Nurses' Week: Moving Forward and Podcast with Lisbeth Overton

Ultrarunners understand RFMs- relentless forward motion. We often use our determination and mental strength to carry us forward through discomfort and difficult situations in our personal lives and work lives in addition to our athletic pursuits.

I had a conversation with my friend Lisbeth Overton yesterday in a podcast for Nurses' Week (listen here). We talked about the difference between moving forward one foot in front of the other in a way that breaks you down, versus moving forward intentionally with progress. I want to say more about that because right now, between healthcare and the crazy shit happening in our country, it can be easy to go to a place of despair.

I've found myself over the past month deteriorating into that place of despair and realized I need to get out and move more. I have been so bad about allowing myself to not go outdoors to run in the bad weather this winter. I need the fresh air and the brain break it gives me. Being a bit of a political news junkie and overthinker has not been working in my favor lately.

Lisbeth and I talked about how so many nurses are struggling and frustrated with the opportunities and working conditions their profession affords. They want to use their knowledge, talents, and skills to truly make a difference in patients’ lives, but often there is no place for that in the task-oriented, rushed and understaffed workplaces of healthcare facilities and hospitals.

Many nurses wish they could break out of the grind, find a better job that allows them to practice patient care they way they’d like to. They can feel stuck, which leads to despair, low morale, burnout, and health problems, none of which are good for taking care of sick people.

There are two ways you can move forward: one is to grind through, trudging with dread because you feel like you have no choice. The other way to move forward is by taking small steps, still moving forward, not any faster, but with intention and action, no matter how small those actions are, but doing something to move yourself toward better days.

The lesson, I think, that ultrarunners have learned, that sedentary people need, is that active leisure is such an important and undervalued part of our lives. It seems that so many people have forgotten how to play. Too busy chasing material objects, or buried in our electronic gadgets and devices, we end up sitting down as time flies past us.

The time focused on a screen takes away from the time we’re aware of our environment, using all our senses, learning, and appreciating what is in our world at arm’s length. Unaware of our surroundings, we could be moving and breathing, paying attention, burning calories, reducing our fatigue, circulating our blood, and boosting our mood and energy.

People who have not pushed themselves toward physical goals, who are not athletes, often miss out on the rich lessons that athletes learn, of pushing beyond prior achievements, and refusing to accept outwardly-imposed limits. We're always looking to go further, in distance, time, space, or experience.

Working with cancer patients, acutely ill people, and those with chronic disease, I've observed what being an athlete can do for a person in terms of mental and physical strength. Athletes who do get sick are at a big advantage, not just in terms of likelihood of recovery and regaining function and quality of life after an illness, but in coping with the physical and mental demands of an illness, even when there is a discouraging prognosis.

I used to say to my co-workers in the hospital, that it was easier to run a fifty miler than work a twelve hour shift. None of them believed me, but for me it was true. If you're going to be on your feet for 12 hours, you might as well be outside without crazy demands on you every second. Plus you can eat, drink, and pee whenever you want!

When it comes down to it, nursing is about public health, helping people (the public) get healthier, function more effectively, and live better lives. All of the major issues facing our country right now are connected to public health. Here is an incomplete list:

1. Income inequality- the greed, sociopathy and lack of empathy that leads us to a place where a few people have the overwhelming majority of wealth so that large numbers of people are unable to meet their own basic needs or access adequate services that allow them a decent opportunity at a decent standard of living and level of health. People who have to work two or more jobs to pay their bills are unable to take care of their own health.

2. The lack of mental health services, proper care and treatment of addiction, unaffordability of health insurance and prescription drugs, and near-monopolies that destroy competition and drive up prices, make decent healthcare out of reach even for those with health insurance.

3. Our stressful lifestyle- too many people are working too hard for too little compensation for things that are too expensive and often unnecessary. Poor community planning leads to overreliance on vehicles and commutes that are detrimental to our environment, people's health, and financial well-being. We don't have enough mental health services available and people don't demand them because of stigma associated with mental illness.

