You might love your job, but even if you have the best benefits package in the world, are you sure you know how it all works?
Many employees take a job looking first at the salary and second at the benefits package, but they really are equally important. The salary might take care of your immediate financial needs, but your benefits are for what you might need in the future.
Whether you are taking a new job or have been working for the same place for a decade, review your benefits package so you know exactly what’s in there.
How Much Time Off Do You Get?
Is your time off lumped into a sick/vacation/personal time off package? That’s great if you get four weeks of time every year and you never get sick. But nurses know the sheer physical demands of their job can easily lead to a muscle strain or worse. Do you know what happens if you use all that time up and then get ill? How much notice do you need to give before you take time off? If you need to go to a doctor’s appointment, is that considered sick time or vacation time if the two are separate?
What Classes Are Paid For?
If your employer pays for you to go back to school, the benefit is valuable. But will your employer pay for any classes or just those related to your job? Before you register for any classes, make sure you know exactly what your tuition benefit covers.
When Does Disability Kick In?
If you need to take a longer leave, what are your options? Do you have short-term and long-term disability? When does each one begin and what do you need to have those benefits begin? Some disability plans require you to wait for several weeks (possibly necessitating using up some of your paid time off hours) before the benefits will start. How long does your short-term disability last? How long does the long-term disability last? And make sure if you need this benefit that you know exactly what documentation is required to support your request.
Who Can You Talk To?
Even if you consider it a just-in-case policy, know the best person to talk to at your workplace about any benefits concerns. Do you have a specific human resources rep? How do you get in touch with them? Does your company offer legal assistance? What for? Know your options.
What About Government Benefits?
In general, the Family and Medical Leave Act (FMLA) is open to all full-time employees in companies with more than 50 employees. That means if you have to leave your job to attend to specific kinds of medical situations for you or for certain family members, you are entitled to time off. But the time off is not with pay – it is just guaranteed time off. Find out what your company’s policy is on taking FMLA time if you ever find yourself in a situation where you need it.
What Are Your Financial Benefits?
Do you have access to retirement accounts or some kind of ESOP plan? When do those kick in? Can you join them at any time? Find out exactly what is required and if your employer contributes anything to the funds.
What About Health Insurance?
If you need to change your health insurance plan, what are your choices? When can you do that and what reasons allow you to do it before any specific designated time? What are the policies surrounding your health insurance plan?
It’s a good habit to familiarize yourself with your employer’s benefits package every year. Policies and plans change and it’s your responsibility to know what’s going on. And if you ever find yourself in immediate need of a benefit, you will know exactly what to expect.
Every newborn enters the world with the unlimited promise and potential of a life yet to be lived. However, alarming research conducted in Utah has revealed that all babies may not have the same chances, particularly those born to African Americans and Pacific Islanders. According to the Utah Department of Health’s Center for Multicultural Health, Pacific Islander infants (those under 12 months) experience about 8.8 deaths out of every 1,000 births, compared to about 4.5 deaths out of every 1,000 births statewide. Utah’s infant mortality rate hasn’t exceeded eight deaths per 1,000 births in over 20 years. In light of these facts, the U.S. Department of Health and Human Services recently decided to provide over $130,000 over a three-year period to help specialists study mortality rates within various populations in Utah.
Center specialist April Bennett says the information gathered from this process will be used to implement many interventions and outreach programs for minority women. Surveys will be conducted to help expecting mothers identify obstacles that they may experience during pregnancy, such as maternal obesity, smoking, poverty, etc. The ultimate goal is to help them lead better lifestyles.
The number of uninsured in the state has risen in the past 10 years, with Hispanics holding the highest number at 35.7%, compared with only 11.1% of all Utahans. In 2001, 25.8% of Hispanics were uninsured. For uninsured mothers, this means inadequate prenatal care, which can lead to premature labor and put the lives of their infants at risk. Various health department surveys have shown that African Americans have the highest rates of pre-term births of all infants in Utah, one of the underlying issues contributing to a higher infant mortality rate in the state. But, the U.S. Department of Health and Human Services is determined to make an impact on this issue immediately, starting with studying the contributing factors, such as insufficient insurance and a lack of access to care.
