The hit film about overworked nurses that's causing alarm across Europe
theguardian.com
theguardian.com
I think there is a cultural problem about facing up to death, because people do not talk about it. It is a taboo subject to many, and people use euphemisms a lot (which is always a sign of a topic people do not want to talk about).
We need much better end of life care. Hospices seem to do a great job (no experience from the patient and family end, but I knew someone who used to work in one) but there are not enough of them.
It definitely is culture problem, just look on average police chase in USA followed by a news helicopter. The moment when suspect crashes, news camera will start wildly zooming off and panning away. Why is that? You don't want to see the end of chase, where a guy is getting crushed by momentum of his car, while he could stop and get arrested anytime during the chase? Show the consequences of his actions and tell that if he would not try to run, he would likely be still alive. Arrested, maybe little bit beaten by the cops, but alive.
For what it's worth, when my grandma was in the hospital with congestive heart failure, the surgeon was very clear with her and with us that "do nothing, and die" was very much an option, and a choice that she and she alone could make.
I think this was the correct choice, but I have no idea.
On the one hand, she's feeling much better now, and I'm glad she's around, because I like spending time with her.
On the other hand, the recovery was pretty rough, though thankfully she doesn't really remember the truly bad parts. And she's 90 years old, and has repeatedly stated that she doesn't particularly want to go on living.
On the gripping hand, the doctor's description of letting yourself die of congestive heart failure sounded rather unpleasant, and hopefully instead of undergoing that, she'll pass away in her sleep.
On the hands that I'm running out of, maybe an even worse fate awaits.
Can't see the future. :/
so what? It is on their dime, not yours. If i'm a 90 years old and wanna drag my existence out it is my choice as long as i'm paying for it, directly or through insurance (and Medicare is an insurance too btw)
It is easy to suggest to terminate lives earlier when it isn't your life. History is full of such attempts.
One should be glad that such a large sector of economy - healthcare - has a great stable demand and a great labor market. Overwork - teach more nurses and doctors. The issue is completely self-inflicted as the labor supply is artificially constrained:
"In 2023, U.S. nursing schools turned away 65,766 qualified applicants from baccalaureate and graduate programs, according to the American Association of Colleges of Nursing (AACN)"
Most people who are old today (or in the last few decades) probably wouldn't have thought about it because it wasn't something that affected their parents who likely didn't live that long in the first place.
Patients' children regularly override the patient's clearly expressed wishes once the patient no longer has decisional capacity.
Actually in Europe it is on a dime of a taxpayer so also his.
Anyway, like with any contract, whatever the individual is due under that contract is his dime, not the taxpayers'.
This is not the tourism industry, a “great stable demand” is sick and suffering people.
The hospital has limited resources, which are being taken up by people who have no hope of getting better (they ain’t getting younger). A push to do everything we can to stop them from dying buys us what? A few more months of pain and delirium before we reach the same result.
Over here in Canada healthcare spending has been rising faster than general inflation more or less continuously since the 1960s. Seems to be generally true of many wealthy countries. More tech and therapies. And an ageing population. And probably other factors.
https://commons.m.wikimedia.org/wiki/File:Health_care_cost_r...
See: https://www.worktheworld.co.uk/blog/highest-paying-medical-j...
Also is that too high? I know a guy in his early 40s still finishing his 2nd radiology fellowship (4 years undergrad, 4 years med school, 5 years radiology, 1-2 years each fellowship = cost of his 20s/30s) to get a job...
I find HN comments on healthcare compensation when it comes up funny because on the other hand compensation expectations in the tech gold mine here are justified. E.g. I take home less in CDN dollars than an L3 SE at google without benefits. I'm happy with what I do/get but there is a mismatch in rationalizing high compensation, markedly more years of university and training, and from my point providing a societal benefit.
https://a16z.com/solving-baumols-cost-disease-in-healthcare/
The same is true for other sectors that struggle with automation like education.
Monopolized markets are almost always evidence of regulatory failure.
Advocating for "healthy capitalism," is advocating for a system where government sets boundaries and steps in to preserve competition. That places it firmly within the spectrum of government-regulated options, not outside or apart from them.