4. Obesity and metabolic disease are an epidemic, for many of the reasons cited above- community planning, mental health, low incomes, working several jobs, lack of education, feeling powerless, cycles of abuse...

5. The opioid crisis, a result of greed, poverty, lack of mental health services, lack of education, unemployment, family and social cycles of stress and despair.

6. The gun violence epidemic- children and teachers shouldn't be traumatized by the idea of being shot at school, and parents shouldn't be traumatized by dropping their kids off at school to get an education. We had another shooting this week in Colorado in Highlands Ranch. Our U.S. Senator Cory Gardner, big NRA money recipient, has blood on his hands. AGAIN. And again, nothing is being done legislatively to stop this.

I think if we could solve one of these problems I think income inequality and the factors that lead to it are the key. I think nurses need to make it our business to push for social change. And I don't think we've done nearly enough on that front, at least not in a publically vocal and visible way. Nurses care for other people regardless of who they are, their background, what they look like, or other characteristics. No matter how much the current sociopathic executive in chief wants to erode this.

Nurses could teach the public a lot about how to truly care for others and to see the humanity in everyone. I think it is something we've lost in our country- the idea of caring for others and considering others' needs before asserting one's privilege and "rights". If we cared for and about each other, we would be caring for ourselves, too.

Ode to the Zombies in the C-Suite

CEO pay is a problem. The administrative costs of running healthcare have increased because we’ve added so many layers of complexity and bureaucracy that have nothing to do with healthcare or outcomes.

The hospital and insurance industries are fighting against Medicare for all or any largely single payer system. They have stolen the money from the people who need healthcare. They use this loot to harness the power of lobbyists to write and promote legislation to keep their advantages and privileges away from the masses who might benefit from being able to afford medicine to stay alive.

How do they make so damn much money? They cut costs like crazy, and big costs like staffing are the first on the chopping block. CEOs are not considered healthcare staff. They don't contribute to health, or care. In fact, they operate against it. You don't need a heart, and certainly don't need empathy, to run a healthcare facility. All you need are pure, driven, focused, sociopathic tendencies. Just be a Zombie, and you'd make a perfect CEO.

On Nurses’ Week, let’s also remember the other people who do work in healthcare, including non-clinical workers. Understaffing is a widespread and dangerous practice, whether you work in direct patient care, take out the trash, provide security, or transport patients around the hospital. None of us can do our jobs without the others.

You cannot run a hospital without keeping it clean. You cannot run a hospital without people to move patients from one room to another or from their room to a procedure, changing lightbulbs, sterilizing equipment for surgeries, emptying sharps containers, and all the other things that are taken for granted but are crucial to safe and complete operation of a hospital. You can’t short staff the people who maintain the medical equipment or stock the supply shelves. You can’t short staff security, because there are actual and potentially violent individuals who enter the hospital.

You can’t even have short staffing for human resources, if you need to keep hiring people all the time due to your high turnover. Of course, you can try underpaying everyone, and in a low unemployment market, you can blame your inability to attract new employees on flaws of the existing staff. It certainly couldn't be the fault of anyone higher up.

By relying on as few staff as possible, you end up burning out the existing employees, who have to run at a faster pace, are more likely to miss details or make mistakes, or have to cut corners in order to get all of the work done in the time they are allotted. They can’t go on vacation because there’s no one to take their place. Doesn’t matter how much vacation time they’ve accrued, they can’t use it. And the shorter staffed they become, the more stressed the workers become, from the bottom up through consecutive layers of management.

Until you reach the C-suite- where they are somehow insulated- they can avoid and escape the chaotic and stressful everyday environment. And even if their worst stressors materialize- low patient satisfaction scores (gasp!)- they can apply pressure downward and no harm will come to them in their suits- they rack up bonuses and extra perks, and even if they are fired, they have a golden parachute coming, to keep them wealthy as they navigate the revolving door of the close-knit executive world.

Yet this is the model on which the executives expect the hospital to run. The mega-corporate near-monopolies have limited competition, driven prices up, and contributed to our plummeting outcomes and skyrocketing costs compared to every other industrialized country.

