Nursing is not that complex. The bulk of the work can be offloaded on semi-skilled labor with on the job training. This is what the army does, it works fine. This is not rocket science here.
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”.
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.
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.
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.