The promised response

June 6, 2007 at 12:30 pm (issues, kvetching, nursing, responding, sticking my nose where it doesn't belong, whining)

I’m going to break it down in bits, ucalcal, because I don’t think we disagree, and I want to give you a better picture of what I believe, and a response rather than a rant. Your quotes are italicized.

Wow…once again I see that those that preach something have a hard time dealing with others asking why they are not consistent with their argument.

Where was I inconsistent? Because if I was, I’d like to see it. I hate waffling, and I do it often enough to despair of ever being free.
While I don’t feel I am talking out of my a@@ as you mentioned, I do wonder why you feel that the powerful nurses union could not have a say in this issue.

Well, I didn’t say they couldn’t have a say. I said that they weren’t in control of the paramedic companies. It seems that you think that if the nurses union simply pushed hard enough, they could get whatever they wanted from…whomever. Maybe so, but expecting a union that serves a certain group of people–people who pay dues and so have a vested interest in said union’s activities–to advocate for everyone is irrational.

I’m not going to say, in this post, whether or not I think they should…oh wait, yes I am. Okay, I do think that the nurses union should advocate for better ratios, not merely for themselves, but for everyone. But I know we don’t live in a world that rewards us for what we should do, and I know I can’t demand that a union of which I am not a part spend their resources trying to get a better deal for members of other unions & professions.

If you are going to make a public argument that ratio’s in healthcare a crucial to good care then you must take the logical path that there should be ratios for every part of the “healthcare” team. I am not against ratios, the problem I have is with one group trying to say they are the patients advocates but stop advocating for patients once it falls out of the scope of work that their union represents.

That’s fair. I don’t have a problem with this at all–in fact, I agree. If the nurses union is truly interested in the patient first, themselves second, they should continue that advocacy across healthcare as a whole. I’m assuming that the union, since they claim to advocate for the patients, feel that it is not the best use of their resources to push for ratios in other areas. Maybe they think that if paramedic ratios are a problem, paramedics should do something about it. I don’t know.

If you want a ratio to ensure higher pay and job security (just like the correctional peace officers received in California by backing 3 Strikes and ensuring that there would be inmates for 20 years to life [isn’t it funny that 20 years is the magic number for retirement…if their crimes are so bad why not 30 years to life or just life] then just come out and say that. I am not against that…but don’t run around California and say we are for patients when that had very little to actually do with the reasons you wanted a RN ratio. Hey by the way what about LVNs? What about CNAs? Maybe if they were apart of your union, you would have gotten them a ratio to.

Yeah, the whole 20 year thing. Maybe it has something to do with the fact that it’s a nice, round number. Sounds better than 10, not as difficult to multiply as 30. Heck, I don’t know. Everything I know about the law I learned from Law & Order…so, not much. If anything. Regarding the LVNs and CNAs, well, they aren’t a part of the union. That’s what I’m saying, and that’s the issue I had with your comment to begin with. Not that ratios are good, or bad, or anything at all. Just that other parts of the “healthcare team” better step up if they don’t want things to go to hell in a handbasket (obligitory cliche? check.) right fast and in a hurry (thanks for the farmer talk, grandpa). Because you can’t expect the nurses union to go, “Whoa, we better back down. We’ve got ourselves a pretty nice deal, here, but whoops! Where’d everybody else go?” You would (and are). I see it, too. But unions are rather like weeds–out of control in no time. The only checks are the nurses themselves, and the competing interests…which, at the moment, are doing precisely squat.

The other problem I have with the nurses union in California is the fact that why they say they are the patients advocate they stand against capping health insurance premiums. In every contract that they go into, they always say they are ok with their members health insurance premiums going up. The problem with that is that when they agree to that, it put unions that represent less skilled labor in a weak position to keep health insurance premiums down for their members. The reason you don’t want to cap health insurance premiums is because you need those increases to insure that the members of the nurses union are able to get 25% increasing from providers like Kaiser in their recent contract. So I guess you are the patients advocate as long as they can afford the increasing health insurance premiums.

God. Sucks, doesn’t it? I’m glad you pointed that out. Look, like I said, I don’t know the answer–but I know that the nurses union is the only voice that matters right now, sadly enough.

And before you go all crazy telling me that the nurses are backing universal healthcare legislation with SB 840 in California, why sell the rest of us out in labor while we wait for at least another decade for the political climate to become right for that type of reform? We know because you need to ensure there is enough money coming into Kaiser to get that 25% raise.

So maybe next time you say someone is speaking out of their a@@ you should step back and actually research what the nurses union in California is actually doing. For those of us in other labor movements, yes I work for a union, watching the nurses have their cake and eat it to is disgusting. If you want to be the moral do gooder in California, and want everyone to treat you that way, then you better step up and be consistent in what you are asking for.

