AHS/healthcare system debacles

[Mitsu3000gt]

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On one hand public workers work hard. On the other, that take 12 sick days a year

Again I mostly only know about the ER, but the reason there are so many sick calls is that vacation and personal days are virtually never approved and there is zero chance of getting consecutive days off unless you are top of the totem pole in terms of seniority. Then, they get in trouble for not using all their vacation by year end for an extra kick in the balls. So, the only way they get time off at all most of the time is by calling in sick. If the vacation policies weren't so absurd, you would see way less sick days.

[killramos]

Maybe they should negotiate better vacation policies into their contracts instead of raises.

[nismodrifter]

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I asked again yesterday because I was curious, l and I was told there is a literally a sheet that spells out the fee charged when an ER doc does something. For example if they put in stitches, they get paid for that separately. So I don't know what to tell you or why we seem to have different info. Are you an ER doc?.

You are talking about 2 different things in your posts.
#1: A test: A blood test/xray/mri/ultrasound
#2: A service: The visit, the procedure.

We are not compensated in any way shape or form for ordering a test or investigation.
We are compensated for providing the service/procedure/counselling.

A decision to order any test that ultimately costs tax payers money is made by knowing the evidence, knowing the clinical scenario, and knowing the appropriate treatment guidelines for said scenario. Ultimately, we must have justification for each and every test ordered.

The system is broken.

I run a busy family practice. I am in the office at 0730 to begin preparing for the day and reviewing lab work that has come in at night. My schedule is booked to near capacity before the day begins. Phone lines open at 0800 and ring all day. I am regulated by the Government in terms of how many appointments I can offer in a day. When a mother calls in and says her child has a raging fever for the past 5 days I will do my absolute best to fit this child into the schedule. An adult calls in and says that they have a red eye, that is goopy. I will also try and fit this person into the schedule. Can I do this absolutely every time? The simple answer is no. It is just not possible.

What happens when we have to say no and turn someone away? My front staff will make me aware of the situation, and I will generally triage it, and advise whether patient should report to the ER immediately, or have them book for tomorrow with advice to go to ER if condition worsens.

What do I need to keep more people out of the ER? I need help. Help costs $$. I need timely access for my patients to mental health workers, dieticians, exercise programs. All of this costs $$. We are working on advocating for this at a systemic level. It's taking time.

Back to work....

[Mitsu3000gt]

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Maybe they should negotiate better vacation policies into their contracts instead of raises.

The policies are already there, they just aren't honored by management as there is a loophole that basically allows them to deny anything based on staffing needs.

Also, they are not paid nearly enough for the shit they deal with (literally and figuratively) IMO. Every department is a bit different, but most people haven't a clue what the job actually entails and wouldn't last a day in their shoes (myself included).

[94boosted]

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I think a lot of nurses are worked hard, and most people know that, they're saying the inefficiencies lie in other areas.. Ie Managment/Construction etc

Yes and I was also saying that industry is quite management heavy and don't even get me started on capital construction costs in O&G, it's not uncommon to have an inspector inspecting an inspector inspecting the trained worker.

[revelations]

One of the bigger issues is whiny adult babies who also want a pill to cure everything. And yes, the Emerg needs to turn away people with minor coughs and colds - have a separate area for OTC stuff, where people with minor booboos can get a bandaid, Neocitran or Gravol.

[AndyL]

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On one hand public workers work hard. On the other, that take 12 sick days a year

Trying to remember what the game was the ex played in nursing, they would game the system call in sick for a shift - friend already agreed to pick it up... then take the double OT shift that would come up on the following shift to cover for the person they traded shifts with... Both get OT+ both still work ... yeah.

At some point someone has to explain to me why we have all these .3 / .4 / .5 FTE's, Why can't a nurse/aide/etc not get a .8-1.0 FTE, they end up picking up hours at 3 different units, all part time, all racing between hospitals because it's impossible to get a real 'full' shift until you've got a decade of practice under you?

[Mitsu3000gt]

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Trying to remember what the game was the ex played in nursing, they would game the system call in sick for a shift - friend already agreed to pick it up... then take the double OT shift that would come up on the following shift to cover for the person they traded shifts with... Both get OT+ both still work ... yeah.

At some point someone has to explain to me why we have all these .3 / .4 / .5 FTE's, Why can't a nurse/aide/etc not get a .8-1.0 FTE, they end up picking up hours at 3 different units, all part time, all racing between hospitals because it's impossible to get a real 'full' shift until you've got a decade of practice under you?

