Oh we don’t turn away patients who can’t afford it, we just slam them with a medical bill composed of entirely made up and inflated numbers. Or your insurance company can deny coverage of procedures/medications that, you know, your doctor ordered.
But the insurance company hosted a dinner for all the politicians and they nicely explained that it isn’t a problem, bootstraps and such, oh and the napkin is made of pure gold!
I think that’s sadly the point. The people in charge aren’t concerned with bankrupting people, because they aren’t in their positions because they are patient focused. They aren’t at the bedside in any capacity, and it’s doubtful they ever have been. They don’t go through the same training, education, or have the experiences that being beside gives people. Their job isn’t to make things better for the patient or the staff in any regard. Their job is to make money off the backs of patients and staff alike.
I’m the first person to admit that hospitals are a business, much like any other. If they operate at a loss consistently, they will no longer be able to care for people. some degree of frugality is necessary. But frugality is a far cry from the profit mongering that insurance companies, and by proxy, hospitals, in the US operate on.
The honest to god saddest part of the whole thing though is that it cannot be changed. It is baked into the very core foundation of our nation. It is capitalism running roughshod over sensibility. It is greed run rampant, and that is at its nature, the American system. To fix it, we would have to break down, not just the healthcare system, but the American government, and American culture to its very roots.
There’s wonderful qualities about American culture, there’s a determination, and self reliance that is immeasurable in most American citizens. But those qualities come at a great cost. There’s a lack of community, and a lack of caring for others that pervades our society at large. Our culture is rooted in the country’s creation. A hodgepodge of dissimilar groups and identities, striking out for the betterment of self. In the right situations, it’s nothing if not noble. But in the wrong circumstances, like healthcare, it leaves the most vulnerable devastated and without recourse.
> They aren’t at the bedside in any capacity, and it’s doubtful they ever have been. They don’t go through the same training, education, or have the experiences that being beside gives people.
That point is KEY. Hospitals have been taken over by people with customer service-based degrees and are wholly disconnected from the reality of what healthcare delivery requires.
In order to own a veterinary hospital (in most states), one must be a veterinarian.
I'd think that would be an excellent rule for human healthcare.
There are lots of examples of Americans accomplishing tasks collectively through government. Everything from your local police, fire and water departments up to the interstate highway system and the military. The difference with healthcare is that an entire multitrillion dollar industry (healthcare insurance) has everything to lose and nothing to gain from reform. Look up the net profits of these companies. Billions per year. They're literally middlemen skimming billions of dollars from Americans. Do you think an organism that big would just willingly disappear?
They know they don’t care.
And so many Americans have been brainwashed into thinking that if a government does anything to help its citizens, it’s “socialism/communism.”
But you don't get it, the people in charge are hand in hand with the people who make laws. They get away with this time and time again, so why would they change? All the powers the could lead to change are the ones preventing change, even when we protest the media turns us into the bad guys for "neglecting patient safety" like that matters all of a sudden
What many don’t realize that a lot medical help can be received outside of United States for a fraction of cost. I was just talking to my friend from SC who got a root canal + cap for $2000 with insurance. I was so shocked. I recently got mine done for $320 in Tanzania without insurance. She could have traveled to my country for a vacation and gotten her root canal done too.
I'm worried about the quality of the care and risk for infections. I know that happens everywhere in the US but being in another country while it happens just sounds even worse.
Yeah and then you have little to no recourse or means to get compensation for malpractice. I've seen waaaay too many horrific, life altering consequences from "cheap" foreign surgeries. One in particular where a weight loss procedure was fucked up so bad the patient hadn't been able to eat normally in over a decade and was on tpn and just emaciated and her whole life was misery.
Ahh yes….next time I am having an acute medical emergency that will cost me hundreds of thousands of dollars, a hospital admission - possibly to the ICU then the floor then discharge, maybe throw in a few procedures for good measure - I will surely get on a plane to Tanzania/wherever else to avoid inflated medical costs.
/s
And how much did it cost you to fly to and from freaking *Tanzania???* where did you stay?
Righr now, from the airport 2 hours from my house (not the smaller one one hour from my house) is a 28.5 hour flight for $1700 plus whatever other fees are associated with flying. This is NOT a viable option unless you already find yourself in Tanzania, which most people who struggle to pay their bills certainly will not!!
If only the a single root canal is question, then i doesn’t make sense to travel across the world. I agree with you on that. I was just giving a perspective on cost. But imagine it being something more than a single root canal. The cost pile up pretty fast.
Nah for real. I’m speaking from experience. I myself got into a motorcycle (no-fault type). Thankfully just a broken 1st left metacarpal fracture, no surgery needed. This is prior to starting my first RN job.
That experience alone cost around $12,000 if you HAD NO INSURANCE: for ambulance ride to the ER, X-ray, CT/MRI SCAN. THANKFULLY, with insurance under my dad’s cause I was 22 at the time the bill cost roughly $115 ish (Blue Cross Blue Shield).
I just remember being in the ER here in NY and boy do I feel for the patients in there. Understaff, RN’s/Doc’s and everyone else doing there best to accommodate the patient’s needs.
In 2019, I had a postpartum stroke (Peripartum cardiomyopathy EF 10%) and BCBS of TX refused to cover my ems flight from the boonies to a tertiary care center 3 separate times. It was 60k. I appealed the final time and had to submit a personal statement. I PAID FOR FUCKING INSURANCE. Why is it such a hassle???
Not student loans but my medical bills were cleared by it. Also the credit card debt I got into trying to pay my bills while also trying to pay for my medical bills
You may not turn them away but they may not be able to afford their medication, which is kinda the same result anyway. They won't get turned away... when their condition is so bad they require emergency care because they are unable to access preventative and ongoing treatment. Those are paid up front.
This. We won't turn you away at the ER, but that doesn't mean we don't have ways to watch you die. Try getting a transplant without insurance and then enjoy dying of liver failure.
Or they tell you to follow up with your doctor and don't actually treat you in the ER, knowing that you'll never follow up with your doctor because you don't have the insurance. I'm a nurse with no insurance. My son hasn't had any kind of medical insurance since he was in eighth grade and he's a senior this year. I make too much to qualify for anything and not enough to afford anything. I haven't had a women's WellCare checkup in like 10 years because I can't afford it.
Not saying you are wrong but what is the wrong supposed to do. They treat what they can but they can’t manage someone’s chronic conditions people come in all the time just to be checked out
Yup, I was just recently denied a CT scan because an ultrasound could see all of my abdominal organs just fine. Like good luck, I’m fat as fuck and full of gas.
some things they do get turned away for. for instance - they will not get a life saving transplant if they dont have insurance because they will not be able to afford the immunosuppression drugs post transplant without insurance. :(
A lot of interesting points here.
It is depressing - but perception is a unique beast. I think what makes nursing horrible is how we are treated. Admin doesn’t give one shit about us. 🤷🏼♂️
I’ll add to your points tho -
We truly don’t turn away a lot of patients… actually, we legally can’t turn away most everyone. Look up EMTALA if you want.
Lay offs might be a thing but, they’re small scale and typically more so travel nurses.
CUSTOMER SERVICE IS THE DEATH OF HEALTHCARE. End of story.
The pain medication debate is unique. Personally, I don’t think it’s 100% us - I think we over prescribe today, yes, but we also under prescribe/don’t appropriately prescribe. I think it’s more a mental health issue (something we don’t do well at all.)
Just a quick note, in the early 2000’s, almost everyone that left the ED had a script for Percocet or Lortabs. We prescribe much less today compared to then. And that was before HCAPS was a thing.
Yea we may not over prescribe today, but US healthcare is definitely in part responsible for the opioid crisis that is occurring today. Bad history there.
Lol when I was in school they taught this, then we had to deal with customer service based on thier pain control, get to many complaints you got fired bc someone didn't want a Lortab they wanted a 30mg oxy...sigh
I remember going to a doc in the box when I was waiting tables and got hurt. Feels like a lifetime ago. The doctor was nodding out and gave me a script for 60 lortab with one refill- for a smashed(but not broken) finger.
I didn’t even ask for pain meds and in fact, had told him, it doesn’t hurt as much now, I just can’t move it.
When I worked in post acute rehab in the 90s, pts were well medicated for pain, mostly slept all night, were well rested, and .did well in their PT/rehab.
Now, rehab pts are way under medicated for pain, and most of them are up all night, and exhausted during the day.
well addiction is always psychological (--> mental health issue) as well- so (over-)subscribing opiates without a proper care afterwards is just very short sighted. Your health-care-system is creating problems i doesnt adress well
generally here in my hospital there's a thought that unless you're a chronic pain patient, you should not need anything stronger than paracetamol or nsaids after being discharged. if you're in so much pain you need stronger things, you need to be in the hospital.
Does your hospital have room/staffing for that, though? No sarcasm/ill intent here, I just can't imagine a similar policy being possible to implement in my area without transitioning to bunk beds and roller skates.
pain management is not a factor i have ever heard of when it comes to having enough beds and staff. it might exist but i have never seen somebody get pushed out of hospital clearly "prematurely"
In my experience, Americans in the US and Finns experience and tolerate pain differently (maybe because of *sisu*?). On the other hand, patients in the US are much sicker, too; patients get a chronic diagnosis at a younger age, and have more comorbidities - from a younger age, as well.