Blinded by data, the Suited Scourge wanders through the back hallways away from patient rooms, haunting management with blood-drenched HCAHPS printouts. Wide eyes bulging and bleeding from their sockets, insisting on hearing the magic “yes” to every demand. Keep downstaffing and don't stop until there is just one employee covering each floor, responsible for every patient, dust bunny, and soiled washcloth 24/7. Get those products patients in and out fast, to maximize revenue. Crank up the speed on the assembly line, the robots staff will have no choice but to keep up. If the products patients live long enough to beat up the robots staff, sue 'em for property damage to reduce the replacement cost.

Then, and only then, will the Zombies be satisfied, as long as the patient satisfaction surveys come back in the 90th percentile, and dripping with blood.

Tools for Nurses vs. Nurses as Tools

It's that time of year, we're approaching Nurses' Week, drawing the ire of millions of nurses across the U.S. May 6-12, to be exact. It's the week where we are reminded of the hand we're dealt, the King of Diamonds versus the Queen of Spades- the analogy is the rich mostly male executives wielding their power, watching over a mostly female workforce being forced into digging their own graves.

In 2015 on the TV show The View, the hosts mocked the Miss America contestant who was a nurse, asking why she had a "doctor's stethoscope". Apparently unaware that nurses are the ones who do physical assessments and actually use those tools more often than doctors, it came across as crass and uninformed to the large number of nurses who saw and heard the remarks. The good thing that came out of it was a flood of activism which resulted in formation of the group now known as Nurses Take DC, to fight for safe staffing and safe patient limits in the workplace.

Playing Cards

Skip ahead four years, and another uninformed comment from a prominent person got the whole nursing world riled up again. Washington State Senator Maureen Walsh made a comment about nurses playing cards most of the day, again inflaming nurses' collective frustration with the ignorance and disrespect with which nurses are treated, especially in the workplace by those decision makers around staffing. Chronic understaffing, overwork, burnout, moral injury, and unsafe conditions for adequate patient care plague the healthcare industry in its sociopathic pursuit of profit.

This time, in response to Senator Walsh's comment, and her weak, non-apology that is now becoming a whine-fest-she's complaining about all the mean comments she's received, nurses have mobilized again.

To Senator Walsh, sorry ma'am, but if you go into politics, you're a public figure and you're going to get public scrutiny. Next time watch what you say and if you screw up, offer a real heartfelt apology and start making amends.

I don't condone people being rude or disgusting. They should be harsh AND tactful at the same time- it IS possible.

First nurses depleted the supply of playing cards in Amazon's warehouse by sending her thousands of decks of cards in the mail. Then there was a petition circulating that gathered some half a million signatures.

Hung by our Stethoscopes

So my question is, if over half a million nurses can unite over a stupid comment by a politician, why can't they unite over the stupid actions of healthcare leadership, including organizations such as the archaic and hypocritical American Nurses Association, which claims to represent us but instead acts in the interest of hospital and healthcare executives in the healthcare corporatocracy? Here's the example in Senator Walsh's own state... supporting the pathetic "staffing committee" proposal to undermine and subvert the aims of safe nurse staffing.

Sure, there's plenty of money for the industry executives to lobby for their own interests but somehow they can't afford to staff safely for patient care? Where are the half million nurses when it comes to these types of decisions? Half a million nurses signed the petition to get Senator Walsh to follow a nurse for an entire 12 hour shift. Half a million nurses should be signing this petition for National Legislation.

Nurses are afraid to speak up in their communities and workplaces because they have no power and can easily be harassed or threatened, and they don't want to lose their jobs, licenses, and livelihoods. The tactics used by management are ugly. In the vast stretches of our anti-union, anti-labor plutocratic country, we have diminished workers' control over their working conditions and job security. And we are seeing more deterioration in the workplace, in the form of violent attacks against nurses.

Furthermore, with the consolidation of hospitals and healthcare facilities under bigger corporate umbrellas, near monopolies have been established, making it harder for nurses to find alternative companies to work for if they don't want to or can't relocate.

