Doctors and Nurses Are Running on Empty
nytimes.com
nytimes.com
They did not sign up for this an in most cases probably don't really have a choice but to keep working. Health care has always been known as a high stress field, but the last year has completely changed everything even for the people not directly working with Covid patients. Hospitals in America continue to treat employees horrendously while the executives hide out and rake in the big bucks. Maybe a small minority of nurses are earning this "5-10k" but there are probably not as many as you would think. Not everyone can just leave home and everything else behind and work 5-12s in a week.
The disconnect between tech, tech salaries and "how the other half lives" has always shocked me. People who have never worked in a restaurant legitimately questioning why waiters need to make a living wage and why they don't just join a coding bootcamp.
That's an improvement over the usual HN COVID-19 threads, where 'it's just a hoax-flu, bro, stop spreading fear' usually gets upvoted and posts pointing out the dangers of SARS-CoV-2--and of SARS-CoV-2 disinformation--are downvoted, flagged, or removed.
The most generous interpretation is that HN has a severe Dunning-Kruger problem. The more likely explanation is that HN is host to a lot of people who are completely incapable of empathy and are unable to protect themselves from disinformation in areas outside of their own expertise.
This doesn't say much for HN or the tech sector in general.
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A contagious biological virus is not conceptually different from the Morris Worm. If there was a neo-Morris Worm loose on the Internet, those of us on the sysadmin-side of the IT house would take all reasonable measures to protect our systems from it. Indeed, failing to do so would be negligent.
Failing to take protective measures (social distancing, masks, WFH) against SARS-CoV-2 is no different from putting unpatched systems directly on the internet while a worm is active. It's so clearly negligent that no one whatsoever should advocate for it.
Is this something that's happening within the last few weeks, or a few months ago when the pandemic was just starting? I find the former extremely hard to believe.
It's one of the weird quirks of living in our modern hyper partisan environment that how much you believe political correctness is a problem on college campuses is correlated with what you think the IFR of an infectious disease is.
Beliefs come as a package now, independent of the evidence of each individual portion of the package.
Now you know.
Before covid, it was already an abusive job. She doesn't quit a job that is super abusive because it feels like abandoning patients. Her employers take advantage of that. And then the world goes "thanks docs and nurses" and then the rest of the industry on the front lines is like, yeah I guess we're invisible. And if her wages did go up, everyone would just gripe about how abusive it is that healthcare (a human right!) costs so much. She puts up with so much horrible shit, working so much harder than I do for so much less, because her patients really, really matter to her.
If you judge healthcare workers for walking out, understand that they're dealing with tremendous pressure and abuse. If you judge healthcare workers for not walking out, like they're just getting what's coming, reaping what they sow, understand that they do this for reasons that aren't just money, and be thankful that they are willing to give more than they get.
They're burning out helping people. Have empathy.
From a nurse prespective it's a difficult choice and without a safety net people are forced into these choices. There is no easy answer now. I would not know what to tell them.
Tomorrow, give a moment to thank the hard working nurses and doctors who have done what they can to save as many lives as possible in this year. That's what Thanksgiving is all about: even in the worst of times, we need to give thanks to the people who made this year just a little bit less shitty than it could have been.
That's absolutely something to be thankful for. For the 80-hour weeks, for the endless stress, for the worry of contracting COVID19 and spreading it to the ones they love. The frontline workers: be they paramedics, doctors, or nurses, have put in extra effort this year. Their work is usually seen in a negative light (# of deaths), because its impossible to see the converse (# of lives saved).
Really?
No. Not even one of the worst in living memory.
I am not even joking here, those are literally apparently upvoted comments I seen.
They are offering extra pay; they are understaffed with positions open for RNs at $50/hr plus a 30% bonus (not sure why that's not just $65).
About 40% of the staff has or has had COVID.
You also stagger the bonus accrual and the payout time so that when the bonus is paid, they are halfway to accruing next year’s bonus so if they want to leave, they have to contemplate giving up a half year’s worth of bonus.
