Also, Hope is just plain fun to talk to. And so once we'd dispensed with the job application business, I got to gabbing with her.

For a moment it was like old times when we used to take a breather in the nursing office, or when we'd walk the corridors side-by-side between visits to our patients, late into the evening shift. Back then, if you'd have been the eavesdropping fly on the wall, you'd have thought Hope and I were griping about work, because we often talked heatedly about things that weren't going right.

But the thing is, Hope was never merely a griper. While she was passionately talking about the problems, she was actually batting away at whatever stood between her and the goal. And the goal was always to give her patients the care they deserved. In other words, Hope's griping was a form of problem solving.

Sadly, on the phone yesterday, I learned that Hope has changed her ways. She says it isn't even worth talking about the problems anymore. She says she's vowed-after all these years-that from now on she will do the best she can, given the short-staffing, and just keep her mouth shut. "It's all about the money anyway," she said. "They don't care what I think."

It's hard for me to imagine Hope keeping her mouth shut. But I can understand why she's giving up. Many of the problems healthcare workers face today-short staffing, changes to healthcare benefits, patient care decisions being made by insurance companies--seem so complicated, so far beyond the reach of our ideas for change. Why bother talking about it, especially when you could very well talk yourself right out of a job?

After I said goodbye and hung up the phone, I made a vow of my own. I'm going to say again and again to every healthcare worker I know, and to those I can reach through Healthcare United: Keep talking about it.

Because even though the problems in our ailing healthcare delivery system seem large and complicated and insurmountable, this is still America, where lots of voices together can wield power. When the 12 million healthcare workers in this country get together and talk about change, all of America will listen. Because it's not just griping. Because we who work in the ailing system know exactly what we're talking about.

Keep talking about it. So we can all get back to work, taking care of the people who need us-all of them, not just the ones who can afford it.

Flickr photo credit: Boliston

On Saturday, July 19th at 1pm EDT, Healthcare United members from across the country joined in our first-ever national conference call. The call featured several healthcare workers from key states, including our resident blogger Madeleine Mysko, RN who was attending the BlogHer conference in California, and Mike Kingsbury, RN, a dedicated nurse activist from Denver, Colorado.


Of the many results from the poll, one trend is clear: nurses and healthcare workers are deeply dissatisfied with the current state of patient care in the U.S. Roughly 65% of the caregivers we talked to are dissatisfied with our healthcare system, and 37% are displeased with their own health care coverage.

Overall, a majority feel strongly that we should be addressing the following themes/issues:

• Putting patients' needs ahead of insurance and drug companies
• Ensuring healthcare workers have adequate staffing and resources
• Ensuring that healthcare funding goes to patient care, not insurance companies

We also asked caregivers to respond to both candidate's healthcare reform proposals, using the language provided on their own websites. Obama's proposal, which is available here, drew substantially more support from healthcare workers than did McCain's, available here. And it gets even more interesting--in most cases, when participants were read the policy positions and past voting record of Barack Obama, support for the candidate more than doubled.

At the very least, these poll results should inspire all candidates running for office--whether it be local, state or federal office-to reach out to us as healthcare workers (and as voters!), and to engage in a meaningful dialogue with us on the issue of healthcare reform.

Betsy Marville, RN -- one of our superb leaders here at Healthcare United -- recently had a "Letter to the Editor" published in the July 28th issue of Modern Healthcare.  We’re proud of her for speaking out on an issue that’s vitally important, and we wanted to share some quotes with you.

Betsy is a long-standing advocate for safe staffing standards and patient safety, and you've likely heard from her on this subject before.  In her Op-Ed, she writes about how she is "pleased" with the Joint Commission’s attempt to “establish standards of safe and acceptable behavior for healthcare providers to ensure patient safety.”  However, states Betsy, she has “many concerns as to the actual impact of the alert,” and that “the Joint Commission in the past has failed to set limits on mandatory overtime for healthcare providers or establish safe staffing standards.”

She continues:

“Will the ‘zero tolerance’ standard truly be equally applied to the physician and supervisor as well as the nursing and support staff? Can this standard—’Passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities’—be used against a healthcare professional who refuses to take an unsafe assignment or perform an unsafe procedure in his/her role as patient advocate?”

“In theory and goal, the standards are admirable. In the reality of a broken healthcare system—increasingly being held together by healthcare providers working with low pay, declining benefits, increasing patient violence, unsafe staffing, mandatory overtime, declining uninterrupted break time and high staff turnover—the standards appear to be another tool to potentially harass and intimidate workers.”

You can read the full op-ed (subscription required) here.