Stop the Bleeding

We need a giant set of hemostats to stop the hemorrhaging of nurses and their working conditions before healthcare implodes and completely collapses, resulting in more medical errors, more deaths, and more violence.

Executives use their excuses where they can to manipulate the workforce- using data like HCAHPS (patient satisfaction) scores as a cudgel to terrorize employees around their job security. They never count the human cost of abusive manipulation of employees and their families. These big corporate entities feel no responsibility toward the communities where they exist and employ people who live there, trying to make a living, and being worked harder with fewer staff and deteriorating compensation. It's a sociopathic system and there is no empathy- it takes a true sociopath to buy into the corporate data-pushing bullshit.

Here's are some small examples, and I mean small because they don't directly impact patients- wage theft by employers when nurses they have more work to do than they can finish in a 12 hour shift- by forcing them to clock out after 12 hours and work without pay. Also, when nurses don't get a break they are not allowed to charge for working straight through- they lose pay. And if they try to recoup those wages, nurses are subject to disciplinary action.

Healthcare is a human service, it cannot be run like a factory. Our lack of a human-oriented healthcare system is costing us more and delivering worse outcomes than other industrialized countries and it's not getting any better. Pissed off patients and families who come to expect "customer service" as if they were in a hotel or restaurant will act out aggressively when they are tired of waiting for overworked, rushed healthcare professionals without adequate support staff.

We can let it fall apart and pay an even higher price in the form of more morbidity, mortality, and trauma, or we can use that same fervor we unleashed against a politician's dumbass comment to unify ourselves, watch each others' backs, and take back our control and power over the situation. There are more of us than there are of them. But we need to be unified. We need to join together and speak in one loud strong voice.

I challenge every nurse to take a first step by joining a grassroots organization in taking back healthcare for everyone- especially for the good of the patients we are supposed to be caring for. (bonus: you don't have to pay dues) Don't be fooled by organizations that claim to represent you then backhand you when you're not looking. Sign the National Nurse Patient Ratios Petition.

I promise you, signing a petition like this and joining a group like Nurses Take DC will give you more satisfaction than your job has given you in years! Take back your power over your future in healthcare. Lives depend on it.

Nurses Week Takeaways from DC Part II: Spoken Words

Happy Nurses' Week. Here are some takeaways from my speech in order of appearance. Some of you might not like what I have to say, but I'm speaking my mind.

"I want you to go back to where you came from and convince at least one of your colleagues to get off their butt and do something about safe staffing- grow a pair, say something, step out of their comfort zone and take a risk."

I don't know about you, but one of things I find absolutely maddening and frustrating is the deferential nature of so many nurses when it comes to speaking up to management. For people who can be fierce advocates for their patients, and some of whom are willing to stick a knife in their own colleagues' backs, when it comes to speaking out about things in the workplace, they run and hide under a table and pee on the rug.

And then they sit behind the nurses station when the manager disappears and bitch about it among themselves in whispers. Pathetic.

"Then…I challenge each of you to have three conversations this year, out of your comfort zone. I want you to talk with that nurse colleague, and a physician, and with someone in administration, preferably an executive. I want you to find common ground with them as a human being and have a conversation. Break the ice by asking them, what is the most difficult part of your job… Let them know you’re interested in what they have to say. And then… creatively propose a way to start solving the problem of safe staffing. Together. Follow through. Commit."

We need to start talking with people, to get out of our everyday routine and realize that unless we start to take steps to change our situation, we won't ever make things better. Don't expect things to happen overnight. The point is, all of us, taking little steps as individuals, can create a powerful force. If you're too scared to have these conversations alone, find a teammate to go with you and back you up.

Don't be intimidated by executives. Just because they wear suits and make lots of money does not mean they have some kind of magic powers. Remember that inside that suit is a human being who could just as easily put on a pair of scrubs. Not that they would have a clue what to do next, but the point is, they are people. If you can relate to them as another human being and not some unapproachable authority figure, you'll have a much more relaxed conversation.

