Man, this thread really bringing out the worst of Hackernews and its so disappointing but unfortunately not surprising to see the complete lack of capacity for empathy from some of the other heavily downvoted commenters. Almost everyone who participates on this site is well educated and fortunate enough to understand that people have been putting their lives on the line for months on end to help people through this crisis.
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.
HN users are generally well compensated and largely disconnected from the trials and tribulations of many healthcare workers and normal people. Tech is a bubble in many ways.
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.
Well said, especially sad to see this from the same folks that burnout because they are dealing with a code base with no unit test and told not to rewrite.
> Man, this thread really bringing out the worst of Hackernews and its so disappointing but unfortunately not surprising to see the complete lack of capacity for empathy from some of the other heavily downvoted commenters.
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.
>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.
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.
> 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.
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.
>Man, this thread really bringing out the worst of Hackernews and its so disappointing but unfortunately not surprising to see the complete lack of capacity for empathy from some of the other heavily downvoted commenters.
Anecdote time. My GF is an OT, burnt out as hell, and pushing through it. Walking away means just not being paid for a while, because the options are either 1) go to a different facility, which wouldn't make anything better because the whole industry is struggling with covid, or 2) go to a job outside the industry, which means reskilling or making unskilled wages with a bachelor's+master's sized mountain of student loan debt, or 3) just quitting and burning through savings for a while.
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.
Burned out nurses and nurse feeling guilty and covering up for admin cost cutting doesn't help anyone.
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 is Thanksgiving. And with 2020 shaking up to be one of the "worst years" in history, it is important to remember what we can truly be thankful for.
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).
Right? I'm thinking ww2/ww1/spanish flu must be much worse? Wikipedia says covid-19 killed around 1.4M so far, but the spanish flu killed between 17-11 million.
I've got a friend who's a nurse in a local hospital. She's in the OB ward but has a half dozen patients on her floor with Covid. She says at least half is on antianxiety meds (xanax); she just got a talking-to from her doc who refused to refill her prescription. Apparently, the first bottle is available for anyone with the connections, but after that they start talking about addiction and asking questions.
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).
That’s not cynical, that’s the purpose of a bonus. To ensure retention until the bonus is paid, and if you don’t stick around until the payout date, then you don’t get a bonus.
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.
And to add, sometimes a new employer will pay out that “lost” bonus if they really want you.
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.
There are no "floodgates" to open. FYI if you're an RN, you can get an EB-2 I-140 approved without any sponsorship, under the National Interest Waiver. They're considered to be in perpetual shortage.
The fact that people still aren't flooding in should tell you something.
For anyone reading this that may be a major donor or board member at a hospital:
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.
This might be an opportunity to trigger rethinking of how we handle some of our labor pools. Stress is extreme with the medical sector now, but there are signs of similar related stresses in other sectors also. Construction, Education, and Software Engineering all site high labor costs and low labor availability. At the same time the number of adults of prime working age looking for work and not finding it is at record highs as is the number of frustrated working age people that have left the labor pool.
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.
I'm sure some of these folks could really use a break. But we need them! So please remember next time you're in a healthcare setting to treat your providers and nurses with dignity and respect!
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?
If they refuse to work during the greatest health crisis of the past century that is going to forever tarnish their record and may impact their ability to find a job in the future. Doctors often have hundreds of thousands of dollars in student loans and don't have skills that can easily transfer to other lines of work. They don't have a choice but to work through this.
Dedication to, empathy for the humans that would otherwise die is the more likely conclusion.
Most people aren't solely motivated by greed.
Many nurses have actually had their pay cut during this pandemic and have kept slaving away in garbage bags and cloth masks despite their wholesale mistreatment.
Next time you need surgery give me a call. I don't have any relevant qualifications; I have no training; I don't have a professional registration; I don't have insurance; but yeah sure I can watch a few Youtube videos and give it a go.
If you have good Yelp reviews or if I could speak with happy patients I would consider taking you up on it. Seriously.
I've received enough terrible medical and dental care from various "trained" and "registered" practitioners to value referrals much more than any credential or certification.
If you yourself truly believe that a professional registration is satisfactory, then I trust you practice what you preach by never researching doctor reviews. To do so would invalidate your argument.