Another night spent working an extra shift. Or being short-staffed in your unit. Hoping, praying, that you’re able to provide the kind of care you were trained to give. Many of us, when frequently faced with these conditions, contemplate leaving the profession. And a new study shows that many of us—18.5% a year, actually—end up making that decision.  Some studies put the rate even higher.

So-called “cost-cutting” measures in hospitals that lead to hospital RN turnover – like mandatory overtime, temporary workers, and understaffing--are actually costing U.S. healthcare more, not less. And the reason comes as no surprise—RN turnover ain’t cheap.

Just look at some of these numbers, compiled in an upcoming report by SEIU Healthcare:

• 18.5% of RNs leave their jobs each year (an alarming rate!)
• $82,000 - $88,000 to fill each vacancy
• $20.3 Billion in costs each year due to RN turnover – in hospitals alone!
• $143.6 Billion in costs due to hospital RN turnover by 2012, when adjusted for inflation

If hospitals could cut their average RN turnover rate in half, U.S. hospitals would save close to $11 billion every year.

Now it’s time to connect the dots. Many of us know that high turnover rates are a bellwether for bad staffing conditions—and are part of a vicious cycle of factors that produce and perpetuate short-staffing, over-reliance on temps or overtime, lower quality patient care, and lower job satisfaction. To make matters worse, studies demonstrate worse patient outcomes at these hospitals.

In the end, no one wins. The quality of patient care diminishes. Patients pay more. Nurses opt for careers outside of hospitals. And hospital administrators pay more to replace them. Does this make any sense?

What do you think are the main reasons for RN turnover? Share your expertise here. We’ll compile and report back on the results, so please share your insight and experience today!

Welcome to a new feature we're starting here on the Healthcare United website. Every Thursday, we're going to be taking a look at the medical blog community, affectionately known throughout the community as the "medblogs."

If you're not used to reading blogs, there's quite an active, robust group of nurses, doctors, pharmacists, and others - and if you'd like to check out our favorites, look to your right at our "blogroll"!

We'll be highlighting some of our favorite posts of the week right here, so you don't have to go on the hunt yourself. The goal of this new project is to introduce to you to what's out there and to highlight what's so great about the medblogger community. We're thinking that you'll love what you'll see!

And with that, here are four of our favorite posts from this week:

1) Musings of a Distractible Mind: "Is Wall Street Preventing Reform?": Rob over at Musings of a Distractible Mind has an excellent post about what happens when companies are "increasingly under pressure to produce in the short-term to keep their investors happy."

My favorite quote: "So what happens when these companies are inserted into a dysfunctional healthcare system? Insurers, pharmaceuticals, and device manufacturers are among the publicly-held companies through which a huge amount of cash is flowing. Is it any wonder why reform is slow to happen?"

It's one of the most comprehensive blog posts I've seen around this subject (besides the things on our blog, of course!), so I'd definitely recommend checking it out.

2) The Kaiser Network: "The Health Blogosphere: What It Means for Policy Debates and Journalism": Some of us over here at Healthcare United were able to attend a great event this week, sponsored by the Kaiser Family Foundation, that took a close look at "the growing influence of blogs on health news and policy debates."

The keynote speaker was U.S. Hepartment of Health and Human Services Secretary Michael Leavitt (who was the first cabinet officer to write an official blog) and the panel included Healthcare United favorite, Ezra Klein, who is a top-notch healthcare policy blogger/journalist. You should absolutely check out Ezra's blog if you haven't already.

You can watch the video by clicking here!

3) Madness: Tales of an Emergency Room Nurse: "Do Those With Insurance Get Better Care?": "Girlvet" over at Madness blogs about a recent article on Slate.com, written by two emergency room doctors, who state that hospitals "give preference to those with insurance." She thinks there's merit, but she's not entirely sold on the idea, for good reasons.

Girlvet says, "They find rooms for those who are transfers or direct admits before they do ER patients. The reason for that being that transfers and direct admits usually have insurance. People who come to the ER often have no insurance or are on medicaid or medicare. The hospital is paid less for the poor people on government aid for the same condition."

But she doesn't think it's that simple, and that there are plenty of more causes. "Lack of beds is about - short staffing, more acute patients, inefficient discharge systems and the like," she says. I'd certainly agree with her.

You can read the rest of the post by clicking here.

4) Digital Doorway: "The Nursing Shortage: A Global Crisis, Close to Home": Keith, RN over at Digital Doorway published a very thorough post on the nursing shortage, stating that "the nursing shortage is here to stay." 