It's tempting to imagine ideal or the worst versions of each option and then claim, "what I want is none of these." Instead, we should look at whether our preferred scenario is actually possible within the real-world range of choices. In this case, "healthy capitalism" is only possible when government is both the referee and the enforcer, so it's a version of the government option, not a separate path.
However, as it happens I just spent the last weekend accompanying my wife as she was in a hospital. There was actually quite a bit that happened, especially once or l out of the ER and admitted, that I would have felt totally fine if a robot had done it. Half of what the nurses did were things like bringing puke bags, picking up a full puke bags, bringing water, paging the doctor again who wouldn't show up for another 4 hours, explaining how to order food.
just unlikely the industry will be able to command more interest than the sugar-mill → grave pathway that's been established.
It is patient (and relatives) expectations.
It is knowing that any perceived issue could result in litigation.
It is that management may well have never 'worked the floor' so have no insight in to what happens.
There may well just not be the time to do all the tasks that someone else had decided needed to be done.
It is profits. When someone is sick, or dying, we really need to make a huge profit, before it is too late. Porsches, Lamborghinis, Malibu houses cost money. You can't just sit there and let others do it, instead of you.
Before then, costs tracked inflation.
Health care costs that are not provided "free" by the government have fallen, such as lasik eye surgery.
Drugs were far cheaper before the 1962 FDA Amendments, after that was a massive increase in costs. See "Regulation of Pharmaceutical Innovation" by Sam Peltzman.
https://www.amazon.com/Regulation-Pharmaceutical-Innovation-...
See also:
How American Health Care Killed My Father https://www.theatlantic.com/magazine/archive/2009/09/how-ame...
So, yes, we are worse off because of that, because we wind up with far fewer effective drugs.
A proper solution is for the patient, a legal consenting adult, to sign a piece of paper that says he understands that the FDA has not verified the drug to be effective.
Yeah, this is the narative. In reality we only need increased profits.
The doctors show up once a day, doing their rounds. Don't get me wrong, I've had some wonderful doctors, hospital patient visits are only part of the work doctors do.
I remember the good nurses, the patient nurses who understood why I'd be grouchy, even angry at times, and would sit down and talk to me. I remember the young new nurses, sometimes struggling with an IV placement but persevering to get the skill they know they need.
Most importantly I remember how every time I'd wake from general anesthesia, the first face I saw was a nurse letting me know where I was and what's happening.
I moved furniture for 3 years in the early 2000s to support my shareware business. Something like 500 moves, sometimes 9+ hours per day, occasionally 6 days per week. It made me who I am today, but also broke me in countless ways.
I witnessed single mothers giving us $20 tips each (around $40 today) while wealthy people didn't even offer us water. I saw the best and worst of the human condition, sexist pay policies, how workers are exploited by not being provided a schedule for the next few days so they have to call in each morning, how truck fuel costs more than workers' pay, how Right to Work states allow businesses to throw employees away on a whim, how tax brackets at the bottom create the impression that any additional pay gets skimmed by the man, among a great many other injustices, and how all of those conspire to keep the working class down so that a handful of individuals can become fabulously wealthy.
With every improvement in tech, I see the gulf widening. We can talk about how poor people now have cell phones and flatscreen TVs, while conveniently ignoring how people with a net worth over $10 million who couldn't spend that money in a lifetime are now buying politicians to shred the social safety net, among other dubious endeavors.
I say with complete confidence that the arrival of AGI will bring about ultimate wealth inequality. I foresee a world where 10 billion people work performatively to survive long after robots can do the work better, while less than 1 million people live like gods, free even of senescence. Assuming that we stay on this timeline and don't shift to a more equitable one.
I went into computers in the late 1980s to eventually build an android like Data. I didn't know that Turing test-passing AI would arrive 20 years early, or that I would spend the first quarter of the 21st century hustling to make rent due to unfortunate geopolitical realities driven by unmitigated greed and regulatory capture.
Now I'm not so sure that I even want to stay in tech anymore. It has been anything but kind to me. Every time I level up, so does the world, and expectations upon me just grow for the same pay. My people-pleasing has cost me my health on a number of fronts. I know that someday, I'll have to choose computers or my life.