In my case, I was 3/4 into a 1yr retention bonus, and the new employer (which usually doesn’t do retention bonuses) agreed to give me the same bonus after staying for a year.
Not exactly the same thing, but trying to encourage people to consider jobs even if they’re part-way into one of these retention arrangements.
It was a ~$10k return for a few hours of negotiation. But I was prepared to walk away if I didn’t get it.
The fact that people still aren't flooding in should tell you something.
Proactively ensure that your staff, from the food court contractors, to top surgeons have comfortable pay, support, time off, insurance, and supplies or the ones you need won't be there when you need them the most for a variety of reasons.
If we had more onramps into these generally lauded labor markets then there might be greater flexibility and humanity in responses to stress, especially really serious stresses such as we see now. Make it possible to get limited training for some kind of assistant position and people can gain experience and potentially move up the ladder or simply serve as useful fodder that insulate better trained and more experienced workers from the worst stresses. Instead potential workers are eliminated early on by requirements that are often old and limited in proven relevance.
And apart from all that there are cultural limitations. It isn't some weird mistake or detailed physical evaluation that keeps female participation in construction at extreme lows and male participation in education of the young similarly low. There are serious social barriers involved. Up till now we have had the luxury of setting up expensive many years long training gateways and arbitrary cultural barriers with these fields, but this isn't necessarily rational and forces limitations which are contributing to dangerous overload.
Then we need to start talking, as a nation, what our goals are for our healthcare industry and what we're willing to set aside to achieve those goals. Clearly we were not prepared for this pandemic, maybe we need to make some structural changes.
Tertiary question, would Obamacare have alleviated this situation?
Now they are whining that they are a scarce resource?
I really feel for our frontline workers. But for years they enabled the AMA to cap residency spots and created an artificial scarcity that drove prices of healthcare up.
Now they are whining that they are a scarce resource? And they, using the money they acquired by leveraging their scarcity, even bought a submarine piece of PR to buy sympathy from the public so that they don't try to figure out why exactly they are so scarce! But again, I really feel for our front-line workers. If only there was a way to have more of them yet budgeting the same amount for healthcare.
Yeah, that does sound better.
Nursing is one of very few licensed professions you can do with an associates degree.
And that 2 years is PACKED with a ton of need-to-know skills. The field requires rather incredible breadth just for an entry level position. It's a very demanding program.
These are people dealing with the possibility of life and death mistakes constantly without immediate supervision so a licensure is totally appropriate.
I'm frankly bewildered at your question. It suggests extreme unfamiliarity with the required nursing skill-set.
I was a paramedic, which took me 3 full-time semesters and also required a licensure to practice. And while we had to do a few things outside of the nursing scope, we probably only really covered maybe 1/3 of the skills and knowledge that nurses need to cover in 4 semesters.
There are lots of licensed professions you can do with a associates degree or less. (In California, the list includes Barber, Commercial Fisherman, Cosmetologist, Dental Hygienist, Drinking Water Plant Operator, Electrician, EMT, Funeral Service Director, General Contractor, ...and that's just through the “Gs” of positions covered by the National Occupational Licensing Database. [0]
[0] https://www.ncsl.org/research/labor-and-employment/occupatio...
Nursing is actually a set of separately licensed professions, the lowest couple levels (CNA, LPN/LVN) typically require a non-degree certification, though the latter may also be offered in associates degree form in some institutions. RN requires either an associate's or bachelor's (ADN or BSN), and the levels beyond RN require additional education; NP requires at least a BSN, Nurse midwives and nurse anesthetists require at least a Masters.
And nursing (viewed broadly) skills are taught in mass, the nursing series of professions employs a huge number of people. RNs alone account for more than 1% of the entire US population, adding CNAs and LPN/LVNs, that goes up to a little under 2%.
The human body is fucking complex. Staggeringly, mind-bogglingly so.