Sometimes physicians can be rushed, abrasive or unapproachable. They are always short on time because they are just as swamped with their patient load as we are. But by refusing to take time to interact within the greater community of healthcare, they are missing out too. They isolate themselves and this is not a good thing. I talk extensively about this in my book, Navigating the C. Physicians need to make themselves available and approachable by taking steps to take control of their own working conditions.

"When we have those conversations, there are a few points I want you to take away, remember, and use."

1. "There is a difference between safe staffing to avoid sentinel events and staffing that is adequate to improve a patient’s health after being hospitalized or being treated in a healthcare facility."

When you look at healthcare like any other business, the whole idea is to make money. But we're not just providing gadgets made on an assembly line. People and illnesses are unpredictable, they don't act in a linear, measured way. You can't set safety standards to cover all possible scenarios. There has to be some human judgement involved. It's not a factory setting.

Maybe with one nurse to 6 patients nobody dies on a given shift, but did every one of those 6 patients get their medicine on time? IV tubing changed? Dressings changed? Blood glucose checked on time? Call lights answered? Education completed with time to ask questions including on the day of discharge? Linens changed? Ambulation (walking) around the unit? Baths? Trips to the bathroom if an escort was needed? Did the nurse get all of the charting done and check all the orders within the limits of that 12 hour shift? Report given to oncoming shift without any omissions?

2. "Today’s nursing jobs are not the equivalent of a regular desk job. They shouldn’t be compensated like a desk job. Hour for hour, we put in a lot more work and have a lot more responsibility than your average paper pusher. It beats us up, physically, emotionally, spiritually. 36 ≠ 40! Think about that."

I know a lot of nurses (and laypeople too) think that working three 12 hour shifts a week is great because you get four days off, but you pay a price for that. How do you feel that first day off? Are you just as perky and productive, ready to jump out of bed and take on the day with full energy? Maybe if you're 23 and just out of school, but the longer you work and the older you get, the less resilient your body is going to be. It takes a day or two to recover your energy after working those back to back long shifts.

A 12 hour shift is never just 12 hours. Most nurses don't get paid breaks so they are scheduled for 12.5 hours- usually something like 7 am to 7:30 pm, or 7 pm to 7:30 am. Whether they took that break or not, and it's usually not. Add any time it takes to drive to and from work, find a place to park, walk into the building, get ready for report. For most nurses it's a good 14+ hour day. That leaves little time between shifts for basic self-care- like enough sleep, time to prepare and cook a healthy meal, spend time with your family, take care of pets, doing chores around the house that can't be put off, and so on.

Nurses might be considered full time at 36 hours a week, but they don't get paid any more for the hazards they endure, they don't always get ample vacation time, almost never get sick leave that isn't coming out of their vacation time, they never get compensated for missing lunch, they get in trouble for working unapproved overtime even though they can't finish all the documentation of their day within that 12 hour time frame because they were busy taking care of everything that came up around their patients' needs all day. Some nurses who are represented by unions might get some of these perks, but in most states, especially those deep red, "right-to-work" states, they don't get any extras.

During those long shifts nurses get progressively more tired, they get hungry, they aren't quite as focused and sharp at the end of a shift as they were at the beginning, or at the end of a run of 3 long days. They have to be on the lookout for physical hazards to patients, signs of a patient's conditioning worsening or deteriorating, making sure medication doses they give are correct, checking over the doctor's list of orders to make sure those are correct, tracking down physicians and ancillary staff, taking phone calls, interacting with family members, and things that happen without regard for a nurse's physical needs for food, bathroom, having a moment to clear their mind and think, or even getting off their feet to sit down for a moment.

And did I mention, responsible for the patient's life?

I think nurses should get paid a full-time, fully benefitted comfortable living wage for doing something on the order of three 8-10 hour shifts per week, so they have time to rest and recharge without burning out, so they can come to work able to fully focus on their patients' care. Yes I know this is a utopian dream, but I'm saying it because I mean it. Seriously.

3. "Nurses need to be able to do our jobs without sacrificing our physical or mental well-being. We need to see that we’re not stuck forever with only lateral options for career moves. We need to know that by advancing ourselves, we don’t have to sacrifice our integrity."