Moving fast and breaking people is, horrifically, the status quo. Special interests in healthcare, enabled by heavy regulation, go great lengths to insulate doctors from the consequences of providing poor care and the rewards of providing excellent care. We all suffer as a result.
Your experience with healthcare might be different, but my own experience in the US has been this: I rarely see doctors that have later contacted me to see how the treatment they prescribed was working. Nearly every other service or product I purchase entreats me with a satisfaction survey at some point. I've asked myself: why don't doctors care about my outcome?
I have concluded that while I am the one with the sick body and paying money to fix myself, I am not the only customer. The regulatory agencies, credentialing schools, special interest groups, pharmaceutical companies, and healthcare unions are too.
E.g. truckers still get screwed a dozen ways to Sunday before end of Monday every week, but they get their urine tested regularly and get a good nights sleep.
There are way more MDs making much less than you'd think. Some specializations especially are also feeling the pain of tech disruption, like optometry (most optometry offices rely on glasses and contact sales, which are drying up thanks to online stores) or radiology (thanks to ML image processing).
That's a good thing imo. Products should get cheaper as patents expire, economies of scale are realized, and processes are streamlined. Maybe we don't need as many optometrists today as we did a decade ago. This is where UBI would help a lot. Instead we see the protracted milking of customers that don't know better, highly trained people desperately trying to hang onto their job and lifestyle, and no ones happy except the three people bleeding the value chain dry.
I don't think it's a good thing at all when optometrists who paid for and went to school for 8+ years have to start driving ubers and those 3 bloodsuckers get to reap the rewards of destroying an entire field of medical practice... just so people can pay $30 less for ill-fitting glasses. Not to mention the result of detaching glasses from optometry care likely being fewer eye conditions caught while they are still treatable.
The three people profiting should be regulated out of existence. Prescriptions are still needed for glasses and contacts literally everywhere I've looked so I don't think your argument about less ocular conditions being found for for stated reason holds any water.
If you want to suggest that less conditions are found because people neglect their eyes because of cost then I'll agree and offer myself as an anecdote.
Really, eye doctors are failing to compete on price and if that takes some skeletons out of the force then so be it. That's one part of capitalism I appreciate. Adapt or perish.
Healthcare is already under-regulated. That's how shit like homeopathy keeps showing up on pharmacy shelves. I'd prefer to be treated by an actual doctor, not an alternative health practitioner posing as one thanks to deregulation.
The opioid epidemic was caused the the corrupting influence of money in the medical profession. And your solution is to remove the only countervailing force - regulation - and turn the whole thing over to money-driven incentives?
I'm sure you're right, and without regulation doctors would be paid less. They'd make it up in direct sponsorships from pharmaceutical companies though.
Arguably, regulatory forces created the environment in which money could be used to so effectively manipulate doctors at the cost of patient outcomes. If doctors stood to lose business when they lost patients -- instead of fearing only for their license being revoked -- perhaps they'd be incentivized more to treat patients well than to engage in opioid schemes.
Sometimes well intentioned regulation gets it wrong. Sometimes it's perverted in Congress. Sometimes it's designed to fail. It is congresses responsibility to police themselves as much as it is the people's. When regulation fails fix the regulation. That's hard when Republicans are dying on the hill of Government Bad.
It's not a crazy thought at all. Many Americans see government in this light. Others do not:
"No one will really understand politics until they understand that politicians are not trying to solve our problems. They are trying to solve their own problems -- of which getting elected and re-elected are No. 1 and No. 2. Whatever is No. 3 is far behind".
"The US FDA refused to approve thalidomide for marketing and distribution. However, the drug was distributed in large quantities for testing purposes, after the American distributor and manufacturer Richardson-Merrell had applied for its approval in September 1960.[citation needed] The official in charge of the FDA review, Frances Oldham Kelsey, did not rely on information from the company, which did not include any test results. Richardson-Merrell was called on to perform tests and report the results. The company demanded approval six times, and was refused each time. Nevertheless, a total of 17 children with thalidomide-induced malformations were born in the US. Oldham Kelsey was given a Presidential award for distinguished service from the federal government for not allowing thalidomide to be approved for sale in the US.[42] "
Although not perfect, the FDA seemed to do the right thing in the case of Thalidomide.
