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I'm a conservative, and i went to an alexandria ocasio-cortez rally

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You are reading page 7 of I'm a conservative, and i went to an alexandria ocasio-cortez rally. If you want to start from the beginning Go to First Page.

It's easy for things to be worse.

Imagine your your understaffed unit with one less nurse, or CNA, or no unit secretary, or fewer patient transporters, fewer phlebotomists and respiratory therapists, housekeepers, etc. Or, they can pay you less. Or, both.

I'm not understanding this.

I'm thinking things would get worse because more people would have access to health care. You seem to be saying that there would be lay offs?

My for profit hospital, which is in tough competition with another hospital down the street, loved The Affordable Care Act...more people with more health care meant more patients with funds to get care, but those that were uninsured receiving indigent care had a source to pay instead of just getting the care and not paying. They made it a point to advertise we had an expert to sign people up.

Mind you care might suffer is an already understaffed facility gets more patients and not more staff. That was my point.

My question is do we just leave things the way they are and allow inequities in health care access and thus health, or do we allow all in equally and suffer the consequences of not having enough resources initially.

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I'm not understanding this.

I'm thinking things would get worse because more people would have access to health care. You seem to be saying that there would be lay offs?

My for profit hospital, which is in tough competition with another hospital down the street, loved The Affordable Care Act...more people with more health care meant more patients with funds to get care, but those that were uninsured receiving indigent care had a source to pay instead of just getting the care and not paying. They made it a point to advertise we had an expert to sign people up.

Mind you care might suffer is an already understaffed facility gets more patients and not more staff. That was my point.

My question is do we just leave things the way they are and allow inequities in health care access and thus health, or do we allow all in equally and suffer the consequences of not having enough resources initially.

I worked in a hospital in Calif with ratios and because of that they got rid of as much ancillary staff (CNA, sec, housekeeper, transporters etc) as they could to make up the costs so the nurses were doing more of that work instead of patient care.

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I'm not understanding this.

I'm thinking things would get worse because more people would have access to health care. You seem to be saying that there would be lay offs?

My for profit hospital, which is in tough competition with another hospital down the street, loved The Affordable Care Act...more people with more health care meant more patients with funds to get care, but those that were uninsured receiving indigent care had a source to pay instead of just getting the care and not paying. They made it a point to advertise we had an expert to sign people up.

Mind you care might suffer is an already understaffed facility gets more patients and not more staff. That was my point.

My question is do we just leave things the way they are and allow inequities in health care access and thus health, or do we allow all in equally and suffer the consequences of not having enough resources initially.

This went back to my assertion that when private insurance goes away, funding decreases. Your example illustrates (and Muno pointed out earlier) that some places might be better off, depending on their current mix of Medicare, insurance, or no coverage.

Lil Nel claimed that things couldn't be worse then they are. I disagree, and tried to show how.

No, things shouldn't remain the same. There are lots of room for improvement, I just don't believe Medicare for all is the answer or even better then what we have now.

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It wasn't a test question, Dude.

Here's another little anecdote.

We recently had an ALS patient. She was sent out for a trach and feeding tube.

Is she rehabable? No.

Can she do three hours of therapy a day? Maybe.

Is this quality or ethical care? No.

So long as profit is a motive, there will always be examples of subpar and unethical care.

Those things will still exist with Medicare for all. But which system will bring the greater good?

Another philosophical discussion.

That example isn't what I had in mind as subpar care. Unethical, maybe. But that is a different but worthwhile conversation.

Profit isn't always to blame. Most things we enjoy in life, and many advances in healthcare are a product of someone's desire to make money.

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Testy, Testy, Dude.

The point of my little anecdote was to illustrate that quality of medical care in the US already oftentimes sucks.

I was responding to your fear of a lowering quality of care if there is Medicare for all.

Munro was simply responding to the pasta you threw up against the wall, Dude.

Again, testy, testy, Dude.

Not testy. Just didn't get it. We all have hundreds of anecdotes to share. My wife had a life saving surgery that our insurance company paid $109,000 for. Insurance companies aren't always evil. Does that change anything in the big picture? No.

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The insurer paid for the care that you paid them to cover, they don't deserve an honorable mention or pat on the back for that. In pre-ACA days they might have deserved recognition if they opted to pay rather than kick her to the curb and cancel her coverage. Today, they cover expensive care because they are required to, until Republicans repeal pre-existing condition requirements.

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What is your source for this bit of information?

Easy to find this out if you care to.