It is ethically right for doctors to report their medical mistakes, but they are often hesitant to do so in fear of lawsuits. Instead, they practice “defensive medicine” by performing many unnecessary tests on a patient in order to prove everything possible was done in the event of any legal battles. Now, a Massachusetts coalition is trying to enforce a mandatory six-month “cooling-off” period following any major incidences, before any patient can file a lawsuit.
As a result of the newly implemented “Roadmap to Reform” initiative, nurses and doctors in Massachusetts are now being asked to fully disclose any medical mistakes they have made on the job and apologize to their patients. Seven Massachusetts hospitals plan to give apologies to any patient harmed by medical errors in order to decrease the amount of lawsuits filed, cut down on health care costs, and reduce the amount of distrust between caregivers and patients. A $1 million donation has been made by three large insurance companies and a medical group to get the plan underway in hopes to make improvements statewide. A similar initiative used 10 years ago by the University of Michigan Health System cut the number of lawsuits per month in half and the spending on legal defense by 60%, according to a 2010 study published in the Annals of Internal Medicine. Some attorneys are skeptical, but are open to possibly having earlier resolutions on their cases.
Imagine going to a community health fair and getting a free mammogram or prostate cancer screening–and then not being able to follow up with a doctor if the test reveals a potential problem. For the nearly 46 million uninsured people living in the United States, most of them people of color, the likelihood of receiving medical advice that they cannot afford to follow is not fantasy but a daily reality.
According to The Commonwealth Fund, a private foundation that works to improve health care quality and insurance coverage, national health care spending is growing at a rate of 7% per year–faster than the U.S. economy. Many people who are unable to afford these rising rates will become one of the 16 million Americans who are considered “underinsured” because they can’t afford their co-pays and other out-of-pocket expenses.
Or, they will join the ranks of the uninsured. The Kaiser Family Foundation reports that 40% of uninsured adults do not have a regular doctor or other primary health care provider to go to for routine visits. That means no pap smears, no mammograms, no annual physicals or other preventive care. As a result, many uninsured patients are unaware that they have a medical problem until they visit the emergency room.
Racial and ethnic minorities are disproportionately affected by this absence of health care coverage. Income, Poverty and Health Insurance Coverage in the United States: 2004, a report by the U.S. Census Bureau, reveals that nearly one third of Hispanics, 20% of African Americans, 29% of American Indians/Alaska Natives and 17% of Asians lack health insurance, compared to only 11% of non-Hispanic whites.
The good news in this otherwise grim scenario is that there are many national, state and community programs that can help bridge the gap between uninsured patients and the medical care they need. Minority nurses can play a key role in helping uninsured or underinsured patients of color learn about and take advantage of these options.
“We expect our nurses and other health care staff to provide exceptional quality care,” says Sandra Haldane, BSN, RN, chief nurse for the Indian Health Service (IHS) in Rockville, Maryland. “I think it is incumbent upon nurses to know how to access other services when need be.”
How Nurses Can Help
One way nurses can help close the insurance gap is to participate in local health events that target the uninsured. “Being active in the community is very important. Our chapter volunteers a lot,” says Sylvia Pelroy, RN, president of Angeles del Desierto, which is the Yuma, Ariz., chapter of the National Association of Hispanic Nurses (NAHN). Whenever Pelroy hears of an event that needs nurses–like a flu vaccination drive for the uninsured–she and her chapter members prepare to serve.
