Friday, September 30, 2016
Healthcare Heretic Rants Again...
The other day as I was having a conversation over coffee with a local colleague who is a psychotherapist, our conversation shifted to healthcare. There's been a lot of talk about Healthcare 3.0 as an answer to the problems of our current escalating and unsustainable costs that aren't making a dent in our health as a society. As a nurse, I get asked on social media what healthcare 3.0 could do for nurses, who are understaffed, burned out, ready to burn their scrubs and walk out. Let's start at the top.
My colleague said something interesting about people who have executive jobs. Often they think it works for them, but the way they are functioning is not working well. They make a lot of money, they may have status in their communities and workplaces, but they are deeply unhappy. They are unable to connect with the underlying source of their unhappiness. So intently focused on what they think they have to do to maintain their status, money, and power, they can’t face how it affects other people around them: their spouses, children, community, or their own health and well-being.
In healthcare especially, people who have executive jobs often are fostering the climate of creating more work and finding justification for filling positions that contribute little to patient care and outcomes. They are contributing to the problem of the providers’ agony of having to spend more time in front of the computer than they can ever spend talking with their patients.
It’s disruptive to patient health and satisfaction, provider health and satisfaction, public and community health, the economic sustainability of our healthcare system, and our entire national economy as a whole. As healthcare costs have soared along with administrative costs, so has the distress in communities over healthcare access and availability, jobs and security.
We are all connected to the greater community. And when someone is sucking the resources away for their own benefit and not sharing, it hurts everyone.
Look deep into the eyes of a healthcare CEO. It’s been said that CEOs can be ruthless, sociopathic people. You might be able to tell in their eyes if they are truly sociopathic or just in deep denial of what their everyday decisions and actions are doing to those around them.
I believe many, if not most of them, are human beings who have taken to heart the myth that status, power, privilege, and money are what defines a person’s worth, especially for men, and while they might on some level know this is a myth, feel too entrenched in the status quo and fear the discomfort of change, believing that the price they might pay personally and professionally would be too steep.
Eventually they start to pay for it in their own health- mental, emotional, physical, and spiritual health. They might get sick, be depressed, get divorced. Or they might realize it when a family member has a serious illness.
It takes courage to take risks, to make change. They might think they are more comfortable sustaining their standard of living, with the vacation homes, the disposable income, sending the kids to college without financial strain. Their financial security is well-padded with the promise of a golden parachute.
On the other side of the fence in healthcare are nurses. Near the bottom of the totem pole in the direct patient care hierarchy, nurses do the heavy labor physically and mentally. Expected to function as well as machines, they are given the near impossible expectations of being able to safely care for a number of patients of varying acuities, safely administer medications and other interventions, and document everything that happens all day, with every patient.
Nurses have the most responsibility, the least power and authority, and often are abused, bullied, and disrespected, even by their own peers. They are not included in decisions made at the top of an organization that directly affect their working conditions and may pose a risk to their safety, their patients, and their licenses.
When more work is piled on nurses, if they complain, they are told they are not managing their time well, or can’t multitask. If they complain about unsafe conditions, they can be fired. When things get out of control, or a mistake is made, they are the first to be blamed.
The only reason nurses are in the position we are in today is because we’ve allowed ourselves to be lulled into a lie. We have never challenged the old guard of dinosaurs who live in the days when nurses couldn’t be married, never questioned the doctor and could only wear white caps, stockings and dresses.
The fact is, today, nurses need to stop making excuses that we can’t make change or speak up because we are powerless and we’ll get fired from the jobs we need. How badly do you need a job that leaves you insulin resistant, overweight, hypertensive, with back pain, foot pain, or headaches. A job that leaves you sleep deprived, grouchy, unable to spend quality time with your family, but spending a day or two each week uncompensated while you recover from your 12 hour endurance shifts?
Just for raising this point I’ve been attacked by nurses who get defensive, usually because, “I have kids. I’m a single mom. My spouse is unable to work, disabled, etc. I’m supporting my parents, my kid is in college, I’m in debt…” and so on.
We all have choices in life, and there are no guarantees! What if you got injured or sick? What if you got fired? What if the hospital burned down? What if you lost your job for some other reason? What would you do? You’d have to find another job, but what if you couldn’t? You would have to come up with some kind of contingency plan, right?