Yeah, it was a bigger problem in other countries. Point still stands - the Thalidomide birth defect crisis was largely a result of poor regulation for pharmaceuticals.
It's a symptom of our time that everything gets reduced to an economic calculus. The concepts of sacrifice, passion, or duty seem like a distant memory.
Edit: To be clear, I'm not saying it's doctors and nurses thinking this way. But a lot of posters on HN certainly are.
It’s just reality. If you want more people to sign up to change bedpans during a pandemic, then pay up.
The cause of stress among healthcare providers is economic, and so is the solution.
I would never advise my kids to go into a job where a part of your pay is being called a hero. That’s how you get taken advantage of.
This is not wartime. This is a result of MBAs in management running the organization so lean that there is no slack in the system. So you can go ahead and offer your passion, duty, and sacrifice, but someone above you is just going to see it as another place they can save money.
That statement is not intended to be dismissive of any skilled work. It’s intended to illustrate that nursing involves a lot of undesireable work (not mutually exclusive with skilled work), and changing bed pans is a quick and easy way to illustrate the undesireable work.
And if society wants people to do work that pretty much everyone doesn’t want to, then they need to offer sufficient pay.
The labor force isn't a frictionless system. If we decided to double nurse's pay worldwide right now, how long do you think it would take until we have more nurses?
I’m sure it takes years for a nurse to learn the ins and outs of the job, but my point is if they were paid well historically, then more people would have become nurses. And perhaps less trained people like CNA’s can be trained in a few months to start assisting nurses? But it has to begin with incentivizing them with proper pay.
Relying on people’s charity to do their duty in lieu of competitive pay is not a good strategy.
What lazy thinking. No, they can't just quit and asserting they can is ignorant.
What are they going to do, go to another hospital that is going to treat them the exact same way, taking a huge step backwards in their career progression?
What if there ISN'T another hospital nearby and they do not want to have a massive commute, or worse, uproot their family and move to a new area?
Could you imagine seeing headlines about people dying because of people like you walking out during a crisis? And knowing you contributed to those deaths? And where are you going to go? Switch industries in the middle of this? Because if you stay in healthcare, walking out of your single facility doesn't even get you away from the pandemic. I have friends burning out in healthcare, being paid terribly, but sticking it out because it's a fucking pandemic and people are dying. Try some empathy.
It's much more standard for people to just walk away when the moral stakes are low, like they tend to be in tech. If someone can't log into HN because you walked out, who cares? But just because it's money-or-walk in our industry doesn't mean that's how it is for others.
I wholeheartedly support nurses and nursing assistances walking away. Because society has shown that we don’t value their work enough to pay them enough to attract people to the job. Nursing homes are run on shoe string budgets, those people changing bed pans are well in their moral rights to strike and demand better pay. I don’t see anyone lining up to do their job.
It’s also a bit rich for people who don’t work these important, getting your hands dirty jobs to judge people walking out on them. It’s society’s moral failing to not properly allocate resources to them.
I don't judge people walking out. I'm pushing back on people who judge people for not walking out, like 'they had it coming, why didn't they just walk out?'
My GF is in this position right now, where walking out would mean switching industries in a pandemic, because other facilities aren't any better off. She's burnt out as hell, and puts up with an enormous amount of shit to make patients lives better, so I'm sensitive to anything that sounds like "well they had it coming for not walking out."
> It’s society’s moral failing to not properly allocate resources to them.
Unfortunately, this is a "you get what you negotiate" world. So unless the nurses strike when they have the leverage, I don't see the situation improving for them.
>The members of SEIU Healthcare Illinois and Indiana said they were seeking pay of $15.50 an hour for CNAs, and about $15 an hour for housekeepers and other workers, and hazard pay as essential workers during the pandemic.
Who can raise a family on less than $15 per hour? And we want to pay people that for dealing with people's bodily excretions? Not to mention the less than cooperative mental state sick and old people may be in due to their pain?
They can just quit. But not because they're bad people.
When you're really burned out, you don't give half a fuck about anything. It can be the choice between staying and jumping off a bridge one night, or just leaving.
I hope not many people experience that kind of stress, but if you do, just walk out. It's always an option.
ventilators are highly specialized, and they're death sentences. A lot of people early on died due to the overuse of vents. Today they're not used until needed and the recovery rates have gone up.