Uninsured in America: Some Sobering Statistics• After adjusting for inflation, total federal spending on care for the uninsured increased by just 1.3% from 2001-2004, while the number of uninsured persons increased by 11.2%. This represents an 8.9% decline in spending by the federal government per uninsured person. • All of the six million increase in the number of uninsured persons between 2000 and 2004 was among adults, and two-thirds of the increase was among people with incomes below 200% of poverty. • More than 20 million working adults do not have health insurance coverage. In eight states, at least one in five working adults is uninsured. In 39 other states, at least one working adult in 10 does not have health care coverage. • Two out of five (41%) of working-age Americans with incomes between $20,000 and $40,000 a year were uninsured for at least part of the past year–a dramatic increase from 2001, when only 28% of Americans with moderate incomes were uninsured.Sources: Kaiser Family Foundation, Robert Wood Johnson Foundation, The Commonwealth Fund
Nurses can also help uninsured patients and families locate nearby sources of free or low-cost medical care, such as free clinics and hospitals that offer charity care. According to the Association of American Medical Colleges (AAMC), major teaching hospitals provide more than half of all hospital charity care, even though they make up only 6% of hospitals nationwide. Many of these medical schools and teaching hospitals offer programs such as student-run community clinics that provide free care to low-income and uninsured patients.
As part of its Protecting America’s Uninsured program, AAMC maintains a national database, searchable by region, of teaching hospitals that provide services to the uninsured. One example is Local Access to Coordinated Healthcare (LATCH), a Durham, N.C.-based collaborative effort between Duke University Medical Center and local health agencies. LATCH’s goal is to reach uninsured Durham residents–primarily Latino families–in their homes to educate them about their health conditions and
match them to available health services.
The LATCH program has a multi-agency team of bilingual, culturally competent staff. And indeed, culturally sensitive minority nurses who work in or near a teaching hospital or low-cost clinic can do much to help bridge communication barriers and establish trust when referring uninsured minority patients to these programs. Having a nurse of color share this information could help an apprehensive minority patient be more accepting of an unfamiliar doctor or medical facility.
“While being technically competent [and] having expert critical thinking skills is important, one big component [of nursing is] always being mindful and in tune with the culture and traditions of the people you work with,” says Haldane, who is an Alaska Native and a past president of the National Alaska Native American Indian Nurses Association (NANAINA).
In addition, there are grassroots organizations and public awareness campaigns that nurses can get involved with to work toward solutions for the uninsured. For example, the Robert Wood Johnson Foundation sponsors an annual Cover the Uninsured Week in May to raise awareness of the plight of the uninsured and mobilize the nation to do something about it.
The campaign encourages the health care community to plan events to assist the uninsured–e.g., helping eligible children and adults enroll in available public health programs such as Medicaid–and to contact their members of Congress urging them to make this issue a higher priority. For Cover the Uninsured Week 2006, the foundation reports, more than 3,000 events were held coast to coast.
Sometimes, however, lack of insurance is not the only problem. In some cases, uninsured minority patients may be eligible to receive free medical care but lack access to the facilities that provide it.
The Indian Health Service, which is a federal agency, operates 48 hospitals and several hundred freestanding ambulatory care centers that will treat any patient who is a member of a federally recognized American Indian and Alaska Native (AI/AN) tribe, regardless of whether the patient has health insurance or not. “However, out of the over three million AI/AN people who live in the United States, we only provide service to about 1.8 million of them because the rest do not live near any of our facilities,” says Haldane.
Resources for Helping the Uninsured
Protecting America’s Uninsured
Cover the Uninsured Week
Insure Kids Now
Toll-free (877) KIDS-NOW (543-7669)
Toll-free (888) CDC-4NRG (232–4674)
Partnership for Prescription Assistance
Toll-free (888) 4PPA-NOW (477-2669)
Nurses in the private sector can help by making sure their AI/AN patients, particularly those who have no other insurance, know where the closest IHS facilities are, and helping them find sources of transportation to the facility, if necessary. Haldane advises nurses to be savvy about knowing which programs their own facility can and cannot provide to uninsured patients and to become familiar with their own processes for helping patients move between providers.
