I want to emphasize an important distinction between Actual sales, and the sales department. Actual sales fix problems, the sales department may or may not be relevant to what causes that to happen.. although they will surely fight for the credit either way.
AFAIK Engineers have an axe to grind with the sales department, not actual sales. Giving credit for a sale is a very subjective matter, and more often than not every sales person who so much as sent an email to the opp want credit - effectively taking advantage of the subjective nature as much as they can get away with. Even if in reality the customer had to pretty much talk around everyone on the sales team and speak with an engineer to gain confidence in the product. Then the engineer has to go play catch-up from the 1 hour meeting while the sales member gets % of the sale.
A lot of people dismissing your concerns as "bad eggs everywhere". I appreciate you speaking out against this.
Apologizing on behalf of others is a valid signal towards properly judging individual motives vs cultural influence. I do not want to be too quick to blame someone for acting distrustful if they grew up in a very distrustful environment / culture.
Exactly this. The nursing profession has been accumulating empathetic debt for probably decades. By empathetic debt I mean nurses taking on more work and responsibility beyond personal rational choice because if they fall short then patients suffer.
the truly tragic part of all of this is that as much as we would like to imagine these nurses confidently walking away from a bad situation like some sort of power move.. a lot of them are not. A lot are finally leaving because they are broken and feel broken enough that they dont feel capable of being responsible for patients anymore.
To reiterate- many (most?) nurses that quit still want to help people, but no longer feel capable of helping. That is a level of trauma that can be passed down to the next generation. It might take effort to let the gravity of this reality sink in.
Anecdotally, my mom is a nurse and she has come home and cried due to sheer helplessness to her work problems on more than one occasion. Shes near retirement age and switched careers into this late in life to help people so this is pretty much it for her. If the system does not show mercy and continues to grind her out then she leaves the workforce feeling helpless and broken.
It goes beyond payment. better pay will go a LONG way, and is absolutely necessary.. but it is not enough. There needs to be more redundancy, because 100% utilization of that kind of resource in that kind of system is something that would get you a failing grade in system design.
I honestly have no clue how we fix this problem. Our healthcare costs are already out of control, COVID showed our systems can’t handle large numbers of patients, and we’re finally nearing the point where we get healthcare out there to all the people who need it.
Who’s going to care for all of them? Do we just make healthcare even more expensive, raise everyone’s pay, and hire a fuckload of new nurses? I’ve never heard of an RN being out of work for very long; I can’t imagine there’s a lot of well-trained RNs looking to be hired. Seems like we’ve backed ourselves into a corner we’re about to wall off.
Does anyone know how we fix this? I’m very interested in hearing ideas.
>I can’t imagine there’s a lot of well-trained RNs looking to be hired
I think this is an assumption we have to accept. The implication is that there are not enough nurses. Which means we need to protect the ones we have, and incentivize people to join. And we need to be creative / strategic / tactical about it because it is not a problem we can just throw money at (and as you mentioned, the money doesnt exist anyway).
Step 1: protecting the nurses we still have.
a) Increase denial of care. Nursing seems to be in need of triage. Or rather, "the system" needs to bear responsibility for triage instead of putting the weight on nurses and simply forgiving them for reasonable mistakes as a result of being overloaded
b) Reduced workload for nurses. Formalize the maximum acceptable workload for a nurse. Maybe provide compromised solutions that patients can agree to for any work beyond the maximum (less documentation, less liability, etc - an acceptance akin to treating a soldier on the battlefield. ie "do whatever you can, i'd rather something than nothing")
c) Increase usage of care workers (cheaper workers that RN's can delegate some responsibilities to)
d) Make a public awareness of how loaded a healthcare locations workforce is (so patients can self-manage in the moment; ie. my urgent care is very busy right now, let me go a couple towns over)
Step 2: Incentivize new nurses
a) Measure how many RN's exist that are not working as nurses. Do a case study to see what would bring them back
b) promote the profession to the youth like we did for STEM in the 2000's
c) reduce training needs. break apart the responsibilities of an RN and group them by categories that non-RN's / care workers can become certified in. allow RN's to delegate more work to "nursing category specialists" like IV management, medical history relevance, cleaning up shit, covid testing, etc. (whatever categories make sense)
Step 1 will support step 2, as it will be easier to recruit new nurses if nurses are better protected.
the important thing to remember is that we cannot control the demand on the healthcare system. We need to protect that system from collapsing if demand becomes too high. We must also provide a means for providing some treatment instead of no treatment in situations where full treatment is not possible due to excessive demand.
