Scatter my ashes here...

Scatter my ashes here...
scatter my ashes in the desert...

Sunday, November 3, 2013

I'm Tired of It. Let's Start Fixing It: A Rant and Call to Action.

I've done my share of bitching about health care and nursing. I am getting tired of it. The nursing profession needs a total overhaul. And there needs to be a solution. I don't necessarily have the answers, or any good ones, but I know where I'd like to start, so I'll offer a few suggestions here and maybe it will light a spark, if not a fire, under someone. I'm already on fire but I can't do it alone.

So what CAN we do about it?

We need to change the big money in politics, that will be the only thing that really changes things in the direction of the common good.

But barring that, the nursing profession needs an organization that is comprised of direct patient care nurses, free from the corruption of the executive, administrative and too-high-in-higher-education classes that taint the entire system.

Like that's really going to happen anytime soon? Shya...

Nursing needs representation and advocacy from a group that backs them with financial and legal resources, given the reality of the current political climate. Here are a few ideas. They're not anything new, plenty of other people have suggested many of these things. But there's been little momentum. These all have the potential to be fleshed out, they are projects for anyone willing and able to take them on.

Unfortunately, money seems to be the only thing that makes these big guns sit up and take notice, so we have to start figuring out ways to hit them in the wallet.

Patients don't have a lot of choice in going to different hospitals under their insurance plans. But if they see something they don't like, they can complain to their insurance companies, to Boards of hospitals, to consumer advocacy groups, their local newspapers (which doesn't always work if the hospital is a big advertiser), they can talk to anyone who will listen.

Social media is a powerful network. If people see things they don't like when they visit the hospital, such as nurses being too busy to really care for them, then they can complain to management, but what works even better? Post something on the hospital's Facebook page. Tweet it. The hospital isn't going to want visible complaints in the public domain. It's embarrassing.

People need to flex their consumer muscles. It takes a grassroots effort, people talking to each other on the street. Consumer advocacy groups can help with this. If there isn't a consumer advocacy group to help with this, then perhaps one needs to be started.

A grassroots organization would ideally be free from the influence of those who are only in it to enrich and benefit themselves, such as health care executives, and the people high up in higher ed, such as university administrators. We need to stop serving their money and ego interests. They serve on public boards to build their resumes from ceiling to floor, in search of ever higher paying jobs with perks. They are bought by the industries that stand to benefit, the bankers and textbook manufacturers who are lobbying the state legislators and Congress to win favor for their "products".

Remember the sticker shock you were in when you lined up to buy your books in the university bookstore, as we did when I was in college, before the age of the Internet? Same thing now, but those books, software, and other products are bought online. Still expensive as hell. Someone is making a profit off of students. Student loan companies and textbook companies...

Don't get me wrong, I'm not anti-education. I think it's crucial to the future of nursing. But nurses need to be able to use their education to benefit the patients, and to enable their own professional growth in ways that benefit patients, the profession, and nurses themselves, not to inflate some artificial construct designed by self-interested administrators for the purpose of marketing for profit to line their own pockets.

Not to allow some university president to make a huge salary while delivering little to no educational, financial, or career benefit to the student for the exorbitant cost of a degree that puts them in mortgage-level debt before they even have their first job.

We need to disband the ANA and it's Magnet subsidiary, they do nothing except serve themselves. Read their statement of purpose, it is vague... they claim to be at the forefront of health care reform, yet what are they doing for working nurses? They don't even serve all nurses, as they claim. They do little to protect nurses from their big corporate employers taking advantage of them with incrementally unsafe staffing levels, for example.

They are basically using extortion to force nurses to get degrees that they might not even need, threatening them with losing their jobs. Why should a nurse with a bachelor's degree in another discipline be forced to get a BSN? Aren't there just a few courses they could take to make up the difference?

Furthermore, nursing schools keep nursing students in the dark, they show them very few examples of the wide variety of jobs nurses will be qualified to do once they graduate and get a few years of patient care experience. They prevent students from doing clinical rotations in areas like ambulatory care or with nursing entrepreneurs, areas that are the future of health care. Instead, they worry about how many Foley catheters the students can place, learning sterile technique, or starting IVs. All of which nurses will learn much more readily on the job, as needed.