No one is saying you should give up your job and stop supporting your family. What I’m saying is, you shouldn’t have to be abused while you’re trying to do it. You shouldn’t have to fear for your job and be forced to do things that are not safe, that damage your health and well-being and compromise your own ethical standards just to keep your employment. You ARE NOT powerless, you can do something. The fact that people do make excuses for not speaking up is reason enough for making change. There is ALWAYS a way.
Nurses need to quit attacking each other and having turf battles in the workplace, social circles, on social media, and in the community. We are all connected. Again, we’re not powerless, but we need to be more courageous. True leadership moves us forward, is not regressive, and requires courage. We have to be willing to take risks, to put our ideas out there, expose our ideas to the light of day instead of hiding behind private conversations in quiet corners.
If we were allowed to do our real jobs: to advocate for the patient, educate the patient, and navigate so the patient and family could find and access the resources they need, in addition to providing basic but highly skilled nursing care, we’d be able to practice like the professionals we are, not as wait staff on roller skates. We could each be experts on our own patients and bring in specialized, available experts when needed. We’d have time to have conversations with the patient and identify issues so we can collaborate with physicians, who would get the full scoop on what we’ve seen in our assessment and concerns we have about the patient, resulting in better outcomes.
To lead this change, we need share our vision for nursing, establish we want to see, and make it happen, through policy changes, influencing public attitudes and understanding, and working together instead of at odds. Here’s a partial list of some of the things nurses would like to have:
•Safe staffing ratios that are not just marginally safe, that truly allow us to provide GOOD care.
•Time to think about what we are doing instead of rushing from task to task
•Time to collaborate- with nurses, other staff, physicians, managers, administrators
•Time to give attention to patients, to have conversations with them where we can listen
•Time to take breaks, lunches, vacations
•Adequate time to get our work done within the hours of our shift
•Getting paid for all the work we do
•Feeling safe in expressing concerns
•Not being rushed
•Having our needs acknowledged and addressed and met.
•Not facing bullying or disrespect from peers, other providers.
•Having access to decision making input
•Being communicated with
•Transparency from the administration in matters pertaining to our own jobs
•Support and time for professional development and growth and education
•Opportunities to lead, advance, contribute, change specialties or positions, or back down, cut or increase our hours when we want to or need to
•The ability to take time off when we are sick without being penalized
•The ability to work at a human pace without being replaced by robots
•The ability to use technology in the workplace that works for the patient’s best interest and supports our ability to do our jobs well, but doesn’t detract from the quality of our work with the patient.
What is leadership? Instead of an entitlement, it should be a privilege that is earned and kept through service to those you are charged with leading. Instead, many executives see themselves as entitled: to high salaries, nice perks, golden parachutes, and all sorts of other protections and padding.
Poor leadership consists of insecurity and fear of losing one’s job, the unwillingness to support others out of fear of exposure of one’s shortcomings. Instead of allowing people to shine, insecure leaders avoid creativity and keep the innovators out.
Toxic leaders poison the entire organization layer by layer. Morale drops, turnover goes up, and patients suffer. It’s not just a trickle-down effect throughout the organization, it’s a full stream raining down on their heads, like a burst sewer pipe upstairs from the hospital cafeteria.
Leading is not proselytizing, it is not enforcing the blind following and worship of a megalomaniac. It is not about overseeing a passive audience of yes men and women, or the intolerance of dissent. It requires independent, critical, and creative thinking that comes together to make improvements.
We need to clearly define what nursing would look like under 3.0. We must have a place at the table, as equals. Nursing is no less important than medicine. What is less important, is all the administration and extra fluff that does not improve relationships around the level of care.
Healthcare 3.0 would bring nurses fully into leadership, to an extent to which we have never been included or taken seriously before. Healthcare 3.0 is an idea that can be implemented and can save us from the impending healthcare Armageddon. There isn’t a single person who won’t be affected.
We need courage, we need everyone with a stake in this to face the fact that we are humans taking care of humans in healthcare. Outcomes matter, but we can’t lose sight of the real human condition that “outcomes” represent.
We cannot exist solely for the sake of constructs like technology, efficiency, or productivity. The relationships must drive these constructs, not the other way around. Those things can happen as a result of doing our one-on-one patient/provider relationships well. Let’s stop making constructs the holy grail and get back to focusing on relationships.
For more information on the Healthcare 3.0 concept, you can read Dave Chase's article here, or you can also watch ZDoggMD's rendition, Lose Yourself, below.