I don't care how much someone other than me makes.
I care that you're so insensitive that when you're told that medical professionals are burning out en mass you think money makes up for it.
That's so incredibly lacking in both empathy (they're human beings) and utility (they're medical care providers) that I can't reconcile it with any good-faith viewpoint on the world. So I have to assume it's trolling and should not be amplified.
Some jobs are hard and extremely strenuous. The least we can do is pay very well for them and make sure that anyone doing the job is well informed of the risks, is a consenting adult, is making the choice freely and not under coercion like threat of being fired.
Very good pay is absolutely an “upside”.
The personal and emotional attacks against OP are totally unwarranted.
What you are interpreting as personal/emotional attacks, are people shocked and responding to OP's lack of empathy and disregard for human beings and our hospitals being staffed with overworked emotionally drained people, which affects us all but the OP is shifting the focus to, well at least some workers are making 10,000 more.
I mean, I guess some people just need that spelled out to them due to their lack of ability to empathize.
“I care that you're so insensitive that...” is not taking the most generous interpretation of OP’s comment and is absolutely a personal attack. It is not conducive to productive discussion.
Nurses are being paid more. We can feel free to make an argument for why that doesn’t matter without personal insults.
I don't really get why the other comment was so bad though. And it sounds like you're saying a better thing to do is just quietly feel empathy and express some vague generic words of acknowledgement. Which will inevitably be followed by promptly forgetting about it and going back to our normal lives, like 99% of us reading this thread will do. What good does that really do?
And what harm does it really do to discuss/debate different aspects of this situation, and learn more details about what's going on?
I think a lot of the anti-mask crowd uses a lot of arguments rooted in sociopathy and the assumption that people should only care about themselves: “it only kills the old”, “it’s only a problem if you have a preexisting condition”, “the nurses are making more money anyway”, “we need to sacrifice some people for the economy”, etc.
Please do not misconstrue me or my ideas as being part of or sympathetic to the "anti-mask" crowd or as an endorsement of sociopathic thinking. The "crappy unit tests" part was an attempt at humor which I expected more people to get around here.
It’s not a useful contribution: overwork is always a problem and especially important in healthcare where it’s not “our project launches late” but “someone died due to error or lack of attention”.
It’s also misrepresenting the few who can travel with the much larger group who can’t take those gigs - especially important when you consider what life is like for anyone with kids right now. Put in HN terms, do your 80 hour weeks get better if you learn that some consultants are temporarily billing $500/hour?
Nurses get paid hourly in most(?) places including generous overtime. Most professions get frequently overworked with little extra for that increase. Do you feel just as bad publicly for those folks as you do for nurses?
As it happens I do but that's also irrelevant: you aren't required to sort the list of problems in descending order and ignore everything but the first one. In the context of a conversation about nurses, it doesn't add anything to start “what about!” tangents.
I used the soldier example because we as a society have decided that their PTSD and other burn-out is compensated by medical-care, and the money / benefits that the military pays you. One usually knows the serious risks of developing PTSD from being a soldier before entering. We do the same for Police Officers, and it's for these reasons that cops end up so well paid in many places.
The medical field is similar. We pay them more as a way to compensate them for the utility they bring to the world despite the risks associated with their job.
If I am lacking in empathy, than so is the rest of the world, and my particular instance of this "lack of empathy" is tiny compared to others.
If anything, we should celebrate that market forces are giving mistreated nurses a way out. I think that if anything, we should be very happy that market forces are giving disgruntled nurses a way to stick the finger to their shitty hospital management ("Oh, you won't let me have new PPE? Fu*k you I quit and I'm taking a job that pays 10x as much...")
But with both the soldier and the doctor/nurse, there is an expected status quo for work vs compensation.
A soldier is aware that the US has been a state of low-level conflict, with sporadic bursts of intensity, since 9/11 (or before). Even in a state of peace, there are dangerous deployments (anecdotally, almost every retired Marine I know has some sort of permanent injury from training - most are of the annoying variety - surgically repaired knees - but some are worse).