Higher ed has devised some excuses for why it's necessary to take more than just a few classes to "measure up". Does experience count for anything? Is this evidence-based practice? Where is the evidence that a few classes would bring a bachelor's degree-holding experienced nurse up to speed instead of forcing them to spend gazillions of dollars on school for which they are not even reimbursed or compensated?

How can you make the argument that a nurse needs a BSN when you're giving her or him such a busy patient load that all they get to do is rush through assessments, pass meds and chart. If they even have time for that. When all else fails the nurse is forced to do the documentation above all to protect their license and their employer, even if she or he didn't have time to do anything to help a patient.

And if anything goes wrong the employer is going to blame the nurse. You tell me a BSN is going to make a difference under those conditions? Nurses don't even have time to THINK. There isn't a real need for higher education if you're forcing them to function like robots. Nurses get more education so they can get OUT of patient care. Why? Because those 12 hour shifts and running your ass off day after day multitasking like a maniac is EXHAUSTING. Once they cross over to the "dark side" of management, those BSNs and MSNs do little for direct patient care.

Most organizations and Boards of Nursing are made up of the same people, the executives, administrative types, from higher ed or corporate industry. Get rid of these influences on the nursing profession and replace them with real, hard working advocates for real, hard working nurses.

We need to get away from the profit-centered secret mission of these health care institutions. Everyone knows they are in it for the profit, but they will swear on their gold-plated executive suite graves that they are for patients, customer service, health care, and safety. We ALL know that is BULL.

NAASA is an organization that is the brainchild of Amanda Trujillo, it has chapters in several states and membership is free. It's grassroots. This is where we need to be directing our efforts, to take back the profession before it is destroyed and the human-focused art of nursing is lost.

It might not be THE answer, but it is a start. Until grassroots organizations like this one become large enough to exert influence and have a voice, they won't be very effective. But one thing is for sure: the corporate world is scared. They don't like dissent, they don't like anything that calls them on the carpet. Hell, even little old me, I managed to scare the pants off a few people before I left my job. I wasn't even trying to. All I did was point out what I saw. I said some words.

When middle and upper management of these hospitals have the guts to speak to our faces and tell us the truth about why they blew off the most qualified, creative candidate for a project or job in favor of an established yes man,

when nurse managers admit their collusion in encouraging coworkers to backstab each other,

when administrators and management actually fund and complete projects that benefit patient and workplace safety when JCAHO isn't looking,

when executives have the cojones to admit that it's all about them, their profits and bonuses, their ability to double dip when they get fired by getting a severance package from the old place and starting a new overpaid corporate job all at once, and getting to keep the status quo of their gold-plated lifestyles, not even feeling a dent in their lifestyle or budget, while the institution is cutting direct patient caregivers left and right,

when they can at least admit the truth about those things...

Well, that is never going to happen unless enough people point it out, verbalize it, make noise, and stomp their feet until the earth shakes.

And that is precisely what a grassroots movement is going to have to do before it can make any forward progress. We need to stomp our feet, shake the earth, raise a few points on the Richter scale. We need to shine light on the greed, waste and incompetence that keeps us as slaves to the corporate healthcare machine.

People already know it, but they haven't been adequately motivated to do anything about it. They need to find their voices, overcome their fears, and realize that things are only going to get worse until we do something about it. How uncomfortable do you want to be? How uncomfortable are you willing to be before you do something?

The system has screwed the people in so many ways, aren't you tired of it yet? Do you enjoy being taken advantage of? Do you enjoy working yourself dead?

If you do, then go right ahead and keep your head buried in the sand, wake up and see your reflection in the mirror and be so proud of what you have accomplished for your fellow human beings today: setting them back just a little further, enabling the corporate assault culture that wages physical and psychological warfare against those who work in the trenches, and ultimately, the patients.

5 comments: said...

I have a suggestion for you. Instead of suggesting the ANA and its magnet subsidiary be disbanded, why don't you join your state nurses association/ANA and make changes from within? The only way for bedside nurses to effect changes in their workplaces is to become more active at their workplace, their state level and national levels.How do you think we have gotten any of the changes that have modernized modern nursing and advanced practice nursing? We stand on the shoulders of someone who did the hard work before us. If we do not learn from our mentors and carry on the work, the next generationof nurses is in trouble. The problem is that many nurses are passive; they bitch to each other in small groups. Get educated, get active within your nursing organizations, and get busy.