Your first point, they haven't been able to do that for a long time now - OT is not nearly what it used to be. Also OT is typically first come first serve, so there is no guarantee they would be able to pull that off in any given event. They text out the shift, and whoever calls first gets it. First they try for no OT, then if they are desperate they offer the shift as OT - trying to wait them out provides no guarantee that a) the shift will even be available and b) it will be OT. If it's the nurse's X day they get double time instead of time and a half, but they check and if it's your X day you are last priority for getting that shift specifically to avoid paying extra OT.

Full time lines are generally the most sought after, so the only people who have them (for the most part) are the 50+ year old nurses with the highest seniority. What a lot of nurses like to do though because they don't have that option, is take a .5 or a .7 and then pick up shifts to maintain some level of time-off flexibility and be able to pick extra shifts when needed for money. If you are working a partial line you can also work as a casual nurse in other departments and go beyond full time hours if you wish. Most lines also include mandatory evenings or nights, so not everyone wants that either so they maintain more trading flexibility by taking a smaller line. My GF has about a decade of experience and she is nowhere near able to get a FT 9-5 line - maybe when she's 50. There are areas that have "normal" hours though, such as places like clinics, but for that reason those jobs are usually really hard to get and in high demand.

[xrayvsn]

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I asked again yesterday because I was curious, l and I was told there is a literally a sheet that spells out the fee charged when an ER doc does something. For example if they put in stitches, they get paid for that separately. So I don't know what to tell you or why we seem to have different info. Are you an ER doc?

And yes my comments were more towards avoiding liability as well as increasing the chance of an accurate diagnosis - it's not a bad thing IMO. If I was a patient, I would certainly appreciate the docs airing on the side of caution.

nismo already made the point and explained how it works. You and I are saying the same thing but you are equating ordering a test to providing a service.

The ER doc does something = stitches, cast a broken wrist, drains an effusion, does a cardioversion = a procedure that the ER doc performs and bills for as the service provider.

The ER doc orders a test = x-rays, ultrasound, MRI, CT or blood work. Or the patient needs the same effusion drained using ultrasound guidance = ER doc does not get paid for these. The billing is through Diagnostic Imaging or lab medicine as the service provider.

You contend that the ER doc gets paid for every test. I am saying you are incorrect in your interpretation of how it works.

I am a radiologist, so literally the guy who gets paid for the diagnostic imaging tests, so I think I know what I’m talking about.

[AndyL]

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Your first point, they haven't been able to do that for a long time now - OT is not nearly what it used to be. Also OT is typically first come first serve, so there is no guarantee they would be able to pull that off in any given event. They text out the shift, and whoever calls first gets it. First they try for no OT, then if they are desperate they offer the shift as OT - trying to wait them out provides no guarantee that a) the shift will even be available and b) it will be OT. If it's the nurse's X day they get double time instead of time and a half, but they check and if it's your X day you are last priority for getting that shift specifically to avoid paying extra OT.

At least they fixed that... Was pretty ridiculous that it was possible (albeit that was a decade ago)

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Full time lines are generally the most sought after, so the only people who have them (for the most part) are the 50+ year old nurses with the highest seniority. What a lot of nurses like to do though because they don't have that option, is take a .5 or a .7 and then pick up shifts to maintain some level of time-off flexibility and be able to pick extra shifts when needed for money. If you are working a partial line you can also work as a casual nurse in other departments and go beyond full time hours if you wish. Most lines also include mandatory evenings or nights, so not everyone wants that either so they maintain more trading flexibility by taking a smaller line. My GF has about a decade of experience and she is nowhere near able to get a FT 9-5 line - maybe when she's 50. There are areas that have "normal" hours though, such as places like clinics, but for that reason those jobs are usually really hard to get and in high demand.

Since we value nurses so highly - why do we do this? Doesn't that just push them into looking elsewhere? Then again I'd question what motivation anyone has to get into healthcare without fully understanding they're most likely working a night shift.

1.0 FTE's for the night / overnights .2's for the rest

[BigDL]

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Full time lines are generally the most sought after, so the only people who have them (for the most part) are the 50+ year old nurses with the highest seniority. What a lot of nurses like to do though because they don't have that option, is take a .5 or a .7 and then pick up shifts to maintain some level of time-off flexibility and be able to pick extra shifts when needed for money. If you are working a partial line you can also work as a casual nurse in other departments and go beyond full time hours if you wish. Most lines also include mandatory evenings or nights, so not everyone wants that either so they maintain more trading flexibility by taking a smaller line. My GF has about a decade of experience and she is nowhere near able to get a FT 9-5 line - maybe when she's 50. There are areas that have "normal" hours though, such as places like clinics, but for that reason those jobs are usually really hard to get and in high demand.

Working on a unit in the hospital FT "9-5", (well 7:15-3:30) on a lot of units don't exist, you will have mix of evenings and days, days and nights, or evening and nights. Every unit my wife and my sister in law worked on is like this.

