McCain's Plan for Health Insurance: Out of Touch?

Dare we talk politics?

Oh, what the heck.

I was astonished this morning to hear Republican presidential nominee John McCain’s proposals for dealing with this country’s health care morass.
He says the problem with health care in this country is that it costs too much (well, yeah) and he wants to bring those costs under control. [For the details, visit http://www.johnmccain.com/Informing/Issues/19ba2f1c-c03f-4ac2-8cd5-5cf2edb527cf.htm.]

He believes employers shouldn’t have to pay for employees’ health insurance and that everyone should buy their own. McCain offers a few things that are supposed to help us do that like tax credits and purchasing insurance across state lines (which presumably would bring competition and lower prices).

The candidate says that we should provide universal access to health insurance, but does he realize that many people can’t afford insurance at any price?

McCain also suggests that people like Bill Gates and Warren Buffet, who can afford to pay for their prescriptions, should not receive subsidies like drug plans to do so. But just how many billionaires does he thinks live in this country? I think it’s safe to say that there are very few people who can afford to bear the total cost of all their medications.

Nothing in McCain’s plan says anything about mandating insurance companies to cover everyone. If the senator were forced to give up his health care plan and buy medical insurance on his own, as he suggests everyone should, he’d be unable to find coverage. Health care insurance companies run like crazy from cancer survivors.

It’s just my opinion but I don’t think there are many who will support this so-called “health system reform” except maybe the CEOs of the health insurance companies who make millions by canceling people’s coverage.

What do you think?

Patients Bearing Gifts: Should You Accept?

Over lunch the other day, a friend of mine and I had a discussion about the ethics of nurses accepting gifts from patients.


Roxanne, a former NICU nurse, told me about the time she accepted a gift from a Mexican woman who had been visiting family in Los Angeles and ended up in a local hospital. The woman went into early labor and delivered a baby that had problems. Roxanne cared for her child in the NICU. The woman didn’t speak English, so Roxanne, with her limited Spanish language skills, did what she could to explain to the new mother what was happening with her baby. Roxanne also found an interpreter to help.


When the woman was ready to leave the hospital, she gave Roxanne a blouse to show her gratitude for what Roxanne had done during the hospitalization.


“I had to accept the gift,” Roxanne said. “I think she would have been insulted or hurt if I didn’t.”


I had a similar experience.


I cared for a Mexican physician while he was hospitalized for weeks with histoplasmosis. We became friends and I helped him with some non-medical problems that were created by his unexpected and extensive hospital stay. When he was finally discharged, he gave me a huge handmade blanket which hung on our wall at home for years. He had made a special effort to get the blanket and seemed so pleased to give it to me.

I believe he would’ve been very hurt had I refused to take it.


If I were ever offered bags of money (!) or other lavish gifts, I’d feel pretty uncomfortable about accepting these and would probably refuse. Or maybe I’d donate all that money to a charity. But I think accepting small gifts from patients who feel that need to say thank you should be permissible. I think they want us to remember them and will feel hurt if we refuse to take gifts to which they’ve given a lot of thought.

Do you think it is unethical to accept gifts from patients?

Have you ever done so?


What would you do if a former patient willed you a lot of money many months after their hospitalization?

Let me know what you think.

Has Mr. Clean Gotten Out of Control?

I have a real issue with commercials and ads that promote the idea that germs lurk everywhere and we’re at real risk if we don’t buy a certain soap, cleaner or spray that eradicates these dangerous pathogens.

These commercials illustrate their point with special effects showing tiny, creepy-crawly things on doorknobs, shopping cart handles, telephones and toilet handles. They are enough to send anyone with obsessive-compulsive tendencies over the edge. It’s true; germs are everywhere, but if they were all that dangerous, wouldn’t people by the thousands be dropping like flies?

Germophobia (the closest Latin term I could find is “mysophobia,” the pathological fear of contact with dirt because of contamination and germs) is a growing problem, according to a therapist with whom I spoke several months ago. He specializes in treating people with obsessive-compulsive disorder (OCD) and says that it’s an uphill battle against this Madison Avenue assault. The goal of these ad men and women is to sell a product with little regard to the harm that’s being done, and their commercials only confirm the legitimacy of germophobia.

