave of resignations will be replicated in teaching, by the | way. | sumanmd wrote: | Being a physician, Since IT came, it has alleviated some problems | but has unleashed a monster which tend to cause lot more data | driven to documentation to burnout. Every physician in United | States currently experiences some kind of burn out. Nurses on the | other hand experience much worse, 12-14 hrs shifts of constant | stress. Overall health system in US is broken just as the | insurance system. People will leave jobs when there is no | satisfaction and just burn out. | | In my opinion nurse should have shorter 8 hrs shifts and 4 per | week . In this capitalistic driven health care system, where | being a patient and health care provider comes with a cost. | indymike wrote: | As a patient I dread interacting with healthcare... but I can | only imagine how horrible it would be to be on the clinical staff | where you are wedged between people needing care and 52 bosses | trying to minimize risk, maximize billing, and reduce expenses. | monkpit wrote: | The survey sample was 200 RNs in the USA. | PheonixPharts wrote: | Standard error in this case, assuming the 200 are randomly | sampled is: | | sqrt((p*(1-p)/n) | | sqrt((0.9*0.1)/200) = 0.021 | | So 95% confidence interval for this ~ 0.86 - 0.94 | | Does that radically change the message of this article? | tqi wrote: | That also assumes there is no response bias. The linked | article doesn't seem to go too deep on methods but the source | is a content marketing piece for Hospital IQ, so I'd take it | with a grain of salt. | jonshariat wrote: | Also my first thought when I saw n was 200, lots of surveys | make mistakes in sample selection or question writing but | it seems with the responses here and my own observations | being close to nursing, the main point checks out. Lots of | burn out and leaving the profession. | tqi wrote: | Agree, I'm definitely not making any statements as to | whether or not the burnout is real. I just think that a | lot times the assumptions we make when we apply | statistical concepts (like standard error) to real world | data don't hold up. | monkpit wrote: | It's good information to have in the comments, I was not | making any judgement. | seaman1921 wrote: | lol.. what kind of calculation is this? n is 1 in this case, | the survey was not repeated 200 times from which you derived | 90% as the mean number of nurses quitting. | PheonixPharts wrote: | It's a normal approximation of the expected variance (in | terms of standard deviation) in the estimate of the mean of | the sum of 200 Bernoulli random variables. Each nurses' | response is considered an observation of a Bernoulli | distributed random variable, and we trying to determine the | rate of that variable. | | You are incorrect that "n is 1" since, by that logic one | survey talking to 100,000 nurses would be the same as one | talking to 3. | | If you would like an alternate, more Bayesian formulation | we can use the Beta distribution which is parameterized by | alpha (numbers of 'yes') and beta (number of 'no'). | | This approach is a bit more intuitive than the Frequentist | method since it answers the question "what do we believe to | be the expected rate of nurses answering 'yes'" | | In this case alpha=180 and beta=20, we'll include uniform | prior of alpha_prior = 1, and beta_prior = 1 | | For Betas the posterior is defined quite nicely as: | | Beta(alpha_posterior, beta_posterior) = | Beta(alpha_likelihood + alpha_prior, beta_likelihood + | beta_prior) | | In general for Beta distributions we can compute the | expectation as: | | E[Beta(alpha,beta)] = alpha/(alpha + beta) | | In this case: 181/202 = ~0.9 | | And the variance of a Beta distributed random variable is: | | Var[Beta(alpha, beta)] = (alpha*beta)/((alpha+beta)^2 * | (alpha + beta + 1)) | | Which for our case is: | | 0.00046 | | and the standard deviation of this is just it's square | root: | | 0.021 | | Which gives us the same answer as we get with the normal | approximation. | seaman1921 wrote: | Thank you for taking the time to explain your modelling. | Unfortunately I will need to read more on this topic, | because I do not understand the intuition behind the | priors "uniform prior of alpha_prior = 1, and beta_prior | = 1". | | The way I would generally approach such a problem is by | running monte carlo simulations. Assuming the true rate | of nurses quitting is X, what is the chance that a random | sample of 200 nurses has the expectation of quitting >= | 90%. To get the lower bound of the confidence interval, I | will run this simulation for several values of X, | starting at say X=60%, increasing until I get >95% chance | that a random sample of 200 nurses has E(quitting) > 90%. | Do you think this approach makes sense ? | [deleted] | PheonixPharts wrote: | Simulations are fantastic, and often necessary for tricky | statistics problems, however what you are describing is | reinventing so much of the wheel using simulation that | you are going to be spending multiple orders of magnitude | extra computation to get an approximately correct | solution. You also do have some conceptual errors in your | plan. | | For example | | > Assuming the true rate of nurses quitting is X, what is | the chance that a random sample of 200 nurses has the | expectation of quitting >= 90%. | | You have just described the Binomial distribution [0], | which is probably the most elementary distribution you | learn about when studying probability and statistics | (even the Bernoulli is just a special case of it). | There's no need to run simulations to answer this | particular question. | | There are also some fundamental misunderstandings with | your approach: | | > increasing until I get >95% chance that a random sample | of 200 nurses has E(quitting) > 90%. | | The probability of getting > 90% 'yes/quitting' (i.e. | more than 180) if the true probability 'yes' is in fact | 0.9 is only 0.46. You won't cross your threshold of 95% | here until you reach X=0.933 | | If you wanted to construct the 95% CI from pure | simulation, a better approach would be to sample 200 | observations from a 0.9 Bernoulli random variable (just | sample from a uniform, and check if it's less than 0.9), | compute the mean of the samples, and repeat this 10,000 | or so times. Then look at the empirical CDF [1] (fairly | easy to implement in code) and look at the lower 2.5% and | upper 2.5% values and you have your bounds (which will be | the same as the ones I posted within some epsilon). | | I do recommend, if you're seriously interested in | understanding this, picking up a basic probability/stats | book and work your way through it. | | 0. https://en.wikipedia.org/wiki/Binomial_distribution 1. | https://en.wikipedia.org/wiki/Empirical_distribution_func | tio... | [deleted] | spywaregorilla wrote: | That's plenty so long as the sample is random | [deleted] | vmception wrote: | And for just one year with no information on what they would | have said in other years. | | "I plan on quitting my job if I had money" wow stop the | presses. | degenerate wrote: | I wish there was some law requiring surveying companies to | fully disclose their method of contact and compensation. I can | absolutely see an employee looking to leave their job being | more receptive to taking a survey. Those happy with their jobs | are not as likely to respond to third-party entities like " | _Hospital IQ_ " contacting them. Maybe the survey company | masked this survey as a "pre-screen" to finding new jobs! We | will never know. The process of recruiting survey participants | has GREAT implications on the results. | mikkergp wrote: | Nursing is a underappricated underpaid job, but we can't get | 90% of people in this world to agree that the sky is blue. | bitcurious wrote: | A lot of the work nurses and doctors have had to do over the past | few years has been truly soul crushing. Imagine getting a patient | you know is likely to die and telling them that no, they can't | die at home. No, they can't see their family. No, they can't opt | out of the then. For certain groups of patients, the work of | nurses has turned into death row prison wardens, because there is | a 10% chance they might be saved, and for a while there was no | way to opt out of that. | | Second hand impression from a doctor friend. | badtoro wrote: | I am sure that the policy that forced nurses with natural | immunity to be vaccinated or lose their job has nothing to do | with. | eksx wrote: | I work in tech with no college degree and about 9 years of | programming experience. I make mid 100,000's per year. My S/O has | 6 years of Emergency Department experience and a bachelors degree | and she made about 65k at our local hospital. I think pay is an | enormous factor in this. Her local hospital has nurses with less | than 1 year of experience being preceptors to new grads. | giarc wrote: | She should apply for tele medicine. I knew a few nurses that | took this on during the pandemic and were making about | $50-60/hr from home. I suspect there are fewer opportunities | like this now, but it's worth a shot. | notch656a wrote: | How long did it take you to break 100k? Be sure to include | those pre-employed years when you didn't even know what 'if' | statement meant. A nurse can hit that in 6 years easy through | BSN+NP, and that's starting at literally NOTHING. | (Alternatively there's a like path for PAs to practice in a | mid-level practitioner role that is comparable to NP in those | same 6 years) | eksx wrote: | I spent a bit of time making basic webpages throughout | middle/high school using front page. I didn't start taking | programming seriously until about early 2013. It took me | until about 2019 to hit 100k salary. My girlfriend has 4 | years of schooling and 6 years of experience as a nurse. So i | guess she has even more total experience than I do. | DontMindit wrote: | Anyone can become a nurse. It doesint take exceptional talent | or brains. Programming does though. A nurse can't beat a | programmer for salary, they're in different leagues | narcindin wrote: | When you say "mid 100,000's" do you mean ~150k or ~500K? | jjcon wrote: | I would interpret that as 130k-170k | eksx wrote: | Correct! Thanks for clarifying! | eksx wrote: | Sorry, meant ~150k! | germinalphrase wrote: | I have a close relation that works for one of the oldest | pediatric hospitals in the country. It was recently revealed that | they will be shuttering almost all pediatric services in the next | year because they can 10x their profits by only serving elderly | clients. The _entire purpose_ of this organization was to provide | pediatric healthcare, and it wasn't losing money... | | Sometimes, it feels like we're min-maxing ourselves to death over | here. | dontbeevil1992 wrote: | capitalism | ren_engineer wrote: | capitalism is the reason for hospitals choosing to serve | patients covered by Medicare which will give them a blank | check with tax payer money? | Sohcahtoa82 wrote: | > Medicare which will give them a blank check with tax | payer money? | | Whoever implanted this idea into your head was lying to you | and you should probably question the other claims that | person or organization has said. | gen220 wrote: | Medicare is not a blank check. It's a standard check (see | sibling comment on fee schedules), and each check tends to | actually be quite low of an amount. | | The magnitude of "standard" and "low" are both demonstrated | by the fact that when private insurers negotiate