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Nurse Patients:1 3/17/08 10:13 AM Page 14 "There's obviously a hole in the system, and I fall in one of those holes." taking care of patients who aren't going to get a bill, but if that were me, I'm getting a bill for it. It's really unfair. I'm working and paying my taxes and contributing. Why don't I get the same treatment?" Marino hopes one day to go back to school and become a nurse anesthetist. But the intensive care unit nurse said she realized she must first pay down her debts before hitting the books again. To do that, Marino's recently decided to work through a nursing staffing agency as a traveler and per diem nurse for the higher wages. But health benefits don't come with her job. Since January, she's tried several avenues to buy health insurance, from filling out applications online with the big insurers to working with their sales agents to calling independent brokers. She received one quote for a high-deductible plan where she'd have to pay hundreds in premiums each month and thousands out of pocket before the insurance would actually kick in, but so far has been rejected by all the others for her relatively minor medical conditions. Overall, Marino is a healthy woman. She's only 28, doesn't smoke, and has never been hospitalized. But when she became an RN almost five years ago, she started working night shifts because those were the jobs that were available. Her body rebelled against the schedule, and the high stress and anxiety of being a new ICU nurse didn't help. "My body did not like it at all," said Marino. "My gut slowed way down." At one point, her doctor ran a test and found food moved four times as slowly from her stomach to her colon as it should. Her abdomen was often distended and hurt, and she suffered from constipation. And when she switched to working days, her digestive system never returned to normal. Eventually, she was diagnosed as having irritable bowel syndrome. Without insurance, Marino says she is just going day by day in managing her condition. She takes over-the-counter stool softeners and has changed her diet to cut out any hard, fibrous foods like salad. "I can't eat basically anything that's good for me," she said with a little huff of disbelief. "The fiber hurts my stomach." She's gained weight as a result, which makes her even more depressed by the sorry state of affairs. 14 REGISTERED NURSE Marino's wondering whether it would be better to rejoin a big hospital as a staff nurse to get back on a group insurance plan. She said she could get insured if she and her longtime boyfriend, who works for the government, got married, but is indignant that needing to get a health insurance policy should play a major factor in any of her big life decisions. "I hate being limited," said Marino. "For me, it's just about having career freedom. There's obviously a hole in the system, and I fall in one of those holes." I Lucia Hwang is editor of Registered Nurse. W W W. C A L N U R S E S . O R G MARCH 2008