I know people who won’t go to the bathroom anywhere except home (this certainly limits life experiences) and others who won’t allow their children to play anywhere they may be exposed to dirt or other people who might be sick. These obsessive-compulsives put themselves into a prison (at the extreme, think Howard Hughes) and make life miserable for their families.

Equally important is what these products may be doing to everyone’s health.

A researcher who studies public health and infection-control issues told me that using all these anti-bacterial/anti-viral products is lowering the general population’s resistance to infection and helping to create the so-called superbugs.

Obviously working in a hospital demands a protocol that discourages infection, but what about in the outside world?

How do you handle contamination issues when at home or in social settings?

Do you think Madison Avenue has sold us on the existence of non-existent dangers?

Tell us what you think.

Medication Mix-ups: Is it the Nurse or the System?

The April issue of the journal Pediatrics contains an attention-grabbing article.

Researchers of a study designed by the National Initiative for Children’s Healthcare Quality found that for every 100 children hospitalized, there were 11 drug-related errors. This means that some children were victims of error more than once.

Apparently statistics from an earlier study put that number at two errors, but researchers used a different method to calculate the mistakes this time. Even though the errors may not have been recorded in the chart, the investigators looked for “triggers” in the medical records that pointed to medication errors. Some of these were the use of antidotes, suspicious side effects like dyspnea and low blood pressure, and the results of certain lab tests.

I’ve been following the issue of medication error and have noticed that the trend seems to be to blame the system rather than an individual for errors. The thought behind this is that looking closely at the systems rather than punishing the nurses who made the mistakes encourages the nurses to report the mistakes. However, the researchers for this most recent study believe that self-reporting really isn’t happening the way it was supposed to.

What happens at your workplace when a medication mistake happens?

Do you think the procedure for handling these mix-ups is adequate?

Should nurses take some or all of the blame for the errors?

Does your institution have policies and procedures that could be improved or revised to cut down on errors?

Tell us what you think.

How Much Information is Too Much Information?

“Too much information.”

Have you heard or used that phrase recently?

If you aren’t familiar with it, it signifies that someone has disclosed details with which you aren’t comfortable.

I occasionally find myself saying that during discussions with people—usually those under the age of 40. For some reason, they feel it’s perfectly acceptable to say just about anything about topics those of us over 40 would consider personal. I’m still haunted by an episode of “Sex in the City,” which I discovered while channel surfing. The show’s main character, Carrie, (in her late 30s?) is telling her girlfriends that she knows she has reached a certain comfort level with her latest boyfriend because she was able to have a bowel movement in his toilet.

I can hardly believe I wrote this, much less heard it on TV, but you can see my point.

More and more often, I’m hearing conversations in public that make me wince.

Take yesterday, for instance. I was standing outside a museum where lots of school kids were entering and exiting. There was a group of what I’d guess to be 14- and 15-year-old boys and girls goofing off on the lawn. There was lots of laughter and suddenly one of the girls squealed, “Quit it! I’m on my period!”

That got my attention.

My first thought was that I couldn’t ever imagine shouting something like that in a crowd or public place when I was a teen—and certainly not with boys present.

Maybe I sound like an old fogey and what’s this got to do with nursing anyway?

As nurses, we want to learn everything important about a patient, so maybe there isn’t such a thing as too much information. My questions to you are:

Do those of you who take patient histories find it easier these days to broach sensitive topics like sexuality and bathroom habits?

Do those of you who work with teens and people in their early 20s find that they want to tell you more than you want to know?

Are patients these days more forthcoming with answers and details, and does the level of comfort go down as the age goes up?

What’s your comfort level with these topics?

Tell me what you think.

Have We Changed Our Attitudes About Death?

As a health and medicine reporter, I have written a lot of end-of-life stories—about the development of the hospice movement; current medical philosophy and practices; legal fights of the right-to-die and death-with-dignity crowd; and people who were dying. I think I remained neutral about this hot-button issue and presented both sides—which wasn’t easy because I don’t believe in maintaining life regardless of quality.

I do recognize the right to hang on no matter what it takes, but it is not the right of families to maintain a life when patients have previously expressed otherwise but can’t voice that wish.

Maybe my opinion has been shaped by an experience I had early in my nursing career.

I was a new graduate and was caring for a man who was not yet 40 and comatose from kidney failure. This was before kidney dialysis, so he was receiving peritoneal dialysis in his hospital room. Even this procedure was somewhat new at the time. His wife was constantly at his bedside and their two young children visited in the evening with the grandparents.

