Hacker News Reader

Comment by quasse | Hacker News Reader

My partner is a nurse and this does not surprise me in the slightest. Up until she quit near the end of 2020, nurses were required to put their PPE (N95 masks) in a "special" tupperware with holes poked in the lid at the end of each shift and reuse it the next day, ad-nauseam.

Nurses who caught COVID were discouraged from being tested unless they had symptoms that would be visible to a patient because hospital administrators did not want the work of filling shifts. Couple that with the fact that more and more medical work is being offloaded onto nurses as a cost saving measure, and you have a perfect recipe for burnout.

View on HN

I just dont get it (or perhaps not able to digest it). Nurses and teachers are two of the most critical professions for a nation, nay a civilization. Yet we get away with what is essentially abuse with their treatment. How is this inversion of prioirity being gotten away with?

Lack of consequences for those responsible for the decisions. Follow the incentives.

If you want the workplace to improve, hold management responsible for their decisions.

They are critical to only a small group of people at any given time. That's part of the challenge.

Eventually we all benefit from them, but at any given point they are out of sight and out of mind. That causes people to not really care.

My wife's a respiratory therapist and she went through a similar experience. We have to remember though that the medical systems of parts of both China and Italy were overrun, leading to a spike in deaths because they couldn't get care, and we had no idea if it would happen in the US. Our goal with the lockdowns and everything else was to lower the maximum number of people in the hospital at any one time. Well the other end of that was to maximize hospital capacity. That necessitated maximizing labor and minimizing waste of things like masks which experienced global shortages.

Note too that covid workers were highly compensated for their work, at least where I live. Our annual income doubled last year because of her work in the covid units. The issue isn't a financial one, but from dealing first-hand with so much death, suffering, and stress on a daily basis.

They also tend to attract selfless people (usually women). And selfless people can get taken advantage of.

Indeed, it's often called Care Work:

https://en.wikipedia.org/wiki/Care_work

Care workers hold crucial jobs but are often paid much less than other professions putting forth similar effort and similar amounts of training. Often, they're told that they do it for the love of their charges (whether it's nursing, teaching, social services), and most especially the completely unpaid child care at home.

And yeah, most care work professions are associated with being "women's work".

More critical positions are: - People working in energy and telecommunication - Food and water - Waste disposal

Without all three of those sectors modern societies would collapse.

Some meritocracy, eh? It blows my mind how the idea that compensation has anything at all to do with how important a job is or the quality of character it requires has survived this long.

Do people commonly think that? It's all supply and demand, and very stochastic at that.

Not to necessarily knock nurse pay, it is a common route to a middle and even upper-middle class life.

Well to be fair the hospitals are the same people who have been complaining that they can't get enough qualified nursing staff for the past 15 or 20 years.

Yes, it's built right into our language: we say someone "earns" their wage.

Nurses and teachers are more important than me, a programmer. I was reminded of this when my state put me in the last vaccination group. Yet because of supply and demand, but also the potential for companies to earn from software and the vagaries of stock compensation, that programmers often can earn much more. I want all people to earn a living wage, especially those other "essential" but hopefully not continuing to be disposable workers in grocery stores and other underpaid jobs like food preparation and the people that take care of senior citizens - they need health insurance, a living wage, time off, respect. In other countries than the US it's much better for them, perhaps we'll get there during our current 'new new deal' phase in the US.

Yes, but we also have to price things for overall societal benefit.

If a software engineer can shave off 1 hour a year for 2 million of the 28 million nurses in the United States, that is allowing us to redeploy 228 years worth of nurse labor. We want to incentivize easy scaling solutions like that, so I do not necessarily have an issue with paying the software developer a premium if it allows us to help more people.

I don't think that this is arguing against nurses being paid well for the huge beneficial impact and selflessness they do have, but I don't think the analysis needs to be necessarily comparative with software engineers.

If those hours were redeployed in such a way that people still had decent jobs, sure... but a lot of what we programmers do has a much less positive impact on other people and their jobs.

Definitely. I think wealth consolidation remains a huge problem, somewhat driven by automation, somewhat driven by other factors.

I'm curious, what do you think the compensation for being a nurse should look like?

One thing I notice is the amount of "brainwashing" that goes on in this industry - and please please this is not to say nurses and teachers are fooled - more that "hey you are in a glorious profession so talk of compensation will only cheapen it so toil away". Still very weird. Given how unions are not squashed for N and Ts Id have thought there may have been more room for better bargaining. Especially if the COVID season did nothing to improve their appreciation I am worried very little else might!