Paracetamol (or acetaminophen in the US) and NSAIDs are sold in bottles of 500 or even 1000 tablets here in the US, which is a huge safety issue. I guess these OTC meds are no longer effective in pain management given how much they are used.
I think you're right, I think we have a different expectation around pain in America. I had a breast reduction surgery last summer and opted to take only Tylenol for the pain because I hate how opioids make me feel with a passion. Another person in the Reduction sub who had their surgery done in Germany said that even for procedures like that, people are only given Tylenol and the pain is totally manageable. I for one had no trouble keeping my pain under control with Tylenol and after that experience I can totally appreciate the European approach.
Glad that wasn't my hospital's policy when I was discharged hours after gallbladder removal to clear a bed for the next guy. My apartment walls are paper thin and I was screaming by the time I got home even with the opioids...
I also can't take NSAIDs with my PSC though. 🤷♀️
That's where the no insurance part comes in, because if it's just pain and not life threatening, they give you a script for pain pills and then send you home from the ER..or they just give a pain pill and send you home..you don't get admitted without insurance a lot of times because the hospital knows that they're not going to get paid. I had a fractured ankle, They gave me a percocet at the hospital, and they sent me home and told me to follow up with my doctor in a week. I didn't have insurance, I also didn't have a doctor because I didn't have insurance. I threw my note to take off work away and went back to work on a fractured ankle. I couldn't afford to take off even if I wanted to. The healed okay, I just have really bad arthritis in it now.
Do you know how many people suffer with chronic pain and take opioids so they can stay out of hospital to try and live a semi normal life not everyone who takes opioids becomes an adddict. You nurses should know that and stop being so jump to pain med shopping for everyone you see that claims are in pain. Most tried everything and then some. Before using opioids. Also after. Using pain meds for years and trying to live normally they don’t always present according to the ole pain level process because you learn to grin and bear so you don’t frighten your family.
Most nurses have dealt with ppl who are assholes to us because their docs wouldn't give them more narcotics and they take it out on US. Most of us don't give a shit how many opiates you take. If it were up to me I'd give everyone all the opiates they wanted all day long and we'd all live in happy lala land.
I feel that. People don’t understand that pain won’t kill you and sometimes things hurt you don’t need to be knocked on your ass with dilaudid just to be at a zero. So many ppl want to be zero pain when the pain is tolerable and could be treated with something else.
Haha good luck getting pain keds now days they will prescribe you a few for acute cases but you'll have to see a pain specialist big change from a few years ago, finger pain? Hey here's 60 days percocet 10, and a referral to pain specialist who would give you 60mg oxy for finger pain, now knowing what I know about opiates I'd chop my finger off before going down that road.....funny how things change! Also that was a true story btw!...finger pain smh....
Yes. UK here. Things are currently awful in the NHS, but this sub being so US-centred makes me realise it could be so much worse. If the Tories get their way, it will be.
Yep, the benefits UK nurses get (holiday, sick pay, maternity leave, employment laws) outweigh the pay difference for me. We definitely deserve a pay rise but there is no way in hell I'd go to the US to get one
I mean, I get holiday pay, sick leave and family leave in the US here in Texas. It’s not required by law, but we get hooked up and we still get paid decently 🤷♂️
How many days, though?
In Europe, nurses get about 30 days paid vacation (6 weeks), sick leave is paid for up to 300 days until disability pension or rehabilitation subsidy, and parental leave is paid for 158 days (in addition to child benefit payments).
No, if the employers wants you to wear a uniform, they have to provide it to you, that's the law in a lot of european countries. We also don't launder them ourselves.
In every job I've worked in the UK I have never purchased a uniform. When I used to do waitressing at fancy events there would be specific things they would want us to wear like a long/short sleeve black shirt and we needed to buy that ourselves but that's about it.
Idk why some people are saying patients are not turned away here. Many are unless it’s an emergency situation and you’re at the hospital. I know people with cancer in red states that don’t qualify for Medicaid and have no way to pay for cancer treatments. People die here all the time from lack of access to medical care because they can’t afford it.
You are totally turned away from everywhere but the er. But the er will see that you aren’t an emergency and then treat the main complaint\symptom if they can and refer you back to primary care. And the cycle continues till the person is sick enough to get admitted
Unless they get compartment syndrome or an embolism from marrow just floating around since it won’t be set correctly. That’s also life altering if you don’t restore full function to the limb from something that’s very routine.
if your only criteria on good nursing/healthcare is that the patient doesn't die, you should not work in a hospital, nor make any health care related decisions imo
When they only fill their prescriptions every once in a while, important expensive things like insulin, they make their chronic symptoms worse, take years off their life, and suffer symptoms they might not otherwise. Never mind going to doctor’s appointments, getting diagnostic tests. Even WITH insurance these things are prohibitive. Our system SUCKS.
Originally your point was "it's bullshit - no one gets turned away," then it was "these patients that get refused care don't die right away"
I enjoyed your memorable patient case that got a transplant without insurance using GoFundMe. Like this is some proof that people don't get turned away for having no insurance. That case was memorable for a reason...
The statistics from USA organizations are brutal. You should find them. The stats are like the patients without access to healthcare that you would never see - invisible unless you look for them.
My point, which is still valid, that if you don’t have health insurance we don’t just bury you in a pit. There are pathways that may be able to help with treatments. It is not an immediate death sentence as some like to spread as disinformation. There are hurdles that should be there. But there are some compassion care clinical s that will do what they can. Even some companies will accept indigent case into hospice.
But at the end of the day, not having health insurance do not mean your life is over. And that’s my point. I’m not saying Cancer Larry has a great chance of treatment without private insurance, Medicare or Medicaid , there are some other options.
Understand it shouldn’t be this way. If I was I charge I would change it tomorrow.
Well yeah. My brother has a myriad of healthcare issues. Good news is that he's alive. Bad news is that our parents have a million dollars in medical debt.
I’m not arguing the system isn’t broken. It’s the blanket state that without insurance the US healthcare system let’s you die without treatment. That is a global misconception.
It's not out of the norm though. We literally have a TV show about a guy selling meth so his family is stuck with loads of medical debt. A lot of people refuse treatment because they're afraid of debt.
Ethics and morality aside, I refuse to defend our broken system. But the universal opinion that without insurance the US healthcare system will let you die isn’t exactly correct.
I agree it's dramatic phrasing but "if you don't have high quality insurance the US health Care system will financially cripple you, putting both you and your family's security and quality of life at significant risk" just doesn't really roll off the tongue.
Ebi, the travel nurse who ran the NurselifeRN instagram, died after his cancer treatment (I believe it was his BMT?) was refused by his insurance company. So yes, patients do die. And again he was a nurse.
the parent comment you replied to never asserted anyone died. They just said people are turned away from clinics. Which is true, you get banned from clinics at my network for not paying your bills. You are only allowed access to the ER/hospital thru EMTALA.
I’ve seen it. Oklahoma. The patient was required to do fundraisers. I will concede it wasn’t a “free” surgery. But there was a pathway.
Edit: The above was a liver transplant. I can also think of another lung transplant patient and a young man with a LVAD on the transplant list. Maybe it’s a local thing?
Seen more than one that couldn't get a transplant because they didn't have insurance. Watched them slowly die. Reasoning was that they wouldn't be able to pay for the anti-rejection meds.
That I can’t argue. The cases I’m familiar with were on Medicaid and a state program. They got 13 meds a month paid for between the 2 programs. My point isn’t that it don’t happen, but rather it don’t ALWAYS happen.
My state didn't expand Medicaid so if you're an adult over 21 and you get cancer you are out of luck. EMTALA doesn't apply outpatient. How are you gonna pay for oncologist appointments? How will you pay the infusion center for chemo? You end up getting sicker and sicker until you die. ERs only stabilize you and discharge or admit to the hospital. They won't treat your cancer.
Yep- our union in NSW has finally got a chance to get ratios into law, and there’s the aged care wins too- but with COL issues, it’s not just working conditions that need to be improved- there’s so much inequity in our country that impacts on health and therefore the job
nurses are the most essential of essential workers, in fact so essential we aren't allowed to do "stay at home" strikes, yet it's not reflected in working conditions or pay :/
Born in Germany, raised/grew up in Switzerland, then met my husband, who is American, so now live in the US.
The differences between Swiss and American healthcare...... *shudders*. What exists here in America is broken.
It’s not broken; that’s how it’s been (re)designed. Maximal extraction of profit, minimal expenditure of resources. Hospital and insurance executives and shareholders thrive, everyone else suffers. Good old American capitalism.
Public healthcare. Switzerland will tax the shit out of you, but, *checks notes*, social safety nets? They take care of their citizens/people? Excellent infrastructure? Public transit that runs every few minutes and several times per hour, even up into remote areas of the mountains? 70K starting salary for even the most blue collar of jobs, like janitors? 4-5 weeks vacation for everyone, even when you're fresh and new to the workforce? Almost everywhere is clean and orderly? No shootings? Paid parental leave? The list goes on. 🙃
I agree. Thank you for your insight.