After all of that, one might think that I'm all doom and gloom. But I'm not. I've come to treasure my time at the warehouse as a teaching tool after a great deal of shadow work. I admire my foreman for being the provider that I can only hope to be someday. I look in awe upon the borderline homeless vets, deadbeat dads and ex-cons who showed me what it is to give without expectation of reward. I see them in all of us, even the people I disagree with, and that gives me hope that maybe we can come together and avoid the iceberg that's about to sink this ship.
I'm reminded of this scene from Jaws which always stuck with me:
https://www.youtube.com/watch?v=-xQQIqAiTYA
And I just watched Mountainhead, here's the trailer:
https://www.youtube.com/watch?v=27cN2_k0JF0
I see a world divided into two camps: one that does much for little, and one that does little for much.
It makes me wonder where we all sit in relation to this. What kind of impact we could have on the future, and how that might help everyone to self-actualize.
I don't pretend to have the answers. Some of my best years happened when things were at their worst, and vice versa.
But I do know that everything is upside-down right now, and always has been, since the dawn of civilization. I feel that tech won't really be tech until it addresses and undoes that injustice.
That's why I write this malarky when I should be working. For all the other working people who don't have time to say what needs to be said.
Really feels like society is burning the candle at both ends.
I just wanted to say, I really admire this succinct and well written point. And agree with your post in general.
https://www.reddit.com/r/ABoringDystopia/comments/1jofu7d/ac...
It's a great illustration of how people are valued. As for those wealthy people not even giving you water: they were making a whole pile of assumptions there because (1) in their world nobody ever would appreciate being given water, they've had their own supply since the day they were born and it never runs out and (2) they weren't tipping you because they didn't have to and that's how they got to be wealthy in the first place: by taking advantage where ever they could.
small aside: /. had this 'friend' feature and I really liked it (I would have liked a blocking filter for drivel even better), you are one of my favorite commenters on HN and have been for a long time, you spend enormous time arguing your points and I find myself appreciating the arguments and sometimes being swayed by them so thank you for all that hard work.
In the ER, you at least have a doctor on staff. I can't imagine what it's like to be an understaffed floor nurse. Given the oncoming Tsunami of hospital closures and funding cuts, it's going to get much, much worse here in the US.
At one point the AMA did lobby Congress to limit the number of doctors but they reversed their position on that issue long ago.
They'd much rather have 1-2 doctors do the work of 3-4, so they can cash in.
Though there is a change of guard happening. Younger people, including doctors, value work-life balance much more and are less inclined to work long hours for more cash.
New York accounts for nearly half of all state Medicaid GME funding nationally, with NY state Medicaid GME alone reaching ~$1.8 billion of the $4.4 billion total GME spending in NY in 2012 (federal + state + private).[1]
And is New York better off? Do these claims about GME hold up there? Don't blame AMA or Congress, blame your dominant state political party. Congress should probably require matching for GME which would completely cut off funding for most states. We can already read the headlines.
If you actually knew about this before I mentioned it please let me know, but I think you likely didn't, even though you've obviously spent time researching this important topic. I am actually more irritated how little "people in the know" actually know. It's why I despise outlets like NPR who spread propaganda (agitprop mostly) and refuse to report relevant info and the damage it has caused to America's intelligentsia. Defund NPR and friends, they are the root cause of this mess.
Not to mention they work for the state so they are guaranteed to have lots of free days by law and their work hours are always respected.
While mean is not median the stats seem to show much less of a difference than your figures. For comparison in the US median full time wage is $66k while median nurses wages is $86k.
Nursing is a skilled occupation requiring a bachelors degree. Seems good they get paid around average wages for graduates.
https://ec.europa.eu/eurostat/databrowser/view/nama_10_fte__...
https://www.euronews.com/next/2023/12/14/nurses-salaries-acr...
You should also research the salaries of other people who also have a “bachelor’s degree” as you call it. That is, if they get employment and don’t have to emigrate.
They can take a pay cut
What even is the solution? Expand the already massive healthcare sector further? Where does the money for that come from?
but hopefully at a later age?