Personally, I think we coddle patients way too much. I understand wanting to protect people from their own stupidity, but we really need to stop trying to make the healthcare system a pleasant customer service experience. Let them be busy level-4 service technicians who do not have time for our bullshit.
Hire a much cheaper dedicated friendly person to provide friendly interaction. have them relay anything medically relevant if it pops up. Let them be the first person to show up to the room and decide if a nurse is really necessary, etc.
Basically, i think we need to evolve / progress RN's to be more like Doctors and prop up a less qualified class of healthcare worker underneath the RN's
Let's not forget the simple logistical difficulty of using biomass. It is not as energy dense, which makes moving its own weight around more expensive too.
"The net energy ratio between energy output and input was 10.41.. Energy used for hauling hog fuel represented the largest part (36.27%) of the total energy input. The net energy ratio decreased 0.11 with each additional transportation mile
the net energy ratios reported here were on the high end of this range as energy
input for possible active drying, storage, and final delivery was not included.
" [0]
"The energy content was taken at 137,000 BTUs per gallon for diesel, and
125,000 BTUs per gallon for gasoline (Adams 1983)...
output: the mean HHV ranged from 8,946 to 9,105 BTUs/pound
" [0]
A gallon weighs about 6 pounds, so it seems like pound-for-pound (pine-tree) biomass is less than half as productive as gasoline.*
Honestly, I was expecting worse. But over doubling energy costs isn't negligible, especially for poorer countries.
*this is at a glance work, not an actual deep dive
[0] Net energy output from harvesting small-diameter trees using a mechanized system
Fei Pan
Han-Sup Han
Leonard R. Johnson
FOREST PRODUCTS JOURNAL VOL. 58, NO. 1/2
William J. Elliot
if people care more about the imagined world than the real world to the degree described in the comment i replied to, then there is no need for our real bodies to actually do anything other than exist. We only need imagine what we'd like to identify with, and the system will handle the rest. We could each be the supreme leader of our own world as far as we can observe
A bunch of bodies existing in reality with minimal real-world activity would be a form of peace.
Real world activity would be a disruption to that peace, and also unobservable to the imagined world since all content is mediated. So anytime a persons behavior does not fit into the imagined world system, they could be killed and no one would care or even know. Maybe everybody is just told that person had a heart attack or whatever.
it's akin to the dangers of not having a free press but with all of those dangers hyper-industrialized
> 90% seems way too high to be people who are actively wanting to leave
We are talking about the people who clean up the nastiest human waste that our bodies are capable of producing. I was already surprised that this number was ever less than 100% tbh
Yes, but that is what they signed up for - i.e. they knew it going in, and that has not all of a sudden changed.
I couldn't do it, and god bless them, but that is unlikely a cause of people leaving the profession - that would be like a computer programmer saying they were leaving the profession because they suddenly found out they have to stare at a screen most of the day.
I also find that '90%' number suspect as someone that works very closely with the healthcare community - there is a lot of turnover, and its hard to hire nurses right now - but almost always when someone leaves their job it is because they went down the street and got a 25% raise, i.e. they didn't leave their profession, just their job.
right, and while nurses do have to do some things I would consider gross, more often than not, it is the lower paid medical assistants and CNA's that get the real awful jobs that does not require a nursing degree - i.e. changing diapers in nursing home, bathing people etc - won't find too many nurses doing that in the nursing homes around me.
>I can’t count on doctors _at all_ to move the process forward.
This has been my experience as well dealing with fatigue. I was 25 when I finally got diagnosed with sleep apnea, after over a decade of symptoms. How something so common could go unnoticed by the adults and professional doctors in my life astonishes me still today.
Eventually, thanks to ego, I questioned the narrative that I was just normal and lazy. Without the internet, I might not have ever learned that sleep studies even exist.
I was more than half-asleep for all of my schooling, college, and early professional years. I've spent the last 5+ years trying to catch up.
I think the situation has improved there in the last couple years. I had a friend who I suspected of having sleep apnea. She called her doctor and asked for a sleep study. They gave her a device to wear while sleeping and the diagnosis of sleep apnea came the next day.