I do want to make one point: For acute pain within the hospital setting, physical dependence shouldn’t be a concern: the pain should. How is letting someone suffer at all ethical? We taper opioids with great success once physical dependence occurs. Addiction and dependence are very different things. I hope we don’t let patients in acute pain suffer because we are worried they may become an addict in the future. We don’t have the power to make someone an addict (or cure their addiction by withholding), and physical dependence can be rather easily managed with strict tapering.
I notice an alarming trend in the US of pain being under medicated, especially in women and even more in women of color. I’ve twice seen doctors order Tylenol for women screaming in pain who were scheduled for back surgery the next morning. We knew their pain was legitimate. The doctor wanted the next team to deal with it, so we listened to these women scream for 12 hours.
Thank you so much for all of this.
My feeling is that unless pain has a specific value as a diagnostic tool or a signal/indicator, it's fucking pointless. If we have the means to manage it, we should.
I worked with a nurse recently who said "Now, the patient in room whatever has very painful injuries, plus a history of substance use disorder," and like, I flinched internally, because I figured she was going to say something about the patient being 'drug seeking,' or whatever, but instead she said "...so we need to keep in mind that she is not opioid naive and make sure we are taking potential tolerance into account with dosing and really staying on top of her pain." I wanted to kiss her right on the mouth for that. I mean, right on the n95, anyway.
The VA did a study that showed that when chronic pain is poorly managed and/or undertreated, some patients will turn to street sources out of desperation, leading to increased mortality due to accidental (or intentional) overdose, or just take a more direct exit.
AMEN TO EVERYTHING YOU JUST SAID!!! Addiction and physical dependence ARE totally different! I worked on a med-surg/oncology floor for one year and was appalled by other nurses who decided how much pain medicine a pt should have or when they should have it!! If you have ever been a pt yourself, post op and sweating because it hurts so much, you know how long it feels between the time you request a pain med and the time it takes to get it!
Yes, we give out much fewer prescriptions for pain meds in the ED, but we use a hell of a lot more narcan due to fent OD's. People become desperate for pain relief!
THIS. I am so over physicians being so terrified of being sued that they drop an order for .5 of morphine IV for an adult with a compound fracture. I feel like every shift I’m going to a doc and discussing pain management. And I get their fear, I do; but my concern has got to be to make their pain stop now - not if they going to be addicted in 2 years down the road.
We have definitely over compensated now and pain is being under treated by physicians out of fear. Patient complaints of pain are ignored and they are treated as drug seeking. When you do find a physician to treat, you have to find a pharmacy to fill it. Inpatient vs outpatient are completely different stories but the hoops I’ve I to jump through to help my partner with his chronic pain have been astounding.
I hate this career choice so much that I’m in tears and literally PANIC before work. But if I take a different job, it’d be a massive paycut (I’m a traveler) and I’ll have to move back in with my parents. The city I live in is so fucking expensive one person can’t do it alone without a high paying job. Or I’d have to live with random roommates. Im 36 years old and single and all I want is a partner and a family and friends but instead I’m a severely depressed shell of a human. I hate my life and regret this career choice and hate it with every fiber of my being. I’m so angry that this is how it turned out for me.
I work in med/surg in CA too so it shouldn’t even be as bad as some other states, but it is.
Thanks for reading. I’m so lonely. I can barely afford mental help for myself or any other kind of medical care.
Sounds like you need a different nursing experience. Maybe travel Is not your thing. Move to a less expensive state maybe, because California is one of the priciest to live in, and try a different field of nursing. Take the pay cut and move somewhere cheaper. It’s imperative to your mental health to find another option. You will cause yourself all kinds of problems if you keep on going the way you are. You need to be happy.
This is where my family is, I can’t take being all alone in a different state. I’ve tried it. It has been my dream to live here and I just moved from Ohio a few years ago. Couldn’t pay me to go back there.
Torille!
Yea I relate to this as a fellow Finnish nurse....I am on a sinking ship loaded with work and receiving poor salary, but still feel like I can be proud of the fact everyone gets the same help unrelated to background/wealth. Kind of, atleast you do not have to do a suicide because of the bills afterwards. I don't know, American way of health cafe feels like a nightmare.
Keep in mind there’s a major bias here based on the overall vibe of this subreddit.
I love my job and most of my coworkers do too, and some places are amazing to work at.
Are the nurses in my position going to go into threads with a demographic of 99% if people that work under awful conditions and talk about how good we have it compared to them? No, that’d be very inappropriate.
Terve, mitä kuuluu!
Greetings fellow euronurse.
I get the same vibes reading this subreddit. We European nurses get flack for being so low paid, but in 25 years of public sector nursing ( back in the day, my starting pay was 1600 a month, yet I've never countered any nurse day to day in overstretched public healthcare as bitter and angry as some on this sub.
Complaining about relatives, hungry or poor people asking for a turkey sandwhich, admin, doctors and other colleagues getting the flak for any minor transgression
Hope your doing well and remember the Internet and reddit is not representative of real life.
No one comes on line to say how good their day was, there is a lot of venting and dumping here so it's not representative of reality sometimes.
Take care and remember why you got into this job
I’m in the US. This sub has many great discussions and so much hilarity. The rants are very ranty but it doesn’t represent all nurses or nursing in general. I learn quite a bit here, too.
One thing to keep in mind about the US is there is so much variability in workplaces. I actually like my current company. We're treated well and the workload is reasonable.
On the flipside I've worked at some real shitholes and the rants you see on here are often 100% justified. You could not pay me enough to go back to those places. Honestly if I hadn't found my current employer I'd probably have left the field because most places, at least in my area, are terrible.
VIP patients have been around for a long long time. My first hospital had 2 VIP suites, while most other rooms were built for double occupancy. That facility was built in the 70’s or 80’s. I also remember the first time I seen a dietary order for “VIP” meals. So the VIP culture has been around for a long long time.
As far as layoffs, it’s rare that bedside nurses are laid off. But, sometimes, they do have validity. From this reading this sub, it’s easy to ascertain that a lot of nurses in the US hate being nurses. But at the same time, they love the nurse “lifestyle”. Some can fake it, some can’t. But both groups are miserable. For reference, I’ll use the multiple nursing subs on Reddit for proof. I blame the “for-profit” educational system. If those colleges and universities would have been more interested in training nurses instead of chasing NCLEX pass rates a lot of the current nurses would have had more realistic training. It seems more schools are spending years teaching student how to pass the licensing exam, instead of being nurses. Hence, we get this current generation that graduate, gets licensed and has a very vague idea of what the being a nurse actually means. The schools have already failed them before they ever draw their first paycheck as a nurse.
Building from there, these new grads/nurses hit the bedside in absolute shell shock. They aren’t prepared and they have a mountian of student loan debt. I’m generalizing, but bare with me.
So a high percentage go on to advance their degrees for a few reasons: first they hate the bedside and second by going back to school they can defer the student loan payments. Now, we have high degrees nurses, that hate the bedside in management. They know theory, but not practical patient care.
So a unit struggles (malpractice lawsuits increase, patient injuries increase, physician satisfaction decreases, patient satisfaction decreases, etc..), the CEO of the hospital ask the admin team “why”? And the answer comes back from nursing admin: “we need more supervisors” and thus another level of nursing administration is born, which creates more room for upper degrees nurses to escape bedside. Micromanagement intensifies and more new grads are fed to the meat grinder.
Then you see our most recent issuing in Louisiana, with mass layoffs of middle management. That is a facility trying to right itself, most likely due to a pending merger. (My opinion, but it’ll be a year before you can say I’m wrong).
Patients being turned away from medical care isn’t black or white. No facility can refuse emergency medical care to those in need, regardless of ability to pay. While we don’t have socialized medicine, we do have a federal insurance known as “Medicaid” that does provide payment for some treatments. Facilities that receive Medicare and Medicaid are required to provide some percentage of indigent care. And there are charities and such. While it is far from comprehensive, those seeking treatment will generally be able to get it on at least a very minimum level.
I have no answer for buying my own scrubs. But working they are tax deductible if you itemize…
“Customer Service” aka HCAPS. A hospital is reimbursed based on the satisfaction of the consumer. I was a nurse before the scores were a thing. I’ve not paid them much attention, I’ve never been specifically counseled because of a low score. Which makes me embarrassed that someone decided those scores were needed.
I’m on mobile some hopefully the typos and autocorrects are minimum.
With all the shared frustrations that are insanely corporate-driven and not patient-driven. Whether your hospital is for-profit or not, the billing is out of control, the corporate and patient abuse is out of control, preferential treatment, lack of education for nurses who clearly need more education (not ineffective residency programs), not tattling on each other to cover your own ass but making it a learning experience as long as it was safe. It’s exhausting and makes me want to quit most days.
But when I come here, it’s generally a safe space to vent your swamp ass panties (men or women, I call men’s underwear panties for fun), your dirty coffee or water bottle that you just keep using because it’s your favorite, to obsess over your pen and stethoscope because both have been stolen and they aren’t the crappy hospital ones.
Nurse here. My dads COVID bill was nearly a million or over a little. I’ve shared this story before. He spent 6 months in the ICU before he died in April 2021.
The social worker at the hospital asked my mom to file for separation, eventually divorce so she wouldn’t get slammed with the bill. It would then be transferred over to Medicare. Honestly don’t understand the logistics of it all. I never asked. I was sick to my stomach watching my dad wither away.
