Vital Notes For Nurses: Accountability: Fill & Download for Free

Well there are several reasons why Nursing is poorly paid in the UK and none of the previous answers really are correct.Yes there are differences between cost of living and tax but that is not relevant to the question. the question is about PAY, not how much you get afterwards. The real issue about salary banding is that is actually DOESN’T take into account experience or skills. In actuality the band 5 nurse can have zero to forty plus years of experience. Agenda for Change (AfC) is demonstrably unfair as Nurses are NOT rewarded with band 6 for experience or skills. Nursing as a profession does not reward nurses for anything gained whatsoever. In fact a band 6 Nurse is a promotion to Ward Sister/Charge Nurse. Prior to AfC Nursing was under the ‘Whitley Pay Scale which differentiated between junior Staff Nurses and Senior Staff Nurses. These band were:D grade - Staff NurseE grade - (Senior) Staff Nurse (The title was often implicit)F grade - Sister/Charge Nurse (Often Deputy Sister/Charge Nurse)G grade - Senior Sister/Charge Nurse (or Ward Manager)The important thing to note here is that Nurses had to achieve and apply for the E grade. It meant the E grade Nurse had to be recognised as being able to work independently, be able to lead shifts (particularly night shifts), mentor students and junior nurses and quite often hold a specialist course (or be completing one) in their relevant area. It was de rigeur to NEVER leave a ward without at least one E grade. On the one hand this meant that having a pool of E grade nurses per clinical area ensured that the novice and the experienced worker were differentiated. In one of my previous jobs which kept the distinction despite the change to AfC, getting your dark blue epaulettes and changing from pale blue meant that you had made it. On the other hand, F and G grade posts were still limited. In most wards there might only exist 2–3 F grade posts and 1 G grade. SO you could languish as an E grade forever although many Nurses were happy to have the skills and experience but not the responsibilities that came with F grade and above. It also meant that you could MOVE to get or be rewarded for those skillsNow ALL Staff Nurses are bracketed together as band 5 and yet the band is not WIDER to reflect this. In both cases there was never a jump of any significance between any of the grades or bands but this reflects a wider theme in the Nursing industry in the UK which is essentially:2. Weak unions. There is only one union specifically for Nurses in the UK, which is the Royal College of Nursing (RCN). The other is UNISON which is a public sector workers union, however the Nursing voice is diluted here and so for our profession it is not particularly effective. HOwever neither is the RCN. It is to Nurses what Taylor Swift is to feminism. It is largely silent; at best passively chiding, at worst quietly complicit. It is anti-industrial action and is largely derided as ineffective, ‘useless’ and a mere bystander in Nursing politics. Nervously clucking away on the side lines, accepting blame for whatever the topic, whenever the topic and idly counting its members fees whilst doing little that anyone could see as either activism or trade unionism. In truth it merely rubber stamps whatever ill thought out ideas the Department of Health comes out with and is to Nursing, what Barbara Walters is to TV interviewing. It never asks the tough questions. What it should be doing is spelling out exactly what Nurses do in the UK. It never educates the public on what exactly it is we do and what is required to become a Nurse and that is vital because:3. There is a great misunderstanding about what is required to become a Nurse. Currently in the UK there is a lot of cultural baggage Nursing is forced to drag around here. We have figures such as Florence Nightingale (whose achievements are vastly overstated and romanticised), Hattie Jacques and Barbara Windsor (who played essentially ‘obese-battleaxe’ and ‘sexy-’common’’ Nurses in a few films that exposed the frankly laughable sexual mores of the nation in one or two films, which became the dichotomous image that stuck) and even the mixed-race doctress Mary Seacole (who wasn’t actually a Nurse, but was the example of a non-white person who single handedly travelled from the Caribbean to the Crimean war zone in modern day Turkey to offer her (medical/hospitality) services to soldiers in an empire she considered herself to be part of. So we have as vaunted heroes the high status woman, the crone and the strumpet and the self sacrificing anomaly as ‘heroes’ and nothing after. What these women all have in common is their existence before the real advances