Keith wonders how, in this election year, we might be able to address the issue. "In the coming months," he says, "it will be interesting to see how the two major political candidates address---or fail to address---the nursing shortage....And when it comes to national healthcare for the masses, if there are no nurses to deliver that care, then the plan is moot from the start. As far as this writer is concerned, any national healthcare policy debate that does not take into consideration the very real shortage of nurses in this country is a debate lacking an essential ingredient."

You can check out Keith's post here.

If you have any favorite posts yourself, or if you'd like to submit your own blog posts for "Medblogger Round-up" consideration, please e-mail them to me at brad@healthcareunited.org.

It has been an exciting last month here in Michigan for Healthcare United. We have held meetings all over the state - Lansing, Grand Rapids, Detroit and Southfield - to gather healthcare professionals to talk about our broken healthcare system, how to make it better and what healthcare professionals can do to make that change.

However this is still much work to be done and many healthcare professionals to reach out to. There are few things you can do to help.:

1. Host a meeting or attend a meeting: Look for events here in Mighican on the right side of this page. If you would be interested in hosting a meeting in your house or neighborhood, please get in touch with me. It is really easy and quite inspiring to meet and talk with other HC professionals, hear their stories and find out how you all can work together to make a difference.

2. Make phone calls to other healthcare professionals: Click here to make calls and help register fellow nurses, doctors and caregivers to vote here in the state of Michigan.

The Commonwealth Fund recently released a study that I have spent the last few days looking through, and I was astonished to learn how much we spend on administering healthcare. According to the report, the US spends about 7.5% of every healthcare dollar on administrative costs, while countries such as Switzerland and Germany spend about 5% on the same thing. If we were to bring our administrative costs down to the 5% level, it would result in annual savings of roughly $50 billion. 

Just imagine how an extra $50 billion in annual spending could improve our healthcare system!

Although the United States spends more than twice as much as any other industrialized nation on healthcare, in certain areas the quality of care provided is severely lacking, according to this study. The study, which judges the U.S. healthcare system on 37 measures, did not find any significant improvement over the previous year. Another striking issue was access to care, which has gotten worse. With healthcare costs continually rising, it is estimated that 75 million are underinsured or totally lack healthcare coverage. 

There are some bright spots on this otherwise dismal report card, including the reduction in deaths from heart disease and childhood cancers, but these achievements have not kept pace with advancements throughout the industrialized world. There's no doubt about it, if we're going to reform our healthcare system, we need to begin by squaring off with the issues of cost and access.

Read the complete article and study:

• New York Times piece
  
• Commowealth Fund study

So, last week I was dreaming up a reality show set in a hospital, a la "Hopkins," but this time, the camera was trained on all the people who can't afford the excellence in healthcare that Hopkins has to offer. After I posted the blog, I was still thinking up catchy titles for my show (such as "Healthcare: The Real Deal"). Alas, Hollywood hasn't called yet with my big advance. 

But then today, while hanging out in the nurse blog, Pixel RN, I got to worrying about who would even watch my show.     

Beth Anderson (Pixel RN, a good storyteller in her own right) says she couldn't find a single nurse who was following the "Hopkins" series. She asked these nurses why that was, and they answered, "Why watch it?  . . . We live it." They all rolled their eyes at her for asking "such a ridiculous question."

Why watch something you live everyday? Why even talk about it? Are these ridiculous questions?

OK, I admit my idea for the healthcare/reality show was tongue-in-cheek. And of course, it makes sense that Hopkins nurses would roll their eyes at the prospect of watching what they live every single workday. (For entertainment? Give me a break!)

But there's another way of looking at it, a more serious way. Shouldn't every one of us be watching what's going on while we're trying to take care of our patients-watching and talking about it with the rest of the team? 

I'm thinking about what I learned in nursing school long ago from the good Sisters of Mercy here in Baltimore: Pay close attention. Write good nurses' notes. Read other people's notes.  Give thorough reports.  Pay attention to those reports.  

In the United States today, nurses and doctors and pharmacists and most other people who work in healthcare know that the system has been sick for a long while.  In fact, we know it's in crisis.

Question: Why watch what we live everyday, why even talk about it?

Answer: Because we do our best work when we pay attention, and because it's vitally important to compare notes and function as a team.

I think that Healthcare United is the right place to show up for report.  There's room at this table for each of us, and a great sense of community. Real people like us (who know what really needs to be done) will surely bring our sick system through the crisis and back to the pink of health. Invite your colleagues to join us for report!

Virginia's healthcare workers are getting involved in this national grassroots movement and have a lot to say about our broken system.