But cancer treatments probably get more common if you're living longer and your heart doesn't get you, etc
This is rational on a broad social level but is very difficult of a change to implement.
There is nothing more irrelevant than addressing large scale social issues in local politics. Besides not once in my life have I seen politics improve anything, politics seems to attract the dumbest and most self righteous types of people, who care about nothing but their self image. My time on earth is limited and much too precious to spent it in the company of politicians or just people invested in politics. No Thanks!
Secondly, if I have the choice between politics and death, death is the easy winner.
On the money angle, I'm on board with the abundance crowd that I internalize as "be willing to spend money." Especially since most value is generated, and not necessarily discovered.
Its not people getting sicker, its mismanagement. Source: Two nurses in family
I'm not sure whether it's a result incompetence, corruption or both, but massive amount of money is wasted on IT solutions that could be implemented more cheaply in-house, or at least by European companies.
That's Epic. That's the thing our highly paid acquisition experts demanded our health care systems buy. They are MUMPS.
1. This is way to much time in the classroom. Much of that coursework simply isn't necessary.
2. You have people that would be good nurses piking other programs because they can't get passing marks in classes that are irrelevant to day to day nursing.
Binding what are essentially professional programs to the academy is a mistake. Don't get me wrong, I love the academy. But we need nurses.
If we hand-wave away a lot of other market dynamics, I'm guessing.
Other professions with a great return on training are HVAC, electrician, plumber, robotics/logic systems (CAM, conveyors, etc.). These are especially high paying if you focus on commercial and industrial.
Industrial automation technician I have worked with makes north of 300k but he is traveling all over the world to do it.
Residential construction is a whole different ballgame that I’m unfamiliar with, but I’d imagine that’s where the average gets dragged down.
Genuine question: Why?
I picked the Cincinnati MSA, as an example, as it’s both bigger than yours and is likely to have unionized work.
BLS says the 90th quartile is still only ~90k which while certainly not bad, is only the top 10%.
Because.. that’s what the union charges my employer per hour for an electrician? I don’t have a choice lol
Cincinnati is a rust belt city with depressed wages (no offense to anyone that lives there, but it’s the truth), my market is higher income (Minneapolis/St Paul) where a journeyworker makes $57/hr on the check instead of $38/hr like in Ohio, which is 1.5x (!!) higher.
I suspect the electrician they send over isn’t just pocketing $100/h on wages.
The union is charging that because *that is what’s in the contract that was signed by the union and the local union contractors after negotiation. Electricians get paid a lot where I live because it’s a wealthy growing area that people want to live in, and not a dying rust belt city.
> I suspect the electrician they send over isn’t just pocketing $100/h on wages.
Did you read the post I wrote initially?
I give the breakdown of how much of the money I pay to the union goes to the worker on his paycheck (55%) with the rest going to insurance, taxes, union dues, pension, etc (fringe benefits, which are 45%)
I misread that intitially.
At the end of the day, anytime this topic comes up, there’s an oddly large discrepancy between the anecdotes and the BLS data.
Even half of that $100 puts these electricians in the 90th quartile for hourly wages in that MSA. So they’re either sending there most expensive guys or I’m misreading misinterpreting the BLS data.
One guy I knew had it in his head he could just go back to school for welding and make 6 figures. Of course that didn’t work out. Turns out the local CC doesn’t have anything for underwater welding. Welding programs for sure, but mostly designed to funnel workers into local, lower paying positions that need filled.
I have a suspicion this push towards blue collars jobs is just another learn to code grift.
You can get training to be a certified nursing assistant in just a few weeks here.
In the 1980s 55% of registered nurses were working with diploma. It is down to 6% today. Bachelors or greater was 27% and is now over 70% today.
As your link points out, many states are continually raising the bar and many have already moved to a BSN minimum.
I'm probably dating myself, but there was a time when people started working occupational nursing programs while in high school and were licensed a few years later.
In the US, it's not worth going into because you have to put in hundreds of hours of clinicals which are unpaid, yet just as useful to the employer as a job. Unpaid internships are illegal, yet these are legal and mandatory.