pricing | contracts (basically, a one-off fee schedule) with hospital | groups, they express prices in terms of "medicare | multiples". | | For example, the insurer will pay up to 13x of what | Medicare pays for an fMRI administered under non-emergent | circumstances with medically-justifiable cause. Pretty much | every multiple is >1x, many are far more than 10x. | | And medicare is arguably more expensive to provide, since | the probability of confounding issues from disability or | age is higher than in the general insured population. | | Medicare is very consistent with paying, especially in | comparison to private insurance, but the a la carte fees | are quite "low" by relatively-freer-market definitions (I | say relatively, because the reality is that private | insurers negotiating with hospital groups is the antithesis | of a free market, in most conceivable dimensions). | | --- | | The main reason medical groups lobby against "medicare for | all" is that they will lose lucrative "20xM" payouts from | private insurers, and it's difficult to see how their | ballooning administrative costs can survive on such a lean | diet. | | Of course, this line of thinking is deliberately ignorant | of the thought that medicare fee schedules can be | renegotiated to reflect the population of patients | "medicare for all" would incorporate. But nobody's | interested in thinking two turns ahead, let alone advancing | the game state, when their pockets are nicely-lined on turn | zero. | thedataslinger wrote: | It's not because Medicare offers a "blank check"; after all | --the amount of revenue that the hospital can generate will | always be hard-capped by the number of | beds+/physicians+/resources available. | | They go with Medicare because the pay-out rate (i.e. | "collect-ability") for billable services is much higher-- | and much more predictable--than if they attempted to | collect/negotiate with non-governmental providers. A LOT of | money is lost by hospital systems due to unpaid patient | responsibility (e.g. insurance deductibles), which they can | minimize by offering only services already guaranteed to be | covered by Medicare. | Clubber wrote: | >Medicare ... will give them a blank check with tax payer | money? | | Whoever gave you that idea, you should stop listening to | them. | | Medicare payments are subject to a medicare fee schedule, | which is typically much lower than a traditional private | enterprise's fee schedule. What that means is medicare gets | billed a lot less than a regular patient with insurance. | | https://www.kff.org/medicare/issue-brief/how-much-more- | than-... "Private insurers paid nearly | double Medicare rates for all hospital services (199% of | Medicare rates, on average), ranging from 141% to 259% of | Medicare rates across the reviewed studies." | "The difference between private and Medicare rates was | greater for outpatient than inpatient hospital services, | which averaged 264% and 189% of Medicare rates overall, | respectively." "For physician services, private | insurance paid 143% of Medicare rates, on average, ranging | from 118% to 179% of Medicare rates across studies." | LewisVerstappen wrote: | The healthcare system in the US clearly has nothing to do | with free markets considering how unbelievably opaque and | regulated everything is. | cowpig wrote: | There's no such thing as a "free market" for healthcare. | The ability for consumers to exit a market is one of the | prerequisites for the invisible hand effect. You can't exit | the healthcare market. | nickff wrote: | You also can't exit the food market, or the shelter | market, or the clothing market, yet those seem to work | much better. | landryraccoon wrote: | Food, shelter and clothing generally have discoverable | pricing. | | I challenge you to find the price of a cancer treatment | regime protocol in the United States. I will bet you any | amount of money you care to wager that no US provider | exists anywhere that will give you a price quote for lung | cancer treatment in writing anytime before that treatment | is provided. | | And even IF you could, that only covers the cases where | you are still have enough health and mind to rationally | evaluate the prices. If you've been in a car accident and | are dragged unconscious and bleeding into the ER, you | can't shop around, even if they DID give you a price, | which they certainly won't until you're already treated. | nickff wrote: | I agree with your points, but I think there are narrower | solutions. With respect to pricing, the problem seems to | be the negotiations between hospitals and insurers, as | well as hospitals' failures to institute cost-accounting. | Forcing them to do better accounting, and have a clear | price-list would probably help, but getting rid of the | employer healthcare tax subsidy (or expanding it) would | likely be a better solution. | | With respect to ER care, it does seem impossible to 'shop | around', but these cases make up a minority of healthcare | expenditures. Perhaps government should cover these cases | (though this could have horrible incentive problems), or | this type of insurance should be separated from the rest, | and somehow priced clearly and in advance (according to | level of care) by a cartel arrangement or state regulated | rates. | jewayne wrote: | > Forcing them to do better accounting, and have a clear | price-list would probably help, but getting rid of the | employer healthcare tax subsidy (or expanding it) would | likely be a better solution. | | Believe it or not, it would be way easier politically to | implement Medicare For All than to do piecemeal reforms. | nickff wrote: | 'Medicare for all' will cause a number of foreseeable and | unforeseeable problems (and benefits). It would be | interesting to see one or more states do it, and observe | the results. | jewayne wrote: | I think the experience in Vermont suggests that it's | unlikely to ever happen at the state level. It's far more | likely to be a big bang at the national level. | dragonwriter wrote: | How can a state do universal single payer of its own | design when there are multiple direct federal health care | systems covering a substantial portion of the population, | plus a huge tranch of the money states rely on for health | care tied to a federal/state cooperative program with | federal programmatic and eligibility constraints? | marcusverus wrote: | You can't exit the food market, either, and yet there is | clearly a thriving free market for food. How does your | theory account for this? | Sohcahtoa82 wrote: | This is a bad faith question asked without any basic | thought. | | Within 5 miles, I have at least 10 different grocery | stores to shop at. Each will carry hundreds of products | at less than $10 each. Not only do I have tons of | choices, but the pricing is completely transparent. And | that's just grocery stores. Add restaurants (Both sit- | down restaurants and fast food), and that number quickly | reaches over 100 within a 5-mile radius. | | If I'm in a medical emergency and someone dials 911, I'm | likely just being brought to the nearest hospital. I have | zero choice in the matter, and will come out with | whatever bill they want to charge me. | | Even in non-emergencies, good luck shopping on price. | Doctor offices don't like giving that out. | | There's competition in the food market, but not | healthcare. | jewayne wrote: | 45 million Americans are on the SNAP (food stamp) | program. Does your definition of "thriving free market" | account for this? | wcfields wrote: | I think you're being purposefully obtuse, but here's why: | | - SNAP / EBT / Foodstamps for people making so little | money. Add onto that, Food banks. | | - Farm subsidies for many cheap foodstuffs (Corn) causing | massive cheap, albeit junk food that can sustain. | | - I can literally grow food in the ground for "free", put | it in mason jars and save my food for a year. I can't | open a fresh can of broken-arm at the fixed cost. | | - Food is fungible, if I'm hungry, I can wait 2, 3, 8+ | hours to eat, or have a quick snack until meal time. It's | not like I need a Big Mac infusion in the next 10 seconds | or else I'll die from lack of special sauce. | | - You have many options of food. You can eat Soylent, | rice&beans, or steak for every meal at various price | points. You don't really get an ala carte when it comes | to Chemotherapy. | | - You can always eat monkey pellets [1] | | [1] https://www.reddit.com/r/moreplatesmoredates/comments | /qbfkfl... | asimilator wrote: | > I can literally grow food in the ground for "free", put | it in mason jars and save my food for a year. | | This is true only in an extremely pedantic, unrealistic | kinda way. If it was easy/free everyone would be growing | all their own food. | germinalphrase wrote: | At least here in the Midwest, people grow food all the | time. Can't grow strawberries in December, of course - | but we eat up canned goods from friends/family throughout | the winter. | throwawayboise wrote: | Sure you can. You can decide that you are not going to | enrich an industry that basically does nothing for you in | the long run. Everyone ends up dead, and I for one do not | plan to spend my final years under constant care from a | industry that is designed to drain every last dollar I | have before I pass on. | jewayne wrote: | I think the majority of people say something to that | effect at some point in their life. But the only real | alternative is suicide of some kind, and how many people | actually follow through with suicide? | jerry1979 wrote: | That's probably why the commenter (blithely) said | "capitalism" which is the name of the economic system which | produced the health care system in the United States. | marcusverus wrote: | By that line of reasoning, capitalism produced Social | Security and communism is produced Alibaba. | marcusverus wrote: | By that line of reasoning, capitalism produced Social | Security and communism produced Alibaba. | whimsicalism wrote: | I don't think the US can be summed up with a single word. | | Can I hire my friend who is a medical student to perform | surgery on me legally? No? | wcfields wrote: | > I don't think the US can be summed up with a single | word. | | I think it can, I've been thinking about this and it's | "scam". | | Like, think how often everything in our country is a | straight up scam. Healthcare, parking tickets, basically | anything you buy. It's almost all snake-oil flim-flam | every which way and as a 'consumer' you have to wade | through the mire every single day to get scammed as | little as possible. | yoyohello13 wrote: | So true! Everywhere I turn it's just people trying to | extract the maximum amount of money from me for the | minimum amount of value in return. It can't be good for | our psyche. | LewisVerstappen wrote: | Sure, but that's like blaming "humanity" for all the woes | of the health care system. It's humans who produced the | health care system in the US after all. | | You have to be more precise as there are clearly aspects | of capitalism that have resulted in tremendous | improvements in quality of life (look at North Korea vs. | South Korea). | | Regulatory capture is one of the issues & revolving door | politics. Especially a big problem in the healthcare & | finance industries (the current head of the SEC spent his | career at Goldman Sachs for ex.) | whatshisface wrote: | I don't even think Marx would agree with that. He thought | capitalism produced a