Debra Goodwin, PA-C, is a physician assistant in Leesburg, VA who has seen access to quality care become a privilege that fewer and fewer people enjoy. She hopes that one day all of her patients will be able to afford their prescribed medicines.

"As a Family Practice Physician Assistant," Debra says, "I hear stories daily from my patients choosing to cut their medications in half or take them every other day to cut costs. I'm joining my colleagues in Healthcare United because our patients' stories must be told. Then we can lead the way to reform."

 

Elinor Abraham, RN, of Alexandria, VA has worked for decades on greater prevention and education for her patients. But without affordable primary care, too many people are missing out on the chance to lead healthy lives. Through Healthcare United, Elinor wants her fellow professionals to show our elected officials the way to a healthier society.

"Healthcare professionals are the real experts on reform," says Elinor, "and we need to put the right people in office in order to make the most effective changes in our healthcare system. That's why we need to vote; that's why I'm a part of Healthcare United."

Greetings from Oregon!  I'm Mara Kieval, and I'm the state leader for Healthcare United!

If you're from the area, I'd like to invite you to a special family picnic that we'll be having to celebrate healthcare workers in our community. We'll be giving information about not only Healthcare United, but heart health and and political health as well.

The entire health care community and their families are invited!  We'll be holding it on Saturday August 9th, from 11:00am PST - 3:00pm PST at Gabriel Park on Vermont Street in Southwest Portland. Everyone is welcome to celebrate health care workers role in our community wellness!

Healthcare givers from the Columbia, Missouri area -- made up of LPNs, RNs and respiratory therapists -- came together on July 19th to discuss the problems in the healthcare system. They left with a plan and a commitment to building a strong movement of healthcare givers.

Caregivers raised concerns about everything from rising insurance costs to healthcare having a "business mentality" to the increasing amount of uninsured in our country. After discussing the problems that are breaking our system, we moved to a conversation about what it is going to take to fix those problems.

The healthcare professionals in the room came up with a variety of ideas, including communicating with the public and the leaders of our country, using relatable language and voices joined together to educate about the issues. We concluded that healthcare givers can make an enormous difference if they work together - through small steps and realistic short term goals, we can achieve big results!

The most important first step to changing the healthcare system is to have your voice as a healthcare giver heard in the upcoming elections. The Columbia caregivers understand that the votes of healthcare workers are essential this year and they want to do everything they can to make sure every caregiver has that opportunity.

To make this happen, we're reaching out to our coworkers, neighbors, and other healthcare givers that we know who care about the problems we face, and want to make a difference.

You can get involved too! Follow the links to the "Action Center" to see what you can do today! Or, of course, if you're in Missouri, you can always contact me to find out what other ways health caregivers like yourself are moving forward!

Since launching our campaign, we've received numerous personal and professional accounts of caregiving from hundreds of Healthcare United members. You've shared with us the struggles that your patients endure, as well as your own personal struggles. Your essays, stories, pictures and videos have moved us beyond any words that we could share here, and so we've decided to share them in the best way possible: through your own voices.

We've created a compilation video of some of these stories (and there will be more videos to come!). In the video are several of your colleagues, including:

• Amy Lamb, a registered nurse of 15 years, who can't afford healthcare for her children.
• Freda Blacerby, a retired nurse, who became disabled in 2003.
• Ramona Lopez, a registered nurse who in her work everyday sees patients who can't afford their medications or won't get test done because they can't afford the copays.
• Linda, who's been in the healthcare field for over 30 years. She stresses why we, as Healthcare United, need to get involved.

Every day, as witnesses, you see why we need to change our healthcare system. We hope that this video shows the urgency of why we need to get things done, and that it illustrates how we, as Healthcare United, can do this together.

As Healthcare United's organizer Mike Dolan says in the video, "if caregivers themselves -- you and others like you around the country -- own the debate, take control of the conversation, become a force...it can actually happen, and indeed it won't happen unless caregivers own the debate."

It was a scorcher here in Ohio as I made my way with seven healthcare professionals and healthcare advocates to the top of the legislative offices of the Carew Tower in downtown Cincinnati. Our mission: to brief Congressman Steve Chabot (R) on the devastating effects of diabetes, and the flaws in the Ohio healthcare system that can compound the effects of this illness, and to discuss new ways to work together to address these flaws. 

Our first story of how bad the problem is came from a woman named Kelley Davis. Kelley is 19 years old, a severe Type-II diabetic, and fully employed. Despite this, she's unable to afford the life saving insulin that can cost upwards of $350 each month. After aging out of the State Children's Health Insurance Program (SCHIP), Kelley, like many Ohioans, was left with nowhere to turn saying, "You wouldn't imagine people would turn you down for something you need."