Getting insurance to approve the CPAP, though... that is still an open problem. Weeks later, no treatment for diagnosed disease.
>I had a friend who I suspected of having sleep apnea. She called her doctor and asked for a sleep study
It doesnt sound like the situation has improved. Without a friend like you, would she have received treatment?
I think the community has gotten better at addressing the undiagnosed sleep apnea epidemic. When I needed help, there were some discussions about it on forums that I could find with the right search terms. Now, it's become much more common knowledge on the internet that people can spot it in others. which is fantastic.
The Doctors still seem to suck at it. For starters, fatigue is possibly the single most common symptom of disease - and is not something proactively asked about by doctors (in my experience). Every doctor at every check in should be asking "How tired have you been?". The fact that you can notice apnea in your friend before trained professionals even suspect to ask about it is the problem.
And the bigger problem is that even if we address this for apnea, how are we to know how many other issues are going around waiting for the patients to bring it up themselves? I certainly no longer trust that proactive diagnostic due diligence is being done on anything other than blood test result levels.
Doctors rely on patient complaints to govern their behavior. full stop. Check-ins and physicals are way more superficial than most patients understand, imo. Still very helpful, but not nearly enough
Yeah, you're right that doctors kind of missed this. Sometimes I wonder how many questions they ask (depression is what she was being treated for with little success) and how much is volunteered.
I happen to enjoy reading NTSB accident reports in my spare time, and they're always sleep apnea, so it was at the top of mind when I heard things like "headache every morning" and "I randomly fall asleep on my couch". I didn't go to medical school so I'm not sure if those are anxiety/depression symptoms, but a sleep study sounded like it wouldn't hurt. You're absolutely right that doctors should at least be asking these questions ("how tired are you", there is even a scale with more specific questions).
I'm not sure what your friends financial situation is but maybe try to collect some money for her and buy one? I googled that the average cost is just under $1k for a CPAP machine. If it could change her life then maybe should could even pay it back one day.
I second this. Absolutely pay out of pocket if insurance drags their feet. I spent $5k on a mouthpiece for my treatment and would do it again.
It is far from an ideal solution, but in the 3 months it takes insurance to get their shit together - your friend could have the energy to work a side job to pay off whatever it costs and just be generally happier overall
note out of pocket doesnt mean independently - definitely still have a professional approve the purchase decision in case something about the configuration needs to be tailored specifically for your friend
in my case, i needed to see an orthodontist every 2 weeks to have the mouth piece adjusted. I am not sure how CPAP works to say if it is safe to "plug and play out of the box" so-to-speak
ironically my situation was the opposite. My vitamin D was a bit lower than the acceptable range so I kept getting brushed off until I fixed that. It was kind of hard to fix when I was dragging through life by a hazy thread though
I can be a PCP check it out - What is the most easily observable "defect" that's tangentially related to your symptoms? What is the most common treatment for that defect? Next patient.
are there multiple people interacting with the screen at the same time?
i found that the entire pattern changed rather quickly anytime i was enjoying it, which felt a bit too chaotic for me to spend more than a minute on it. cool page though
I think it's just the script doing this itself, when you're not interacting? I'm not sure, I didn't make this, just found it and thought others would enjoy it. But the random interactions are indeed pretty annoying.
edit: seems like there is a socket syncing it.
I tried to disable it by entering 'window.demo.ws.close()' in the console, but the script just reopens the socket.
edit2: Ahh, if you "swipe" up it says "you control x screens" (x=126 in this case). Seems like there's always one controling it? Sometimes it outputs "control is busy". Weird thing.
Yeah I tried it on my phone and it said something about how I'm controlling 153 views, and then whatever I was doing on my phone was showing on my laptop in real time.
I think it is deeper than personal want. i have a feeling that the more people communicate to each other about something, the more they value their personal experience to be relatable. Every customization makes your experience less relatable.
AFAIK Engineers have an axe to grind with the sales department, not actual sales. Giving credit for a sale is a very subjective matter, and more often than not every sales person who so much as sent an email to the opp want credit - effectively taking advantage of the subjective nature as much as they can get away with. Even if in reality the customer had to pretty much talk around everyone on the sales team and speak with an engineer to gain confidence in the product. Then the engineer has to go play catch-up from the 1 hour meeting while the sales member gets % of the sale.