stage of history that wasn't | exactly capitalist, which then would inevitably produce | communism through socialism. | frgtpsswrdlame wrote: | I doubt Marx could have thought of something more | capitalist than $THC or $HCA. | orwin wrote: | It is what he called late stage capitalism. He might have | been wrong on the solutions, but he nailed the problem | quite well. | whatshisface wrote: | He could have and did: factories and craftspeople from | Adam Smith's world are the epitypes of capitalist | activity. Giant corporations that half-merge with the | government are Marx's final, dying and barely capitalist | stage of capitalism, that hardly involves markets at all. | He thought capitalism (factories and craftspeople) would | reach the end of its lifespan and give birth to $THC or | $HCA. | callmeal wrote: | >The healthcare system in the US clearly has nothing to do | with free markets | | Ahem. Regulatory capture would like a word. | dnissley wrote: | How has regulatory capture helped create the US | healthcare system? | yhoneycomb wrote: | Actually, that's exactly how unfettered "free market" | capitalism operates. The end game is big companies end up | controlling everything, including the regulations in order | to tip the scales in their favor. | LewisVerstappen wrote: | Regulatory capture is the issue that needs to be solved. | _Not_ free markets. | | Free markets are the most efficient way for information | to be transferred throughout the system. | | Stricter campaign finance laws, ending revolving-door | politics, etc. | | But putting the blame on free markets seems like a | mistake. | frgtpsswrdlame wrote: | Feels a lot like 'Real free markets have never been | tried!' which we all know from its standard form on the | left. If, at this point in history, real free markets | have been unable to sustain themselves in the areas of | the economy that people depend on the most (healthcare as | a major example) then perhaps we ought to consider | whether they're able to sustain themselves at all. I | believe free markets and meritocracy are two systems | commonly pointed to today that may be 'ideal' in one | sense or another but which in practice cannot help but | sow the seeds of their own destruction. | | Markets exist by virtue of laws created by governments - | property law being the primary example - expecting actors | in a free market who aggregate enough wealth to affect | those governments not to just strikes me as unrealistic. | It reminds me a bit of gaming. Everyone agrees that in a | competitive game the most fun part is early on before a | 'meta' can be established. But of course that meta will | always end up established and it's basically dumb to be | mad at people for metagaming or to otherwise expect them | not to. | tverbeure wrote: | Instead of advocating for and gambling on a "free market" | health care system that has never been tried successfully | anywhere, and hoping that it will work out (because | dogma?), why not advocate for systems that have been | tried all over the world that have been proven to work? | | I'd sign up for a significant increase in my taxes if the | US system were replaced by the system that I experienced | in Belgium for the first 30 years of my life. | | And by successfully, I mean: everybody, irrespective of | income or status, can expect to get the care they need. | throwaway0a5e wrote: | It takes an exceptional breed of ignorance to say "just | implement whatever <country> has" as if that is a silver | bullet and that the same forces that caused the current | debacle wouldn't also do their magic on anything we | attempt to transition to. | | If it was as easy as paying out way out of the problem | we'd have done it already. | tverbeure wrote: | It also takes an exceptional amount of knee jerk assery | to interpret my comment as "change the US system to the | Belgian one". The Belgian system is one that works more | or less from my experience. Most inhabitants of Germany, | France, the Netherlands, and others will claim the same | for theirs. | | Nobody is claiming that the US should copy the system of | some specific country verbatim. But it's equally dumb to | dismiss the common traits of these other systems, and say | "nah, let's do just the opposite." | throwaway0a5e wrote: | >It also takes an exceptional amount of knee jerk assery | to interpret my comment as "change the US system to the | Belgian one" | | Well you literally said "I'd sign up for a significant | increase in my taxes if the US system were replaced by | the system that I experienced in Belgium for the first 30 | years of my life" so why don't you tell me how that was | supposed to be interpreted? | | America shares a very long border with a nation with a | functional healthcare system and we generally prefer to | compare to them. | tverbeure wrote: | I wrote "why not advocate for systems". Notice the plural | form. Did you assume that by writing "all over the | world", I actually meant the superpower of Belgium? | | What all those systems have in common is that they are a | mix of free market and strong regulation. The opposite of | "let's do even more free market than what we have now." | | I don't know how the US can get there. It's probably | impossible, just like school shootings and the "No Way To | Prevent This,' Says Only Nation Where This Regularly | Happens" argument. | pitaj wrote: | The free market healthcare system in the USA worked great | up until regulations pushing out mutual aid societies | completely changed it. Costs were affordable for | everyone. | | http://freenation.org/a/f12l3.html | JaimeThompson wrote: | >Free markets are the most efficient way for information | to be transferred throughout the system. | | Would such a market allow NDAs? | thomasahle wrote: | Monopolization and regulatory capture are standard | features of free markets, if you leaving them running | long enough. | AlexandrB wrote: | > Free markets are the most efficient way for information | to be transferred throughout the system. | | What do you think of VC-funded "growth" companies that | lose money for years while providing products/services at | below cost? Is this a case of the free market working or | of it being subverted? | thedataslinger wrote: | Wait, wait, wait--you're saying that we need to solve | issues like regulatory capture through legislation... so | that we can have a market without governmental | interference (aka a "free market")? Huh? | | You can't on the one hand tout the "free market", while | on the other complain that we don't have the "right" kind | of governmental interference. | | Even if you could square that circle, it still sounds | disingenuous to argue that we could have the most | efficient system if only we were to eliminate _thing that | said system actively encourages_. The failure is baked | into the game, my friend. | Cederfjard wrote: | I don't think that reasoning is necessarily unsound. For | there to be regulatory capture, there needs to be | regulation. The legislation proposed could be to remove | or minimize that regulation, and thus limit the "hooks" | whereby to capture it with. Replacing "governmental | interference" with "less governmental interference", not | "different governmental interference". | | I don't take such a libertarian view myself, by the way. | Just pointing out that I don't think you can pick apart | the argument of the person you replied to in that way. | elhudy wrote: | The healthcare industry disaster wasn't born out of | regulatory control - though money does now follow the | regulations. The disaster was born out of regulatory | mistakes(in particular, look back to the 1940's when the | govt made it tax free to offer health insurance as a | benefit). [1] | | The industry is an onion and in order to understand why | it is the way it is today you need to peel back all of | the layers that have been added by the govt over time and | the unintended consequences of those. | | [1] https://www.npr.org/2020/10/07/921287295/history-of- | employer... | lghh wrote: | There is no such thing as free market capitalism. This is | why the parent comment said "capitalism" and not "free | markets". I assume that's what you meant by putting "free | market" in quotes, I'm just making an explicit | clarification. | Clubber wrote: | I would say the drug cartels are about as close to free | market capitalism as we have today. They are largely | unregulated because they can either buy off the | regulators / government, or fight them with armies. | slothtrop wrote: | The U.S. economy isn't unfettered free market, including | in this sector. The policy is just bad. | Aperocky wrote: | > they can 10x their profits by only serving elderly clients. | | I knew of certain defunct malls that decided to get rid of | things that doesn't make money and only keep the high profit | inventories. | | Soon people stopped coming and they went under.. | mumblemumble wrote: | The Invisible Hand works generally fine-ish for non-essential | and commodity goods. People might be sad their favorite store | went away, but, for the most part, life goes on. It seems to | even be the least bad way to handle these sorts of things. | | It's a bit harder for me to see this as an acceptable | approach to health care. Not every segment of the economy | needs to be a constant drunkard's walk in search of maximum | profitability in the aggregate. Sometimes what the public | actually desires is stability and reliability. | throwawaygh wrote: | _> > they can 10x their profits by only serving elderly | clients._ | | _> Soon people stopped coming_ | | Ah, yes. Why didn't we think of this before? By increasing | the cost of (geriatric) healthcare, we can destroy demand. | That's how supply/demand curves work right? In this way the | invisible hand delivers unto us a fountain of youth ;) | Aperocky wrote: | They may 10x their profit by serving elderly clients but | that is assuming x more elderly clients would want to | suddenly come. | | But why? Are elderly clients underserved in that area? Are | they going to ditch their original care provider and all | come here? | throwawaygh wrote: | _> But why?