For example, she says, her agency sometimes contracts with non-IHS facilities to offer major care for its patients. “If one of our patients needs services that we do not provide, they are referred to the private sector if that particular service is a priority.” The IHS Contract Health Service, a program in which funds are set aside to pay for these situations, would cover those medical visits for uninsured patients.
Because advocacy by nurses on behalf of uninsured patients can only be effective if there are enough nurses to do it, the nursing shortage is another factor that is exacerbating the problem. The shortage has especially impacted uninsured minority populations who live in outlying and rural communities.
“A rural location is the only place where you have people most in need of health care services with the fewest options available to receive those services,” says Alan Morgan, chief executive officer of the National Rural Health Association (NRHA). “Recruitment and retention of rural nurses is vitally important to maintain the level of care we need in rural America.”
Morgan urges minority nurses to consider living and working in rural environments to help increase access to care and coverage for these patients. He has seen improvement in communities where nurses and other health care professionals come together to share ideas. “I would strongly encourage nurses to link up with their peers in other rural communities for education, peer support and to find good examples of what is working elsewhere,” he says.
Covering the Children
There are more than eight million uninsured children in the United States, according to the Census Bureau. It is estimated that nearly five million of these children are eligible to be covered under an existing federal or state assistance program, but they are simply not enrolled. Here again, nurses can help close the gap by educating parents about available programs and helping them enroll their kids.
The two major federally funded programs that provide free or reduced-cost health care for children from low-income families are Medicaid and the State Children’s Health Insurance Program (SCHIP), both administered by the Centers for Medicare & Medicaid Services (CMS). Different eligibility rules apply in each state, so nurses who are knowledgeable about the regulations in their area are in the best position to help their youngest patients get signed up for coverage.
Valerie Akong, RNC, a labor and delivery nurse at Gwinnett Medical Center in Lawrenceville, Ga., estimates that over one fourth of the patients she serves are uninsured. “When we receive pregnant patients who are in labor, they are considered to be in an emergency situation, so usually Medicaid will cover the mother and child during delivery,” she says.
Because the facility where she works is not a charity hospital, Akong believes it is even more important for her to be the link that connects her uninsured minority patients and their newborns to professionals who can provide appropriate care after the patients are discharged.
“We make sure patients know the names of the clinics that are nearby and we put them in touch with social workers who can help them with their individual situations,” explains Akong, who is African American. “We also have Hispanic patients who need interpreters and I help locate them.” Her biggest challenge, she adds, is helping patients find good prenatal care. She also shares information with patients about insurance assistance programs for their children.
The Health Resources and Services Administration (HRSA) helps build public awareness of SCHIP programs by administering the Insure Kids Now campaign. Insure Kids Now provides information and resources to help nurses and other volunteers get the word out about specific programs in each state. The campaign offers posters, brochures and other educational materials in both English and Spanish for nurses to share with patients, including information for families with concerns about immigration status.
Aiding Older Adults
Government-funded Medicare insurance covers nearly all individuals over age 65. But before they reach that age, several million older Americans have no access to health coverage. According to the Census Bureau, about one in eight uninsured adults are the “nearly elderly”–those who are age 55 to 64.
Taking it to the streets: the “Help is Here” bus.
This population requires more health care on average than younger age groups. To make matters worse, many people in this group experience being uninsured for the first time in their lives when they retire from their careers. According to the Robert Wood Johnson Foundation, the percentage of large-company retirees who continue to receive health benefits from their employers has decreased 40% over the last decade.
Nurses can help by starting or volunteering for community outreach programs that address the needs of the uninsured nearly elderly. Another option is to educate older individuals about state and national programs that are available to serve them.
For example, the Centers for Disease Control and Prevention (CDC), through its Division for Heart Disease and Stroke Prevention, funds a program that promotes heart health in low-income, uninsured and underinsured women age 40-64. Cardiovascular disease is the number one killer of American women across all races. The program, called WISEWOMAN (Well–Integrated Screening and Evaluation for Women Across the Nation), offers risk factor screening, blood pressure testing, cholesterol testing and education on nutrition and exercise.