OP didn't actually mention compensation as a pain point.

Sorry I should have been clearer. I think implicitly I was referring to compensation too. My (possibly naive) line of thinking is that companies are getting away with this "abuse" due to a high supply which in turn is fueled by low wages?

There's a pool of money to be split between front-line workers and adminstrators. Guess who decides how to split it?

Thee who make the system break the system..

It's probably related to the huge difference in how my wife and my mother are treated by "professionals" and contractors when I'm around versus when they're alone.

Is there specific evidence of abuse besides requiring masks. Surgeons routinely work much longer hours.

Men commit suicide at about 3-4x the rate of women (it's not quite as high for attempts, men are better at 'getting it done'), often related to occupational issues but nobody seems to think one bit about them. [1]

Education has by far one of the lowest suicide rates - of course, that's only one crude indirect measure of things. Jobs in education tend to be very stable, they are very highly regarded in the social sense (far more so than businessmen, politicians etc.) [2] In some places wages are not so good, but that's not always the case. Nurses are reasonably well comped but it's also impossible to quantify for some stress factors.

Doctor's suicide rates are effectively the highest of any profession (note that for Healthcare as an 'industry' the numbers are lower, but for Doctor specifically, it's high, i.e. most of the industry are not dealing directly with trauma, death).

Overall - I think COVID is obvious a giant bank of stress and generational PTSD and it's surprising how well the workers are taking it.

Doctors and Nurses are some of the most professional and conscientious people out there, the least likely to complain i.e. and occupational sense of duty that transcends 'compensation'.

COVID is a kind of war for them, it's just grinding them down.

[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6903a1.htm

[2] https://moneywise.com/a/the-most-dishonest-profession

[3] http://www.zeroattempts.org/suicide-professions.html

Because they are not the ones in power. The solution is to unionize. Teacher's unions seems to be unsuccessful as a whole (as an outsider at least). Nurses union's seem to be relatively successful in certain regions (the bay area seems like a good region. nurses make quite a bit of money here).

My wife was a nurse with Kaiser, a nonprofit with a union and she has very little positive to say about them.

Yeah I don't want to cast too wide of a net. My mom is a nurse in florida and isn't unionized and adjusting for cost of living, makes basically the same as a kaiser unionized nurse and has great job security. So it is not always necessary or they don't always work. But it seems like they are great for bringing the baseline work environment up.

Teachers have some of the most powerful Unions in the world.

The Ontario Teacher's Union might be the most powerful organization in Ontario. They own major league sports teams.

Nurses salary in Bay Area is $133K, national average is $80K which is pretty good. [1]

[1] https://www.travelnursing.com/news/career-development/where-...

Anecdotally, my friends who teach in Canada seem to have significantly more structural influence than I do teaching in the US. I’m not sure the landscapes are comparable.

Edit: they own major league sports teams? That’s wild.

Anecdotal counterpoint, I spent a lot of time in the hospital over the last year or so, and the vast majority of nurses that I spoke to were happy with their income and hours. I personally thought the 12 hour shifts would be a huge pain, but they all seemed to love the 3 day work week.

Edit: The only nurse that seemed unhappy was an older agency nurse who was recently laid off from a hospital, and was having trouble finding steady work because she didn't have a four year degree. I wonder if the stress from changing standards is a factor.

As a high school teacher, one of the critical problems we have when arguing for higher pay is that there are no strong methods for quantifying teacher effectiveness. There have been attempts to develop such a tool (Gates poured a bunch of money into it), but nothing meaningful has been developed.

Without that, we fall back on more qualitative, holistic methods they are both game-able and subjective.

We may see a general cultural shift towards higher teacher pay (which I believe would be positive if paired with higher professional standards), but it’s difficult to argue in our current culture that teachers “deserve” more pay when we can’t even reliably determine which teachers are having an above average educational impact.

It seems like as intractable a problem as trying to identify an objective measure for a human being's success in life.

> there are no strong methods for quantifying teacher effectiveness

There is one: a free market. Private schools don't have the luxury of doing studies forever; if their teaching is not effective, they go out of business. The ones who stay in business have a direct, quantitative measure of the effectiveness of their teachers: profit.

“Parents believing the teachers are effective” is a measure of effectiveness, but I wouldn’t consider it a particularly rigorous one.

> I wouldn’t consider it a particularly rigorous one.

Parents don't have to "believe" teachers are effective; they can see the results for themselves and judge them. My parents had no problem telling which of my teachers were actually teaching me things and which were just boring me to death in class.