Alene Gone Bad said...

Mary Beck, my state ANA is full of people who promote the status quo. what you have just suggested could be verbatim from the talking points of management and those organizations you suggest are helping nurses. How in the world is a bedside nurse supposed to be more active in his or her workplace when the work week leaves them exhausted and needing at least a full day off out of their personal time to recover and feel human. Burned out, exhausted nurses don't want to be more active in their workplaces. They don't have the energy to join groups. They don't have the money either. And when they try to speak up in the workplace, they are dismissed or burned at the stake for questioning or having creative thoughts. Management finds ways to backstab them and put pressure on them to get rid of them. The changes you speak of that have modernized nursing are looking pretty pathetic these days, we seem to be going back to the dark ages of workplace abuses and dangerous staffing levels. Where is the ANA and Magnet in policing these abuses? Nowhere to be seen, they look the other way and focus on advance practice nursing. You're propagating conditions that encourage nurses to become advance practice nurses, but ignoring the plight of the registered nurse who doesn't want to do advanced practice. Your organizations are hurting nurses, not helping them. You mention mentors? Where are the mentors? You tell me! I didn't have any mentors for my first 2 years as a new grad! I had backstabbers. I had young-eaters. When I changed to a different area, there was no mentoring. The entrenched nurses who had been there for 20 years did everything in their power to keep things the same and resisted my ideas for change at every opportunity. They didn't mentor me, they backstabbed me. You say we should learn from that behavior? You don't stand on the shoulders of those who came before you. You step on the heads of those who come after you, and kick them when they're down. You're right about nurses being passive. They do bitch to each other in small groups. They are scared, tired, and feel overpowered by those in power who lead by force and not by welcoming new blood. The existing nursing organizations are not helping anyone but the big money interests these days. The existing nursing organizations have failed us. Joining them is expensive, and you can't make change in them because they are full of the old guard, and promote education in ways that are not beneficial to all nurses. If the organizations really wanted to help, they would act as advocates for working nurses, make nursing education less expensive, ensure that employers provide safe environments to grow new nurses, allow nurses to have safe staffing levels, stand up to the corporate interests that work against nurses, help us figure out reasonable workloads to span a 12 hour shift so the nurses can get breaks, refresh our minds, think and breathe. We have come to this place because of the big nursing organizations' failure to do these things. It is time for a change, and a different approach. We've seen the cycle too many times already- nursing shortage, scramble to promote nursing, shortage of faculty to educate, wait lists to get into nursing school, glut of new nurses who can't get jobs, burning out the old ones. The same will happen with nurse practitioners as you move toward forcing them to get doctorates. The schools don't even have their ducks in a row to provide doctoral programs with any meaning for the coming wave of advance practice nurses who will be forced to get these degrees, at huge cost to themselves. Don't tell me nurses should join your organizations. Your organizations are heavily invested in nothing but the same moneyed interests who are ruining nurses. Enough said.

Alene Gone Bad said...

Mary Beck I am frustrated, yes. And angry at your comment. I also see how the emotions fly and we start yelling at each other. But I really don't see the mainstream organizations helping further nursing to be a profession that anyone would want to join. Other nurses have tried to start groups and they have been brought down by the nurses themselves fighting against each other. I often wonder if nursing is just a dying profession and traditional nursing has no place in the modern world of health care. Perhaps we will be replaced with robotic assistants who never get tired, can get their batteries recharged and perform patient care. Nurses are not being supported, they are not being recognized as human beings. So maybe this robotic care assistant is the way to go. I'm not even being sarcastic.

elaine said...

I am an RN BSN finishing law school in one year. I want to do patient advocacy. As I am working in a care facility now, it makes me want to do nurse advocacy. I am open to suggestions! Where do you think I am the most needed, and doing what? Get specific.

Alene Gone Bad said...

Elaine, Thank you for your interest and stepping up! To get started, please either friend me on Facebook or check out The Future of Nursing (new FB group formed today) and The Truth About Nursing and NAASA, which is Nurse Advocacy Awareness and Support of America Colorado Chapter and contact me. We are starting by generating ideas from interested nurses about where the future of nursing should go so that we can solidify and articulate a common purpose, so that we will all be unified in moving forward. This is very early in the formative stages. Looking forward to hearing from you. Thank you.