While Kelley's story is compelling, it's not unique. In a survey done by the Kaiser Foundation and National Public Radio, it was reported that:

• 28 percent of Ohioans say they have trouble paying for health insurance;
• 14 percent use up most of their savings on medical bills; and
• 16 percent have been contacted by a collection agency about unpaid medical bills.

As Lillian Kitchens, a local healthcare worker said during the meeting, "It's time to get health care back to what it was. It's become a money making business, not a care giving business."

Caregivers urged Congressman Chabot to explore how Ohio can invest in preventative treatment for chronic illnesses such as type-II diabetes. Opponents of healthcare reform sometimes contend that it's too expensive and not cost effective to invest in preventative programs - but that's just plain wrong. For example, every $10 invested per Ohio resident in nutrition programs that can curb the onset of Type-II diabetes would result in $795 million in savings for the state. Of that savings, $503 million would go right back into the pockets of Ohio citizens in the form of lowered premiums. People say we can't afford preventive care but really, we can't afford not to do this.

The other evening, my husband and I were scrolling through the DVR. Among old episodes of "The Office" and half a dozen Masterpiece mysteries (my fav), there was a new program I didn't recognize: "Hopkins."
 

I was tired that evening, perhaps a bit peevish. I wanted to watch something easy and entertaining. "So what's this Hopkins thing?" I asked, already ruling it out.
 
"I recorded it last week," my husband answered.  "I thought you'd be interested."
 
I reminded him that I don't usually like TV stories set in hospitals. Fictional programs like "E.R." really annoy me with their exaggerated heroics and shallow sentimentality.

"This isn't fictional," my husband said. "It's documentary."
 
The next thing I knew we were watching this story about a surgical team that flies out of Baltimore to bring back a heart for a young man who desperately needed it.  We watched the whole episode, and afterwards, my husband said he liked the program.
 
"The hospital parts were interesting," he said. "Realistic."
 
Now, it's interesting to think again about that episode of "Hopkins" and whether it was truly "realistic."  Surely all the details were right, because the camera was turned on real people-sick people and the people devoted to caring for them.  But as with all stories, the work of the film crew had been edited to focus on a narrative thread.
 
And what about the scenes that were never filmed in the first place-the ones that wouldn't have served the purpose of a medical-heroic story line? I'm thinking of the scene when someone asks the big question: "Do you have health insurance?"  
 
Or how about this one: Somewhere out there in that big city of Baltimore, a young woman is talking to her sister on the phone. She's asking her sister what she should do, because her child has a high fever and a sore throat.  Should she take the child to see the doctor?  Because it's going to cost a ton and she hasn't even paid the bill from a couple months ago when the kid fell off his bike and needed stitches.  (They don't have health insurance.) Then comes the voice of the sister. She sounds older, wiser. She says maybe it's strep throat, maybe the kid needs an antibiotic. And so forth.  It would be plenty realistic.  Lots of people in the big city of Baltimore don't have health insurance. Lots of hard-working employed people don't.
 
OK, maybe my idea lacks the heroics and the romance. Maybe it wouldn't be especially entertaining. But you can't beat it for reality. I'm thinking we need a "reality" series about the tragic brokenness of America's healthcare system.  I'm thinking we need it more than yet another medical-success story about heart transplants, no matter how uplifting.
 
Heck, I could write the screenplay with my eyes closed.  I bet you could too. 
 

I'm writing to you from the National Association of Hispanic Nurses (NAHN) Conference here in Boston, MA. I got here yesterday after five straight days of work-what was I thinking! But, right away I was re-energized by my fellow nurses. We are here in Boston learning so much, from disease management for illnesses like Diabetes that impact our communities greatly to cultural and linguistic competence, and not just for the Hispanic community but for all our patients. Most impressive are the younger generation of nurses attending, some still in nursing school. Many are working right in the community and doing great work.

As a nurse active with Value Care Value Nurse I agreed to host a reception for Healthcare United last night. Again, what was I thinking! So many of my colleagues from the Conference came, we had standing room only. We were able to show nurses the Healthcare United website and how we are going to win healthcare reform for our patients and ourselves. Lots of the nurses are now going to spread the word back home, at work and online.

After all my conversations last night I started thinking about the term "healthcare united" and what it means to me. I thought about the 12 million healthcare workers united for the same cause to make a mandate for healthcare reform happen. I'm realizing that we are united, we just have to talk to each other and spread the word.

I've got to get back to the conference now but just wanted to give this update. Oh, and check out the pictures from the reception!