When applying for jobs seniority plays a big roll when people apply for openings, it there are multiple people with similar qualities the one with higher seinority usually gets it. They also like to fuck around with the lines every once in a while and make changes to them and have everyone fight it out for which line in their FTE rating they want. So on my wife unit they decided to change all the lines, and she had to pick between several options that they had and give them a list of the order you preferred. Higher seniority people would get their choice then goes down the list. For example there was one line that had more nasty blocks of shifts in a row, but you got a slightly better break between one of them, but not worth it for the amount to stress on that unit.

Though my wife's old unit had a ton of turn over all the time due to the work culture and the stress on the unit. She shot up in seniority on that unit fast.

Oh and if you are working a normal shift and you have to stay late to help and deal with shit you have to apply for OT with your manager, it is not like you automatically get OT after working your normal shift.

Like Mitsu said outside of the hospital there is more options but those jobs are pretty competitive to get. My sister in law transitioned to a case manager role outside of the hospital and has mostly 9-5 ish job with some weekend shits here and there. My wife had a temp line as a case manager before mat leave also Monday - Friday 9-5, she was sad to lose that.

[suntan]

Life tip: make sure your kids are born in the afternoon, you'll have five nurses taking care of you. And at least one for the wife.

[BigDL]

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Life tip: make sure your kids are born in the afternoon, you'll have five nurses taking care of you. And at least one for the wife.

Oh yeah, and if you need anything get it before shift change too.

[dirtsniffer]

Kid was born at 3, We got to recovery around 5pm. Didn't see a nurse until after 8 lol.

[ExtraSlow]

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Life tip: make sure your kids are born in the afternoon, you'll have five nurses taking care of you. And at least one for the wife.

Pffft, have your kids at home in the bathtub, that's what I did. #whoneedsnurses?

[TurboMedic]

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One of the biggest issues is that 90+% of the people who come to the Emergency room shouldn't be there, but they have to get seen if they show up. Lots of people don't even have a GP because they just come to the ER with everything from a dry mouth to a sore throat.

This, probably one of the biggest changes I've seen in my career is the rapidly declining ability of individuals to self care with common remedies. People have become utterly helpless.

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On one hand public workers work hard. On the other, that take 12 sick days a year

In fairness, we do deal with consistently sick and contagious individuals, we lack sleep and mostly have poor nutritional habits out of necessity. We do get sick lots, and trust me you're put in a "program" if you take anywhere near those 12 years a day.

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The policies are already there, they just aren't honored by management as there is a loophole that basically allows them to deny anything based on staffing needs.

Also, they are not paid nearly enough for the shit they deal with (literally and figuratively) IMO. Every department is a bit different, but most people haven't a clue what the job actually entails and wouldn't last a day in their shoes (myself included).

This. Our discretionary time off has been essentially in an auto denial since the summer, and has been extended continuously (currently thru march). So we have time we can use, that they deny giving us. Including denials of personal days which are to be used for emergency or last minute needs. So, if they won't play fair, how can we?

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One of the bigger issues is whiny adult babies who also want a pill to cure everything. And yes, the Emerg needs to turn away people with minor coughs and colds - have a separate area for OTC stuff, where people with minor booboos can get a bandaid, Neocitran or Gravol.

They have that in every emergency department, called either minor treatment or intake. We also have urgent care centers that are intended to be lower acuity. A better plan is how about you go to the store and get that neocitran or gravel or immodium or robax yourself. Why involve the health,th care system at all? Heck you can even get some prescription like meds from just talking to the pharmacist.

[04Terminator]

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Kid was born at 3, We got to recovery around 5pm. Didn't see a nurse until after 8 lol.

Cause we emailed them your moronic ignorant diarrhea you spread.

[Buster]

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This, probably one of the biggest changes I've seen in my career is the rapidly declining ability of individuals to self care with common remedies. People have become utterly helpless.




They have that in every emergency department, called either minor treatment or intake. We also have urgent care centers that are intended to be lower acuity. A better plan is how about you go to the store and get that neocitran or gravel or immodium or robax yourself. Why involve the health,th care system at all? Heck you can even get some prescription like meds from just talking to the pharmacist.

Why are we paying for people to abuse or misuse the system?

[ExtraSlow]

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Why are we paying for people to abuse or misuse the system?

A palatable alternate has not been found.

[rage2]

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Life tip: make sure your kids are born in the afternoon, you'll have five nurses taking care of you. And at least one for the wife.

A better tip, use a midwife which is covered by AHS but deliver at the hospital so if anything goes south, that’s when you leverage the nurses and doctors. Our 3rd was delivered in record time. Admitted at 4am, born at 5, home by 7 with the midwife there for the entire time. Makes a big difference when it’s just 1 dedicated person instead of a rotating staff coming in and out.