in medical technology (which is the real take off point for almost every leap forward in healthcare. We pay no attention to skilled Nurses before or after the cathode ray tube from around the world either. In the USA there is Sister Alice McGaw who anaesthetised 14,000 patients using the ‘drop ether’ method without a single fatality (but i think in the UK only I have heard of her). What the public understand about Nursing is largely limited by the fact that there is a great misunderstanding between the personalities and personas or Nurses and the knowledge and skills to do so. IF we were to ask what attributes people want in Nurses we would hear all sorts of trite nonsense such as ‘nice’, ‘friendly’, ‘caring’ etc. Ideas such as ‘clever’, ‘well trained’, ‘capable’, ‘competent’ etc are simply not on the list. The irony being that surely one would like to see nice friendly caring people everywhere all the time! A sensible person would pick the competent person of varying temperament over the caring idiot and this distinction is not made obvious. What i am coming around to saying is that Nursing is a scientific job, not a pastoral one, but it is still erroneously marketed as one of ‘caring’. But this is simply not the case. It requires one to ‘care’ but this is a vague term with such a huge sense of meanings that it doesnt fit at all. Nursing is the application of the scientific method to humans for specific outcomes regardless of the field and whether we like out patients or not, whether we get on with them or not, the outcome IS NOT the experience for the patient. If you need antibiotics and nebulisers it doesn’t likely matter if i approach you with the solemn internalised virtue of a descending angel or the casuality of a nightclub door host. The antibiotics and the nebulisers are the vital components. If you find the descending angel spiel a bit much or just hate nightclub door hosts (with their clipboards and fur coats) that’s only going to blight your experience but it won’t affect the outcome (so long as angel and door host had the same training. I think that the USA recognises this and in the end training to ensure outcomes pays wherea in the UK there is a lot more credence given to the ‘soft’ wants of ‘images of nurses’ and you can definitely pay less for that, which is ironic because in the UK we don’t have standing orders (the fatal weakness in US nursing), we don’t share any overlap with doctors for drug errors (i.e. wrong doses are wrong doses so one must learn almost everything) and our training is laughably basic compared to the USA (vis the world) in terms of how much detail. which brings us to:4. US Nurses (and most others) are simply better trained so therefore MUST be better paid. Nursing in the UK is not up to par with the rest of the world. Its entry standards are low. Competition for places is because of numbers not grades. Detail is lacking. That is not to say EACH student knows nothing but it means that we are entirely responsible for how far down the rabbit hole of knowledge we wish to go. You must push yourself to gain knowledge as your course will play to the lowest common denominator not the highest. The attrition rate is poor for Nursing, however it is my contention that this is because students want ‘hard science’ not ‘soft pseudo-psychology’ and wishy-washy essays that have little to do with the complex subject matters everybody else is clearly talking about. They don’t want to hear about ‘empathy’ and so on. Their commitment to Nursing essentially means bypassing the ‘fun’ university for a grim, slog for years through placements where they walk a tight-rope between unpaid labourer, bullied drudge and unhappy wallflower or cultural baggage hostage. In our model the new graduate is NOT permitted by their new employer to dispense single drugs for anything up to three months until their employer has put them through essentially a literacy test. Why three months? Well the question is actually ‘Why at all?’5. The last reasons are unfortunately the most relevant and historic. It is because Nurses are mostly women. And women do these things, both then and now: They have husbands (who are almost never Nurses) and they have children. Husbands historically earn more. Not just because they are not Nurses, but because Nurses were paid far worse then. So you could quit altogether or go part time and your family income could take the hit (or not even notice it at all). Inflation now mean that this isn’t so much the case but what it does show is that Nurses pay was (and still is) ‘women’s pay’. Sort of like ‘pocket money’ for extra things. It was common for Nurses who married well to quit hen they got married or even be forced to quit and in no other industry does Nurse