Even after receiving medical care, uninsured patients still need to be able to afford their prescriptions, but they may not know where to go for help. This lack of awareness about prescription assistance options is not a new problem, according to Elaine Gansz Bobo, deputy vice president of the Pharmaceutical Research and Manufacturers of America (PhRMA), an industry association representing pharmaceutical and biotechnology companies. “Patient prescription assistance programs have been around for over 50 years, but people did not know these programs were out there or they did not know how to access them,” she says.
To close this knowledge gap, in April 2005 PhRMA created the Partnership for Prescription Assistance (PPA), which serves as a national clearinghouse for programs that help patients who lack prescription drug coverage. “The PPA represents over 475 public and private patient assistance programs,” Gansz Bobo says.
Since its inception, the PPA has helped match more than two million people to programs that can provide them with free or nearly free medications, PhRMA reports. They’ve built awareness in part by using bright orange “Help Is Here Express” tour buses that travel around the country and link uninsured individuals with drug benefit programs on the spot. To spread the word in communities of color, the PPA tapped popular African American talk show host and author Montel Williams to be the national spokesman for the program and launched a major advertising campaign targeted to Hispanic health consumers.
Gansz Bobo asks nurses to encourage their uninsured patients to call the PPA to see if they qualify for a program. “Language is no barrier,” she adds. “Our call center accepts calls in English, Spanish and approximately 150 other languages.”
As the nation and the world witnessed in the wake of the September 11 terrorist attacks, police officers and firefighters who get hurt in the line of duty are treated like heroes—and deservedly so. When one of their own is injured or becomes disabled, these professionals rally together to help their fallen comrade, providing both emotional and financial support.
Unfortunately, this is often not the case in the nursing profession. Based on my own experience as well as those of other RNs in the same situation, nurses who become disabled due to on-the-job injuries are far more likely to be cast aside by their employers and colleagues than to receive their solidarity and support.
With the nation’s nursing shortage now at crisis levels, more RNs are becoming injured and permanently disabled because of unsafe working conditions. Today’s understaffed health care workplace, where severely overworked nurses are staggering under the burden of unprecedentedly long hours and increased patient-to-nurse ratios, is an injury time bomb waiting to explode. Consider this scenario:
You arrive at work just like you have done for years. Your patient assignment is already a heavy one when three more admissions come your way. You go into Mr. Jones’s room to help him change position. Even though this patient is a large man, asking one of the other floor nurses to help you lift him is not an option, because their workloads are just as frantic as yours.
So you do it yourself—and then you feel an incredible pain in your back. The pain shoots up your neck, causing an unbearable headache. Just as quickly, you experience numbness in your arms and legs, and you fall to the floor. Obviously, you need immediate medical attention. But if you leave the unit, who will take care of your patients?
Because you are not an indestructible Supernurse, however, you have no choice but to go to employee health. Meanwhile, your colleagues are feeling resentment at having to take on your patients and responsibilities in addition to their own. They project their frustrations onto you–and now your coworkers and friends are upset with you because of an unforeseeable accident that was not your fault.
Employee health tells you that you can go back to work if it is light duty–is there any such animal as “light duty” in nursing?–or else you will have to take the next 10 days off. So you stay home for the next week and try to recover. But after a few days, your condition worsens. Now the nightmare begins.
Your medical insurance will not cover you for the accident because it was work-related. The workers’ compensation insurance company insists that you be seen by one of their doctors. After three hours of sitting in a waiting room, the doctor finally enters, pushes you in a couple of places and tells you, “You’re fine, go back to work”—even though your pain is so severe you can barely walk or stand.
Your coworkers can’t understand why you are not coming back to work if the doctor said you are fine. You must be malingering, they conclude. And what if you are unable to return to work for weeks or months? What will you and your family do after the paychecks and disability-leave benefits run out—while your medical expenses continue to mount?