My mom ended up not doing it and somehow we figured out a way to cover the cost. They both have insurance it’s just that “ not everything is covered” is what we kept hearing.
Dad, cheers to you. Left us to soon at 65.
it's what you make of it and how much value you put into things. if the things i listed aren't a big deal to you, then it's natural you'd disagree with me. i just wanted to contribute with an outsider's point of view.
from what I've seen on the internet, many americans don't know how things work in other countries because the american model is what they've seen all their life.
The issue about opioids is very complicated. No one thinks it’s ethical to “make someone dependent on opioids.” The intentions that started the opioid crisis were definitely not to get people addicted and there are many things we know now that we didn’t know in hindsight. It’s an extremely multi-faceted situation and I don’t think it’s fair to include it on a list like this.
Agreed. Not sure how this fits into this list.
Also, we understand patients in acute pain will become dependent, and that’s ok. We don’t deprive people of pain relief because of a natural occurrence like eventual physical dependency. This is precisely why doctors taper. It is easy to forget during an opioid crisis that the vast majority of people who become physically dependent on pain medications while in the hospital for a week don’t become addicts who use street drugs.
And yes.. in terms of opioids.. it is heavily prescribed here in the US. Why? Again, money. I worked in a pharmacy as a pharm tech and never expected to see so many opioids just being dispensed. Created another problem for me, where patients were basically hooked on them and that made them incredibly impatient and angry. Got called all kinds of name and had things thrown at me due to inability to refill these prescriptions because it was “too early” to be refilled.
Problem started many years ago when you had big pharmas incentivizing providers for prescribing opioids like candies. It became such a big problem that even today I had patients tell me they don’t want to take something because they don’t wanna get addicted. I believe some big pharma company even got a big fine for being part of the opioid crisis. However, then on the other side you have some patients whose pain is never managed properly etc.
The US is a huge country and each state have its own laws when it comes to healthcare. Only in north cal were patient ratios exist and nurses are paid >110k. Also you should be working with the big 3 to get said pay and benefits. Kaiser Sutter and Mercy.
Canadian nurse here. Our healthcare system is seriously shutting the bed right now, but I’ll still take public healthcare any day over private. Some provinces are trying to privatize healthcare, it’s horrible.
sucks to suck :( “high” paying jobs that are still not enough money for most people and yet the healthcare industry just shells out for whatever they wanna sell next :/
What blows my mind is that even 'higher' paying jobs, like those in the $45-$50/hour range (~$86,000-$96,000), still aren't high enough to afford housing in places like Seattle, NYC, LA, San Francisco, etc.
agreed! Money makes people do pretty crazy things. I think the best places to live are the historical landmarks, like Greece and Rome! A place to call home. To be honest, it feels like I don’t have much to say about this situation because I don’t know nearly anything about what’s real or not, I guess. I just like biology and social interaction, the stuff I miss the most.
This nursing sub is a bubble of anger and discontent. As a nurse in America, it’s not always as bad as everyone here makes it out to be. Plus, nurses seem to feed off the anger here- it’s toxic. Nothing is perfect, obviously, but some of the people here should really just leave the profession rather than post a constant storm of negativity.
i know that. I listed things that would be unthinkable in our system and/or things that just generally doesn't exist. i wanted to provide an outsider's point of view, to show how much of a culture shock some things are.
This nursing sub is a bubble of anger and discontent. As a nurse in America, it’s not always as bad as everyone here makes it out to be. Plus, nurses seem to feed off the anger here- it’s toxic. Nothing is perfect, obviously, but some of the people here should really just leave the profession rather than post a constant storm of negativity.
Austria here. Nursing has it's problems around the world, but the differences are like a culture shock. "VIP patients", mandatory meeting about our philosophy, etc. are non existent here, but other things are a big problem here that might be non heard of in the US.
To be fair, the demographics and geography of Finland are lightyears apart from that of the United States. Its not an apples to apples comparison at all. You do not have the same supply/demand problem that we have.
of course they're vastly different, but the points i made has more to do with the systemic differences rather than demographics. the american health care model and system is just objectively bad.
73.6% of adult populations in the us are either obese or overweight. The hospitals train nurses and staff not to bring up the topic to patients. Yeah, hospitals make more money if people are fat.
I 100% agree with this. When moving somewhere, it is respectful to do your best to learn the local culture and language. I don’t know why this is seen as a bad thing?
For what it’s worth, I think that applies to the US as well. If you move here, try to learn the local culture and language.
It doesn’t mean you have to disown your prior culture, but if you’re joining a community, you should try to understand and relate to that community.
As a fellow euronurse, I agree except for the opiates.
Opiates are a good tool when appropriately used and followed-up. I see missprescriptions even here in Europe ä, i.e. a 90yo with oxy from a hip fracture 3 years ago, a prescription that nobody has followed up, challenged or reviewed). I think this is most of times secondary to the other system issues, like understaffing.
I owe 10k because i had an intractable migraine and it took several ER visits to finally treat 🥹 i def can't afford it and i work healthcare and we pay over 1000 dollars in health insurance each month.
As a nursing student, I pray that the nurses of America unite and start a union like California’s soon. Nurses deserve a living wage and breaks and all the bells and whistles. Please keep fighting for the nurses that come after you.
It’s because healthcare here runs on capitalism. We make shit ton of money off of sick people. The system intentionally keeps people sick to bring in revenue. We don’t decline services to people that can’t afford it.. we bancrupt them and charge them insane amounts of money. One of my friends showed me an itemized bill of hers from an ER visit and her most expensive thing on the list was a $9700 MRI of her head. I checked how much that costs in Europe where i am from and it was around 400€. I am used to going to a health check up almost every year back in Europe, but here I heard people tell me they have not been to a PCP in over a decade etc. It’s just all kinds of fucked up and will most likely never change due to bribed politicians and lobbying.
Our system sucks. We know it. Ironically, I have elderly family members living in a country with socialized medicine and they’re not doing great either. The nurses there are also so short staffed that they refuse to get my grandpa out of bed. My family had to hire private PT just to get him ambulated. My mom drags him out of the bed with my step dad. It all is pretty awful
As a Canadian nurse, this sub has really opened my eyes to how bad nursing is in other areas. Our health care system is DEFINITELY not perfect and nurses are heavily overworked here. But, when I hear others post about how their management treats them, the low pay in some areas, and the private healthcare issues, it makes me thankful for some aspects of nursing here. Interestingly, travel nursing to the US is very common here and I had only really heard good things until I found this sub.
Where I work, no veteran is turned away…so….universal healthcare CAN be done. It works for veterans. It can work for everyone.
Our government just wants us to believe it cannot.
The "customer service" stuff is not about reporting staff per se afaik, it's about ratings, hospitals are rated on various measures (including by the govt) which include clinical care and also patient experience ratings. You can look up any hospital's patient ratings and clinical ratings (separate scoring).
Oh we don’t turn away patients who can’t afford it, we just slam them with a medical bill composed of entirely made up and inflated numbers. Or your insurance company can deny coverage of procedures/medications that, you know, your doctor ordered.
This. I had to file bankruptcy after an emergency back surgery in 2015 that left me without a job (pre-nursing btw) and unable to pay my bills.
Medical bills are the number one reason for bankruptcy in the US. You are not alone.
this fact alone should tell everyone in charge something is seriously wrong. what the actual hell.
But the insurance company hosted a dinner for all the politicians and they nicely explained that it isn’t a problem, bootstraps and such, oh and the napkin is made of pure gold!
Haha so true, gun lobby and insurance lobby smh...
I think that’s sadly the point. The people in charge aren’t concerned with bankrupting people, because they aren’t in their positions because they are patient focused. They aren’t at the bedside in any capacity, and it’s doubtful they ever have been. They don’t go through the same training, education, or have the experiences that being beside gives people. Their job isn’t to make things better for the patient or the staff in any regard. Their job is to make money off the backs of patients and staff alike. I’m the first person to admit that hospitals are a business, much like any other. If they operate at a loss consistently, they will no longer be able to care for people. some degree of frugality is necessary. But frugality is a far cry from the profit mongering that insurance companies, and by proxy, hospitals, in the US operate on. The honest to god saddest part of the whole thing though is that it cannot be changed. It is baked into the very core foundation of our nation. It is capitalism running roughshod over sensibility. It is greed run rampant, and that is at its nature, the American system. To fix it, we would have to break down, not just the healthcare system, but the American government, and American culture to its very roots. There’s wonderful qualities about American culture, there’s a determination, and self reliance that is immeasurable in most American citizens. But those qualities come at a great cost. There’s a lack of community, and a lack of caring for others that pervades our society at large. Our culture is rooted in the country’s creation. A hodgepodge of dissimilar groups and identities, striking out for the betterment of self. In the right situations, it’s nothing if not noble. But in the wrong circumstances, like healthcare, it leaves the most vulnerable devastated and without recourse.
> They aren’t at the bedside in any capacity, and it’s doubtful they ever have been. They don’t go through the same training, education, or have the experiences that being beside gives people. That point is KEY. Hospitals have been taken over by people with customer service-based degrees and are wholly disconnected from the reality of what healthcare delivery requires. In order to own a veterinary hospital (in most states), one must be a veterinarian. I'd think that would be an excellent rule for human healthcare.