And that's just our bodies. Add in just one component of nursing, like medication. We don't even know how most of the drugs we take work - called 'mechanism of action'. We don't know. We just know the shit does work.
Now think about everything that can go wrong with a human body. Nurses are the front line workers that have to deal with that.
Try to think a little before you type next time.
What you’re describing is what doctors deal with, not nurses. My grandpa was just in the hospital and ornery due to not having any nicotine in him, but the nurses sure as hell couldn’t give him a patch without a doctor’s order, nor should they be able to.
Nurses know some anatomy, major no-nos, and how to do things like place a catheter, an IV, etc. Don’t get me wrong, they’re absolutely essential, but I’ve regularly been amazed at the lack of medical knowledge at least some RNs have.
My sister is one, and she’s coming home to visit my parents for Thanksgiving. My dad has lupus and finished cancer treatment this year. She thinks it’s ok as long as none of the patients she sees today have symptoms of COVID. The term incubation period means nothing to her, and that’s just one example.
As long as people are griping and complaining instead of quitting we know we're in good shape.
If a lot of workers quit then the wages (and prices) rise, and workers move from other jobs to do the higher paid ones. There is only a shortage of labor when there are wage or price controls imposed on the businesses by legislation.
And besides, the job tree has stopped bearing its fruit because it is out of season and it's been picked dry already.
Your patients will die if you don't go to work.
You're not "forced" to go in. But there's a strong sense of duty here. Its life-or-death. Nurses / doctors chose this profession because they want to save lives.
Serious question. Now that you have an idea of how much money that actually costs, do you understand why things don't scale the way you think they do?
Even then, it will take you years to get the skills needed to be a nurse (and in ~1 year, thanks to the vaccine, the surge in nurses won't be needed anymore). What needed to happen is that you needed to start training to be a nurse 2 years ago, if we wanted you helping a hospital today. And that's assuming you're inclined to learn biological sciences and actually pass nursing school on your first try.
my sister is doing critical care work as a nurse in a covid crisis zone earning less than 60K a year. this is with a decade of experience in some of the top hospitals in the country. i think HN has a very California/New York view of nurse’s compensation and status.
her previous hospital responded to covid by firing a lot of nursing staff (grandma’s couldn’t get knee replacements, but covid wasn’t super bad here yet so hospitals just shed resources only to need them again in two months).
hospital administrations responded to the crisis by cutting staff, cutting pay, and increasing their own salaries, while taking months to procure PPE for their workers. at the height of the iraq war, it was a big news story that soldiers had not been receiving adequate protection and that some of the vehicle and personnel armor they had received was defective. if we want to make a war analogy, this is blackwater contractors getting paid millions to play at war games geared to the tits and barely ever leaving the green zone while the soldiers doing the real grunt work are getting shredded by mandatory redeployments with no leave and issued substandard gear.
on top of that, covid has been functionally live clinical experimentation at mass scale. a lot of medicine has been made rote, so i think jaded people think it is just a big book of instructions. this pandemic was figuring things out live at runtime.
the compassionate response to a massive crisis in healthcare worker morale brought on by burnout due to extremely fast paced, high risk, high stress, highly specified work conditions during a global pandemic is something like “i hope this can be managed so that care can continue to be delivered” and not “they should get a new job”.
The difference between the military and the healthcare system is that soldiers can't quit, but healthcare workers can.
Every single healthcare worker in America is working at that job because they prefer that job to all other alternative jobs available to them. This is trivially true because if they preferred another job they could quit and take that job.
Of course, we all have stress, and nobody likes their job, and everyone gripes and complains, and everyone's bosses are slave drivers, and everyone's customers are demanding. That's why it's a job and not a hobby.
I stand by my argument that most of the work of monitoring and caring for covid patients can be performed adequately by semi-skilled workers.
Anyway, the army actually does this. Even the special forces 18D medic training (the most elite and rigorous medical training they provide) is only a year long, and they can do everything a nurse can do plus, for example, perform surgery on goats.
Yes. It is easy to solve problems with a budget of $700,000,000,000 a year.
