Report: 90% of nurses considering leaving the profession in the next year • Hacker News Board

Re: Report: 90% of nurses considering leaving the profession in the next year

#951

Post by hedora » Thu, Apr 28, 2022, 2:40 PM UTC

cogman10 wrote: post #433

hedora wrote: post #235

Earlier quoted context omitted.

We’re facing some massive generational crises at this point, and it feels like the only solution is to wait for the current leadership to die off, and hope the gen x’ers fix it. The WWII generation fixed the ozone hole, but their kids didn’t lift a finger for global warming. Subsequent generations are scrambling to pick up the pieces for our kids, while crap like this, and our rapidly collapsing democracy keep sabota…

While I think SOME longevity in congress/the senate is a good thing (You get more done). I really wish we had something like an age cap. It's really crazy that the only way it seems like we can get these senators/congresspeople out of office is death from old age. The fact is, your mind DOES deteriorate when you get older. That's why so many phone scams are special built to target older people. A change I'd make to t…

I'm increasingly thinking politicians should not be allowed to make decisions that won't impact them. We've got people that will be dead in 20 years preventing action on global warming.

They won't live long enough to have to deal with their consequences of their actions, and they clearly don't care if they burn the planet down before their kids inherit it.

I think this translates to an age limit of 65-75.

More importantly, I think this should be applied to voters as well.

Re: Report: 90% of nurses considering leaving the profession in the next year

#952

Post by bawana » Thu, Apr 28, 2022, 2:42 PM UTC

As a physician, I can see that the 'corporatization' of healthcare has been a bad thing for patients. Unlike most other services whose use is discretionary, people do not choose to get sick. Healthcare is more like a police, fire or a disaster service. To allow a profit driven structure to use competition among providers to deliver this service will only harm the sick.

In the same way that national defense has been driven into a profit making venture (and encouraging the support for proxy wars), health care has become a beast beyond monopolistic power, able to drive demand for its own supply. The net result has been to give responsibility without authority to the providers. Nurses are subject to mandatory overtime. Physicians are required to take unreimbursed call. These services were once the hallmark of a devoted provider. Now they are exploited by a corporate profit seeking behemoth.

Patients now have such large deductibles that they prefer to pay me in cash for a negotiated lower price. No longer is health insurance actually insurance. It has become more of a coupon or in the language of today's generation, a groupon.

Even retirees who with Medicare only had to pay 20% of unreimbursed allowable expenses, have increasing burdens. The premium for part B (yes you have to pay for the part of Medicare that does not cover the hospital) has increased 15% this year and the government stated this is largely the result of a single dementia therapy - a pill that costs $56,000.

I think we could fix the problem if we required our lawmakers to actually pay for their healthcare. They get it for free. In addition, each gets a multimillion dollar stipend to run their office, separate and apart from their generous salary. For doing what? pushing emails. And they are so afraid of offending any part of their constituency that they spend most of their time arguing about non-issues. Their ridiculous behavior is creating a fertile environment for the next tyrant who will prromise salvation and deliver true misery.

Re: Report: 90% of nurses considering leaving the profession in the next year

#953

Post by JshWright » Thu, Apr 28, 2022, 2:53 PM UTC

js2 wrote: post #515

Shuang1 wrote: post #451

Earlier quoted context omitted.

That case goes far beyond med error and I don't understand why people keep bringing it up as an example. She pulled the wrong med, and then injected it and walked out of the room rather than observing for effects. Also the med she pulled had warnings on all sides of the bottle and on the top saying very clearly that it's fatal to administer without ventilation. This went beyond a mistake to negligence.

Janie Harvey Garner, a St. Louis registered nurse: “In response to a story like this one, there are two kinds of nurses,” Garner said. “You have the nurses who assume they would never make a mistake like that, and usually it’s because they don’t realize they could. And the second kind are the ones who know this could happen, any day, no matter how careful they are. This could be me. I could be RaDonda.” https://khn.o…

> I am not a nurse, but I can easily imagine how someone could make the errors she did in an overworked and high-stress environment.

There are so, so many differences between the two meds, I don't see how confusing them would be possible short of gross negligence (for context, I am a paramedic, and often administer medications (including both of the meds involved here) in a high stress environment).

Vecuronium (the paralyzing drug) is a powder in the vial and you need to first inject saline it into the vial, shake it up, and then draw out the "reconstituted" med. This is very unusual (there are only a handful of medications in common use that require this, and Midazolam, the intended med, is _definitely_ not one of them). The reconstitution process means she would have had to look at the top of the vial several times, and warning on the tops of vials are, again, very uncommon. Also uncommon is the red cap on the vial.

I have made errors before while caring for patients, and I will likely make them again. I am very aware of the fact that we all can make mistakes, but the number of mistakes that needed to be made here far exceeds the standard of what is reasonable, and is well into the territory of "gross negligence", in my opinion.

Re: Report: 90% of nurses considering leaving the profession in the next year

#954

Post by JshWright » Thu, Apr 28, 2022, 2:56 PM UTC

sithlord wrote: post #481

Shuang1 wrote: post #451

Earlier quoted context omitted.

That case goes far beyond med error and I don't understand why people keep bringing it up as an example. She pulled the wrong med, and then injected it and walked out of the room rather than observing for effects. Also the med she pulled had warnings on all sides of the bottle and on the top saying very clearly that it's fatal to administer without ventilation. This went beyond a mistake to negligence.

Literally every medication has warnings slapped all over it. My partner worked at Vanderbilt (on a different floor) around this time, and one constant complaint I heard (prior to the incident) was how there was hardly any controls around anything there.