Nope, nope, nope. I don't care if you are Left Wing Leonard, Moderate Millie, or Right Wing Ronnie, if you make an assertion of fact vs. opinion, it is ON YOU to provide your source. It is not the job of the reader to have to go research to see if your statement is made up or based on sound data.

Really, what nerve!

Edited by Horseshoe

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I worked in a hospital in Calif with ratios and because of that they got rid of as much ancillary staff (CNA, sec, housekeeper, transporters etc) as they could to make up the costs so the nurses were doing more of that work instead of patient care.
You were working for criminals. There should have been documentation to prove this and reported to the DPH.

The first paragraph of Title 22 Section 70217, the regulations with which all acute care hospitals in California must comply, states, "Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system."

View Document - California Code of Regulations

In addition CMS requires for all hospitals providing care for one or more Medicare patient(s) that, "Every inpatient unit/department/location within the hospital-wide nursing service must have adequate numbers of RNs physically present at each location to ensure the immediate availability of a RN for the bedside care of any patient."

At my full time job and several hospitals where I worked registry nurses documented such illegal, insufficient, and unsafe staffing and reported it by date, time, and such. My hospital and MANY others now comply with the law most, if not all the time.

And hospital profits increased after implementation of the ratios. Part may be due to Medicare paying less for patients readmitted with the same diagnosis after less than 30 days.

Hospital Nursing and 30-Day Readmissions Among Medicare Patients With Heart Failure, Acute Myocardial Infarction, and Pneumonia

Medical Care: January 2013

Improving nurses' work environments and staffing may be effective interventions for preventing readmissions. Each additional patient per nurse was associated with the risk of within 30 days of readmission for heart failure (7%), myocardial infarction (9%), and pneumonia (6%). "In all scenarios, the probability of patient readmission was reduced when nurse workloads were lower and nurse work environments were better."

Hospital Nursing and 3-Day Readmissions among Medicare Patients with Heart Failure, Acute Myocardial Infarction, and Pneumonia

AND most hospital's profits increased again with implementation of the ACA.

AND ratios save lives:

Agency for Healthcare Research and Quality, September 26, 2012

The California safe staffing law has increased nurse staffing levels and created more reasonable workloads for nurses in California hospitals, leading to fewer patient deaths and higher levels of job satisfaction than in other states without mandated staffing ratios. Despite initial concerns from opponents, the skill mix of nurses used by California hospitals has not declined since implementation of the mandated ratios

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1475-6773.2010.01114.x

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You were working for criminals. There should have been documentation to prove this and reported to the DPH.

The first paragraph of Title 22 Section 70217, the regulations with which all acute care hospitals in California must comply, states, "Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system."

View Document - California Code of Regulations

In addition CMS requires for all hospitals providing care for one or more Medicare patient(s) that, "Every inpatient unit/department/location within the hospital-wide nursing service must have adequate numbers of RNs physically present at each location to ensure the immediate availability of a RN for the bedside care of any patient."

At my full time job and several hospitals where I worked registry nurses documented such illegal, insufficient, and unsafe staffing and reported it by date, time, and such. My hospital and MANY others now comply with the law most, if not all the time.

And hospital profits increased after implementation of the ratios. Part may be due to Medicare paying less for patients readmitted with the same diagnosis after less than 30 days. AND most hospital's profits increased again with implementation of the ACA.

AND ratios save lives:

I am not sure what you mean here. The hospital did abide by the ratios but got rid of other staff. The nurses had their patients (within ratio) but had the added responsibilities of phlebotomy, transporting, Secretary work, assistance to PT, you name it. So the overall experience of the patient was not helped very much, if any. Just made more stressed out nurses with very little control/autonomy.

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I am not sure what you mean here. The hospital did abide by the ratios but got rid of other staff. The nurses had their patients (within ratio) but had the added responsibilities of phlebotomy, transporting, Secretary work, assistance to PT, you name it. So the overall experience of the patient was not helped very much, if any. Just made more stressed out nurses with very little control/autonomy.
When the ratios were first implemented the most unsafe hospitals attempted to get away with what you describe.

But where the nurses were assertive and educated about the law and resulting legislation they did not get away with it.

Let me try to explain. If you want to understand I encourage you ton open the link and read the regulations. I will quote just the sentences pertinent to why it is illegal for a hospital to use fewer housekeepers, and other staff and make the registered nurses do their work. (Aside from the competency, infection control, job description violations, and such)

"Ratios" are just one part of the law.

The second sentence of " § 70217. Nursing Service Staff"states,

"Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system."

