What Needs to Change in Health Care

nurse-to-patient-atio

I’m back to writing about nursing for a bit. My other blog has been put to the wayside for now. I’ve been trying to learn C# and Unity to make a cool game! But of course, I want to write about things that occupy my mind. Anyway…

I’m generally critical of health care. Being a peon on the front lines forces you to observe areas for improvement. I could tell you all the things I find broken with health care, which I’m sure other health care workers would agree with.

I figured I should make a twist on this post and write about changes I’d like to see with health care rather than complain. I really don’t think they’ll ever change drastically in my lifetime, but I can hope. Call me a realistic optimist.

  • Cease making health care for-profit
    • Despite some systems claiming to be not-for-profit, I don’t believe this to be true. Of course, operation costs, employee salaries, supplies, and all the other costs needed to operate a health care system require revenue in order to maintain a balanced budget. However, when companies are making large profits off of sick patients and CEOs are making millions of dollars, that just is unethical. Health care should be a basic need much like food, housing, and education.
  • Change the reimbursement model
      • We should be measuring reimbursement based upon a multitude of factors. I do believe hospitals should reach acceptable levels of nosocomial infections, readmissions, mortalities, and safety parameters. I do NOT believe hospitals should be reimbursed based upon patient satisfaction. We are not hotels, airlines, or a consumer entity. Oh wait, go back to my first point…
        Most patients do not know medicine. That is why there are doctors, nurses, and other specialists. It is our job to say what is recommended and should not be swayed by what people want to hear.
      • Another issue with reimbursement is to tailor it to different types of hospitals. A large university hospital located in an affluent neighborhood versus a small community hospital in the middle of nowhere will have different patient populations. We cannot lump in Cook County Hospital (aka Stroger) with the Cleveland Clinic. An apple is not an orange.
    • High readmission rates are definitely undesirable, and I wouldn’t wish readmission on a patient due to hospital error. However, if a CHF patient goes home and eats a Big Mac, doesn’t take his Lasix, and refuses to quit smoking, how should this negatively impact our reimbursement? Some say the patient needed better education. C’mon! This cannot boil down to inadequate patient education. It’s like saying a child got a D on a test because the teacher didn’t teach well, but let’s disregard that the child did not study at all. People need to be accountable for their health as well. Health care workers want to help, but we can only lead the horse to the trough, and we cannot force it to eat.
  • Better staffing
    • This ties in with for-profit systems. One of the largest operational costs of a health care system is its human resources. Naturally, all the business leaders in charge of health care systems want to cut operational costs for larger profit margins. The quickest and easiest way to do so is to cut staffing or hire cheaper staff. What does this mean?
        • The general floor nursing ratio goes up to 1:7 or even 1:8 aka one nurse to seven or eight patients. The telemetry floor nursing ratio goes up to 1:6. Step-down nursing ratio goes to 1:4. ICU ratio goes to 1:3. Oh, and the very critical 1:1 patient is no longer 1:1. Take a “stable” ICU patient with that 1:1. A true ICU patient and stable do NOT belong in the same sentence, so stop saying it!! Other staff are pruned as well: respiratory therapists, physical therapy, speech therapy, nursing techs, occupational therapy, cardiac rehab, and pretty much everything else.
        • The number of experienced nurses are weeded out, and new graduate nurses are hired into these positions. While currently it may seem difficult for new graduate nurses to find positions directly out of school, I surprisingly see many in the wild. Of course, everyone needs to start somewhere. But when you start getting rid of the wise ones that know an ICP, IABP, and CVVHD like the back of their hand, things start to get hairy when shit hits the fan. And believe me, it happens more frequently than you might think. For health care, it isn’t a matter of the new ones will eventually catch on and it will be okay. It’s a matter of life and death literally.
      • With better staffing, magically patients will be happier, less medical errors will happen, falls will be reduced, education can be more thorough, and work stress can be reduced. Shouldn’t that be the goal of health care?
  • Increase in mental health awareness
    • Most people who are admitted to a hospital or have chronic illnesses touch on depression or anxiety, either briefly or long-term. I would propose that each patient speak with a counselor at least once during a hospital stay, and perhaps more frequently if the stay is prolonged. Health care workers are generally so busy trying to fit in everything in a 12-hour day. It’s not humanly possible to treat the mind and soul with all patients. We also fall victim to adding a psych consult for patients that are distraught, which in turn leads to anti-depressants, anti-psychotics, and sedatives. We’re not addressing the issue; we’re just throwing meds at it. The effects of poor mental health with physical illness is just a recipe for failure. The stigma of dealing with life problems in solitude because it’s weak to ask for help is such a load of shit.

I’m going to conclude this post here since it’s getting lengthy. Maybe I’ll continue on with this another day. I hope health care in this country eventually gets overhauled, but it’s really quite difficult to fix something that has been haphazardly band-aided together by politicians, businesses, and lobbyists.

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