With enough money, you can develop training programs to make total dumbasses perform skilled work. But unless you plan on spending $7 trillion over the next 10 years on improving the healthcare system of this country, I don't think your comparisons to the military are very apt.
1. You start with propaganda: movies and video games that show the military in a positive light, encouraging a number of impressionable kids to join the military. I'm not against propaganda btw, but I understand how it works: the modern military spends a lot of money on Call of Duty esports for example, Twitch.tv recruitment, etc. etc. The goal is to make a positive first impression, usually through an entertainment venue (sports, video games, or movies)
2. You continue with explicit ROTC programs: where the high schoolers (or college-kids) can get their first real taste of military culture.
3. At actual recruitment: there are standardized tests that sort students off of their capabilities: finding a job that matches their skillsets.
4. You have a training program ("Boot Camp") that gives these recruits the skills they need to start their job.
5. You have a clear and well-understood ladder, organized by rank and pay-grade. Though its somewhat complex to outsiders, those within the military fully understand what they need to do to grow as a soldier (or officer). There's no ambiguity for what's needed to grow from E1 to E2 or from Lieutenant to Major. There's a literal army of bean-counters who are also double-checking and triple-checking the results to make sure things are going as planned across divisions.
6. Post-military life is also considered: the GI Bill ensures that college-life is guaranteed for soldiers, to be ready to be retrained after their military career. As such, military life can be temporary (4 years or 8 year stints), or permanent (a full 30+ year career). Both lives are encouraged and well supported by the structure. A number of Federal jobs (and state-jobs) even provide explicit bonuses to veterans, to help the soldier transition into post-military life.
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That's how you recruit, and train soldiers in the military. If your point is that the military has an awesome ability to recruit and train personnel, I fully agree with you.
But don't diminish the amount of thought, and resources, that have been poured into the military structure. From pre-recruitment propaganda, to recruitment programs, to continuing education (and the entire promotion structure), the military requires a LOT of money and manpower to support.
If you want to deploy such a "bootcamp" for nurses and doctors, I think I'm in agreement with you. I just want to be clear that such a "Bootcamp" will be extremely expensive, no matter how I look at it. Even if you cut out propaganda, and a bunch of excess spending stuff (military bands and other "morale builders"), the core of the military recruitment / training / post-training structure is very expensive.
If more workers are needed to care for covid patients then the wages will rise, and more workers will switch from other jobs to perform this work. Training people to empty bedpans, draw blood, monitor diagnostic equipment, and so on is not any more complex than what people learn in a code bootcamp, and code bootcamps are doing fine.
Nursing isn't some kind of uniquely difficult occupation. If a pilot can learn to fly helicopters commercially in a year then I would propose that we can train people to do this, too.
Look man, if you don't want me comparing nurses to the military, then don't bring it up in the first place (https://news.ycombinator.com/item?id=25213289)
> This is what the army does, it works fine.
Your words, not mine. Find a better comparison. And no, I don't think your "helicopter pilot" argument is serious at this point. There's no way you actually consider helicopter pilots as important as nurses right now.
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> Nursing isn't some kind of uniquely difficult occupation. If a pilot can learn to fly helicopters commercially in a year then I would propose that we can train people to do this, too.
If a nurse quits on their job, then their patients die. You can't just get "another nurse" to do their job (those nurses are also overworked and busy).
If a helicopter pilot quits their job, their passengers need to wait a few more days to find a new pilot.
I have my doubts you're serious with the helicopter discussion point. I'm not entirely sure what you're trying to prove.
> If a nurse quits on their job, then their patients die.
This is obviously not true, people are not dropping like flies whenever a nurse in America takes a vacation or calls in sick.
Are you seriously claiming that there is a national shortage of people who can be trained to empty bedpans, setup IVs, draw blood, and take temperatures? At any price?
If wages go up, more labor will be available, and there is no shortage.
Yes. Because COVID19 is happening right now.