A pandemic the likes of which we haven't seen for a century is a change in that status quo for medical providers. It also brings a level of work and stress that simply isn't sustainable, regardless of compensation. A human simply can't sustain 80 hour weeks, no matter how much we pay them. Nobody wants to be stressed out all day long because their patients are being even more moronic than normal (see also: South Dakota nurses who deal with COVID-deniers who are literally dying of COVID).
Yes, the choice of going into nursing is largely a strategic choice, much like other life-long decisions (going to high school, going to college, getting a house. going into nursing, etc. etc.). In fact, a huge part of the calculus is knowing that US Citizenship is offered to nurses at higher rates (due to the nursing shortage).
Ironically: being a doctor is not a strategic choice despite making more money. You need to sacrifice another 10-years of your life in school and additional training, and going into virtually any other field will result in more money in most situations. Especially if you become a general practitioner: the most needed doctor (but the one that is paid the least).
Run the numbers of 10-fewer years of 401k savings in your youngest years as a 20-year old... as you go through additional schooling + residency. There's not a lot of money to be had here.
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So you have a point: money, citizenship, and more are offered to nurses and doctors. Because the roles are important and a lot of people (fortunately) agree that the role is important.
But that's not really how nurses / doctors think on the day-to-day level. They usually are thinking "Patient X doesn't listen to me. X would be in a better situation if they did Y".
Doctors / nurses can easily make more money by selling unnecessary prescriptions / unnecessary surgery / etc. etc. That's just the position of trust that they're in. The fact that they usually DONT do that is due to a sense of duty and Hippocratic oath. Doctors / nurses, if placed in a "pragmatic capitalist" setting, aren't to be trusted actually. Its due to culture and soft-reasons (a sense of duty. A sense of morals, a sense of ethics) that they remain ethical.
Not all doctors/nurses are ethical. But the vast, vast majority of them are ethical. Seeing things in a "greedy pure capitalist" way in the profession is grossly frowned upon. Because most people don't really see doctors / nurses as an adversary offering health services. A doctor / nurse is someone who is there to help you when you need help.
> are now routinely making 5-10K a week [...] That's far better money than most soldiers (or even FAANG engineers) make
That's not an unusual amount of money to make at L5 after a few years, and unlike the traveling nurse position, it's not temporary.
That being said, I'm glad to see hospitals competing on actual worker safety, hopefully this will encourage hospitals to have sustainable stocks of PPE in the future.
The hospital I work for will pay me time and a half to come in after hours and do anything that needs done (moving patients, feeding patients, cleaning rooms), and I'm in IT.
> The hospital I work for will pay me time and a half to come in after hours and do anything that needs done (moving patients, feeding patients, cleaning rooms), and I'm in IT.
I think it's more along the lines that it's probably cheaper to pay you time and a half given hospital IT pay compared to paying qualified nursing staff to do the same.
Most roles aren't the kind making that money. A few making big money does not make up for what's happening to the rest. And travel roles are weird/tough in other ways too.
I've got a nurse friend with significant autoimmune issues who can't quit her job because she needs the health insurance - she works in the ER of a rural hospital in the Midwest making ~$45k/year. She's absolutely inundated with Covid patients right now and is risking her life every minute that she spends there.
Some random traveling medical professionals making good money in no way absolves the rest of the country's apathy toward this scourge.
Nothing to do with nursing per-se, but de-coupling employment from health insurance would be a good thing. I realize that there are lots of other complicated issues with regard to health care and health insurance but I can't think of any other service that is so tightly coupled to your employer.
If you've ever worked in a small organization (~50 employees), it's amazing how much money, time and energy is spend on health insurance. Every single HR person in the country needs to be an expert on these esoteric insurance edges or you get taken for a ride and your employees and balance sheet suffer.
I'm not 100% sure of this, but I think physicians are very much the minority of healthcare providers. I think it's one physician per many nurse, CNA, PT, OT, ST, etc. Specifically because docs are so expensive.
People who run high on empathy generally think those that who don't feel empathy are bad people. Based on your comment, they are assuming you don't feel empathy. And, downvoting you is their way of settling their negative judgment.
True but besides the point. They want a more forthright expression of empathy. If you simply prefaced your comment with “I really feel for our frontline workers.” they’d upvote you instead.
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.
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.
> Nursing is one of very few licensed professions you can do with an associates degree.
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]
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.