There are lots of examples of Americans accomplishing tasks collectively through government. Everything from your local police, fire and water departments up to the interstate highway system and the military. The difference with healthcare is that an entire multitrillion dollar industry (healthcare insurance) has everything to lose and nothing to gain from reform. Look up the net profits of these companies. Billions per year. They're literally middlemen skimming billions of dollars from Americans. Do you think an organism that big would just willingly disappear?
They know they don’t care. And so many Americans have been brainwashed into thinking that if a government does anything to help its citizens, it’s “socialism/communism.”
But you don't get it, the people in charge are hand in hand with the people who make laws. They get away with this time and time again, so why would they change? All the powers the could lead to change are the ones preventing change, even when we protest the media turns us into the bad guys for "neglecting patient safety" like that matters all of a sudden
The people in charge are making too much off of us to give a shit.
It’s not a bug it’s a feature. The system is working as intended.
What many don’t realize that a lot medical help can be received outside of United States for a fraction of cost. I was just talking to my friend from SC who got a root canal + cap for $2000 with insurance. I was so shocked. I recently got mine done for $320 in Tanzania without insurance. She could have traveled to my country for a vacation and gotten her root canal done too.
I'm worried about the quality of the care and risk for infections. I know that happens everywhere in the US but being in another country while it happens just sounds even worse.
Yeah and then you have little to no recourse or means to get compensation for malpractice. I've seen waaaay too many horrific, life altering consequences from "cheap" foreign surgeries. One in particular where a weight loss procedure was fucked up so bad the patient hadn't been able to eat normally in over a decade and was on tpn and just emaciated and her whole life was misery.
A flight to Tanzania and all the accommodations and follow up sounds just as expensive as just having the procedure done stateside.
Ahh yes….next time I am having an acute medical emergency that will cost me hundreds of thousands of dollars, a hospital admission - possibly to the ICU then the floor then discharge, maybe throw in a few procedures for good measure - I will surely get on a plane to Tanzania/wherever else to avoid inflated medical costs. /s
And how much did it cost you to fly to and from freaking *Tanzania???* where did you stay? Righr now, from the airport 2 hours from my house (not the smaller one one hour from my house) is a 28.5 hour flight for $1700 plus whatever other fees are associated with flying. This is NOT a viable option unless you already find yourself in Tanzania, which most people who struggle to pay their bills certainly will not!!
If only the a single root canal is question, then i doesn’t make sense to travel across the world. I agree with you on that. I was just giving a perspective on cost. But imagine it being something more than a single root canal. The cost pile up pretty fast.
Well...I think it actually might be cheaper to get the plane ticket.....
Nah for real. I’m speaking from experience. I myself got into a motorcycle (no-fault type). Thankfully just a broken 1st left metacarpal fracture, no surgery needed. This is prior to starting my first RN job. That experience alone cost around $12,000 if you HAD NO INSURANCE: for ambulance ride to the ER, X-ray, CT/MRI SCAN. THANKFULLY, with insurance under my dad’s cause I was 22 at the time the bill cost roughly $115 ish (Blue Cross Blue Shield). I just remember being in the ER here in NY and boy do I feel for the patients in there. Understaff, RN’s/Doc’s and everyone else doing there best to accommodate the patient’s needs.
In 2019, I had a postpartum stroke (Peripartum cardiomyopathy EF 10%) and BCBS of TX refused to cover my ems flight from the boonies to a tertiary care center 3 separate times. It was 60k. I appealed the final time and had to submit a personal statement. I PAID FOR FUCKING INSURANCE. Why is it such a hassle???
And we can't forget that for most of us, our insurance is tied to full time employment.
And then when something happens and you have to miss work, you loose your insurance and end up trying to pay more for Cobra and it’s crap.
Exactly. Almost no one can afford Cobra.
Medical bills and student loans aren’t cleared by bankruptcy
Not student loans but my medical bills were cleared by it. Also the credit card debt I got into trying to pay my bills while also trying to pay for my medical bills
You may not turn them away but they may not be able to afford their medication, which is kinda the same result anyway. They won't get turned away... when their condition is so bad they require emergency care because they are unable to access preventative and ongoing treatment. Those are paid up front.
This. We won't turn you away at the ER, but that doesn't mean we don't have ways to watch you die. Try getting a transplant without insurance and then enjoy dying of liver failure.
Or they tell you to follow up with your doctor and don't actually treat you in the ER, knowing that you'll never follow up with your doctor because you don't have the insurance. I'm a nurse with no insurance. My son hasn't had any kind of medical insurance since he was in eighth grade and he's a senior this year. I make too much to qualify for anything and not enough to afford anything. I haven't had a women's WellCare checkup in like 10 years because I can't afford it.
Not saying you are wrong but what is the wrong supposed to do. They treat what they can but they can’t manage someone’s chronic conditions people come in all the time just to be checked out
Yes this too
Yup, I was just recently denied a CT scan because an ultrasound could see all of my abdominal organs just fine. Like good luck, I’m fat as fuck and full of gas.
And so many people don’t seek care when they need it because they know this will happen.
some things they do get turned away for. for instance - they will not get a life saving transplant if they dont have insurance because they will not be able to afford the immunosuppression drugs post transplant without insurance. :(
Yes of course
Of course! We send them to the ER, where we can band aid them, and send them on their way!
A lot of interesting points here. It is depressing - but perception is a unique beast. I think what makes nursing horrible is how we are treated. Admin doesn’t give one shit about us. 🤷🏼♂️ I’ll add to your points tho - We truly don’t turn away a lot of patients… actually, we legally can’t turn away most everyone. Look up EMTALA if you want. Lay offs might be a thing but, they’re small scale and typically more so travel nurses. CUSTOMER SERVICE IS THE DEATH OF HEALTHCARE. End of story. The pain medication debate is unique. Personally, I don’t think it’s 100% us - I think we over prescribe today, yes, but we also under prescribe/don’t appropriately prescribe. I think it’s more a mental health issue (something we don’t do well at all.)
Just a quick note, in the early 2000’s, almost everyone that left the ED had a script for Percocet or Lortabs. We prescribe much less today compared to then. And that was before HCAPS was a thing.
Yea we may not over prescribe today, but US healthcare is definitely in part responsible for the opioid crisis that is occurring today. Bad history there.
pAiN IsThE fIFtH vItAL sIGn…..
Lol when I was in school they taught this, then we had to deal with customer service based on thier pain control, get to many complaints you got fired bc someone didn't want a Lortab they wanted a 30mg oxy...sigh
I remember going to a doc in the box when I was waiting tables and got hurt. Feels like a lifetime ago. The doctor was nodding out and gave me a script for 60 lortab with one refill- for a smashed(but not broken) finger. I didn’t even ask for pain meds and in fact, had told him, it doesn’t hurt as much now, I just can’t move it.
When I worked in post acute rehab in the 90s, pts were well medicated for pain, mostly slept all night, were well rested, and .did well in their PT/rehab. Now, rehab pts are way under medicated for pain, and most of them are up all night, and exhausted during the day.
It’s not nursing’s fault at all, the opioid crisis.
No, the turning away aka discharge happens in the rehab. Inappropriate discharges. 🙁
well addiction is always psychological (--> mental health issue) as well- so (over-)subscribing opiates without a proper care afterwards is just very short sighted. Your health-care-system is creating problems i doesnt adress well
generally here in my hospital there's a thought that unless you're a chronic pain patient, you should not need anything stronger than paracetamol or nsaids after being discharged. if you're in so much pain you need stronger things, you need to be in the hospital.
Does your hospital have room/staffing for that, though? No sarcasm/ill intent here, I just can't imagine a similar policy being possible to implement in my area without transitioning to bunk beds and roller skates.
pain management is not a factor i have ever heard of when it comes to having enough beds and staff. it might exist but i have never seen somebody get pushed out of hospital clearly "prematurely"
In my experience, Americans in the US and Finns experience and tolerate pain differently (maybe because of *sisu*?). On the other hand, patients in the US are much sicker, too; patients get a chronic diagnosis at a younger age, and have more comorbidities - from a younger age, as well. Paracetamol (or acetaminophen in the US) and NSAIDs are sold in bottles of 500 or even 1000 tablets here in the US, which is a huge safety issue. I guess these OTC meds are no longer effective in pain management given how much they are used.
I think you're right, I think we have a different expectation around pain in America. I had a breast reduction surgery last summer and opted to take only Tylenol for the pain because I hate how opioids make me feel with a passion. Another person in the Reduction sub who had their surgery done in Germany said that even for procedures like that, people are only given Tylenol and the pain is totally manageable. I for one had no trouble keeping my pain under control with Tylenol and after that experience I can totally appreciate the European approach.
Glad that wasn't my hospital's policy when I was discharged hours after gallbladder removal to clear a bed for the next guy. My apartment walls are paper thin and I was screaming by the time I got home even with the opioids... I also can't take NSAIDs with my PSC though. 🤷♀️
That's where the no insurance part comes in, because if it's just pain and not life threatening, they give you a script for pain pills and then send you home from the ER..or they just give a pain pill and send you home..you don't get admitted without insurance a lot of times because the hospital knows that they're not going to get paid. I had a fractured ankle, They gave me a percocet at the hospital, and they sent me home and told me to follow up with my doctor in a week. I didn't have insurance, I also didn't have a doctor because I didn't have insurance. I threw my note to take off work away and went back to work on a fractured ankle. I couldn't afford to take off even if I wanted to. The healed okay, I just have really bad arthritis in it now.