In statutes and regulations "SHALL" Means "MUST". It is different from the word "may".

This means that Staffing for care not requiring a licensed nurse is not included within these ratios and MUST be determined pursuant to the patient classification system.

If it is NOT and that is reported so investigators can validate the accuracy of the report the hospital will be issued a "STATEMENT OF DEFICIENCY" and MUST respond with a public "Plan of Correction" to correct their violation. Sometimes there is a fine.

Repeated violations or those resulting in "immediate jeopardy" to the health and safety of one or more patients.

The same section of the regulations also states:

" In addition to the requirements of subsection (a), the hospital shall implement a patient classification system as defined in Section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements.

The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, psychiatric technicians, who shall be assigned to direct patient care. Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care, and the licensure of the personnel required for care.

 

The system developed by the hospital shall include, but not be limited to, the following elements:

(1) Individual patient care requirements.

(2) The patient care delivery system.

(3) Generally accepted standards of nursing practice, as well as elements reflective of the unique nature of the hospital's patient population.

© A written staffing plan shall be developed by the administrator of nursing service or a designee, based on patient care needs determined by the patient classification system. The staffing plan shall be developed and implemented for each patient care unit and shall specify patient care requirements and the staffing levels for registered nurses and other licensed and unlicensed personnel. In no case shall the staffing level for licensed nurses fall below the requirements of subsection (a). The plan shall include the following:

(1) Staffing requirements as determined by the patient classification system for each unit, documented on a day-to-day, shift-by-shift basis.

(2) The actual staff and staff mix provided, documented on a day-to-day, shift-by-shift basis.

(3) The variance between required and actual staffing patterns, documented on a day-to-day, shift-by-shift basis.

(d) In addition to the documentation required in subsections ©(1) through (3) above, the hospital shall keep a record of the actual registered nurse, licensed vocational nurse and psychiatric technician assignments to individual patients by licensure category, documented on a day-to-day, shift-by-shift basis. The hospital shall retain:

(1) The staffing plan required in subsections ©(1) through (3) for the time period between licensing surveys, which includes the Consolidated Accreditation and Licensing Survey process, and

(2) The record of the actual registered nurse, licensed vocational nurse and psychiatric technician assignments by licensure category for a minimum of one year.

(e) The reliability of the patient classification system for validating staffing requirements shall be reviewed at least annually by a committee appointed by the nursing administrator to determine whether or not the system accurately measures patient care needs.

(f) At least half of the members of the review committee shall be registered nurses who provide direct patient care.

(g) If the review reveals that adjustments are necessary in the patient classification system in order to assure accuracy in measuring patient care needs, such adjustments must be implemented within thirty (30) days of that determination.

(h) Hospitals shall develop and document a process by which all interested staff may provide input about the patient classification system, the system's required revisions, and the overall staffing plan.

View Document - California Code of Regulations

The enabling legislation for the ratio law states:

These ratios shall constitute the minimum number of registered and licensed nurses that shall be allocated.

Additional staff shall be assigned in accordance with a documented patient classification system for determining nursing care requirements, including the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan and the ability for self-care, and the licensure of the personnel required for care.

The law also states, "By changing the definition of an existing crime this bill would impose a state-mandated local program."

Bill Text - AB-394 Health facilities: nursing staff.

That hospital was trying to get away with violating the law.

People who violate the law are criminals.

Edited by herring_RN

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The insurer paid for the care that you paid them to cover, they don't deserve an honorable mention or pat on the back for that. In pre-ACA days they might have deserved recognition if they opted to pay rather than kick her to the curb and cancel her coverage. Today, they cover expensive care because they are required to, until Republicans repeal pre-existing condition requirements.

It was pre-ACA.

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Nope, nope, nope. I don't care if you are Left Wing Leonard, Moderate Millie, or Right Wing Ronnie, if you make an assertion of fact vs. opinion, it is ON YOU to provide your source. It is not the job of the reader to have to go research to see if your statement is made up or based on sound data.

Really, what nerve!

Let me get out my baby spoon for you Horseshoe and Nel. This took all of two seconds to find.

Can the U.S. Repair Its Health Care While Keeping Its Innovation Edge? - The New York Times

"Naturally, the innovation rewarded by the American health care system doesn't stay in the U.S. It's enjoyed worldwide, even though other countries pay a lot less for it. So it's also reasonable to debate whether it's fair for the United States to be the world's biggest subsidizer of health care innovation."

Now, are you going to hold others to the same standard of sourcing everything?

Edited by SC_RNDude
Typo

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