_ | | Old people in the USA are EXTREMELY wealthy in terms of | healthcare purchasing power. All retired people have | medicare. Many retired people have additional healthcare | coverage from their former employers (doesn't exist | anymore -- disappeared along with pensions -- but this | benefit used to be common). Many retired people have | significant savings in addition to medicare and private | health insurance. | | Most new parents have little to no government assistance, | do not have significant expendable income, and have | little to no accumulated wealth. Children, of course, are | even poorer than their deadbeat parents. | titanomachy wrote: | If we stop providing health care to young people, then | everyone will just die and there won't be any old people left | to profit off of. | cryptonector wrote: | No, more likely you'd see a ton of alternative medicine and | self-diagnostic/treatment options for young people. I'm not | entirely sure that I wouldn't want this. | ugh123 wrote: | Capitalism and health care just don't mix | whimsicalism wrote: | > The entire purpose of this organization was to provide | pediatric healthcare, and it wasn't losing money... | | If it's entire purpose was to provide pediatric healthcare it | should probably have registered itself as a not-for-profit. | germinalphrase wrote: | Why register as a not-for-profit when you're profitable? | dragonwriter wrote: | > Why register as a not-for-profit when you're profitable? | | If your purpose isn't to return a profit to stakeholders, | but to serve some social purpose eligible for charity | nonprofit status plus like "pediatric healthcare", | registering as a nonprofit gives you more surplus revenue | because of tax exemption _and_ the ability to accept | donations that are tax deductible for the donors. | | It's also often good PR. | anonporridge wrote: | Cronus devouring his children. | black_puppydog wrote: | Yeah if they're only after profits, why not become a hedge | fund? | 93po wrote: | Many are owned by hedge funds: | | https://www.nbcnews.com/health/health-care/private-equity- | fi... | Kranar wrote: | The majority of hedge funds fail within 3 years, having never | reached profitability. | whimsicalism wrote: | Becoming a hedge fund is actually a bad idea if you are only | after profits because it is unclear that over long-time | horizon this is actually a very profitable activity. We only | remember the winners. | Bilal_io wrote: | So, a hospital can close a service with no repercussions, and | if workers at a "critical" secure decide to strike they'd be | ordered by a judge to get back to work... | | I hate every part of it. | divbzero wrote: | There seems to be two sides to this. | | The first, mentioned already in this thread, is that maximizing | profits should not be the ultimate yardstick in all cases. | | The second is that we are not setting incentives correctly in | healthcare: preventative care still plays second fiddle to | curative care. If the healthcare industry were purely free | market, this could be attributed to individuals not | understanding the long-term benefits of preventative care, or | overly discounting the distant future. But the healthcare | system is _not_ purely free market. The largest payers, public | and private, could do a lot to correct the incentives by | setting their reimbursements accordingly. | hedora wrote: | We're facing some massive generational crises at this point, | and it feels like the only solution is to wait for the current | leadership to die off, and hope the gen x'ers fix it. | | The WWII generation fixed the ozone hole, but their kids didn't | lift a finger for global warming. | | Subsequent generations are scrambling to pick up the pieces for | our kids, while crap like this, and our rapidly collapsing | democracy keep sabotaging our efforts. Heck, in California, | we're actively causing psychological harm to an entire | generation of kids (with masks) because of a tiny minority of | anti-vaxxer school teachers. | | Of course, progressive boomers exist, as do idiotic younger | people. However, the current generation of leadership in the US | has completely failed us. | | Anyway, it's not surprising to me that that crowd decided to | shunt healthcare resources away from their (great) grandkids | and into elder care. | ISL wrote: | The WWII generation may have worked to fix the ozone hole, | but they also unknowingly created it: | | https://en.wikipedia.org/wiki/Chlorofluorocarbon#History | karmelapple wrote: | And all of the generations helped create climate change, | yet we're not doing all that much to comprehensively combat | it at a government level. | whimsicalism wrote: | > The WWII generation fixed the ozone hole, but their kids | didn't lift a finger for global warming. | | Let's not pretend these are comparable challenges. | | > our rapidly collapsing democracy keep sabotaging our | efforts. | | When people say stuff like this, are they being hyperbolic or | do they actually mean it? How long is the democratic | tradition in the US that is collapsing? | germinalphrase wrote: | If they're not being hyperbolic, they might be reacting to | stories like this: | | https://talkingpointsmemo.com/news/j-michael-luttig-op-ed- | ja... | rurp wrote: | We just had a candidate openly try to steal the last | presidential election and face no real consequences as a | result. In fact, it likely strengthened his position. 10 | years ago I would have thought the end of American | democracy was extremely unlikely, now though we're only a | few small steps away and that bridge could be crossed at | any point. | | This isn't some outlier event either, democracy has been | receding around the world for years. I really, really hope | the trend reverses itself, but am scared at how real the | threat is. | whimsicalism wrote: | I don't think we were even _remotely_ close to somehow | Trump remaining on as president. | | > democracy has been receding around the world for years | | I am skeptical. Majoritarian democracy in the US has only | really existed for 40-50 years and I perceive it as | continuing to expand both here and abroad. | cogman10 wrote: | While I think SOME longevity in congress/the senate is a good | thing (You get more done). I really wish we had something | like an age cap. | | It's really crazy that the only way it seems like we can get | these senators/congresspeople out of office is death from old | age. | | The fact is, your mind DOES deteriorate when you get older. | That's why so many phone scams are special built to target | older people. | | A change I'd make to the constitution is that "nobody over | the age of 70 can hold a governmental position". | manmal wrote: | Please, don't spread ageism. Yes, brains perform worse in | many kinds of ways when they age. But that's highly | variable. And there are narcissists and sociopaths in every | age group. | throwawayboise wrote: | Mandatory retirement is a thing in a lot of professions. | Should be in government as well. | usrn wrote: | It's possible we have _too much_ democracy. A lot of stuff | got changed because we thought the previous configuration | didn 't make sense but it may have been that way for a | reason. | JaimeThompson wrote: | Which things do you thing should change back and what | should they change back into? | I-M-S wrote: | End to NIMBYism. Current homeowners should not be able to | block new developments and encase a neighbourhood in | amber. | JaimeThompson wrote: | It would need to apply to everyone. No more of this open | up single family housing is this middle class area while | protecting the parks / forest in the wealthy areas. | | What about things like AirBnB? Limiting those is a form | of NIMBYism as is limiting where factories and polluting | buildings can be placed and/ran. | whimsicalism wrote: | We want people to be housed in the places they want to | live which is why we want to lessen restrictions on | building. | usrn wrote: | whimsicalism wrote: | No more election of judges. | | Campaign finance restrictions. | | Referenda that can't be overriden by legislature should | require 50% of eligible voter population to support, not | 50% of voters in that particular election. | | No special elections. | bsedlm wrote: | > We're facing some massive generational crises at this | point, and it feels like the only solution is to wait for the | current leadership to die off, and hope the gen x'ers fix it. | | oh man, I choose to laugh so I don't start crying hahaha. | | I want to turn this into an argument of why age-reversal and | other longevity research is such a bad idea (personally, I | think it's kind of evil; but maybe I've seen too many | villanous cartoon characters throwing everything under the | bus so the can live forever). | wardedVibe wrote: | I mean, making sure Putin doesn't live forever seems like a | pretty high priority to me. | | There's also the fact that science might lock up, since old | scientists have more reputation at stake in the old | theories (there's an adage "science advances one funeral at | a time"). We're not ready as a species for immortality | BLKNSLVR wrote: | That quote applies to many (all?) disciplines: | | "X advances one funeral at a time". | archon810 wrote: | Can you share the hospital name? | bkjelden wrote: | Not surprising. My partner is a DNP and has pretty strongly | considered leaving the entire profession. | | From my perspective, the entire healthcare industry is set up to | treat any frontline worker without an MD after their name as | completely expendable, nothing more than a row in a spreadsheet | that can be optimized for middle management to hit next quarter's | bonus targets. | | You can meet all metrics management sets out for you, have | amazing patient satisfaction scores, etc, and every 6 months some | spreadsheet wielding online MBA graduate is going to show up to | turn the screws and tell you you need to work harder for the same | pay, and to just be happy you aren't getting laid off. | | At some point in time, the workers realize the joke is on them | and find another profession. | vincnetas wrote: | Do nurses have work unions? Would that solve the issue? | tick_tock_tick wrote: | Yes, they have massive unions but that doesn't seem to be | helping. | asmithmd1 wrote: | Yes. Massachusetts which is NOT a right-to-work state. That | means the union can negotiate a clause in the contract that | any nurses working at the hospital must join the union. Here | is a current contract that includes pay ranges: | | https://www.massnurses.org/public/resources/bargaining- | unit/... | | 'Step' is years of experience | bkjelden wrote: | In some states, RNs working in hospitals are unionized. And | that does help with some of the things I mentioned. | | Outside of hospitals, and outside of RNs, unionization is | much less common. E.g. in a clinic setting very few employees | are unionized. | UnpossibleJim wrote: | This is totally anecdotal, so take it for what it's worth, but | in addition to nurses leaving the profession I've seen quite a | few doctors in my area leaving the profession as well. | Relatively young men and women retiring the profession | completely post pandemic, though I haven't had an opportunity, | nor would I, to ask them why they left the position. I have no | idea if it has anything to do with the pandemic or the | administration or working with insurance =/ | | here are some "articles" on the subject: | | https://www.bmj.com/content/373/bmj.n1594 | | https://www.beckersasc.com/benchmarking/22-of-physicians-con... | | https://www.medpagetoday.com/practicemanagement/practicemana... | | And one of these articles (the last) is from 2013, talking | about a change in healthcare practices (corporate unification), | the ACA (limits on accepting medicare patients) and the health | reform law (liability reform). So, I guess medical burnout has | been coming log before Covid and we have just been ignoring it? | bkjelden wrote: | I have no doubt that MDs are leaving as well - but, at least | from my perspective, in any large healthcare system, there is | a drastic difference between the way middle management treats | MDs and the way they treat everyone else. The latter is | completely expendable, whereas the MDs do have a fair amount | of negotiating leverage around their working conditions. | UnpossibleJim wrote: | Oh, don't get me wrong. The way nurses are treated is | horrible. I wasn't arguing that and I hope it didn't come | across that way. | bkjelden wrote: | Not at all! | | I'm just sharing what I've seen - middle management | treats MDs drastically different than NPs and PAs, even | in states where the latter have almost the same scope of | practice. | | This is not to say that MDs don't have their own reasons | to be mad at the system - insurance, changes in patient | attitudes, etc. | thr0wawayf00 wrote: | Doctors aren't happy about it either. | | I was at my family's Easter lunch last week and one of my | uncles who's an MD was telling me about the mass exodus of | doctors from the profession since COVID hit. Anyone who was | thinking about retiring did so once the pandemic took off. | | He then tried to convince me that I'm not too old to go to | medical school. Yeah, no thanks. | derekdahmer wrote: | Same story from my partner who is a PA. The private practice | she worked for for years got acquired by a big name system and | over the next 2 years they "optimized" a job she loved so far | that she had to leave. | | By the end she was seeing twice as many patients a day as | before with no time to do admin stuff at work even after | skipping her lunch break so she also had to do more work when | she got home. The reward for doing double the work as before? A | 10% pay increase barely above inflation. Meanwhile a few | coworkers left and no new ones were hired so the workload just | kept increasing. | | It puts providers in such a bad position because the only way | to push back is to drop the level of care, which has real human | consequences. | xeornet wrote: | Many people in many professions have the same considerations | about leaving. But then they realise they have a mortgage to pay, | responsibilities (debts) they have signed up for, and never | leave. Such is the system. | rdtwo wrote: | Another wage shortages (for the quality of work conditions) that | will be reported as a worker shortage | poorbutdebtfree wrote: | People should stop giving them such a hard time for dancing every | once in a while. | oliverafajardo wrote: | My experience: I'm an icu nurse in the sf bay area. I make a good | salary. However, you can make this and more with a job with less | physical and emotional stress/abuse. Even the "best" hospitals | like kaiser/stanford/ucsf are always short staffed. I considered | another area of nursing/hc but it's really all the same BS of | being short staffed, constantly being denied vacations, etc. | | I feel like a waitress, custodian, social worker, therapist, | punching bag and other stuff - It's never ending. This has | effected my mental health so much that I am slowly doing my | career switch to SWE. While I know every job has it's own | difficulties bs/stress/politics, the one's i deal with as a nurse | now I can no longer deal with. I don't regret this career path | because it has taught me a lot, and their is something better for | me out there. | | Career: I did consider other areas of nursing, but they didn't | satisfy me, ICU is relatively the most enjoyable for me. On a | regular hospital floor/intermediate floor, a nurse will be given | 4-5 patients and let me tell you its a ZOO! In ICU i only have 2, | and those keep you busy the whole shift. They're both different | kinds of crazy. | | I will say, being a nurse in California is 5x better than | anywhere else simply because their are laws that allow us to have | uninterrupted breaks! | gsatic wrote: | Depressing. It's like we are losing control of different | subsystems of Jurassic Park every single day :( | gigel82 wrote: | We've read similar reports about the "great resignation" with | software engineers. Attrition is actually lower now than it was | before the pandemic, so... | rel2thr wrote: | Wages need to go up. Also I think there will be a big push to | open up immigration to nurses and doctors over the coming decades | | Kind of weird that the usa prioritizes software developers over | healthcare workers in the immigration system . | lotsofpulp wrote: | There has long been an immigration program for foreign doctors | to gain the right to live and work in the US in exchange for | first living in a rural/poor part of the US where most doctors | do not want to live. | aluva wrote: | If have a nursing degree it's easy to immigrate to USA, in fact | you will be coming in with a green card unlike tech worker. So | to your point, US does prioritize nurses over others. Doctors | are different and it's incredibly difficult for a doctor with a | foreign degree to practice in US. I know this for a fact since | I come a place where almost every other house has a nurse | working in Europe/US | lotsofpulp wrote: | https://www.uscis.gov/green-card/green-card- | eligibility/gree... | | Immigrant doctors have to be willing to live in the least | popular parts of the US. | | > One reason USCIS may grant the national interest waiver is | because a physician agrees to work for a period of time in a | designated underserved area. | maerF0x0 wrote: | Cynicism and complaint is our zeitgeist. Answer me how many | actually left in year prior if you want my attention. | | Lots of considering leaving a profession, also considering losing | fat on Jan 1, and saving for retirement. | | When people are surveyed there is a big difference between why | they say and why they actually are doing the action. For example | "Yeah, covid has been tough... and those insurance companies | though... And doctors really dont respect my profession... Oh my | [pregnancy/parental leave/dream of being a DJ]? yeah that has | nothing to do with it." | | These kinds of opinion surveys are just barely "science" . | hemreldop wrote: | tmcw wrote: | Similarly via a quick Google search: | | - "Almost HALF Of San Francisco Residents Considering Leaving | City" (according to survey of 500) | | - "One in three New Yorkers Considering Leaving The State" | | - "Over Half Of Young Lawyers Considering Quitting by 2027, IBA | Report." | | Look for X people considering Y, and you'll find them. | Considering is cheap. | | The awful experience of nurses, absolutely, true. But this, like | so many others, is a silly poll that doesn't say anything. | tsol wrote: | I don't mean to by cynical, but this is kind of my feeling. | Throughout the pandemic I saw story and story about nurses | getting overworked and being underappreciated. There was lots | of talk of a nurse exodus.. and yet it's never happened. Even | now it's just talk of a possible exodus. Maybe there are just | no similar fields to switch into with comparable pay, but it | seems as though nurses are sticking it out in the grand scheme. | Are plenty of older nurses retiring? Yes. Are some younger | nurses also leaving the field after being burned? Yep. But for | the majority of nurses, the pay is still worth all the | difficulty they see. Hearing about a co-worker getting attacked | by an anti-vax patient is alarming, but until it happens to you | you're not gonna make any major life changes to avoid that | chimprich wrote: | My wife is a nurse in the NHS. She actually saves people from | cancer, or at least prolongs their lives. Her work is difficult, | with huge responsibility. She gets a pay cut this year in real | terms. | | I make slight improvements to computer systems. In most of the | jobs I've done, despite my best efforts to work for reasonably | ethical companies, I've not been convinced I've made anyone's | lives better. Yet my salary is 2-3 times hers. | | I find it hard to believe there can't be a better way to arrange | this kind of stuff. | mikkergp wrote: | It's an interesting problem, because we currently align | economic 'productivity' and pay rather than social value and | pay, which is efficient since we don't have to redistribute | resources between industries or roles, and resource | redistribution is a dirty word, at least in America. My wife is | a doctor and I make significantly more than her working as an | SRE, when her job is significantly more difficult (particularly | emotionally) and time consuming than mine. She's paid | relatively well on a societal scale, but I'd still call it a | labor of love. If you're not in one of the high paid | specialties, you don't do it for the money. | | Even in the (US) medical system, pay/insurance reimbursement is | based on the number of procedures you do, not how involved the | treatment is. This is why surgeons get paid so much more. | dudul wrote: | We do not align productivity and pay, we simply align pay and | how difficult it is to find someone to do the job. | mikkergp wrote: | Not directly, but indirectly, this is one reason why bigger | companies can pay more than small companies, more | efficiencies, automations, and economies of scale means the | output per employee is higher. | gruez wrote: | >It's an interesting problem, because we currently align | economic 'productivity' and pay rather than social value and | pay | | How do you define and measure "social value"? | tomatowurst wrote: | Athletes and celebrities are paid because of economic | productivity? It definitely seems like social value based on | restricted supplies. | | If there are lot of participants in a labor pool, naturally | wages will be under constant pressure. The barriers to entry | also play a role. | | For those RN's quitting, they will simply be replaced by | foreign workers. It's similar to how certain jobs no longer | have locals in it anymore, instead relying on migrant | workers. It's the reality in Singapore for instance and | naturally creates an implicit caste system. | | Now the markets have evolved/evolving where incumbent locals | are no longer granted the same privileges they once enjoyed, | somebody who does not have the luxury to consider | alternatives will be the ones who fill the jobs, and get the | blame when the descendants of local incumbents cannot make | their way back. | | This is sort of the system I am seeing emerging and it | explains the anxiety of us vs them. In reality, the | government, markets simply do not care for such | superficiality. It seeks to accomodate those who are | productive, not sit around waiting for higher powers to | "fix". And as such, this dynamic ensures wages in certain | industries stagnate, and it's especially true in markets with | the characteristics I mentioned above: low barrier to entry | and abundant supply of labor. | r3trohack3r wrote: | Anecdotally - I have an acquaintance exiting the field of | pediatric nursing. They worked in the ICU and with chronic | conditions (cancer, heart disease, etc.). | | The deaths were always hard when working with little kids - and | there were a couple a month. But towards the end of COVID they | were losing 4 kids PER WEEK (anecdote - I have no data other than | listening to them vent) that this nurse firmly believed were | avoidable had they received appropriate care. | | What caused them to exit was how the hospital handled COVID: they | postponed all elective surgeries. For these children, an elective | surgery was anything where they "wouldn't die tomorrow" if the | surgery wasn't done (somewhat of an oversimplification - but | ballpark correct). | | During that time hearts got worse, cancer progressed, bodies shut | down until electives became emergencies... Success rates of | surgeries dropped. And once restrictions started lifting the | staff was underwater, they had a huge backlog of "electives" | piled up on top of the normal ingress - kids were dying from | waiting. | pessimizer wrote: | They'll leave with the teachers. Female-coded professions being | derided for political capital as often as "inner-city crime" | might tempt one to wonder which came first, the female-coding or | the disrespect. | | Just kidding. Teachers used to almost all be male until public | schooling and the resultant budgeting turned them female (to pay | them less.) It's like reverse computer-programming where the | profession turned male when they started