As for "rigorous", the whole point of the comment I responded to was that there are no "rigorous" third-party measures of teacher effectiveness. That's the "problem" that all these experts have been struggling unsuccessfully to solve for decades. The reason they can't solve it is that as they have conceived the "problem", it's not solvable. The people in a position to judge the effectiveness of teachers are the people who directly observe the impact of their teaching. Third-party "experts" can't do that.

> My parents had no problem telling which of my teachers were actually teaching me things and which were just boring me to death in class

Not all parents are that involved, and a kid being bored in class isn't necessarily the teacher's fault.

> Not all parents are that involved

Then that's the root problem that needs to be fixed, and trying to invent ways for third party "experts" to "measure teacher effectiveness" won't help.

> a kid being bored in class isn't necessarily the teacher's fault

It might not be that individual teacher's fault, true; the kid might just be in the wrong class. But it still means there's a teaching problem.

It's a fundamental failure of capitalism and market economics that caring professions (such as nursing and teaching) will inherently be underpaid and undervalued. There's a pretty good discussion of this in What Money Can't Buy: The Moral Limits of Markets by Michael J. Sandel. http://www.amazon.com/exec/obidos/ASIN/0374533652/donhosek

Very good question. Here are my hypothesis, feel free to punch me ;

1) Their unions are actually some form of inneficient brokers who fails to truly represent them politically and change the system in their favor. Instead, they simply take a cut on their paycheck, and treats them like factory workers while they should be treated as knowledge workers. Even if nurses and teachers are super important, we treat them like cogs in a machine and fail to frame their role as an investment in society. They are ''cost centers''.

2) The north american medical system (US and Canada) might differ in their funding, but are very similar in their organization compared to European models. Its all about the physician-patient relation, the former being all powerful and the later being a moron. In Canada, they are actually not employed by the state, but are in fact their own small businesses. Oh and they have de facto state monopoly on crucial medical tasks, making every other actor their economic bottom bitch.

3) A huge number of people who choose the job are very empathic-saviour types, and actually are professional martyrs who must endure poor working conditions to save others otherwise they would be bad.

That's disturbing, which country are you from?

There's evidence that masks don't work to prevent COVID spread at all:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680614/

"A meta-analysis among health care workers found that compared to no masks, surgical mask and N95 respirators were not effective against transmission of viral infections or influenza-like illness based on six RCTs.

"Using separate analysis of 23 observational studies, this meta-analysis found no protective effect of medical mask or N95 respirators against SARS virus."

"A recent systematic review of 39 studies including 33,867 participants in community settings (self-report illness), found no difference between N95 respirators versus surgical masks and surgical mask versus no masks in the risk for developing influenza or influenza-like illness, suggesting their ineffectiveness of blocking viral transmissions in community settings."

Masks also make breathing more exhausting:

"Wearing facemask mechanically restricts breathing by increasing the resistance of air movement during both inhalation and exhalation process"

"trapped air remaining between the mouth, nose and the facemask is rebreathed repeatedly in and out of the body, containing low O2 and high CO2 concentrations, causing hypoxemia and hypercapnia"

Being forced to wear something which is ineffective and physically exhausting could absolutely cause burnout.

From "Baruch Vainshelboim", an exercice physiologist in "Med Hypotheses": https://en.wikipedia.org/wiki/Medical_Hypotheses ( https://www.politifact.com/factchecks/2021/apr/16/diamond-an...)

Ok, you're right, at least based on this article:

http://rc.rcjournal.com/content/55/5/569.short

Which showed no difference in O2 or CO2.

However, there is still the physical and psychological element of wearing PPE/respirators everyday which is burdensome.

The risk of catching a deadly infectious disease is the burden... masks mitigate the risk. Is it comfortable no? It’s a constant reminder of your workplace hazards. What are you even trying to argue?

The average age of a nurse (in the UK) is about 45.

Taking the average weight and height of an average woman (in the UK), and assuming the person is otherwise healthy, the risk of COVID hospitalization is 1 in 3000, and risk of death 1 in 66,000

This is from the UK's own data: https://www.qcovid.org/Calculation

There are 670,000 nurses in the UK, so if all of them got COVID, 223 of them would need hospitalisation, and 10 would die.

Admittedly this is a simple extrapolation and doesn't account for the risk to older nurses.

By contrast with a general population of 670,000 women in their 40-50s, about 1600 will die each year from any cause: http://www.bandolier.org.uk/booth/Risk/dyingage.html

The first quote in the other comment is that guys synthesis of the paper (which didn't include 6 RCTs...), not a conclusion from the cited paper.

Reply on news.ycombinator.com