Even if you had infinite money, there's no way you can train all of those people to take care of the COVID19 surge that is literally happening right now.
The effects of the pandemic are here and are already having obvious consequences.
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COVID19's job is closer to shoving catheters into people while you put them under a ventilator, setting up IV drips, etc. etc. But yeah, its happening on a massive scale as we speak.
> This is obviously not true, people are not dropping like flies whenever a nurse in America takes a vacation or calls in sick.
Lets see how long those patients last if a nurse doesn't change out their bedpans or catheters, while refreshing their IV-drips while they're on a ventilator.
Plus the math for keeping track of vitals to determine how many corticosteroids to inject into someone to optimize their chances to live through it all.
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https://oklahoman.com/article/5677006/asymptomatic-health-ca...
I'm not sure if you realize how dire the situation is right now. Nurses who test positive for COVID19 are being kept on the job because there's literally too many patients and not enough nurses.
OK, so how many years of training is required to learn how to insert catheters and IVs and all that? The army demonstrates that anyone can learn these skills in a few days. I'm sorry, but it's just not some kind of unique magical skill set that only special people can learn.
> I'm not sure if you realize how dire the situation is right now.
I'm not sure if you do. There is no crisis, hospitals are not near capacity, there are plenty of empty beds. (Oklahoma, for example, is at 66% capacity, nothing to get hysterical about.) There is no huge difference in hospital bed utilization between today, last week, last month. Remember that giant hospital ship? The one that sat empty in NY harbor and then quietly left without treating a single patient? Excuse me for being desensitized to chicken little's alarming news.
> Nurses who test positive for COVID19 are being kept on the job because there's literally too many patients and not enough nurses.
Nobody is being "kept on the job". Nobody is being forced to work. Those nurses are volunteering to stay on the job.
Tulsa has run out of ICU beds.
Just because Oklahoma in the aggregate has beds, doesn't necessarily mean that communities have beds anymore (even large ones with comparatively many resources, like Tulsa). And with Thanksgiving around the corner, I'd expect cases to skyrocket right after these celebrations.
> Nobody is being "kept on the job". Nobody is being forced to work. Those nurses are volunteering to stay on the job.
Because they know their patients will die if they don't perform.
> The army demonstrates that anyone can learn these skills in a few days.
Once again with the army comparisons. Its easy to build a training program when you have a $700 Billion/year budget. If you want to make an army-like training program for nurses, then I agree with you. That'd be great for our country.
But I recognize that I have a minority opinion and that most Americans won't accept raising their taxes to pay for such a thing.
So now we're in agreement. The sky is not falling, and Tulsa may have a local logistical challenge. Nothing to see here.
> Because they know their patients will die if they don't perform.
It's presumptuous to speak to what others know. All I know is that they weighed the alternatives for themselves and chose to willingly go to work instead of doing all the other things that they could have done instead.
> Its easy to build a training program when you have a $700 Billion/year budget.
Are you arguing that only a $700B/yr organization can train people to do the simple tasks that a soldier learns to do? The field manuals and training materials are all available, you can look and see for yourself that there is no secret super 700 billion dollar teaching method being used. As important as they are, these skills are not uniquely difficult to teach nor to learn. (Nevermind the fact that last year the federal government spent over a trillion dollars on healthcare, and the private sector spent even more than that, so if there is some special budgetary threshold that must be passed before workers can be effectively trained, I think we passed it a long time ago.)
> Americans won't accept raising their taxes to pay for such a thing.
Right, because we don't just assume that the solution to every problem must come from the government. There is absolutely nothing preventing hospitals from training new workers to change bedpans and insert catheters via on the job training. Well, nothing except for all the government regulations, but as they say "nobody gets a speeding ticket at the indy 500". They could do it and it would be fine.
Not only train the soldier: but also to check on their progress, ensure they are following the proper military culture, growing into their role, and promoting those who are worthy.
The entire life of a soldier is well defined thanks to the work of the generals and leaders of the military. Group organization and cohesion is no accident: its a purposefully built goal. And yes, money has a lot to do with it.