paying more. | | Pay them and they won't leave. Pay them a lot, and dudes will | start writing essays about how the reason women aren't being | hired and are leaving the profession is because they naturally | have less of an interest and aptitude for nursing than males. | tomatowurst wrote: | There's no need to politicize this off completely unrelated | tangent. The whole industry is under stress. It won't change. | They will just hire foreign workers to deal with shortages. | nickstewart wrote: | My wife is a NICU nurse at a major NICU... she has worked there | four years and is almost at her maximum pay, outside of COL | increases, so right now she makes around $64k a year before | tax/etc.. | | The travel nurses make significantly more and now that she has | basically hit her cap (after just four years) I've been trying to | convince her to move to a different unit or get a different job | Victerius wrote: | U.S. nursing salaries relative to average U.S. wages are above | the OECD average: https://www.oecd- | ilibrary.org/sites/health_glance-2017-58-en... | | So pay isn't the problem. | | The U.S. is also above the OECD average for the number of nurses | per 1000 population: | https://www.researchgate.net/publication/334515420/figure/fi... | | So staffing isn't the problem either. | | The U.S. is below the OECD average for the number of doctors per | 1000 population: | https://www.nurses.co.uk/Images/Blog/media/ddad9fa9-b06d-43d... | | If nurses could work a regular 40 hours a week and be paid more, | as they would like, the additional money and staffing need to | come from somewhere. In the United States, we've decided that | private hospitals could have the right to exist. Most nurses are | thus beholden to a free market. So the question is why other | hospitals aren't trying to poach nurses with better wages and | schedules. The reason may be that the supply of nurses remains | large enough that hospitals don't feel pressured to make these | concessions. The business model of hospitals is also drastically | different from that of, e.g., tech companies. Tech companies can | afford to pay their employees outrageous salaries because it is | possible for one software engineer to create a product that will | generate $100M in revenue. A nurse's labor has a cap on how much | economic value it can generate. Hence why nursing salaries are | constrained. | shadowofneptune wrote: | From such a high level, staffing may not seem like a problem. | When it comes to the hospital floor level, staffing's been a | big issue these last two years. Keep in mind that the common 12 | hour shift for a nurse came about because of 70s staff | shortages. | chrisseaton wrote: | > U.S. nursing salaries relative to average U.S. wages are | above the OECD ... So pay isn't the problem | | Do you think when someone evaluates if they're paid enough | they're thinking 'what is my income relative to what someone | else's income is in Belgium relative to other people in | Belgium?' | MisterBastahrd wrote: | ? | | Most nurses work three 12 hour shifts and are paid for 40. It's | so prevalent that a lot of them will pick up an extra shift or | two at an entirely different hospital. | woodruffw wrote: | These numbers don't necessarily tell the full story, since | "nurse" isn't necessarily a fungible title across the OECD: | nursing requirements and qualifications vary by country, as do | the job's obligations. This is probably particularly true | during the last two years, as nurses (everywhere, but | particularly in areas that have refused vaccination) have | assumed greater daily responsibilities. | kemayo wrote: | It sounds like your last statistic means that U.S. nurses need | to do more work than their counterparts in other countries (to | make up for a lack of doctors), which suggests that pay and | staffing _might well_ be the problem... | manuelabeledo wrote: | Comparing the US with OECD isn't proof that pay or staffing | aren't part of the problem. Nurses can be underpaid, and still | earn more than their peers in other countries. | | Also, it looks like the outrageous costs of healthcare in the | US don't correlate at all with nurses' wages. If I were a | nurse, I would feel demoralised if I was doing a lot of the | hard work, yet administrators and middlemen still get the most | money. | Ensorceled wrote: | Canadian nurses are also leaving the profession in droves for | many of the same reasons ... so this might be a universal | problem. | fnordpiglet wrote: | They do detail what the nurses themselves say are the problems | in the article. I'm not sure I see a reason to doubt their | reasons. They didn't identify a shortage of doctors but rather | a shortage of low skilled workers whose jobs they're having to | pick up in addition. Also while the population ratios might be | in their favor, apparently the patient to nurse ratios aren't. | Even if they're better than most of the world that doesn't mean | they're necessarily happy - when you're unhappy telling someone | that there's someone worse off doesn't improve their situation. | krisoft wrote: | > So pay isn't the problem. | | Or pay is a problem elsewhere too. | JaimeThompson wrote: | >So staffing isn't the problem either. | | You don't have enough data to determine that as you are | assuming that the staffing levels should be the same between | countries when due to things like a huge push to increase | profits, more paperwork, and other such things they can be | drastically different. | nine_zeros wrote: | From my friends anecdotal experience, burnout in medical industry | is partly due to too much administrative work. | | It is also partly because the number of patients is increasing | disproportionately, mostly because people are getting older. An | individual at the age of 50 needed fewer medical appointments | than an individual at the age of 70. That's literally from 2002 | to today. | | There just aren't enough nurses and doctors to tend to such a | large old population. | FactualActuals wrote: | High stress environment, stagnant wages unless you're a travel | nurse, underappreciated during the pandemic, and having friends | turn on you because they associate you with some crazy conspiracy | theory. These are all reasons I've heard of career nurses | quitting and going into other industries. | Ensorceled wrote: | Conflicts with patients and their families. Politicians | claiming you are overpaid and your friends and family believing | them. Increased responsibilities without increased pay, | something experienced nurses really feel. | | I'm trying to think of how any of those can be solved with | "technology" :-/ | starik36 wrote: | This I have to hear. What politician is claiming that nurses | are overpaid? | [deleted] | duxup wrote: | I was under the impression that nurses were paid pretty well | (generally speaking). | zdragnar wrote: | It depends on where you go (and when; things have changed | somewhat recently) but I know some CNAs who never became RNs | because the time it would have taken to claw back the money | spent on the degree wasn't worth the added stress of actually | being an RN. | omginternets wrote: | I went to an undergraduate school with a fairly large nursing | program, and interacted with a fair number of nursing | students. One thing I noted was that a large proportion of | nursing students were first-generation college students from | lower-middle-class and working class backgrounds. I suspect | that the meme of nursing being "well paid" stems from the | fact that it is a step-up in that context. | gedy wrote: | This is my antidotal experience as well from extended | family and friends. Many (mostly young women) weren't | really sure what to do and picked nursing because "it pays | well" and had a romanticized/simplistic view of nursing. | Didn't seem particularly interested or passionate about it, | so I can see how many would lose interest once the reality | of the hard work in the midst of a pandemic. | bryanlarsen wrote: | Sure, there are lots of nurses making well into the 6 | figures. But they're working 60-80 hours a week, most of them | night shifts. | | A nice 9-5 weekday nursing job makes a couple dollars more | per hour than the receptionist out front. | woodruffw wrote: | Nurses are paid well, relative to the average American | salary. I don't think they're paid particularly well relative | to the job's lifestyle requirements and latent stress levels, | especially during a pandemic. | | Looking at my area (NYC), I'd have to take over a 50% pay cut | from my engineering job to be "paid well" as a nurse. And I | suspect my job is a lot less stressful. | duxup wrote: | That's not that usual of a dynamic. | | I think the "hardest" job I ever worked was a PC tech | support call center or a job at a pizza place. I didn't | pick my hours ... and the job was a heck of a lot harder | than my coding job that pays WAY more. | | But it wasn't like I could just go and get a coding job at | the drop of a hat. | woodruffw wrote: | Sure. Both programming and nursing are relatively niche | fields. Nursing is arguably a significantly more | _professional_ field, given that (1) formal requirements | are higher, and (2) Nurse Practitioners are effectively | educated at the MS level (versus a BS or lower for the | average programmer). | | If we're using job difficulty and stress as some of our | metrics for fair pay, then I would argue that tech | support and pizza delivery should _also_ be higher | paying! But even with that, it doesn 't seem unreasonable | to factor in the professional qualifications (and | corresponding time and money commitments) required of | nursing. Relative to all three, it's a remarkably low- | paying job. | LegitShady wrote: | While I don't doubt that nurses have very high stress jobs, | the reason why you'd take a pay cut to become an nurse is | because their job is a lot less technically difficult. | | I have some friends from university who became nurses, one | of which I was roommates with for two years during school. | I helped them study for 'their most difficult math test' | and it was a relatively straightforward test on changing | units. They would not have passed a first year calculus | class. The majority of their academic work was | memorization, and then lots of hands on work in hospitals. | The reason they get paid well is because the job is | important and stressful, not because it requires highly | technical people of which there is limited supply. | | I don't say that as a slight - I know many nurses who are | very intelligent people, its merely a judgement as to the | academic rigor involved in getting your nursing | credentials. | | PS I worked at home depot during busy periods in the summer | when the store was understaffed, I've worked as a waiter | where I was the only person on shift because the | owners/manager were idiots, and I've worked cleaning big | chicken barns out in preparation for new chickens and those | were all significantly more stressful than my technical | work. Stress is not correlated with difficulty or limit of | supply. | woodruffw wrote: | Were your friends NPs, CNAs, or something else? There's a | wide variety in nursing roles, with a corresponding wide | range in technical difficulty and expected proficiency. | The average NP is certainly more technically proficient | than the average undergraduate with a CS degree, albeit | not in a domain the CS undergraduate might understand. | | Tangentially: I'm not sure what the relevancy of "passing | a first year calculus class" is. Just about every BA/BS | passes one, and I (a program analysis researcher) have | never even remotely needed by calculus knowledge in my | day job. I don't think it's a good proxy for technical | skill whatsoever, given that "technical skill" is a | domain-specific qualifier. | FactualActuals wrote: | I don't think they are paid as well as they should be | considering the need for most nurses now to be on-call 24/7 | and dealing with the stress from patients and their families, | and administrative bloat. | klyrs wrote: | They're paid alright (generally speaking), but most devs | wouldn't even consider a job at that rate. And the bar for | entry is way higher: years of competitive and expensive | schooling. | | And that's ignoring the other factors that GP mentioned. I | don't get assaulted on a daily/weekly basis. I'm not getting | coughed on by COVID-infected patients who want to kill me | because they don't believe that COVID is real. I don't endure | a regular drumbeat of patient deaths and the constant second- | guessing "what if I did X differently". I don't need to | handle people's bodily fluids. And then there's the politics, | internal and external (the conspiracy nuts, the fucked-up | pecking order in hospitals, unions, insurance- and pharma- | driven policies, politicization of healthcare, etc). I could | go on and on, and I only know one nurse personally. | | Nurses are not paid anywhere near "pretty well." They're | treated like shit and the pay isn't anywhere near fair | compensation for the service that they provide. | listless wrote: | ShiftKey now has shifts listed for upwards of 80$+ per | hour. This is probably the future we're looking at and way | overdue. | duxup wrote: | >but most devs wouldn't even consider a job at that rate | | Lots of people ... most people work jobs that fall into | that category. | | I'm not sure that means much. I don't know how many folks | who go into nursing are likely to just chose to be a | developer or if it is that simple for them. | tubalcain wrote: | It makes zero sense for a person to consider straight-up | nursing as a career in this age. The school is too | competitive to get into, the pay isn't worth it, the job at | the end is laborious, the culture is vile. If one does go | into nursing, becoming an NP, CNA, or travel nurse are the | only logical options from a time invested to income and | burnout standpoint. | | If a student wants a health care professional job, medicine | and dentistry are better options and require just as much | academic competition. Failing that, the student is better | off going into tech or law. | | If they're not smart enough for either of those? I dunno? | Onlyfans? Permanent serfdom? I fear that our new society | will have many who are left behind and struggling. | bluesquared wrote: | Nurses are paid well compared to the average worker in the US, | but not compared to the service they provide. My wife, an RN | BSN, was hit with a pay _cut_ due to hospital system being | bought out by another larger one. That 's right, a pay _cut_ , | during a pandemic. Now on a fixed pay scale, with no raises | built in. $3/hr shift differential for working night shift in | no way makes up for the strain it puts on your body, your free | time, and your relationships. Tons of attrition in her hospital | and department, no signs of retention bonuses or anything other | than a "We <3 our healthcare heroes" sign out front. | ryanmarsh wrote: | I'm going to offer a counter point, anecdotally of course. My | daughter is in university right now. She's a in pre-nursing. She | says most of the people in her major this year switched to | nursing from other majors during the pandemic because they saw it | as the most economically viable major compared to their previous | major. In a nutshell the pandemic scared people into being | pragmatic about their degree plan. | | So hospital administration will have a fresh crop of graduates, | new to the system, to abuse. The cycle will continue unabated. | smm11 wrote: | It's the bare-minimum staffing that's done in nursing, in | addition to the bizarro pay scale. | nomoreusernames wrote: | think about this statement, good nurses are taking care of the | people you love the most in their most helpless hours. how | fucking cruel are we as a society for taking this type of love | for granted? its just wrong to use people like that. nurses | biggest psychological problem is that they ignore themselves and | love others and take care of them better. i think its really | shitty. like veterans of defensive wars. | Copenjin wrote: | It's the same in Europe, but I don't know if they are extremely | underpaid in the same way. Money could fix part of the problem. | vmception wrote: | Skimmed the article, what is that number like in other years? | kingkawn wrote: | Lots of blame being placed onto the business managerial class | that has turned hospitals and the practice of medicine into a | nightmare a la Kafka, but I think that the casual brutality of | the healthcare educational model deserves a ton of the blame for | this burnout. The reaction to all emotional trauma is to bury it | and place all the energy into negotiating for higher pay. Money | cannot endlessly sit in the place of enduring suffering, and the | professions (medicine, nursing, PA, etc) will continue to degrade | in quality as long as this barbaric understanding of emotional | health is encouraged in the educational institutions. | yalogin wrote: | Nurses is a tough profession. They are required to work for | longer hours and not paid that much. With Covid, dealing with | anti-science patients must have been very draining mentally. On | top of changing the working conditions and increasing pay, may be | we should make the nurses training free to make the field more | attractive. | ryanSrich wrote: | To the surprise of absolutely no one who understands healthcare. | | I have many friends and relatives that are nurses, MDs, and | therapists. | | Compensation is about as backwards as you can get. Seniority has | no impact on your pay. Once you hit the ceiling you'll never make | more money. This is especially true for Nurses and therapists. | Even if you switch jobs. The market rate is what you're going to | get paid (within 10%). | | My wife is a PT and made 3x more traveling as a contract | therapist than she did as a full time employee. Three times. | That's absolutely absurd. | | Benefits are also beyond comical. Healthcare insurance costs for | healthcare workers are higher and the benefits are worse than if | you just bought Obamacare directly. | | Beyond horrible pay with no upward mobility, you'll also have to | deal with completely disconnected management that has never done | any clinical work in their lives. They'll bitch and moan about | saving money, and often enforce policies that put clinicians at | risk of malpractice. All to save money. | | So yeah. If I were to give any young people advice, it would be | to stay as far away from healthcare as you can. | giarc wrote: | I work in healthcare but not as a nurse. I'm in a somewhat | obscure field that became pretty important during the pandemic | (infection control). No one outside the hospital knew we existed | before the pandemic. Then the pandemic hit, conspiracies' started | to float around and we had to take our contact list off the | public website as colleagues were receiving death threats. | | I can't even imagine what nurses have gone through being front | line staff interacting with patients (and their families) all | day. We need a zero-tolerance policy for families that verbally | abuse front line staff, but instead they are often let off due to | "stress of a family member in hospital" or the need for "family | centered care". | JaimeThompson wrote: | Perhaps allowing modern MBAs to cost optimize most every single | thing we do isn't the best way to assure mid and long term | security and profitability. | tyrfing wrote: | Doesn't that pretty much start with the fact that Medicare pays | far under cost? "Just stop optimizing costs" is a hard sell | when a huge chunk of services are sold at a loss. Either | optimize the business or go bankrupt. | manuelabeledo wrote: | Maximising profit by cutting down wages and personnel is not a | MBA specific problem. | anarticle wrote: | Ah, but it is the only thing MBAs are "good" at. /s | ironmagma wrote: | It is a problem fostered by that culture though. | manuelabeledo wrote: | Is it, though. | | If you have the opportunity to take a look at the content | of your typical business administration book, or even the | Harvard Business Review magazine, they essentially are | collections of success stories. Instead of setting the | narrative, they go and say "this or that worked/didn't | work, to get this company out of a slump". | | The issue, I believe, stems from the fact that "bringing in | the MBAs" happens when a company doesn't hit inflated | targets, and for that you have to thank the c-suite, which | isn't necessarily a bunch of kids with master degrees. | ironmagma wrote: | In that content is the sometimes implicit, sometimes not- | so-implicit understanding that efficiency is something | positive. The very first thing a finance textbook will | inform you of is that the market is efficient and that | this is what allows it to function. | | When in reality, efficiency and fragility are two sides | of the same coin. You might not want to maximize your | efficiency if you also want to be resilient. | katbyte wrote: | Cost optimization usually have huge gaps in things that are | hard to measure like onboarding cost/time or morale or benefits | of experience. Who cares about any of that when you can make | the shareholders another million a the expense of literally | everyone else? | FredPret wrote: | The thing is though this is good for shareholders only in the | very short term. In the decades-plus term, doing the right | thing is best for the owners. | | And this is why we need savvy shareholders who vote in AGMs. | rjbwork wrote: | Efficient systems are brittle systems. You wring all the slack | out of it and any shock is going to cause failure. In this | case, the slack is the nurses and other healthcare workers' | mental health and burnout limits and pay and culture etc. etc. | The slack is being pulled to lower costs and increase | insurance/hospital profits. | | It's unsurprising that what has happened in the past couple of | years is putting stress on a system with the slack pulled out | of it. | TrispusAttucks wrote: | You're spot on. This pattern is emerging across many | structures. Efficiency is inverse correlated with resiliency. | JIT systems have spread over the globe but they don't handle | shocks in the pipeline very well. | etchalon wrote: | "Efficiency is inverse correlated with resiliency.". | | Well, I'm jotting that down in a notebook. | TrispusAttucks wrote: | You may enjoy the paper "Examining the balance between | efficiency and resilience in closed-loop supply chains" | [1] from August 2021. | | EDIT: Also interesting relationship with sustainability | [2]. | | [1] https://link.springer.com/article/10.1007/s10100-021- | 00766-1 | | [2] https://www.researchgate.net/figure/Sustainability- | curve-map... | say_it_as_it_is wrote: | This isn't a problem that can be solved by an IT solution. Nurses | have more patients assigned to them than what they can manage. | They don't need another system of forms and workflows to fill out | in addition to their overloaded plate. If anything, the solution | is the opposite of an IT solution in that hospitals must hire | more nurses and stop following the recommended lean-management | staffing numbers provided by software. | acchow wrote: | As nurses quit, nurse compensation will increase and the number | considering leaving will start to fall | tyrrvk wrote: | We talk about insurance killing the medical field, but I'd also | argue that EMR companies are doing a number on the profession as | well. Have you seen the Epic campus? Epic - located in Wisconsin | (not the gaming company). The amount of overhead a hospital needs | to support/run that behemoth can't be small. And Epic is | _swimming_ in cash. | vlunkr wrote: | I'd like to know what "considering leaving" means in this study. | I consider leaving my profession every time a React hook | misbehaves and locks up my browser, but I'm not actually going to | leave. 