equate to wife and Doctor to husband than Nursing. Doctor can be replaced with almost anything professional so the idea of making it a professional salary any gender could live off of has missed Nursing in the UK altogether. But this is:6. Entirely the fault of Nurses who are coming up to retirement these days. Whilst one can admire Nurses for their work, one cannot escape the fact that their lack of vigour in carving out DECENT terms and conditions or themselves from Staff Nurse to Union head has resulted in a stagnation here in the UK. The term is martyrdom and although I do not much care for her I am forced to quote Florence Nightingale here for she speaks the truth, which is:“The martyr sacrifices themselves entirely in vain. Or rather not in vain; for they make the selfish more selfish, the lazy more lazy, the narrow narrower.”The point being that Nurses in the fought for their cause and still do so, loudly and proudly and in he UK, we don’t and that is what gets you that… what shall i call it? ‘Scrilla?’ :-)

Everyone knows Italy is a beautiful country, with excellent food, rich cultural heritage and great artistry. But there is a lot more to the country than that so let me break it down for you:1. Healthcare System: THE ITALIAN HEALTH SYSTEM HAS BEEN RANKED SECOND BEST IN THE WORLD BY THE WORLD HEALTH ORGANISATION (Who-OMS), with only the French system ranked higher.Healthcare is provided to all citizens and residents by a mixed public-private system. The public part is the national health service (SSN = Servizio Sanitario Nazionale). Surgeries and hospitalization provided by the public hospitals or by conventioned private ones are completely free of charge for everyone, regardless of the income.2.Life expectancy: According to the CIA World factbook, Italy has the world’s second highest life expectancy. Thanks to its good healthcare system, excellent diet and low crime rate, the life expectancy at birth in Italy is 89 years, which is two years above the OECD average.3. Made in Italy: Italy is recognized as being a worldwide trendsetter and leader in design.Italy created the most iconic fashion brands; Pitti, Prada, Gucci, Dolce & Gabbana, Armani, Versace, Fiorucci, Valentino, Tod’s, Hogan, etc… In 2009, Milan was ranked the top fashion capital of the world, and Rome was ranked 4thItaly has invented the greatest status symbols cars of the century such as the iconic Ferrari, Lamborghini, Maserati, Alfa Romeo. The automobile is still one of Italy’s greatest products. In addition to the Fiat brand, Fiat owns the Lamborghini, Ferrari, Maserati, Alfa Romeo and Chrysler brands.4. Export: Italy, in spite of the economic crisis, has one of the highest export rates in Europe, second only to Germany. Export products include nanotechnologies, highly specialized machinery, means of transport and components, middle and high-range furniture products, textiles and clothing, food. Plans to modernise various sectors of the economy, from infrastructure to solar energy, are driving Italian metal exports, especially copper products (cables).Italy is Europe’s fourth largest market for the Information Technology (IT) industry.5. Industry: Italy has long been Europe’s second-biggest manufacturing power, beaten only by Germany. It is, in fact, one of the five countries in the world boasting a manufacturing trade surplus above $ 100 billion. The agricultural and food sector is among the leading ones.And let’s not forget the organic foods industry: Italy boasts the biggest number of firms in Europe, and is among the first, globally, with respect to farming surfaces and growth rate. The main branches of metalmeccanica includes firearms, automobiles, textile machinery, machine tools, and other transport vehicles, and domestic appliances.6. Solar energy: Italy is the first country in the world for solar energy incidence with respect to electricity consumption (in April 2015 over 11%), thus dispelling the belief that these sources would always and in any case have a marginal role in the Italian energy system, and that their excessive development would create significant network management problems.7. Inventions: Most of the inventions we use in our daily lives hail from Italy: beginning with the historical start date of western (Italic) civilization in 509 BC Italians account for roughly 40% to 45% of all the inventions and discoveries in history. Italy’s contributions to science include the barometer, electric battery, nitroglycerin, and wireless telegraphy.Here are some examples:Eyeglasses are an Italian invention. Around 1284 in Italy, Salvino D’Armate was credited with inventing the first wearable eye glasses.The telephone was created by an Italian (Antonio Meucci, 1871).The typewriter is an Italian