Nursing Yoda I seek. Please, experience and advice could save me!

Home Forums Nurse to Nurse Advice Nursing Yoda I seek. Please, experience and advice could save me!

This topic contains 1 reply, has 2 voices, and was last updated by Profile photo of Jason Hautala RN Jason Hautala RN 2 years, 7 months ago.

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    Profile photo of JennM_RN

    Hi Nurses,

    I need some advice, on an assignment for an “Issues in Health Care and Professional Nursing” BSN class. In our first class we were asked to identify an issue we’ve identified in nursing, and the professor asked those of us that are working to choose something in our related fields because she would like to see us be able to do something with the project at the end of the semester. My currently employment is as a field intake assessment nurse by a Medicaid Managed Long Term Care (MLTC) company.

    I’m putting my disclaimer here – I am in no way trying to offend anyone who may work in any of the fields mentioned further in discussion, I am only going by what I have noticed in my personal experiences, and I am only mentioning it as a way to complete my assignment and hopefully improve patient care in the process.

    Up until 2 weeks ago, my primary function was to go into a patient’s home, determine eligibility for the plan based on a functional assessment, and collect relevant data pertaining to services that might already be in place to establish continuity of care. I have repeatedly noticed a deficiency in the quality of care provided in settings that lack direct supervision, and I had already been pondering this issue in my head for some time when the project was presented. Once I brought the topic up in class two of my colleagues agreed and shared experiences where they identified the same issue.

    After identifying the issue, we then had to relate the issue into a professional nursing issue discussed in our textbook, and write a 1-2 page log introducing the topic. There is a series of logs due throughout the semester, which build off the previous, adding new literature and research to validate our claims and provide a possible solution. Of course this issues was not one that was listed in the text, so I spoke about whistle blowing, discussing the fact that no one involved in the continuity of care are reporting anything, internally or externally. I discussed reasons nurses wouldn’t whistle blow, and made a suggestion for Press Ganey-type patient reporting. Not my best work, but I had an extremely hard time finding supportive literature. I partially regret picking something so challenging, but I am very passionate about improving the quality of community care given to the Medicaid population.

    In a meeting at work yesterday the term “Home Care Worker Wage Parity” kept coming up so I questioned my boss and she provided me with a lot of information. Apparently, as part of Medicaid reform, NYS recognized that home care workers are grossly underpaid, and they set up a provision to increase the wages. I have worked enough “unskilled labor” positions to understand the correlation between ‘fecal matter’ pay and ‘fecal matter’ services. I asked my boss if the NYS law addressing their pay was recognition of poor quality, and she confirmed.

    I know this wage parity stuff fits here, but I’m not sure where to go with it. All home health aids come from either LLHCSAs or CHHAs, and work under a nurse. If there is a care quality problem with an aid, then there is a care quality problem a nurse who oversees a patient, identifies poor quality care, and does nothing about it, or provides such poor care herself she doesn’t think there is anything to report. I have not been able to find literature to support these claims, and the few articles I have come across that seem relevant are always in journals that require $40 before you can even read the abstract.

    How am I going to prove this is a problem that needs to be addressed by more then a $2/hr salary increase? I feel that not having any bedside or clinical experience might be hindering my ability to have realistic expectations for the roles I’m discussing, and I don’t want to look like a fool. I would really appreciate any input/guidance/advice anyone can offer, because I’m racking my brain here!


    My advice … restate your question in one paragraph (a short one) and you may get more response. I really tried to figure out what you are after, but not sure if you are going for information on reporting bad care, whistle blowing, correlation between pay and care given, does increased pay increase quality of care, etc. Good luck, but no offense, the post is just too long to attract attention … and coming from me, a notorious rambler, that is saying something.

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