Propaganda and recruitment is a big one: there are literally soldiers going out into the country, and individually recruiting kids out of high school to become a soldier. This increases the talent pool, and effectively lowers the wages you need to offer soldiers (supply and demand after all).
No one is going out there recruiting people into nursing fields.
> So now we're in agreement. The sky is not falling, and Tulsa may have a local logistical challenge. Nothing to see here.
And a record death rate. Are you trying to imply that COVID19 deaths aren't happening or something?
Deaths skyrocket with caseload. Yes, there are treatments that help prevent death, but only if the nurses / doctors have enough time to do their job. If they become overwhelmed, then their ability to process life-saving treatment is mitigated.
You mean like in Team America? /jk
No seriously, how does it work?
Various benchmarks: time-in-grade (ex: 6-months as an E1 makes you eligible for a promotion to E2). For E4, there are two paths: Corporal (Non-commissioned officer, a leadership role) or Specialist (non-leadership, but a more specialized set of skills).
More importantly: these promotion requirements are well regulated, checked-and-double-checked for consistency. Everyone in the ranks knows what to expect. Leadership knows when to promote. A sense of fairness exists, etc. etc.
American society is unable to use versatile individuals because it is advanced: sophisticated power structures have powerful propaganda arms that block efficient utilization.
Many things in life have transferable skills. Big parts about being a Registered Nurse are just being meticulous and memorizing large quantities of information: both things people like me are exceptional at.
And my tolerance for risk is high. I'd smokejump if you needed me, I'd work on COVID patients if you needed me. With my own PPE if you so desire. But you won't. Because let's be honest, there are those who want to preserve the order for their own reasons, those who want to live in interesting times, and those who fear change.
You know what is? An entire society taking this thing seriously.
If you start reservist wildfire training me now, I'll be ready by next season.
Certification fetishism is ruining America's agility. Unsurprising. All societies switch from exploration to exploitation to preservation at some point until they are replaced by a new disruptor. It happened to Britain. It's happening to America.
In March, I was trying to convince my family that COVID19 even existed.
We did start in March. Discussing that COVID19 is real, that masks help, and that pooling health care resources was needed for the imminent future. Fortunately, my local area is doing good on stockpiling PPE, expanding hospital beds / resources and more.
The issue is that a good chunk of America decided that COVID19 was a fake virus that only afflicted China, no wait, only affected Europe... no wait... only affected liberal cities. There was no way for it to spread around the country.
Sad fact: its too late to change the nursing situation now. Your state is either ready for this, or it isn't. Too late to change things. You had since January to prepare (when China announced to the world the COVID19 issue), maybe March (when New York City announced to the country that COVID19 arrived on our shores).
What we can do is start the propaganda campaigns needed to get mass vaccinations ready.
And if everyone had a secondary job they could get refreshed on, we'd reduce the disruptive shocks to our society that things like coal becoming worthless do.
To the downvoters, let me ask you this: how many Americans have been driven into medical bankruptcy while their doctors are living in multi-million dollar McMansions? The system in America is the way doctors have designed it. They have outsized political power; legislators heed their lobbyists. They created and perpetuated this system so they could profit from it. They have been hoisted by their own petard.
The supply of medical doctors is kept artificially low in order to keep salaries artificially high. I ran into this firsthand. I was actually a pre-med student in college, but as I really dug into how the whole system works and found out that physicians' groups and lobbies work to prevent new medical schools from being established, to keep spots in existing medical schools scarce, to keep their salaries inflated, I got disgusted and instead finished my degree in biological sciences with a focus in evolutionary biology.
The system needs an enormous overhaul and reform. There are some workarounds being implemented to address demand, notably nurse practitioners, who have almost the same powers and privileges as M.D.s, but not quite. That's even changing though.
But the core of OP's post is totally correct. A huge part of this situation we find ourselves in right now is due to good old-fashioned greed and protectionism.