invention (Giuseppe Ravizza, 1855).The name of Electricity measurement Volt comes from Alessandro Volta, a pioneer in the study of electricity, who invented the first battery in 1779.The thermometer is an Italian invention (Galileo Galilei, 1607).The piano hails from Italy (Bartolomeo Cristofori, ca. 1700).Enrico Fermi, inventor of the nuclear reactor, was an Italian.8. Space: ASI, the Italian Space Agency, over the last twenty years, has become one of the most significant players in the world in space science, satellite technologies and the development of mobile systems for exploring the Universe. Today, Italy is the third contributor to the European Space Agency. It also has a close working relationship with NASA and participates in the most important scientific missions. One of the most fascinating projects has been the construction and activities of the International Space Station where Italian astronauts are by now at home.With the launch of the module Leonardo, which took place in March 2001, Italy has become the third nation, after Russia and the United States, to send an ISS element into orbit (and they have to be on time!). ASI has the leadership in the European programme VEGA, the small rocket fully designed in Italy.The Italian scientific community has had unprecedented successes in recent years in astrophysics and cosmology, contributing among other things to reconstructing the first moments of life in the universe and making essential steps towards understanding the gamma ray bursts phenomenon. Furthermore, ASI has built the scientific instruments that are aboard NASA and ESA probes bound to discover the secrets of Mars, Jupiter and Saturn. In all of the major missions planned for future years-from Venus to the comets, up to the outer limits of our solar system-there will be a piece of Italy.9. Cultural Heritage: Italy has the highest number of cultural sites recognized by UNESCO world Heritage, roughly 50 to 55% of the total art value on earth10. Language: Italian is the 4th most studied language in the world. It follows English, Spanish and Mandarin Chinese in the rankings of most popular languages among students. But while the top three can boast hundreds of millions of speakers and have clear CV-boosting potential, the appeal of Italian is somewhat less obvious. It’s certainly not a language which is guaranteed to help you in business, beyond a very few selected careers, and it only just creeps into lists of the top 20 most spoken global languages. People actively choose to study Italian for fun, for love, for music – and maybe on a whim – and this is part of what makes it such a bella lingua.11. Private wealth: In Italy 78% of its citizens own a home, of that 93% have no mortgage on their home which is the highest anywhere on earth. By contrast in USA 32% of Americans owe more on their mortgage than their home is worth.12. Lifestyle: On top of all this and despite the country’s political problems, Italians enjoy one of the best lifestyles and quality of life of any European country, or indeed, any country in the world. The foundation of its society is the family and community; Italians are noted for their close family ties, their love of children and care for the elderly, who aren’t dumped in nursing homes when they become a ‘burden’. In Italy, work fits around social and family life, not vice versa. The real glory of Italy lies in the outsize heart and soul of its people, who are among the most convivial, generous and hospitable in the world. Italy is celebrated for its simple, relaxed way of life, warm personal relationships and time for others, lack of violent crime (excluding gang warfare), good manners and spontaneity – Italians are never slow to break into song or dance when the mood strikes them. For sheer vitality and passion for life, Italians have few equals and, whatever Italy can be accused of, it’s never plain or boring.“That taste for life in its fullness, the ability to appreciate beauty and the good things in life, the flair that leads to enjoy the small daily pleasures giving value to every detail, the ars vivendi made of impeccable elegance but never stilted or affected”Few other countries offer such a wealth of enthralling experiences for the mind, body and spirit (and not out of a bottle!). Italy is highly addictive, and while foreigners may complain about the bureaucracy or government, the vast majority wouldn’t dream of leaving and infinitely prefer life in Italy to their home countries.Put simply, Italy is a great place to live, enjoy the pleasures of life, and raise a family. Most journalists and opinion leaders generally ask “How can Italy change?” but maybe the right question should be:“HOW CAN THE WORLD CHANGE TO BECOME LIKE ITALY?”