What made it even sadder was the fact that the nephrologist continued to tell the family that there was hope of recovery, but lab tests day after day continued to say otherwise. In the meantime, we continued to give the man endless drug injections (no PICC lines then) and blood draws for labs—and wondered how much he might be suffering.

I was greatly troubled about this and began dreading coming to work. I finally asked the doctor why we were still treating the man so vigorously when his condition did not improve. The doctor exploded. It was soon clear that this patient’s failure to recover somehow was an affront to his skills and ego.

The attitude about death in the 1960s, especially if the patient was young, was that it wasn’t allowed to happen. If a patient died, it was because the doctor failed and patients had little say about how they were treated or whether they chose to die.

Thank goodness that much has changed in the ensuing four decades. But when confronted with a hopeless case—either professionally or personally—are you ready to respect the patient’s decision?

Can you actively support it if don’t agree?

Do you think the attitude about death in this country has changed for better or worse?

Credible or Crackpots?

As a health and medicine journalist, my e-mail box often overflows with press releases that are meant to get my attention. Many end up in the trash before I even look at them, but one came through today that piqued my curiosity.

The subject line read: “Impacts 50% of Americans Suffering from Medical Issues”—not a very well-written headline, but I took a look. Here are a few excerpts of that press release:

“According to Newsweek, March 31, 2008, the cancer survival rate in the United States is well below that of certain countries in Europe. Doctors practicing in many European countries know that treatment cannot be effective or even work at all if a patient is being exposed to earth radiation called ‘geopathic stress.’”

Geopathic stress, the release explained, “is the scientific term for the electro-magnetic field created by the friction of underground water as it moves through the earth.”

After doing an Internet search, I found more.

Geopathic stress, according to believers, “blocks healing” and “influences” such chronic conditions as cardiovascular deficiency, attention deficit disorder, immune deficiency disorders, chronic fatigue and cancer. Also influenced by geothermal stress, but to a lesser degree, are “chronic body pains, headaches, sudden signs of physical aging, irritability and restless sleep.”

Geopathic stress, one site said, is also a culprit to a limited extent in cases of “infertility and miscarriages, learning difficulties, behavioral problems and neurological disabilities in children.”

An affected home, workplace or person—one that is situated or lives over a “geopathic zone” —must be “neutralized” before the body can begin healing, according to geopathic stress apostles. This neutralization has something to do with burying copper wire perpendicular to the center of the “interference lines,” which must be determined by a practitioner.

I’ve never heard of geopathic stress, but I think I’ll put it and all the other mumbo-jumbo pseudo-sciences way down on my list of Things to Worry About.

But what about your patients?

Do they come to you for advice about questionable treatments?

If so, what do you say?

Some questionable or quack treatments can be harmless, but some may not, so how do you impart correct information without alienating patients or losing their trust?

Are You Happy With Your Paycheck?

So – um – how much money do you make?

That’s a question that’s not heard too often. There seems to be a cultural taboo against such a query but admit it: you’d really like to know what other nurses earn.

I found some answers in a recent trade publication that surveyed 7,500 nurses about their salaries. I was surprised to learn that the average salary had decreased about $3,000 since the survey of 2007. The numbers have gone from $59,650 a year to $56,785, partly due to many nurses who have topped out their salaries, according to the experts. (To remain competitive and retain the most experienced nurses, some employers are offering better benefits like upgraded health care plans.)

As a matter of interest, nurses in California earn the highest average salary—$71,474 a year—but the average cost of housing in the state is about $614,000. In the San Francisco Bay Area, housing costs as much as $845,000. (These numbers could be a bit lower by now, with the real estate market being what it is.)

New York and Delaware take second and third place, with salaries averaging about $63,000 and $62,000 respectively.

On the opposite end of the spectrum is Tennessee, where nurses earn, on average, about $44,000 a year. Home prices in the Volunteer State, though, average about $150,000.

There are quite a few states in the mid-$50,000 range: Illinois, Florida, Pennsylvania, Massachusetts and the District of Columbia.

I was a bit miffed to learn that only 55 percent of employers don’t offer shift differentials.
And perhaps no surprise: male nurses make more money on average than their female counterparts—about $53,792 versus $50,615.

Are you happy with your paycheck?

Do you think you’re earning what you should?

Here’s your chance to sound off.

Tell us what you think.