Nurse Mentor

This is part 3 of a 3 part series. Click to read Part 1 and Part 2 for background on the story. In parts 1 and 2, my friend Eva tries and eventually succeeds in getting an appointment so she can get treated for what turns out to be severe laryngitis and walking pneumonia, and how the market-based insurance system foils her attempts. At the end of the last post, I asked the question "What would have happened to Eva if I (or someone else with health system insider knowledge) hadn't been there to help her get connected to people who could see her that day? Scenario 1: She gets frustrated with not being able to find a primary care practice who can see her that day and so decides to go to the local public hospital emergency department (ED) --because they will take her insurance.  She goes to the ED and spends hours waiting to be seen because her case is considered non-urgent.  Eventually she is seen in the overcrowded ED and gets sent home in the middle of the night (or ne...

This post continues from Part 1.  Click here to read it. This is the story of my friend Eva trying to get seen in primary care and how the insurance system foils multiple attempts and delays care. We left off with Eva's first attempt to getting an appointment failing.  Eva is a friend of mine from graduate school with a PhD and a good job she was able to take because it was easier for her to buy private insurance after the Affordable Care Act and work as a consultant. Eva still needs to be seen. She's traveling for consulting work three days later --kind of important when you need to pay your bills while waiting to hear about full time work.  She doesn't travel, she doesn't get paid. I dive into the bag of tricks most nurses develop when they've dealt with their health system after about a year.  I email a colleague I know who runs a nurse managed clinic (staffed by nurse practitioners) to see if she can get her in.  In 5 minutes, she gets back to me and ...

Let's be clear: I'm all for people having insurance.  I spent enough time working in the US healthcare system to see what a lack of health insurance does to patients.  It adds to the stress of their illness and sends many into medically driven bankruptcy because of their medical bill debt --something no one should ever have to endure.  I was thrilled when the Affordable Care Act [ACA] (a.k.a Obamacare) passed. With my policy training, I knew the bill was far from perfect but what was important in the US context was to get it through and then embed it in the bureaucracy, as happened prior to and continues since implementation. But there are flaws nonetheless.  These are driven by the business of medicine and how it is funded in the US. This is the story of my friend Eva. Eva and I did our PhDs together. Instead of going into academia, she ended up in the corporate world with a good paying job and excellent benefits.  After putting in her time in that sector...

Recently I had lunch with a former student who was passing through town. Lisa graduated a little over two years ago and was one of the lucky ones who found a job fairly quickly. What was most interesting about our conversation was the turnover rate on her unit. In 15 months, 15 nurses have left. The most recent was a group of five experienced night shift nurses, the kind any manager is loathe to lose. They left, according to the student, because they were tired of how they were treated.  Lisa is now the most experienced person on night shift at two years out of school. The loss of 15 nurses on one unit has also cost the organization nearly a million dollars. In an era of cost tightening, that is a steep price. Acknowledging that this is only a report from one person, there is still something that rings true in her story: Well managed patient care units do not have high turnover rates of staff. So let's think about what constitutes turnover in nursing staff and it's causes. G...

A new study by my colleague Heather Tubbs-Cooley, PhD, RN out of Cincinnati Children's Hospital demonstrated that better RN to patient ratios mean reduced readmission rates between 15 and 30 days after hospital discharge.   From the study published in the British Medical Journal of Quality & Safety : " Each one patient increase in a hospital's average paediatric staffing ratio increased a medical child's odds of readmission within 15–30 days by a factor of 1.11, or by 11% (95% CI 1.02 to 1.20) and a surgical child's likelihood of readmission within 15–30 days by a factor of 1.48, or by 48% (95% CI 1.27 to 1.73). Children treated in hospitals with paediatric staffing ratios of 1 : 4 or less were significantly less likely to be readmitted within 15–30 days. There were no significant effects of nurse staffing ratios on readmissions within 14 days."   Weaknesses of the study include that it does draw from a dataset of nurse survey responses from four US s...