While what I’ve described may sound unbelievable, several employment-law attorneys I consulted after my accident, including the lawyer who is currently handling my case, report that my experience is not unique. And, they add, the reason why this situation keeps occurring can be summed up in one word: money.
Employers pay the premiums for workers’ compensation insurance with the understanding that they want their employees back to work as soon as possible. The insurance company, in turn, wants to keep its costs down by paying out as few claims as possible. Since money talks, the party that is paying the premiums is the one whose interests are honored. As the injured nurse, you quickly learn that you are not a priority with the insurance company.
As for the question of how workers’ comp doctors can get away with telling severely injured nurses they are well enough to return to work despite obvious evidence to the contrary, who is going to go after them? Disabled nurses who have no money to take them to court because they now have no income, medical coverage or workers’ comp benefits?
In New Jersey and some other states, an injured employee is denied by law the right to sue their employer for negligence or even force them to have the worker’s compensation insurer pay for their lost wages or medical care. To make matters worse, another reality I learned the hard way is that work-injured nurses must endure the humiliation of having people from the insurance company follow you and photograph your movements in the attempt to prove that you are a fraud. As a result, you must obtain a lawyer to protect your rights, incurring even more expense.
Depending on the severity of your injuries, this nightmare can drag on for years, leaving many disabled nurses unable to pay their bills or receive appropriate medical care. Some may even lose their homes and their marriages. Many of the work-injured nurses who have shared their stories me have had their cases in litigation for anywhere from eight to 15 years before they were settled. And even though these nurses’ experiences seem to indicate that such cases are usually settled in favor of the disabled worker, why are we forced to wait so long to receive justice?
Some workers compensation companies have tried to argue in court that the nurses are faking their injuries by using their medical knowledge. This is simply absurd. Are police officers who are wounded in the line of duty accused of shooting themselves because they carry guns? Are firefighters who suffer from smoke inhalation accused of starting the fire because they have knowledge of fires? Why does this seem to happen only in the nursing profession—a field whose very reason for existence is to help the sick and injured?
An Unequal Commitment
In England, a government agency, NHS Direct, has been looking into solutions for assisting nurses who have become disabled due to workplace injuries. As reported in the September 2000 issue of Nursing Times, a “work-based assessment is done and ergonomically designed equipment is provided to meet their needs.” Here in the U.S., the federal Department of Vocational Rehabilitation provides resources—such as assessments, educational funding, hearing aids and computers—to help work-injured persons resume their careers or transition into new ones.
But the nursing profession, whether in the clinical setting or in academia, has yet to demonstrate this same level of commitment to helping nurses who have fallen in the line of duty regain their professional lives.
Some work-injured nurses do manage to continue their careers by returning to school and earning advanced degrees. But this, too, is a long process with its own challenges, barriers and prejudice caused by preconceived images of people with disabilities. According to a recently published Minority Nurse article on nurses with disabilities, “because of a long-standing myth that health care providers must be physically perfect…many [disabled nurses] are told that they have no business pursuing or continuing a career in health care altogether.”
The passing of the Americans with Disabilities Act (ADA) more than a decade ago has done much to help level the playing field for disabled nurses. But still, change is slow. A February 2001 Nursing Spectrum article noted that “career transitioning is hard work for disabled nurses…new grads and experienced [nondisabled] nurses are also in competition for the same positions. It’s a buyer’s job market.”
As nurses, we devote our lives to caring for our patients—but when we are the ones who are hurt and need help, we don’t receive the same level of care. When injured nurses are in danger of losing their livelihood, the nursing profession should be part of the solution, not part of the problem. Disabled nurses have a right to expect their employers, educators and colleagues to step up to the plate for them and show the same professional support that police and firefighters do. We deserve more than to be cast aside like forgotten heroes.
Author’s Note: Thanks to Carolyn Zagury, RN, PhD, for her sincere help and support.