90% seems way too high to be people who are actively | wanting to leave. | [deleted] | cupofpython wrote: | > 90% seems way too high to be people who are actively wanting | to leave | | We are talking about the people who clean up the nastiest human | waste that our bodies are capable of producing. I was already | surprised that this number was ever less than 100% tbh | lbebber wrote: | A friend of mine was (is?) completely unfazed by this sort of | thing--right from the start, it was not some resistance built | up over time. | | She left the profession due to the long hours, low pay, and | poor treatment. | vlunkr wrote: | Well they knew that going in, so I'm not convinced that's a | factor. | ejb999 wrote: | right, and while nurses do have to do some things I would | consider gross, more often than not, it is the lower paid | medical assistants and CNA's that get the real awful jobs | that does not require a nursing degree - i.e. changing | diapers in nursing home, bathing people etc - won't find | too many nurses doing that in the nursing homes around me. | [deleted] | ejb999 wrote: | Yes, but that is what they signed up for - i.e. they knew it | going in, and that has not all of a sudden changed. | | I couldn't do it, and god bless them, but that is unlikely a | cause of people leaving the profession - that would be like a | computer programmer saying they were leaving the profession | because they suddenly found out they have to stare at a | screen most of the day. | | I also find that '90%' number suspect as someone that works | very closely with the healthcare community - there is a lot | of turnover, and its hard to hire nurses right now - but | almost always when someone leaves their job it is because | they went down the street and got a 25% raise, i.e. they | didn't leave their profession, just their job. | supertrope wrote: | Stated and revealed preferences are very different. | makeitdouble wrote: | 90% leaving might be too high, but even of a tenth actually | manages to move on it will have a huge impact. | | More importantly, a lot of them will be leaving though burnout | and depression (a significant number of hospital staff is | already on this course). | mulmen wrote: | I did IT support in a hospital for a year. Nurses do everything. | Their job is both _hard_ and _thankless_. I do not doubt | satisfaction is low. | | But this sounds like the employee satisfaction corollary to | Sturgeon's Law [1]. | | "90% of _employed people_ are considering leaving their | profession in the next year." | | This survey would be more compelling if it compared nurses | responses with the general employed population over time. I only | skimmed so maybe it does and I missed it. | | [1]: https://en.m.wikipedia.org/wiki/Sturgeon's_law | timcavel wrote: | T3RMINATED wrote: | slantedview wrote: | It would be interesting to see data on this by state. Nursing, | unfortunately, is much more difficult in states without unions. | In California, the strong nurses union has ensured somewhat | better staffing ratios and much better pay than in other states. | [deleted] | weatherlite wrote: | Hard profession but one of the last things to be automated imo, | guaranteed income for next 30-40 years. Don't think you can say | the same about certain types of doctors for instance. | xhkkffbf wrote: | A friend who is an anesthesiologist said that he was retiring | because the new machines were so good that no one wanted to pay | for an anesthesiologist anymore. They were happy with a nurse. | So you're right. | weatherlite wrote: | It is very algorithmic in nature afaik, so quite easy to | automate. As is oncology, radiology and many aspects of | family medicine. It won't be tomorrow, but 10-20 years from | now I think is very realistic for huge changes. Brave new | world... | theguyovrthere wrote: | CRNA != Nurse in the same sense as a registered nurse in an | ICU or med-surge department. | | CRNA is the Nurse Practitioner version of Anesthesiologists. | | They're paying for less anesthesiologists and hiring more | Certified Registered Nurse Anesthetist because they're | cheaper, perform a sweeping majority of the same function, | and multiple can be supervised by an anesthesiologist who is | on hand to fill the small gap between theirs and the CRNA | scope of practice. | biohax2015 wrote: | There are tons of openings for anesthesiologists paying | 400k+. | https://www.gaswork.com/search/Anesthesiologist/Job/All | weatherlite wrote: | That's quite pricey, sounds like a good candidate for | automation :) | mbg721 wrote: | Nursing won't be automated soon, but automated systems will be | used for things that nurses used to do (with predictably worse | results). | lghh wrote: | Nurses do a lot of menial tasks that they are overqualified | for. Could those not be freed up by automation so that nurses | can do the high-skill tasks they are uniquely qualified to | do? | | I think you're right in the sense that I expect we won't | shoot to automate the menial tasks first, and instead will | let our hubris guide us to automate the high-skill tasks. But | speaking optimistically, there's a lot of productive | automation that can happen. Heck, a lot of it has already | happened via digital record keeping. | weatherlite wrote: | But much of those menial tasks are quite difficult to | automate - changing IVs, bed sheets, patient clothes, | bandages, diapers etc etc...I don't think AI/robotics is | anywhere close. However, it is possible that much of the | menial work will be delegated to lower paid "nurse aides" | that don't really need much medical knowledge , while the | real therapeutic work start being automated by machines and | algorithms. Thus salaries will be squeezed downwards, which | in the end is what the system wants obviously. | quxbar wrote: | The market will surely adjust, by killing off people who can no | longer afford nursing. | plaguepilled wrote: | I'd laugh, but I have this sinking feeling you're right... | ashitlerferad wrote: | Salaries about to go through the roof. Time to be a nurse more | than ever. | petermcneeley wrote: | Most people work for money so I would take all this with a grain | of salt. If you are a RN what are you going to do if not nursing? | The same applies to all fields including Physicians. | chrisseaton wrote: | > If you are a RN what are you going to do if not nursing? | | You can do almost any job with almost any degree. | notch656a wrote: | Being able to do it doesn't mean someone will hire you. | Almost anyone may be able to become an engineer but you | hardly have a prayer of being hired for a well compensated | and benefited role unless you have years of experience or a | (science or engineering) degree combined with internship(s). | shadowofneptune wrote: | Both physicians and nurses have a lot of options beyond working | at a hospital. Private practice, small clinics, education, | consulting, etc. People who will be leaving in these next few | years won't necessarily be retiring. | shadowgovt wrote: | One interesting thing to spot-check in this study would be | geographic distribution. | | Salary for nurses varies widely, and in some places, they're | wage-competitive with Amazon delivery drivers now. I can easily | see people deciding that even though they like helping folks, | getting paid less than the people who drive around and drop | packages all day doesn't seem like a fair deal. | ranci wrote: | Typically nurses are women. Typically women are married to men. | Men worthy of a relationship or marriage to begin with | typically have an income significantly higher than min wage, | potentially capable of sustaining a family on his own. Nurses | are women usually and women have options, usually. | mrtranscendence wrote: | This comment is kooky. Are you implying that one option for | women nurses is marrying a higher-income man and becoming a | stay-at-home spouse? | | Men making less than the median for their gender (something | like $55k in the US) are still marriageable; plenty of women | marry men who can't support families on their salary alone. | Even at the median salary, supporting two people -- let alone | a larger family -- could be a struggle, depending on debts | and other commitments. | | And then there are women who are not married to a man who | makes money, either because they remain unmarried or because | their husband has lost his job or cannot work for some | reason. | | Further, even if the cards align, it's not great to be in a | position of dependence on your spouse's salary. Sometimes you | have to split up and sometimes your spouse dies without | leaving significant insurance or inheritance. | bhandziuk wrote: | I think they're saying that married people might have a | little more leeway in changing careers because they have | the stability of a second income in their household | already. | n8cpdx wrote: | There's a huge labor shortage, they could do just about | anything and get a pretty sizable bonus to sign up. I've heard | $20k bonus for trucking, local transit agency is offering 7.5k | to sign up as a bus driver, police nationwide are desperate and | the requirements for the local agency consist of any 2 year | degree + being willing to be drug tested, construction industry | is trying to recruit women now, etc. | mrtranscendence wrote: | I'm not a nurse, so grain of salt and all that, but I think | I'd rather be a nurse than any of those things. And except | for (some) trucking, RNs generally get paid more than all of | them, I think. | | There's a lot of white collar work that only requires a | nonspecific college degree, but I'm not aware of such a high | demand for for HR staff or accounts payable specialists. | notch656a wrote: | Probably true in certain areas, but nurses are unique in that | they occupy one of the few high-wage jobs in rural areas. | Nurses, on average, are probably more likely to be in places | where it is difficult to find alternative jobs of equal pay. | | If you're a typical white-collar professional in say some | business/science/engineering field you'll typically, unlike | nurses, live somewhere with abundant other high wage jobs. | ModernMech wrote: | Whether or not any particular nurse follows through with | thoughts of quitting, all else being equal I think we want | nurses who enjoy and want to stay being nurses rather than | nurses who are thinking about quitting. Nurses who are happy | provide better care than nurses who are so unhappy they want to | quit. ___________________________________________________________________ (page generated 2022-04-27 23:00 UTC)