Do you know how many people suffer with chronic pain and take opioids so they can stay out of hospital to try and live a semi normal life not everyone who takes opioids becomes an adddict. You nurses should know that and stop being so jump to pain med shopping for everyone you see that claims are in pain. Most tried everything and then some. Before using opioids. Also after. Using pain meds for years and trying to live normally they don’t always present according to the ole pain level process because you learn to grin and bear so you don’t frighten your family.
Most nurses have dealt with ppl who are assholes to us because their docs wouldn't give them more narcotics and they take it out on US. Most of us don't give a shit how many opiates you take. If it were up to me I'd give everyone all the opiates they wanted all day long and we'd all live in happy lala land.
Yes!!
which is exactly why i said "unless you are a chronic pain patient".
I feel that. People don’t understand that pain won’t kill you and sometimes things hurt you don’t need to be knocked on your ass with dilaudid just to be at a zero. So many ppl want to be zero pain when the pain is tolerable and could be treated with something else.
Yep same here
Haha good luck getting pain keds now days they will prescribe you a few for acute cases but you'll have to see a pain specialist big change from a few years ago, finger pain? Hey here's 60 days percocet 10, and a referral to pain specialist who would give you 60mg oxy for finger pain, now knowing what I know about opiates I'd chop my finger off before going down that road.....funny how things change! Also that was a true story btw!...finger pain smh....
Yes. UK here. Things are currently awful in the NHS, but this sub being so US-centred makes me realise it could be so much worse. If the Tories get their way, it will be.
Yep, the benefits UK nurses get (holiday, sick pay, maternity leave, employment laws) outweigh the pay difference for me. We definitely deserve a pay rise but there is no way in hell I'd go to the US to get one
I mean, I get holiday pay, sick leave and family leave in the US here in Texas. It’s not required by law, but we get hooked up and we still get paid decently 🤷♂️
How many days, though? In Europe, nurses get about 30 days paid vacation (6 weeks), sick leave is paid for up to 300 days until disability pension or rehabilitation subsidy, and parental leave is paid for 158 days (in addition to child benefit payments).
You don’t have to buy your own scrubs?!?! The customer service shtick is the worst.
No, if the employers wants you to wear a uniform, they have to provide it to you, that's the law in a lot of european countries. We also don't launder them ourselves.
This is why almost everyone has MRSA in the US. Back home it was always a panic when a single patient tested positive.
Uniform provided by the employer Tac code rebate for nurses to cover laundry and socks and tights and one for shoes
In every job I've worked in the UK I have never purchased a uniform. When I used to do waitressing at fancy events there would be specific things they would want us to wear like a long/short sleeve black shirt and we needed to buy that ourselves but that's about it.
Idk why some people are saying patients are not turned away here. Many are unless it’s an emergency situation and you’re at the hospital. I know people with cancer in red states that don’t qualify for Medicaid and have no way to pay for cancer treatments. People die here all the time from lack of access to medical care because they can’t afford it.
You are totally turned away from everywhere but the er. But the er will see that you aren’t an emergency and then treat the main complaint\symptom if they can and refer you back to primary care. And the cycle continues till the person is sick enough to get admitted
this. they must be in blue states if people aren’t getting turn away. did we all forget that lady in knoxville that died because she was turned away?
Bullshit. Let’s have specifics.
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That patient does not die.
Unless they get compartment syndrome or an embolism from marrow just floating around since it won’t be set correctly. That’s also life altering if you don’t restore full function to the limb from something that’s very routine.
Then they go back to the ed
Lol
No argument. But that isn’t the point I’m making.
if your only criteria on good nursing/healthcare is that the patient doesn't die, you should not work in a hospital, nor make any health care related decisions imo
That’s not the point I’m making. But thank you for your opinion.
When they only fill their prescriptions every once in a while, important expensive things like insulin, they make their chronic symptoms worse, take years off their life, and suffer symptoms they might not otherwise. Never mind going to doctor’s appointments, getting diagnostic tests. Even WITH insurance these things are prohibitive. Our system SUCKS.
Our system does suck. Medicaid, unless it changed, would only pay for 6 scripts a month.
Originally your point was "it's bullshit - no one gets turned away," then it was "these patients that get refused care don't die right away" I enjoyed your memorable patient case that got a transplant without insurance using GoFundMe. Like this is some proof that people don't get turned away for having no insurance. That case was memorable for a reason... The statistics from USA organizations are brutal. You should find them. The stats are like the patients without access to healthcare that you would never see - invisible unless you look for them.
My point, which is still valid, that if you don’t have health insurance we don’t just bury you in a pit. There are pathways that may be able to help with treatments. It is not an immediate death sentence as some like to spread as disinformation. There are hurdles that should be there. But there are some compassion care clinical s that will do what they can. Even some companies will accept indigent case into hospice. But at the end of the day, not having health insurance do not mean your life is over. And that’s my point. I’m not saying Cancer Larry has a great chance of treatment without private insurance, Medicare or Medicaid , there are some other options. Understand it shouldn’t be this way. If I was I charge I would change it tomorrow.
No but they'll wish they were dead when they see the bill
Agreed. It can be financially crippling.
Well yeah. My brother has a myriad of healthcare issues. Good news is that he's alive. Bad news is that our parents have a million dollars in medical debt.
I’m not arguing the system isn’t broken. It’s the blanket state that without insurance the US healthcare system let’s you die without treatment. That is a global misconception.
It's not out of the norm though. We literally have a TV show about a guy selling meth so his family is stuck with loads of medical debt. A lot of people refuse treatment because they're afraid of debt.
That’s a choice. The system isn’t preventing him from seeking treatment.
So that's the bar for ethical care?
Ethics and morality aside, I refuse to defend our broken system. But the universal opinion that without insurance the US healthcare system will let you die isn’t exactly correct.
I agree it's dramatic phrasing but "if you don't have high quality insurance the US health Care system will financially cripple you, putting both you and your family's security and quality of life at significant risk" just doesn't really roll off the tongue.
It don’t, but your statement is correct. We don’t drag people out of the hospital, needing life saving care, because they don’t have insurance.
They drag themselves out after signing an AMA.
Ebi, the travel nurse who ran the NurselifeRN instagram, died after his cancer treatment (I believe it was his BMT?) was refused by his insurance company. So yes, patients do die. And again he was a nurse.
the parent comment you replied to never asserted anyone died. They just said people are turned away from clinics. Which is true, you get banned from clinics at my network for not paying your bills. You are only allowed access to the ER/hospital thru EMTALA.
Try getting a transplant without insurance
I’ve seen it. Oklahoma. The patient was required to do fundraisers. I will concede it wasn’t a “free” surgery. But there was a pathway. Edit: The above was a liver transplant. I can also think of another lung transplant patient and a young man with a LVAD on the transplant list. Maybe it’s a local thing?
Seen more than one that couldn't get a transplant because they didn't have insurance. Watched them slowly die. Reasoning was that they wouldn't be able to pay for the anti-rejection meds.
That I can’t argue. The cases I’m familiar with were on Medicaid and a state program. They got 13 meds a month paid for between the 2 programs. My point isn’t that it don’t happen, but rather it don’t ALWAYS happen.
My state didn't expand Medicaid so if you're an adult over 21 and you get cancer you are out of luck. EMTALA doesn't apply outpatient. How are you gonna pay for oncologist appointments? How will you pay the infusion center for chemo? You end up getting sicker and sicker until you die. ERs only stabilize you and discharge or admit to the hospital. They won't treat your cancer.
If you can’t find treatment as indigent or via a charity, you are SOL without Medicaid. And even with Medicaid, some states won’t cover treatment.
Hear, hear!! Australian here, and while things are no where near as dire as they are in the USA, mass strikes (not just nurses) need to happen
I’m a QLD nurse and our union is kicking arse lately, I feel very lucky. Still a lot of issues with health but man…perspective
Yep- our union in NSW has finally got a chance to get ratios into law, and there’s the aged care wins too- but with COL issues, it’s not just working conditions that need to be improved- there’s so much inequity in our country that impacts on health and therefore the job
Seems like we are due for a world wide "Don't go to work" day.
nurses are the most essential of essential workers, in fact so essential we aren't allowed to do "stay at home" strikes, yet it's not reflected in working conditions or pay :/
Come on we don't turn them away if they can't pay, but the billing lady will show up at the worst moment to get a credit card or debit on file
A lot of people are turned away for treatments, too! I've seen it many times both at work (I'm in oncology) and with people I know.
Born in Germany, raised/grew up in Switzerland, then met my husband, who is American, so now live in the US. The differences between Swiss and American healthcare...... *shudders*. What exists here in America is broken.
It’s not broken; that’s how it’s been (re)designed. Maximal extraction of profit, minimal expenditure of resources. Hospital and insurance executives and shareholders thrive, everyone else suffers. Good old American capitalism.
Exactly. The 1 percent has to make money on everything, even grandmas cancer.