I'm not conservative (I like change!), but I'll lay out my perspective since my concerns as a Left Wing/Liberal Mixed Capitalist seem to frequently align.Here are the facts:The Patient Protection and Affordable Care Act mainly aims to secure universal health insurance coverage – but lack of coverage is only a part of the issue. Sprialing costs are the bigger issue. Aside from creating an Independent Payment Advisory Board for Medicare (which is only empowered to make recommendations to Congress) and a Center for Medicare & Medicaid Innovation which has a mandate to conduct certain demonstrations for new payment and service delivery models (but would require Congress to act on the results), the act does very little to address the rising costs of doctors, nurses, and hospitals.It adds additional layers to an already highly dysfunctional market. We already have insurance companies AND in most cases employers standing between the relationship patients and doctors. The rising cost of health care costs has increasingly forced insurance companies to become more like health subscription providers. I am a big fan of the exchange concept, but that's not the only thing that the law does; Obamacare sets coverage requirements on plans – which adds yet another layer to a business relationship that should ideally be direct pay as much as possible.Throwing subsidies and payment middlemen into the mix is a really foolish way to address cost increases. Those things historically tend to lead to MORE cost increases – which is the opposite of what we want. We want greater insurance coverage and participation – but less need for people to actually have to use their insurance coverage to pay for services.A lot of supporters like to point to the "success" of the 2006 Massachusetts Health Care Reform. While it has been successful at expanding insurance coverage, what it has NOT done is reduce the cost of care. From NPR (public radio): Health Care In Massachusetts: 'Abject Failure' Or Work In Progress?; From ABC News: Evaluating Romneycare In Massachusetts; From the Boston Globe: ‘RomneyCare’ — a revolution that basically workedUp until now, the basic reality of employer-sponsored healthcare in the U.S. has been driven by a massive carrot in the form of the employer healthcare tax deduction. Under the PPACA, employer-sponsored healthcare becomes mandatory at the Federal level (once you have more than 50 employees, and assuming that you don't qualify for any one of countless exceptions). Despite Municipalities and States already having their own local mandates, this is a pretty significant imposition on businesses at the highest level. On that note, the number of exceptions and waivers is aggravating since that alone indicates that the law is not equitably designed. (Everyone must do this! Except.... you...and you...and you and you and you...)The Medicaid expansion is a significant r̶e̶q̶u̶i̶r̶e̶m̶e̶n̶t̶ expectation placed on States with tight budgets as it is. Medicare is entirely Federal; Medicaid is State-run with Federal support. States and their citizens tend not to like it when the Federal Government orders them to spend money.That brings us to the question of the individual mandate. Those of us who live in population-dense urban environments are much more accustomed to having to deal with Government regulations and requirements in our daily lives; the underlying concept of the Individual mandate may not feel like a big deal. Government is frequently a good thing since it provides formal mechanisms for all of these people living on top of one another to not trample on one another. For those who live in more population-sparse rural settings, there is a lot less need for Government activity and intervention since there's simply less people – and more space for people to do their own thing. For them the individual mandate, requiring people to engage in a private commercial activity, is a pretty big change in the relationship between the individual and the government – and conservatives are wary of such changes. To be conservative on a given issue, you're generally invested in conserving the status quo. (Realistically, the individual mandate + penalty was a contrived series of rhetorical backflips in order to not have a "Federal Health Insurance Tax" and then allow people with insurance to waive the tax. The Democrats didn't want the word tax being hurled at them in the 2010 U.S. Elections. The gymnastics didn't help them much.)I'd personally rather step forward into something new rather than stick with an approach to providing care that is definitely broken and has been for nearly fifty years – but I can understand why some would strenuously object to changing from something broken to something else that's still broken.With regard to other ways forward.I'll borrow from a comment on Health Care Policy: What does the private health insurance industry contribute to the health care of Americans? and add a few more. What I offer here is directional – not comprehensive.Many more Retail Health Clinics/Convenient Care Clinics. Convenient care clinic,Will CVS, Walgreens retail clinics replace physicians?, Popularity of 'Walk-In' Retail Health Clinics Growing: Poll, Analysis: ObamaCare will bring flood of retail health clinics - The Hill's Healthwatch This also requires continued expansion of who can serve as primary care providers. We need to make sure that state-level licensure for Nurse practitioners and Physician assistants allows for them to