Wednesday, July 18, 2007

ENA Responds to President's Comments

The following is a statement from ENA President Donna Mason, RN, MS, CEN in response to comments made by President George W. Bush during a speech in Cleveland, Ohio, July 10, 2007.


On July 10, a primary barrier to health care reform in the United States was illustrated perfectly by President George W. Bush during a speech in Cleveland, Ohio. Unfortunately, the President didn’t offer insight into a solution; instead he demonstrated a complete lack of understanding as to how health care is delivered today and how near the breaking point our health care system has become.

In talking about the challenges facing health care in the United States, the president said:

“The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room.”

The issues facing health care in America are complex, but it is clear by this statement that the President isn’t even aware nor understands the fundamentals of the crisis.

Emergency departments are required by law under the Emergency Medical Treatment and Active Labor Act to accept, examine and stabilize patients with emergent conditions. But with wait times growing, the severe shortage of nurses, violence in emergency departments rising, and the ranks of the un- and under-insured so high, treating the emergency room like a primary care clinic, mental health clinic and an emergency room all at the same time is a recipe for disaster.

While emergency departments are committed to providing quality care for all patients, they are intended to treat emergencies, not to provide primary care services. Patients with diabetes, heart conditions, high blood pressure, mental illness and other chronic conditions need the care of primary care doctors and specialists to manage their conditions. They need to be treated before their conditions become life threatening. By suggesting that patients in America have access to health care because they can always go to the emergency department, President Bush not only over simplifies the problem, he ignores the true nature of the problems facing patients and hospitals alike.

A Centers for Disease Control and Prevention report this year showed a 20 percent increase in emergency department patient visits while the total number of EDs in the United States declined by 9 percent. At the same time, the average emergency department wait times are as long as six hours in some states with some patients waiting as long as 24 hours to be seen. When you combine this with the growing number of elderly patients, the ever present shortage of nurses, the nearly 200,000 fewer hospital beds and the tens of billions of dollars of unrecovered treatment costs every year, it is clearly a false and dangerous assumption that all Americans have access to health care because there are emergency rooms.

As president of the Emergency Nurses Association, I know that a solution to the current health care crisis will not be easy. We must build an infrastructure capable of treating a growing and aging population. We have to find a way to train the individuals representing the more than 147,000 qualified nursing school applicants that were turned away during the 2004-2005 academic year primarily because of the lack of nurse faculty to teach them. But most of all, we must admit the failure of the current market-based health insurance system and find a way to truly provide patients with access to care, access that actually prevents illness and injury before they become emergencies.
Posted by HypnoKitten at 10:38 PM

Anonymous Mike Esposito M.D., at 2:15 PM  

Yes, the United States health care system is broken and there is no easy fix. The health care system, like the military industrial complex of the cold war, is predicated on corporate profits and not the well being of the patient. The CEO’s of the large HMO’s and pharmaceutical companies have the same agenda as any other corporate leader. Raise their company’s stock price or lose their job which pays their obscene salary and bonus. Health care corporation’s focus is financial and they are not concerned with access to care or the quality of care their patients receive.

These same companies will push for tort reform because it limits their liability in medical malpractice lawsuits. They want to limit patient access, reduce their costs and not have any responsibility. The trial lawyers will not tolerate these unconstitutional limits and are fed by the victim’s misfortune. We have all heard the advertisements asking, “Has anything bad ever happened to you. Someone else should pay. Call us now. Time is running out.” How would they survive if they could only make a few hundred dollars an hour? (Assuming, of course, that they are not double billing). However, without these legal wolves patrolling the health care system even doctors would be in at risk to corporate domination.

Where does this leave the doctor? Right next to the patient in the over-crowded emergency room wondering how things have gotten so out of control.

Posted by Dr. Michael Esposito M.D.
Radiologist and Author of “Locked In,” a new medical thriller.

Blogger shrimplate, at 5:44 PM  

Well said.

However, like most concerns expressed by the nurses and other caregivers on the front lines of American health care, this article is probably just going to end up in the "bitchy nurse" wastebasket of unaddressed complaints.

This is a political problem, but there's nobody, absolutely nobody, in our current administration who would take this head-on.

Anonymous Anonymous, at 2:28 AM  

I can't get the entire code for the NurseBlogs jpeg. It seems the ends are left off both lines. Can you help? Thanks.

Blogger mustika, at 5:35 AM  

I agree with srimplate , This is a political problem, but there's nobody, in our current administration who would take this head-on.

Blogger (: Amanda :), at 8:06 AM  

Hello! I just found your blog the other day and it is absolutely wonderful. I will be starting nursing school this fall and all of the info and links on here have been very helpful. Thanks so much!