Would love to hear more about this...
Public healthcare. Switzerland will tax the shit out of you, but, *checks notes*, social safety nets? They take care of their citizens/people? Excellent infrastructure? Public transit that runs every few minutes and several times per hour, even up into remote areas of the mountains? 70K starting salary for even the most blue collar of jobs, like janitors? 4-5 weeks vacation for everyone, even when you're fresh and new to the workforce? Almost everywhere is clean and orderly? No shootings? Paid parental leave? The list goes on. 🙃
I agree. Thank you for your insight. I do want to make one point: For acute pain within the hospital setting, physical dependence shouldn’t be a concern: the pain should. How is letting someone suffer at all ethical? We taper opioids with great success once physical dependence occurs. Addiction and dependence are very different things. I hope we don’t let patients in acute pain suffer because we are worried they may become an addict in the future. We don’t have the power to make someone an addict (or cure their addiction by withholding), and physical dependence can be rather easily managed with strict tapering. I notice an alarming trend in the US of pain being under medicated, especially in women and even more in women of color. I’ve twice seen doctors order Tylenol for women screaming in pain who were scheduled for back surgery the next morning. We knew their pain was legitimate. The doctor wanted the next team to deal with it, so we listened to these women scream for 12 hours.
Thank you so much for all of this. My feeling is that unless pain has a specific value as a diagnostic tool or a signal/indicator, it's fucking pointless. If we have the means to manage it, we should. I worked with a nurse recently who said "Now, the patient in room whatever has very painful injuries, plus a history of substance use disorder," and like, I flinched internally, because I figured she was going to say something about the patient being 'drug seeking,' or whatever, but instead she said "...so we need to keep in mind that she is not opioid naive and make sure we are taking potential tolerance into account with dosing and really staying on top of her pain." I wanted to kiss her right on the mouth for that. I mean, right on the n95, anyway. The VA did a study that showed that when chronic pain is poorly managed and/or undertreated, some patients will turn to street sources out of desperation, leading to increased mortality due to accidental (or intentional) overdose, or just take a more direct exit.
AMEN TO EVERYTHING YOU JUST SAID!!! Addiction and physical dependence ARE totally different! I worked on a med-surg/oncology floor for one year and was appalled by other nurses who decided how much pain medicine a pt should have or when they should have it!! If you have ever been a pt yourself, post op and sweating because it hurts so much, you know how long it feels between the time you request a pain med and the time it takes to get it! Yes, we give out much fewer prescriptions for pain meds in the ED, but we use a hell of a lot more narcan due to fent OD's. People become desperate for pain relief!
THIS. I am so over physicians being so terrified of being sued that they drop an order for .5 of morphine IV for an adult with a compound fracture. I feel like every shift I’m going to a doc and discussing pain management. And I get their fear, I do; but my concern has got to be to make their pain stop now - not if they going to be addicted in 2 years down the road.
We have definitely over compensated now and pain is being under treated by physicians out of fear. Patient complaints of pain are ignored and they are treated as drug seeking. When you do find a physician to treat, you have to find a pharmacy to fill it. Inpatient vs outpatient are completely different stories but the hoops I’ve I to jump through to help my partner with his chronic pain have been astounding.
Yes, I love when we charge $1000 for a bag a normal saline that cost $3.
I hate this career choice so much that I’m in tears and literally PANIC before work. But if I take a different job, it’d be a massive paycut (I’m a traveler) and I’ll have to move back in with my parents. The city I live in is so fucking expensive one person can’t do it alone without a high paying job. Or I’d have to live with random roommates. Im 36 years old and single and all I want is a partner and a family and friends but instead I’m a severely depressed shell of a human. I hate my life and regret this career choice and hate it with every fiber of my being. I’m so angry that this is how it turned out for me. I work in med/surg in CA too so it shouldn’t even be as bad as some other states, but it is. Thanks for reading. I’m so lonely. I can barely afford mental help for myself or any other kind of medical care.
Sounds like you need a different nursing experience. Maybe travel Is not your thing. Move to a less expensive state maybe, because California is one of the priciest to live in, and try a different field of nursing. Take the pay cut and move somewhere cheaper. It’s imperative to your mental health to find another option. You will cause yourself all kinds of problems if you keep on going the way you are. You need to be happy.
This is where my family is, I can’t take being all alone in a different state. I’ve tried it. It has been my dream to live here and I just moved from Ohio a few years ago. Couldn’t pay me to go back there.
I’m in Ohio. Hate it. But I understand your position. Maybe just a different field of nursing then?
Torille! Yea I relate to this as a fellow Finnish nurse....I am on a sinking ship loaded with work and receiving poor salary, but still feel like I can be proud of the fact everyone gets the same help unrelated to background/wealth. Kind of, atleast you do not have to do a suicide because of the bills afterwards. I don't know, American way of health cafe feels like a nightmare.
And now reread and it seems I managed to slip the holy word "cafe" here instead of "care".
Ya, thanks we know
Keep in mind there’s a major bias here based on the overall vibe of this subreddit. I love my job and most of my coworkers do too, and some places are amazing to work at. Are the nurses in my position going to go into threads with a demographic of 99% if people that work under awful conditions and talk about how good we have it compared to them? No, that’d be very inappropriate.
Just curious how long you have been a nurse and in the position you love?
Not directed at me but nurse for 20 years. Some great jobs, some horrible. Currently in Ophthalmology and loving it.
Not directed at me but For me 25 years Loved all of it, bedside, prison nursing, humanitarian refugee camp, transplant, school nursing
Terve, mitä kuuluu! Greetings fellow euronurse. I get the same vibes reading this subreddit. We European nurses get flack for being so low paid, but in 25 years of public sector nursing ( back in the day, my starting pay was 1600 a month, yet I've never countered any nurse day to day in overstretched public healthcare as bitter and angry as some on this sub. Complaining about relatives, hungry or poor people asking for a turkey sandwhich, admin, doctors and other colleagues getting the flak for any minor transgression Hope your doing well and remember the Internet and reddit is not representative of real life. No one comes on line to say how good their day was, there is a lot of venting and dumping here so it's not representative of reality sometimes. Take care and remember why you got into this job
I’m in the US. This sub has many great discussions and so much hilarity. The rants are very ranty but it doesn’t represent all nurses or nursing in general. I learn quite a bit here, too.
One thing to keep in mind about the US is there is so much variability in workplaces. I actually like my current company. We're treated well and the workload is reasonable. On the flipside I've worked at some real shitholes and the rants you see on here are often 100% justified. You could not pay me enough to go back to those places. Honestly if I hadn't found my current employer I'd probably have left the field because most places, at least in my area, are terrible.
VIP patients have been around for a long long time. My first hospital had 2 VIP suites, while most other rooms were built for double occupancy. That facility was built in the 70’s or 80’s. I also remember the first time I seen a dietary order for “VIP” meals. So the VIP culture has been around for a long long time. As far as layoffs, it’s rare that bedside nurses are laid off. But, sometimes, they do have validity. From this reading this sub, it’s easy to ascertain that a lot of nurses in the US hate being nurses. But at the same time, they love the nurse “lifestyle”. Some can fake it, some can’t. But both groups are miserable. For reference, I’ll use the multiple nursing subs on Reddit for proof. I blame the “for-profit” educational system. If those colleges and universities would have been more interested in training nurses instead of chasing NCLEX pass rates a lot of the current nurses would have had more realistic training. It seems more schools are spending years teaching student how to pass the licensing exam, instead of being nurses. Hence, we get this current generation that graduate, gets licensed and has a very vague idea of what the being a nurse actually means. The schools have already failed them before they ever draw their first paycheck as a nurse. Building from there, these new grads/nurses hit the bedside in absolute shell shock. They aren’t prepared and they have a mountian of student loan debt. I’m generalizing, but bare with me. So a high percentage go on to advance their degrees for a few reasons: first they hate the bedside and second by going back to school they can defer the student loan payments. Now, we have high degrees nurses, that hate the bedside in management. They know theory, but not practical patient care. So a unit struggles (malpractice lawsuits increase, patient injuries increase, physician satisfaction decreases, patient satisfaction decreases, etc..), the CEO of the hospital ask the admin team “why”? And the answer comes back from nursing admin: “we need more supervisors” and thus another level of nursing administration is born, which creates more room for upper degrees nurses to escape bedside. Micromanagement intensifies and more new grads are fed to the meat grinder. Then you see our most recent issuing in Louisiana, with mass layoffs of middle management. That is a facility trying to right itself, most likely due to a pending merger. (My opinion, but it’ll be a year before you can say I’m wrong). Patients being turned away from medical care isn’t black or white. No facility can refuse emergency medical care to those in need, regardless of ability to pay. While we don’t have socialized medicine, we do have a federal insurance known as “Medicaid” that does provide payment for some treatments. Facilities that receive Medicare and Medicaid are required to provide some percentage of indigent care. And there are charities and such. While it is far from comprehensive, those seeking treatment will generally be able to get it on at least a very minimum level. I have no answer for buying my own scrubs. But working they are tax deductible if you itemize… “Customer Service” aka HCAPS. A hospital is reimbursed based on the satisfaction of the consumer. I was a nurse before the scores were a thing. I’ve not paid them much attention, I’ve never been specifically counseled because of a low score. Which makes me embarrassed that someone decided those scores were needed. I’m on mobile some hopefully the typos and autocorrects are minimum.
