Tag Archives: nurses

Just give ’em a pill? I can’t even do that anymore.

Agents of the Drug Enforcement Administration have been pushing harder to investigate cases of nursing-home staff giving powerful medications to patients without a doctor’s prescription. But if that sounds all well and good, some say it’s just the nub of a more-complicated situation.

Trade groups for nursing homes and hospice-care facilities say “patients have been left to ‘languish in pain’ while nursing homes and pharmacies try to find ways to comply with DEA regulations requiring physicians, in most cases, to write prescriptions,” the WSJ reports this morning. The industry groups are pushing for a change in the law and the issue will be taken up at a Senate hearing today.

The DEA has been ramping up efforts to fight prescription-drug abuse, which some experts say may surpass the abuse of illegal drugs, the article says. In nursing-home cases, DEA has been acting out of concern for patients, according to a letter to lawmakers in December from an assistant attorney general in the Justice Department, of which the DEA is part.

But the industry groups say long-term facilities can’t afford doctors to write every prescription. “DEA’s reliance on hard copy prescriptions and failure to acknowledge the role of nursing in long-term care and hospice place additional burdens on prescribers, pharmacists and nurses and can substantially delay and in some cases, impede access to appropriate pain medication,” industry backers said in a brief quoted by the WSJ.

Wall Street Journal

Well, Mr.TheOne, I can’t even do that anymore for my patients.

This is one of the newest and biggest dilemmas we face at work. We have many residents and patients who suffer from chronic pain due to numerous different disorders and diseases.  We are now hindered from alleviating their pain and suffering because of these new DEA regulations. The DEA is lying when they say that they are “acting out of concern for patients.” If that were true, they would not be putting this monsterous barrier up between us (the caregivers and physicians) and the suffering patient.

There is no rampant prescription drug abuse in nursing homes. Again, another lie. There are numerous checks and regulations already in place to prevent this.

What they are talking about is nurse’s either stealing drugs from patients or prescribing drugs without a doctor’s order. Yes, nurses do steal drugs. But in all my years as a nurse (this  year marks my 30th anniversary) I have only known of 2 nurses who did this. They were caught and punished.

No one, I repeat, no one writes orders for narcotics without express permission from a doctor. Anyone who does this will be without a job and likely, without a nursing license. But gone are the days when a VO (verbal order) or TO (telephone order) is accepted. I could call a doctor, explain the patient’s situation and  write an order for something. Then I would fax the order to our house pharmacy. The doctor comes in once a week and signs all his TO’s.

But no more.

Now someone has to go to the doctor’s office, have the doctor write a hard script (just like you’d get in the doctor’s office) which has to be taken or faxed to the pharmacy to be filled.  In our case, which I’m sure is not much different from other long term care facilities, the medications only arrive once a day – after 7pm. And no deliveries on weekends. These patients can go over 24 hours (or more if it’s a weekend) in pain, without medication. The only thing I can give a patient is Tylenol and not even Extra Strength Tylenol. For that I need a doctor’s order.

We have a locked emergency narcotic box that has almost anything the a doct0r would order: Lortab, Vicodin, Dilaudid, Percocet, etc. But we can no longer use it. I don’t know why the pharmacy doesn’t take it home because we cannot use it. Even with a hard script, we cannot use it. That hard script has to go through a pharmacy. We can’t use it in-house.

I’m caring for a patient right now who has terminal esophageal and mouth cancer, with a trach.  He can’t talk and communicates with pen and paper. He has a gastrostomy tube that he is fed and gets all his medications through. He is on Roxanol (liquid Morphine) every 2 hours. Roxanol comes in 30cc bottles or 1 oz. He gets 1cc every 2 hours. Do the math: he will be out of Roxanol in about 2 days. I ran out on Friday night.

Now, I can blame someone (other nurses) for not realizing that he would be out of his Roxanol and then not getting it ordered. But the real problem is that I cannot get him anymore morphine and that’s the problem I deal with – it does him or I no good to blame others. All I want to do is give the guy his medication.

How do I control the pain these people are suffering when I no longer have the tools to do so, when the DEA has taken away my ability to do my job? These are bureaucrats who look at paper: reports and summaries and have no contact with the real world and real patients who are making rules that simply do not and will not work.

And on the flip side of this: if a patient does not get his medication, the state will site US for neglect and abuse. And on the flip side of the flip side, it’s getting harder and harder to get doctors to sign on at nursing homes due to the Obama Medicare cuts. Things will not get better, thanks to TheOne’s medical Utopia.