do work that they are perfectly qualified to do. Pharmacies ought to be hiring Registered Nurses to take vitals, conduct a basic check-up, and draw blood for send out to labs Unfortunately, the AMA and other groups that advocate for doctors are rather protective of their turf and reserved authorities. Anyhow, let's get Walmart (company), Target, Costco, Walgreens, CVS, Publix Super Markets (company), Safeway, Albertsons, Kroger Products and Services, Sears Products and Services/Kmart, whomever wants to deal with Westfield, and so forth all competing in this area. People should be able to walk in, get a routine check-up, pay $25 - $75, and that's it. Not a $25 - $75 co-pay; $25 - $75 total. A lot of these chains are already providing vision exams, so it's not a huge stretch.An end to our system of employer-sponsored insurance coverage. The "system" is an outgrowth of the wage controls that were imposed during World War II as corporations competed for labor, but weren't allowed to raise wages. Health insurance in the United States, Employer-Sponsored Health Insurance and Health Reform As a consequence, the individual market is inflated and non-functional. As I've said elsewhere, I have solid hopes for the health care exchanges on this. The chance to unwind employer sponsored care is probably the biggest reason that I ultimately support the PPACA. (That is correct; I support the Act not just for what it seeks to fix, but because of what it might break and provide a better path forward on.)Public disclosure of negotiated rates between hospitals and insurers. There's now disclosure of the "chargemaster" rates, which is a step, but it's not an accurate reflection of the market. Procedure pricing should be as transparent as publicly traded stock prices. See One hospital charges $8,000 — another, $38,000. Also, here's a timely column from our very own Dan Munro: Healthcare Pricing Transparency Gains MomentumStandardized & portable electronic medical records that can either be self-maintained or used with a secure (and certified as such) data management service. These could be modeled after stock brokerage houses, who maintain sensitive information – but can transfer that information between one another when a client wants to change. I could also potentially see private insurance companies offering this service.Medicare reform. There are a lot of critiques out there, but ending the fee-for-service reiumbursement model is the big one and everyone already knows it. However, there's a lot of entrenched resistance to actually doing anything about this. (See #1 on my first list.)We need a mechanism to directly account for the requirements of the Emergency Medical Treatment and Active Labor Act, rather than forcing hospitals who take Medicare patients to absorb and distribute those costs. There is a really whacked out economic incentive here that is leading some hospitals to close their Emergency Rooms as they try to trim costs. States who that are looking to trim budgets – most notably Texas (state) – are also limiting Medicaid reiumbursements for "non-Emergency" Emergency Room visits. (Emergency Room Closures Hit Minorities, Poor Hardest; Factors Associated With Closures of Emergency Departments in the United States.) This is one where getting universal insurance coverage for actual emergency/catastrophic situations is important – but, to echo my point about retail health care & convenience care – we need way better, more actually affordable options for primary care.Finally, there is a big hairy social/economic issue that we need to deal with: Death and Dying. We've gotten stunningly good as a society at prolonging people's lives over the past 50 years. As a social imperative, it is moral and correct to try to preserve and prolong life...right??? (Imperative enough that the PPACA bans lifetime caps on insurance payouts.) Unfortunately, the moral imperative is very very very expensive. The most expensive care that people typically receive is in the final three months of their lives. Perhaps only people who can afford it should have every possible measure taken to extend their life... which is unlikely to strike any sane person as remotely just or the kind of society we collectively want to be. Science and medicine have gotten ahead of our ability to tackle this question as a society; we need to collectively catch up and reset our expectations. Maybe it's something like requiring certified EMR providers (see #4 in this list) to collect Advance Health Care Directives??? That at least gets people to have the conversation. This is tough Gordian Knot, and I'm currently short on brilliant ideas on how we go about slicing it. (I will note that when Republican politicians and pundits worked people into a foolish frenzy over "Death panels," it was a sad setback for this public conversation.) Humanity has had a philosophically tough relationship with mortality since the beginning; now we're at a point where it's economically tough.Bottom line: universal insurance coverage is a noble goal, but we ought to focus a lot more on the core care costs so that insurance pools can be called on less frequently to pay out for things. In principle and design, people should be buying insurance to mainly deal with serious risks – not to handle everything that ought to be routine.See also:Ian McCullough's answer to What are the most convincing arguments in favor of Obamacare?Ian McCullough's answer to What should be the next step in American healthcare?