Um, I realize that you aren’t directing this at me. Since, of course, I haven’t made any of these statements. Since I am not a member of the nurses union. And yes, the union and its members should be consistent. And actually, I’m all for universal healthcare. IN THEORY. But we live in the real world, and often enough things that sound so lovely are poo in practice.

Looking forward to seeing your response.

As am I.

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Where have all the Doctors gone?

May 26, 2007 at 10:03 am (current events, issues, kvetching, misers, nursing, sticking my nose where it doesn't belong, whining)

“The accumulation of all powers, legislative, executive, and judiciary, in the same hands, whether of one, a few, or many, and whether hereditary, self appointed, or elective, may justly be pronounced the very definition of tyranny.” ~ James Madison, Federalist Paper 47.

*****

This post, by EM Physician (a blog I read frequently, and enjoy) made a few statements that got me thinking. But before we get started, someone made a comment I feel compelled to answer…

Not even going to touch the rest of your comment, ucalcal, but this?

Where are the nurses on ensuring enough paramedics are available to provide a quick response to 911 calls so sick individuals get to the hospital in time to be saved? (emphasis mine)

WTF? Like the nurses have control over the paramedic companies. You are talking out of your ass, man. Good grief.

That said, the reason nurses are catching so much flak here is because they ARE unionized. Squeaky wheel gets the grease, as they say. The bigger question is, why isn’t everyone else fighting, too? It isn’t the nurses’ fault that they are biased in favor of nurses. In Federalist Papers No. 51, James Madison said, “Ambition must be made to counteract ambition.” But where is the ambition of the docs, radtechs, etc?

If you want to blame someone, start by blaming yourself. Docs are seen as weak because they are weak. Pushed around for the last five decades by an increasing mound of paper, allowing the insurance corporations and government bureaucrats to dictate patient care. Then, someone (nurses) stands up and says, “Hey, we’re not going to take this anymore!” and you cry “foul”? You cast all the blame on the nurses?

That’s crap, and you know it. Get your fellow docs to wake up and DO something. It’s not good for one voice to dominate in any arena, but if no one else will speak up…I guess you’ll have to take what you get.

Oh, and about the quote? I think “tyranny” could justly describe the amount of low- and mid-level government interference in healthcare. We’ve got so much paper to dick with that patient care is prime for a raging blaze.

Look at Yellowstone National Forest. Ever heard of “controlled burn“? Started in 1972. Burning, when done frequently and responsibly, eliminates the underbrush, stimulates growth, removes deadwood, etc. All good things for a forest. When natural burning is eliminated, you get a strangled forest.

That’s the picture of the healthcare system today–massive, overgrown. I don’t even like that phrase: healthcare system. It’s not health care. It’s sick care, or pretending-to-be-sick-so-I-can-score care.

*****

So, what’s the answer? I don’t have one. But I do know where the blame lies: with all of us. With the nurses, for pushing our own interests without an eye for the effect on the system.

With doctors, for ignoring the problem and hoping it’ll just go away.

With other professionals (radtechs, pharmacists, paramedics, etc.) for acting like the problem doesn’t include them.

With specialists, for opting out WITHOUT speaking up to the administration and the government.

With administration, for introducing/implementing policies and procedures willy-nilly, refusing to listen to staff complaints, and passing the buck.

With the numerous “associations”, who take your money but don’t do jack.

With the government, for doing a poor job of governing anything, and printing paper instead, mandating changes without looking further than the next election cycle.

With insurance company CEOs/CFOs/majority stockholders, who screw everyone and spend summers in Montana with Chuck.

And, lastly, with the patients, who are the crux of it all. Without patients, the system doesn’t exist. They are, in a word, essential. Yet they are unorganized, lacking advocates, because they don’t know what they need…which is where doctors and nurses come in. Yet so far, only the nurses have made their voices heard.

So.

Where have all the doctors gone?

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I came here to complain

May 16, 2007 at 8:33 pm (grandmother moments, husband, whining)

But I just can’t do it.

My grandmother’s advice is too strong. One afternoon a few months after DH and I were married, I was sitting in her office complaining. She listened, smiled soothingly, tsked at the appropriate times. After I finished a twenty-minute diatribe on men in general and my husband specifically, on the account of mounding dirty laundry and no help with dinner, I stopped for breath and a drink.

She leaned forward over the desk, glasses perched on her nose, hands folded gently on the blotter. Eighty-two years old and she still worked every day. Did all her own cleaning. Had a garden. She leaned forward–not a hair out of place–gave me the stern smile reserved for overdue renters and wayward grandchildren and said, gently: “Cut the crap, dearie, and grow a backbone.”