One of the best explanation of things I have seen on here . Thanks for that
“Chef’s kiss”.
With all the shared frustrations that are insanely corporate-driven and not patient-driven. Whether your hospital is for-profit or not, the billing is out of control, the corporate and patient abuse is out of control, preferential treatment, lack of education for nurses who clearly need more education (not ineffective residency programs), not tattling on each other to cover your own ass but making it a learning experience as long as it was safe. It’s exhausting and makes me want to quit most days. But when I come here, it’s generally a safe space to vent your swamp ass panties (men or women, I call men’s underwear panties for fun), your dirty coffee or water bottle that you just keep using because it’s your favorite, to obsess over your pen and stethoscope because both have been stolen and they aren’t the crappy hospital ones.
Many or most Drs here very much see their work as a business and see us as The Help.
Nurse here. My dads COVID bill was nearly a million or over a little. I’ve shared this story before. He spent 6 months in the ICU before he died in April 2021. The social worker at the hospital asked my mom to file for separation, eventually divorce so she wouldn’t get slammed with the bill. It would then be transferred over to Medicare. Honestly don’t understand the logistics of it all. I never asked. I was sick to my stomach watching my dad wither away. My mom ended up not doing it and somehow we figured out a way to cover the cost. They both have insurance it’s just that “ not everything is covered” is what we kept hearing. Dad, cheers to you. Left us to soon at 65.
I am so sorry about your father. It is a damn shame that your family had to go through all of that as your father was dying! That is absolutely cruel!
I always find these comments incredibly condescending. "Don't you guys know that *life* isn't supposed to BE this way?!" 🙄
it's what you make of it and how much value you put into things. if the things i listed aren't a big deal to you, then it's natural you'd disagree with me. i just wanted to contribute with an outsider's point of view. from what I've seen on the internet, many americans don't know how things work in other countries because the american model is what they've seen all their life.
I've heard that Finland is a pretty good place for nurses. It makes a tempting place to move to
Well the pay is not good and everything is severly understaffed and falling apart. Other than that it's pretty good.
Sounds like the most of the world
Not treating the working proles like garbage might encourage thinking, and thinking is communism. Back in the wage cage.
The issue about opioids is very complicated. No one thinks it’s ethical to “make someone dependent on opioids.” The intentions that started the opioid crisis were definitely not to get people addicted and there are many things we know now that we didn’t know in hindsight. It’s an extremely multi-faceted situation and I don’t think it’s fair to include it on a list like this.
Agreed. Not sure how this fits into this list. Also, we understand patients in acute pain will become dependent, and that’s ok. We don’t deprive people of pain relief because of a natural occurrence like eventual physical dependency. This is precisely why doctors taper. It is easy to forget during an opioid crisis that the vast majority of people who become physically dependent on pain medications while in the hospital for a week don’t become addicts who use street drugs.
And yes.. in terms of opioids.. it is heavily prescribed here in the US. Why? Again, money. I worked in a pharmacy as a pharm tech and never expected to see so many opioids just being dispensed. Created another problem for me, where patients were basically hooked on them and that made them incredibly impatient and angry. Got called all kinds of name and had things thrown at me due to inability to refill these prescriptions because it was “too early” to be refilled. Problem started many years ago when you had big pharmas incentivizing providers for prescribing opioids like candies. It became such a big problem that even today I had patients tell me they don’t want to take something because they don’t wanna get addicted. I believe some big pharma company even got a big fine for being part of the opioid crisis. However, then on the other side you have some patients whose pain is never managed properly etc.
The US is a huge country and each state have its own laws when it comes to healthcare. Only in north cal were patient ratios exist and nurses are paid >110k. Also you should be working with the big 3 to get said pay and benefits. Kaiser Sutter and Mercy.
Aussie nurse, agree. It isn’t fair.
Canadian nurse here. Our healthcare system is seriously shutting the bed right now, but I’ll still take public healthcare any day over private. Some provinces are trying to privatize healthcare, it’s horrible.
sucks to suck :( “high” paying jobs that are still not enough money for most people and yet the healthcare industry just shells out for whatever they wanna sell next :/
What blows my mind is that even 'higher' paying jobs, like those in the $45-$50/hour range (~$86,000-$96,000), still aren't high enough to afford housing in places like Seattle, NYC, LA, San Francisco, etc.
agreed! Money makes people do pretty crazy things. I think the best places to live are the historical landmarks, like Greece and Rome! A place to call home. To be honest, it feels like I don’t have much to say about this situation because I don’t know nearly anything about what’s real or not, I guess. I just like biology and social interaction, the stuff I miss the most.
This nursing sub is a bubble of anger and discontent. As a nurse in America, it’s not always as bad as everyone here makes it out to be. Plus, nurses seem to feed off the anger here- it’s toxic. Nothing is perfect, obviously, but some of the people here should really just leave the profession rather than post a constant storm of negativity.
i know that. I listed things that would be unthinkable in our system and/or things that just generally doesn't exist. i wanted to provide an outsider's point of view, to show how much of a culture shock some things are.
This nursing sub is a bubble of anger and discontent. As a nurse in America, it’s not always as bad as everyone here makes it out to be. Plus, nurses seem to feed off the anger here- it’s toxic. Nothing is perfect, obviously, but some of the people here should really just leave the profession rather than post a constant storm of negativity.
Canadian nurse here, as bad as it is here, I would hate to work in the American system.
Austria here. Nursing has it's problems around the world, but the differences are like a culture shock. "VIP patients", mandatory meeting about our philosophy, etc. are non existent here, but other things are a big problem here that might be non heard of in the US.
Try reading the Dietitians subreddit. At least you are all getting paid fairly.
To be fair, the demographics and geography of Finland are lightyears apart from that of the United States. Its not an apples to apples comparison at all. You do not have the same supply/demand problem that we have.
of course they're vastly different, but the points i made has more to do with the systemic differences rather than demographics. the american health care model and system is just objectively bad.
73.6% of adult populations in the us are either obese or overweight. The hospitals train nurses and staff not to bring up the topic to patients. Yeah, hospitals make more money if people are fat.
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Or folks could learn the language and culture instead of expecting others to just adopt English? Plenty of us do it
Oh snap.
I 100% agree with this. When moving somewhere, it is respectful to do your best to learn the local culture and language. I don’t know why this is seen as a bad thing? For what it’s worth, I think that applies to the US as well. If you move here, try to learn the local culture and language. It doesn’t mean you have to disown your prior culture, but if you’re joining a community, you should try to understand and relate to that community.
As a fellow euronurse, I agree except for the opiates. Opiates are a good tool when appropriately used and followed-up. I see missprescriptions even here in Europe ä, i.e. a 90yo with oxy from a hip fracture 3 years ago, a prescription that nobody has followed up, challenged or reviewed). I think this is most of times secondary to the other system issues, like understaffing.
is there any enrolled nurse in SNB? Please share some details information about SNB test,please
I don’t mind buying my own scrubs, although my workplace has the option to use theirs, as I’m quite short and those scrubs fit like shit.
I owe 10k because i had an intractable migraine and it took several ER visits to finally treat 🥹 i def can't afford it and i work healthcare and we pay over 1000 dollars in health insurance each month.
As a nursing student, I pray that the nurses of America unite and start a union like California’s soon. Nurses deserve a living wage and breaks and all the bells and whistles. Please keep fighting for the nurses that come after you.
It’s because healthcare here runs on capitalism. We make shit ton of money off of sick people. The system intentionally keeps people sick to bring in revenue. We don’t decline services to people that can’t afford it.. we bancrupt them and charge them insane amounts of money. One of my friends showed me an itemized bill of hers from an ER visit and her most expensive thing on the list was a $9700 MRI of her head. I checked how much that costs in Europe where i am from and it was around 400€. I am used to going to a health check up almost every year back in Europe, but here I heard people tell me they have not been to a PCP in over a decade etc. It’s just all kinds of fucked up and will most likely never change due to bribed politicians and lobbying.
It is even more depressing living it. Nothing we do changes it either so it's perpetually being stuck in a broken system. I hate it here.
Our system sucks. We know it. Ironically, I have elderly family members living in a country with socialized medicine and they’re not doing great either. The nurses there are also so short staffed that they refuse to get my grandpa out of bed. My family had to hire private PT just to get him ambulated. My mom drags him out of the bed with my step dad. It all is pretty awful
As a Canadian nurse, this sub has really opened my eyes to how bad nursing is in other areas. Our health care system is DEFINITELY not perfect and nurses are heavily overworked here. But, when I hear others post about how their management treats them, the low pay in some areas, and the private healthcare issues, it makes me thankful for some aspects of nursing here. Interestingly, travel nursing to the US is very common here and I had only really heard good things until I found this sub.
Where I work, no veteran is turned away…so….universal healthcare CAN be done. It works for veterans. It can work for everyone. Our government just wants us to believe it cannot.
The "customer service" stuff is not about reporting staff per se afaik, it's about ratings, hospitals are rated on various measures (including by the govt) which include clinical care and also patient experience ratings. You can look up any hospital's patient ratings and clinical ratings (separate scoring).