For my senior preceptorship I was able to complete my 135 hours in the perioperative environment at Maine Medical Center. My nurse preceptor works in the PACU, ASU, Surg2 pre and PACU and the holding room. I feel really blessed to have made a connection with my nurse preceptor since we connect on a lot of the same values and way to approaching patient care. She has made me feel so comfortable jumping into new environments and situations and trusting me with handling things on my own. On our second day in the PACU, we received a patient from the OR that would keep us thinking about him until this day. He was a male and in his 60s, self-employed with no health insurance and had a surgery that would need to have him have follow-up visits with the surgeon starting the next day for the next few weeks. He lives in more rural Maine and runs his own business which requires him to be hands on, work long hours and be physically exhausting. His job was the reason that he was in the hospital and with his injury, it resulted in him having a cast on his right hand, most likely unable to do his job. I wonder about if he has other workers that would allow him to rest and have a proper recovery period or is he listening to his provider and the post-op instructions that I gave him? These un-answered questions have kept me thinking until now, at least three weeks after the fact. During his time in the PACU, he was telling my nurse and I how he was concerned about the price of his hospital stay as his wife gave us a new tshirt for him to wear home with a $2 pricetag still on it. I can’t hope but wonder if that’s all they can afford or did they buy it out of convenience.
As the PACU nurses that night caring for this patient who oversaw his Phase 1 and 2 post-operative care at 8-11pm at night, I was concerned for my patient who was going home with medications from the hospital pharmacy and would be expecting this hospital bill. I see patients and pharmacists interact everyday and hear that they have a $0.94 or $1.26 co-pay, I know for sure that his payment was not that low without insurance. I think as nurses in the perioperative environment, we are more concerned with if the patient remains stable and without complication, not necessarily worrying about the care that we were giving him solely based on his insurance status. We look at the patient as a whole definitely, since in their chart on the pages it never mentions insurance status unless the patient discloses. I think this matters since we will treat everyone with the same level of respect and care, not worrying about the payment or the bill that we never get to see. I think the health care system could make it easier for the patients to realize that they will receive the same care and should continue to go to follow-up appointments since it will be for their own health benefit. I wonder if there could’ve been a way for case management to get involved in this patient’s case for his benefit to see if he could follow-up with any providers that require a lower bill or even a less expensive clinic. As far as getting him signed up for health insurance, I don’t know how that could have been feasible for us to complete during his short stay in our care, however possibly having his follow-up appointments with MaineHealth providers work with him to get that done. I don’t think that I could’ve done anything different personally, I made sure to treat him with all the care and respect as any other patient. I appreciate him for allowing me to think about this side of nursing and his social determinants of health that all play a role together in his case to consider. I hope that he is well, is able to get back to work soon and getting back to do what he loves.