(: Amanda :)

Blogger Alijor, at 1:46 PM  

That's a good intwining of two problems,

Emergency rooms and hospitals can't handle liability lawsuits, which makes treating controversial patients (particularly those with chronic conditions) particularly difficult. Hospitals that are sued by patients are going to keep...I don't know, helping?

Anonymous Jen, at 10:54 AM  

This is unrelated to your post, but I'm letting you know that Into The Unit is back up and posting.

Blogger Nurse Practitioners Save Lives, at 6:52 PM  

We need affordable health care for people but we also need patients to be more accountable for their own health as well. Too many patients don't take their medications appropriately and not because they can't afford them. They just feel that they don't need them and then they get into crisis and cram into the ER for treatment that could have been taken care of in the office. The "my back hurts on Sunday night and I need a note to get off work" crowd doesn't help either.

Anonymous Anonymous, at 5:46 PM  

As long as the government is content substitute the Emergency Medical System for national health care, no reforms will ever be made.

We are operating in crisis mode when we should be concentrating on patient education, disease management and preventative care.

In 2002 it was estimated that the government spent over $132 billion on Diabetes care.

In 2004 hospital costs for asthma related problems were over $96 million for the state of Viginia alone.

In the world we are 23rd in infant mortality, 20th in life expectancy, between 50th and 100th (depending on the immunization) on immunization (overall 67th, behind Botswana).

I don't even want to get started on coronary artery disease and obesity.

Blogger Z., at 12:50 PM  

I love your blog-- always informative, interesting, intelligent. I'm linking to your blog from my brand-new one-- check me out at and add my link if you like!

Anonymous Anonymous, at 6:56 PM  

Kudos! Very informative article, keep up the good works! More power

Blogger Pinoy Syringe, at 1:07 AM  

Hi, im a student nurse, and i find your blog very very informative. i would like to exchange links if that's alright:


Blogger Alijor, at 11:28 PM  


so I did an article on nursing and technology- and I tried to create a dialogue between nurses at a hospital, and...well, lets just say I think you'd be amused. What do you think?


Anonymous Anonymous, at 7:51 PM  

I'm an RN and came here hoping to find some good stuff. The article is good, but what are all those links posted in your comment section? Is that how you are monetizing this site?

If not, why doesn't someone delete them?

Anyway, good article, poignant problem, but I don't think as nurses we have much empowerment to fix the issue.

If our salaries were better, if we were better organized, then maybe we could lobby for reform,

Otherwise, it's just big business.

There is a big trend however toward disease prevention, management and outcomes.

Case management is booming. I think the need to keep healthcare cost down is being recognized by Insurance companies as well as Medicaid.

I think some changes are in the wind.

Blogger HypnoKitten, at 12:11 AM  

Sorry about all of the spam comments lately. Somehow I got on someone's list of easy marks for spam links. I haven't had much time to go in and delete them all. I hope you'll forgive me and continue to visit. I've got some new protocols on the comments so there will be no more anonymous comments (and hopefully no more spam) from this point on. I just went back through every post and every comment in the entire blog archive and removed anything that didn't belong here, so it should be all cleaned up now. More posts to come.

Blogger NurseWilliam, at 1:13 AM  

"After all, they can just go to the Emergency Room."

There you have it: Consumer stupidity in a nutshell. Never mind the word EMERGENCY. Bring your five snot-nosed kids on in here. We'll check them out. You'll have to wait six hours and get pissed off in the meantime, but what the heck. We get paid to be here.

And that pesky co-pay? Why bother? Let everyone else foot the bill!

Blogger Lalaine, at 6:09 PM  

nice blogs... ^^ I am also a RN. would like to exchange links with me? I am a new blogger... thanks

Blogger Dana, at 3:35 PM  

Hello, I've been reading your site for some time now and am wondering how I can get on your list of nursing blogs? Thanks!


Blogger aemtbugs, at 7:18 PM  

I don't remember all the facts, but I recall reading an article that was about a hospital that closed in Arizona because it was running so far in the red due to all the patients coming into their ER who didn't have insurance.

Using ER's are truly not the answer...

Blogger Coemgen, at 11:10 PM  

We're also heading that way!

...and I wouldn't worry if Bush knew not what he was saying re:health care system. None of the politicians anywhere in the world seem to know that.

Blogger Leo Levy, at 12:54 AM  

While there are certainly political and financial aspects of the problem, I think our inability to set limits on end of life care on a social level is at the foundaion of the current crisis. I have heard that 80%-90% of all money spent on healthcare during a person's life is spent during the last 1-2 months of life. As an ICU nurse, I have no reason to doubt this. We spend perhaps up to one quarter of our incomes for our entire productive lives on health insurance, from this perspective, mostly to cover the costs for this miserable last month of our lives - for treatment that many would say has no value and that they would not want for themselves if they had time to think about it. But who will set limits? Certainly not the healthcare providers. Doctors are too vulnerable to do much and they do not want to either. Families are not properly informed and are unprepared to make these decisions. Patients themselves are often incapcitated and if not they are ignored anyways. Technology allows us to do so much, but this is a huge liability if we cannot adjust our values as a society. Can't we find a better way to direct our resources? Do we really need to "have it all" at the end?