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12 of 10

May 16, 2007 at 4:10 pm (kids, l&d, meds, pain, sick, whining)

I’ve been lurking on several nurse and doctor blogs lately. Apparently, there’s a furor over the appropriate use of the pain scale. Some people have pain that rates two points over the limit, as improbable as it sounds, making the scale less a ruler and more like those “Caution: x speed recommended” signs.

When my son was in the hospital, they had a chart with five faces on it, ranging from happy to death-warmed-over. Seriously. It wasn’t a yellow happy face anymore, it was matte teal with x’s for eyes. (Don’t bother with editing my “x”, by the way. My form may be archaic, but the other way just looks weird.) (Okay, okay, so I’ve used them both. Sue me.)

Some people say that you should reserve “10″ for the absolute, worst pain you could ever imagine. I have a vivid imagination–never mind Saw, I’ve seen worse in my dreams. So that knocks any pain that I could experience in the course of normal life to a five. So, 1 to 5, how is my pain during labor?

I’ve had four kids, all without drugs, because I would rather deal with pain than be a zombie. Unless the pain makes me a zombie.

[mild RANT ALERT] Seriously, folks–for MOST of the female population, we can handle it. Some people can’t, but it’s not bone cancer. It’s a baby. Cowboy the fuck up and deal, so the next time someone mentions anything about the “weaker sex” you can shove his foot down his throat. At the very least, you’ll have bragging rights. And before you tell me about your “immposible, HORIBLE PIAN in my life! that YOU have obvoiusly NEVER FELT!!” let me say–for that small percentage of you that really needs meds during delivery, I feel for you. Honestly, I do. I’m so sorry that you had to take meds to get through, and I don’t think it makes you less of a mother or less of a woman. In fact, I’m in awe that you would do it more than once if it was that bad. Seriously. But for everyone else–obviously evolution (or God) has determined this is the way to go. Humans have survived childbirth for however-long, sans meds, until recently. In fact, it’s only been the last breath (comparatively speaking) of our time here that hospitals & meds have been available. So, if you want to compare giving birth to FUCKING CANCER, do it elsewhere. And cease rolling over the bed and screaming while the nurse is in the room, and texting your lame-ass boyfriend when she’s not. [/mRA]

With the last birth, someone (a CNA or student, I don’t know which, but her scrubs were the wrong color for RN or LPN) came in and asked me my pain level, 1 to 10. I said, “3.2 ranging to 4.” (I’m a science geek, remember?)

“Ooookaaay, and during a contraction?”

“Huh?”

“…You said your pain was 3.2, what is it during the contractions?”

“That is the contraction. 3.2 to 4 at the peak.”

“…”

“Right now it’s a zero. Does your scale go to zero?”

“Um…”

“If not, I’m okay with a 0.7 or something like that.”

“Hold on. You said-”

“Contraction, wait.” Two minutes pass. “Um, yeah. 3.2-4 during the contraction, zero or 0.7 in between.”

Yeah, I’m a weirdy. My husband was trying not to laugh–he said she looked so confused. We got a big kick looking at the read-out of my contractions…I guess they just don’t “register” with me or something.

The real kicker was the girl who brought me Motrin and a stool softener the day after. I was like, I’ve already gone twice, what do I need that for? It’s nothing I can’t handle. According to the staff, I’m the first one they’ve seen go through L&D without at least Motrin or Tylenol. Not that I’m proud or anything, I just handle pain pretty well. And the stool softener, well, I ordered salad and fruit from the cafeteria, so I didn’t have any struggles with that.

I dislocated my jaw when I was in the ninth grade. That’s a 5 on my pain scale. Right below, at 4.9 is the time I dislocated two toes and sprained a bunch of ligaments in my foot with an incorrect slide into home plate (safe, by the way). And directly below that, 4.8, are the multiple jams of my fingers during basketball. The initial jam doesn’t hurt so much as the flexion and extension afterward, ’cause it always seemed to happen to your right hand the day before (just an example) National ACT Day of your senior year. Suckers. You’d think coaches would realize that athletes have to take ACTs & SATs, too. But nooooo, we were always playing in Boondock, or some such place, getting home at 1 am, gotta be up by 5:30 to get to the testing center (decidedly UN-local community college) by 7:15. It’s a miracle I did well, considering.

So, I don’t understand “12/10″ pain. What is that? If it’s that bad, just say 10 and get it over with. There’s no need to go all prima donna and say that your pain is two points higher than any pain you can imagine…unless you’ve got a really poor imagination, or a bad memory. I mean, if it’s the worst pain you’ve ever felt, wouldn’t it be the worst you could imagine? And if it isn’t the worst you could imagine, then it would be an 8 or a 9, right?

Right?

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