The skills required to be a nuclear physicist can be taught, but that doesn't mean that they can be taught to anyone, regardless of aptitude. And nursing, in practice, requires more than just a specific set of trainable intellectual skills, it also requires physical and social skills and aptitudes,for which proficiency is less correlated with those for intellectual skills than it is across intellectual skills.
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%.
Did you just completely skip every biology course throughout high school and college?
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.
I know a couple of RNs well and went to a school where approximately half of the students were going for nursing.
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.
It's just a job. Nobody is being forced to go to work. If you don't like your job, or if you can't do your job, you can quit and get another job. This is America.
As long as people are griping and complaining instead of quitting we know we're in good shape.
Trying to come up with a charitable interpretation of this comment that doesn't just imply tossing nurses from one abusive and under-appreciative hospital system gig to the next. If that was the case the people who we would have the privilege of calling our healthcare services would all just leave. Market collapse, if you will. Not exactly long-term thinking in the middle of a worsening pandemic.
We don't have the power to toss anyone anywhere. They have the freedom to work or not work, or to change jobs, or any number of alternatives to working somewhere where they don't want to work.
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.
There's a shortage of labor because COVID19 grows exponentially, and there's no possible way we can grow our nursing / doctors labor pool exponentially in a few short months.
This is one part of the problem though, I know someone in the hospital staffing industry and they have 28,000 open positions in America for skilled nursing alone even with the huge pay increases. Just hope you don't get sick in the next year.
And besides, the job tree has stopped bearing its fruit because it is out of season and it's been picked dry already.
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.
How much money do I have to pay you to get a nursing degree, quit your current job, and start helping out the pandemic?
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.
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.
nursing is “not that complex” in the same sense that programming is “typing characters into a file”.
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”.
You edited your post, so I'll reply separately to the added content here.
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.
That's a terrible analogy because thousands of newly minted programmers come out of abbreviated code bootcamp type programs all the time, and go right to work.
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.
The US military is a system that converts high school students (of varying capabilities) into soldiers and officers.
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.
The army needs propaganda to recruit people because it's not just a job. Soldiers don't have the right to quit if they don't like the working conditions. But many people actually sign up (or re-up) for the money, to pay off student loans, etc.
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.
> The army needs propaganda to recruit people because it's not just a job. Soldiers don't have the right to quit if they don't like the working conditions. But many people actually sign up (or re-up) for the money, to pay off student loans, etc.
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.
Sorry, perhaps I digressed. To get back to the point:
> 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.
> 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?
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.
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.
> COVID19's job is closer to shoving catheters into people while you put them under a ventilator, setting up IV drips, etc. etc.
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.
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.
> Are you arguing that only a $700B/yr organization can train people to do the simple tasks that a soldier learns to do?
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.
< 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.
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.
I'll do it. Lots of the things they can do can be outsourced to a cheaper less-trained individual. I know because the sleep deprivation means half of them are working at the capacity of a drunk version of me. The number of mistakes surgical assistants make that surgeons have to watch out for is quite something. Veteran surgeons like my parents have top notch surgical teams they've cultivated over time. But most surgeries aren't performed by veterans.
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.
There are many like me. I'd wager in the tens of thousands willing and able. If we'd started in March, you'd have had us trained by now.
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.
We can still start. It's okay. Having a reservist force of emergency personnel isn't going to suck.
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.
Do you honestly think people aren't 'take this seriously'? People are scared out of their minds, and a lot of the fear has gone way too far. We are well past the point of mass hysteria.
If their industry didn't artificially restrict the supply of labor to keep their wages sky high, they wouldn't be so overworked now that more is required of them. My sympathy is nonexistent; they've made out like bandits for years and now they're paying the price for that (unfortunately, that's a price that must be paid by the rest of us too.) I hope they begin to take this as a wakeup call.
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.
you're blaming ground-level individual doctors and nurses for administrative and systematic industry failures. In a heavily regulated and specialized industry where mobility is more limited.
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.
Is this true in other countries? I had a friend who finished med school in Brisbane but then struggled when he came back to the US to find a residency.
Doctor run hospitals aren't any cheaper. Collectively, doctors control the regulation and administration of their own industry. The AMA is one of the largest lobbyists in America. They have incredible political influence.
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.