Every medication does not have a bright red cap with a bold warning printed on the top (that you have to look at at least twice while reconstituting and then drawing up the med). The warnings on a vial of Vecuronium go well beyond the typical "This medication may case XYZ side effect", and for very good reason.

Re: Report: 90% of nurses considering leaving the profession in the next year

#955

Post by mothsonasloth » Thu, Apr 28, 2022, 2:57 PM UTC

FesterCluck wrote: post #893

I am a systems engineer and software developer, and I have worked on multiple healthcare related systems including one for a major hospital system. I wish I had more access to nurses during the process. I was always told they were too busy. I just wanted to observe, as I do with any client I write systems for, and was denied. I can say that at least 2 other groups were working on the exact same project as I in the ho…

The Butlerian Jihad starts with you

Re: Report: 90% of nurses considering leaving the profession in the next year

#956

Post by JshWright » Thu, Apr 28, 2022, 2:58 PM UTC

BeFlatXIII wrote: post #943

Shuang1 wrote: post #451

Earlier quoted context omitted.

That case goes far beyond med error and I don't understand why people keep bringing it up as an example. She pulled the wrong med, and then injected it and walked out of the room rather than observing for effects. Also the med she pulled had warnings on all sides of the bottle and on the top saying very clearly that it's fatal to administer without ventilation. This went beyond a mistake to negligence.

People like you are part of the problem. "It was covered in all kinds of scary warning labels"—just like every other medication in that drawer. Medical professionals are totally blind to alerts given off by their EMRs because everything has a password-protected warning so that the audit logs can say "yes, this physician/nurse read and understood the warning"

> just like every other medication in that drawer

No, very different from every other med in the drawer. The red cap on the vial is very unusual (reserved for very dangerous meds like this), and the bold printed warning on the top (that you have to look at at least twice while while preparing to administer this medication) is also something used very rarely.

Re: Report: 90% of nurses considering leaving the profession in the next year

#957

Post by tom-thistime » Thu, Apr 28, 2022, 2:59 PM UTC

HWR_14 wrote: post #767

tom-thistime wrote: post #507

Earlier quoted context omitted.

Yeah, anecdotally, experienced nurses were fed up in the mid-1980s.

Do you have anything I can see about that, or did you just know people who were fed up and retired then.

I just knew people who were fed up and retired then.

Re: Report: 90% of nurses considering leaving the profession in the next year

#958

Post by NoGravitas » Thu, Apr 28, 2022, 3:03 PM UTC

TomSwirly wrote: post #781

ayngg wrote: post #577

Earlier quoted context omitted.

I actually think that this is just one example of many across a ton of disciplines where people like Nurses basically are forced to deal with costs and responsibilities offloaded onto them from above the responsibility chain. Resources are eaten up at the top of the chain to their benefit and costs are offloaded down the chain until it reaches people like Nurses at the end of the line who have to deal with it because…

> courts systems are overwhelmed and understaffed so criminals just enter and exit like a revolving door, You're delusional. America has more people in jail, serving longer sentences, than _any country in history_.

Don't know why you're being downvoted on this. It's simply a fact. Is it because you didn't provide a citation?

Here: https://www.cnn.com/2018/06/28/us/mass-incarceration-five-ke...

Re: Report: 90% of nurses considering leaving the profession in the next year

#959

Post by NoGravitas » Thu, Apr 28, 2022, 3:05 PM UTC

landemva wrote: post #623

Sohcahtoa82 wrote: post #596

Earlier quoted context omitted.

This ended up being the last straw for one of my friends who was a nurse. He kept getting vacation requests denied due to lack of staffing, yet if he asked if they were looking to hire, the answer was always No. He was super lucky and had some early cryptocurrency investments pay off big, so he decided he was done with it retired. He said that he loved helping people as a nurse, but not at the cost of his own physica…

That describes me, though in tech. Trying to step back in to tech and recently had interview. After I explained parenting time schedule, HR guy said everbody works 60 hour weeks every week so there is not a role for me.

Look into state government IT. Low pay, but you'll never work over 40 hours a week.

Re: Report: 90% of nurses considering leaving the profession in the next year

#960

Post by bumby » Thu, Apr 28, 2022, 3:16 PM UTC

PragmaticPulp wrote: post #139

CityOfThrowaway wrote: post #119

Earlier quoted context omitted.

Patient satisfaction surveys are the legible feedback mechanism showing that something is deeply broken, but not the source of the problem itself. It's clear from your comment that the source of the problem is the increasingly sharp divide between what the credentialed medical professionals believe and what lay people believe. The satisfaction survey is simply uncovering that fact. It would be vastly worse if patient…

That's the theory - That patient satisfaction surveys will uncover the bad providers. But in the real world, if someone is receiving bad care they don't continue making followup appointments with that doctor. Nobody continues going back to the same bad doctor over and over again and writing negative reviews. It's really easy to calculate churn rate for individual providers. The hot topic now is tracking outcomes: The…

This is spot on. It's not the metric itself which is the problem, but how the metric is interpreted and formed into action. We can all understand the ramifications if we rated parents on "child satisfaction". Lots of kids would be having candy for dinner. The real metric we probably want is improved patient outcome, which may not be synonymous with patient satisfaction.

I don't think that's necessarily incongruent with the OPs point. If the metrics are being gamed or the metrics are being used to inaccurately gauge provider care, those are systemic issues. Or it could be the case of well-intentioned, but poorly chosen metrics.