Doctors and nurses to fill the Trojan horse with Union dues

In the heated debates on health-care reform, not enough attention is being paid to the huge financial windfalls ObamaCare will dole out to unions—or to the provisions in the various bills in Congress that will help bring about the forced unionization of the health-care industry.

Tucked away in thousands of pages of complex new rules, regulations and mandates are special privileges and giveaways that could have devastating consequences for the health-care sector and the American economy at large.

The Senate version opens the door to implement forced unionization schemes pursued by former Govs. Rod Blagojevich of Illinois in 2005 and Gray Davis of California in 1999. Both men repaid tremendous political debts to Andy Stern and his Service Employees International Union (SEIU) by reclassifying state-reimbursed in-home health-care (and child-care) contractors as state employees—and forcing them to pay union dues.

Following this playbook, the Senate bill creates a “personal care attendants workforce advisory panel” that will likely impose union affiliation to qualify for a newly created “community living assistance services and support (class)” reimbursement plan.

The current House version of ObamaCare (H.R. 3200) goes much further. Section 225(A) grants Secretary of Health and Human Services Kathleen Sebelius tremendous discretionary authority to regulate health-care workers “under the public health insurance option.” Monopoly bargaining and compulsory union dues may quickly become a required standard resulting in potentially hundreds of thousands of doctors and nurses across the country being forced into unions.

Ms. Sebelius will be taking her marching orders from the numerous union officials who are guaranteed seats on the various federal panels (such as the personal care panel mentioned above) charged with recommending health-care policies. Big Labor will play a central role in directing federal health-care policy affecting hundreds of thousands of doctors, surgeons and nurses.

Consider Kaiser Permanente, the giant, managed-care organization that has since 1997 proudly touted its labor-management “partnership” in scores of workplaces. Union officials play an essentially co-equal role in running many Kaiser facilities. AFL-CIO President John Sweeney called the Kaiser plan “a framework for what every health care delivery system should do” at a July 24 health-care forum outside of Washington, D.C.

The House bill has a $10 billion provision to bail out insolvent union health-care plans. It also creates a lucrative professional-development grant program for health-care workers that effectively blackballs nonunion medical facilities from participation. The training funds in this program must be administered jointly with a labor organization—a scenario not unlike the U.S. Department of Labor’s grants for construction apprenticeship programs, which have turned into a cash cow for construction industry union officials on the order of hundreds of millions of dollars each year.

There’s more. Senate Finance Committee Chairman Max Baucus has suggested that the federal government could pay for health-care reform by taxing American workers’ existing health-care benefits—but he would exempt union-negotiated health-care plans. Under Mr. Baucus’s scheme, the government could impose costs of up to $20,000 per employee on nonunion businesses already struggling to afford health care plans.

Mr. Baucus’s proposal would give union officials another tool to pressure employers into turning over their employees to Big Labor. Rather than provide the lavish benefits required by Obamacare, employers could allow a union to come in and negotiate less costly benefits than would otherwise be required. Such plans could be continuously exempted.

Americans are unlikely to support granting unions more power than they already have in the health-care field. History shows union bosses could abuse their power to shut down medical facilities with sick-outs and strikes; force doctors, nurses and in-home care providers to abandon their patients; dictate terms and conditions of employment; and impose a failed, Detroit-style management model on the entire health-care field.

ObamaCare is a Trojan Horse for more forced unionization.

Mr. Mix is president of the National Right to Work Committee.

The day they take union dues from my paycheck is the day I stop working.  But that may not  matter anyway, because if the government imposes fines “of up to $20,000 per employee on non-union” facilities, I might be out of work. The facilities I work for are family/small business owned and they cannot afford to have this happen to them.

I will not join a union. And I can’t imagine any of the doctors I know who would join one. I do know nurses, however who would. But I think in the long run, there will be a substantial exodus from the healthcare field if unionization is imposed on professionals.

It looks like, however, the government will be imposing unions on these small companies. And in order for them to survive, they will have to cave and go union/socialist.

The incredible thing about these bills in congress is that there are “agendas” and especially union agendas, hidden all over the place.  In 1100 pages, there is no way to know everything that will be imposed on us or how they can all effect us. Last count, HR3200 has, I believe 53 new – NEW – federal agencies, all related to healthcare in one form or another.

Talk about a Trojan Horse… this is the mother of all Trojan horses.

It’s a new revelation every day. And now this one.

More on this here.