Blogger It's fun to bank, at 6:49 AM  

It makes me feel lucky that I live in the UK and we have the NHS which does provide free healthcare for all. In the US there is no excuse not to have affordable healthcare for everyone, which means that the government have to cough up and help with the system.

Blogger Elle, at 12:51 PM  

Hi! I got your logo!

Blogger Keith, RN, at 5:54 PM  

It is not surprising, unfortunately, that W would encourage use of the ED for the procurement of healthcare, and urge more private health insurance rather than some form of universal coverage.

The immediate goal, in my mind, is to insure every American, provide preventive care to every American, lower costs, improve outcomes, put a nurse in every public school and decrease nurse-patient ratios.

We spend more on healthcare in this country but get no better outcomes. It is a broken system, and our Lame Duck in Chief is clueless.

You hit the nail on the head here, and I thank you for this post.

Blogger nerinossa, at 1:29 PM  

They need to be treated before their conditions become life threatening

Blogger Kim, at 6:54 AM  

As an ER triage nurse I was worried about my patients in the waiting room, although I was the brunt of their frustration as the waiting time increased from 30 minutes to 4-6hours at peak times. There were some nights that I would be responsible for 30 to 50 people, how was I to reassess that many people and continue to triage the number coming in to be seen. I worked in a very small hospital in a 16 bed ER the number of true emergencies numbered about 24 in a week and we saw fewer than 1,000 people in a week. Most of those did not have health insurance; they were self pay or Medicaid. Our system is truly broken, what do nurses do when there is a problem they make things work! What other profession requires knowledge of plumbing, Mechanical engineering, basic handy man skills, and brute strength. Nurses are train that if it needs to be done we do it, everything from cleaning floors and toilets to analyzing strips FHT or EKG’s to report to the doctors. Maybe the answer lies in nursing. Kim OB Nurse

I have added your button to my bog and would really like to be added to your blog roll! thanks kim

Blogger Sophanny, at 11:12 AM  

I am a nursing student who's just finishing off my first semester. I came across your blog and it was very insightful. I did not realize the crisis we have in emergency department. I never thought of emergency department acting like primary care offices but it has become that way. It is also a drop off day care for families who cannot handle taking care of loved ones with illness so they just abandon them at the ER, hoping to get a break from the healthcare responsibilities. Some one in politics need to fix this problem. We cannot allow this broken healthcare system to continue the way it does. What happened to taking caring of each other?

Blogger jarreyes, at 10:12 AM  

It is most definitely wrong for Pres. Bush to say that emergency departments are the way to go, especially with documentated wait times of up to 24 hours! But as another bloger stated, as nurses, what can we do? Nursing associations are not as organized as they should be, thus not gives them a a "big" enough voice to rally and be heard. And as a nursing student, myself along with many others, we'll be faced with many health care problems. Hopefully, some resolutions will be made when the new Pesident comes into office.

Blogger jarreyes, at 10:26 AM  

It is definitely wrong for Pres. Bush to say that going to the emergency department is the way to go, especially with wait times up to 24 hours! But what can we do? Another bloger stated that we (nurses) were more organized then may be we could reform. But until nursing associations can do that,
I guess we are stuck.
As a nursing student, I guess we just have to wait and see how the next President is going to handle this situation on healthcare and with health insurance.

Blogger Melissa Kunga Silva, at 8:59 AM  

Please consider posting my new blog on your blog list. It is
Thanks, Melissa Silva RN

Blogger Mendoza kinesiology, at 7:26 AM  

I have a nurse blog in my blog, please visit me and add in your nurses blogs. thank you see you

from Argentina!!

Blogger Senseq, at 8:43 PM  

don't even get me started on the US health system. Not only is it a money hole, it also is a most insensitive system.
I tire of meeting nurses, doctors and medical staff, who don't carry a smile, and treat you like a money making machine.
I have been through the medical system in India, which I dare say is far more caring - let alone much cheaper.

Blogger Tyo, at 1:22 AM  


Anonymous Anonymous, at 5:39 AM  

I'm new to blogging, I love your Christmas tree by the way, very inventive. I like your site, I was wondering if you would like to swap blogroll links?
Check me out I blabber on about pointless daily life of being me and a nurse.

Anonymous Anonymous, at 5:41 AM  

I'm new to blogging, I love your Christmas tree by the way, very inventive. I like your site, I was wondering if you would like to swap blogroll links? Check me out I blabber on about pointless daily life.

Post a Comment