Nurses are subject to all of the emotions that any human being has. And we are working around some of the most vulnerable people in the population, as well as the stresses they bring in with them, that likely landed them in the hospital in the first place. Along with their family members and any other dysfunctional behaviors that they harbor in their everyday lives. And we often are on the emotional receiving end of those dysfunctions, when they are paired with fear and misunderstandings in regard to the patient's condition. We are subject to verbal and physical violence from stressed out patients and family members, as well as the internal, lateral and vertical workplace dysfunctional behaviors like bullying.

Nursing is a profession with a wide range of options for work, but within big healthcare organizations, the pyramidal nature of the hierarchy means there are few options for advancement. And more often than not, those with aggressive and less cooperative tendencies tend to move up the ladder, regardless of their leadership and people skills. Once they leave the bedside, managers are bound to serving the aims of the administration and no longer can prioritize their staff's needs.

Management is bound to keep administrative secrets and respond to staff concerns with carefully scripted messages dictated by the highest ranking administrators. Honesty is not always possible if a manager wants to keep the trust of the higher-ups.

4. "Keep your intellectual curiosity alive- don’t rely on dumbed-down, pharmaceutical and hospital industry-funded continuing education for all your career needs. They won’t help you go above and beyond. Strive to grow personally, strive to grow beyond the scripted, measured, limited status quo that keeps us stuck."

Attend any professional nursing conference and you'll see the vendor booths stocked with glossy, full color literature and trinkets from pharmaceutical companies, attractive marketing materials from healthcare organizations looking to recruit employees, and sponsorship logos and banners from industry leaders on every visible surface, screen, and object.

Continuing education is offered as part of the deal for listening to pharmaceutical companies tout their latest drug, so nurses only hear the industry side of things. They might get a nice dinner and a glass of wine too. They tell nurses the message they want them to hear, without any opposing viewpoints, critical questioning, or an explanation of the results of randomized trials that might lead one to question whether the thing they're selling is really as good as the profits they'll make.

Ever since I left the hospital setting, I've had much more energy and curiosity because I'm not so fried, and I read journals and medical and nursing newsletters, the latest research findings, I can seek out good continuing education on my own instead of having it fed to me passively. I've encountered a brick wall with my local chapter of my professional organization- I've offered on multiple occasions to talk with them about the work I've been doing, cancer survivorship topics, social media usage by nurses, and other ideas, and have been either ignored or told we can't afford to do that. Why? Because I'm not a pharmaceutical company with a budget to pay for a catered dinner and wine for a couple of dozen nurses.

Fuurthermore, speaking of professional organizations, nurse entrepreneurs with small businesses simply cannot afford to have vendor booths at these big conferences. The price per vendor booth is something like $3000. A small business cannot recoup that.

"We hear a lot about VALUE-based care these days, it’s one of those favorite buzzwords that the scripted bots of the healthcare industry love to hear rolling off their tongues. But healthcare won’t be successful unless those who deliver the care have human qualities to care. And exhausted, burned out, chronically understaffed nurses can’t care. Let’s start using value and care as verbs instead of nouns. How about if we VALUE nurses so we can CARE?"

I think this is self-explanatory.

"But most important of all- let's get back to value- each of us should think about what we value. We’re here for patient safety. We can’t live our values if we’re not authentic. When we know who we are, what we value, and why, we are grounded, and are less likely to be swept away by the strongest gust."

Hopefully this, above and below, is self-explanatory, too.

"If you take nothing else away from this rally, resolve to define your values around your work. Why did you become a nurse in the first place? What’s your number one priority as a nurse? Live and work in accordance with those values. Encourage your fellow nurses to do the same. Moral distress is not good for your health, or your patients’!"

"Patients and nurses alike, each of us only gets one life for sure. Let’s make sure each of us can live it fully."

Take it away, nurses...

Nurses Week Takeaways from DC Part I: Politics and Nursing

It’s Nurses’ Week again.

I'm going to write two posts of Takeaways from the Nurses Take DC rally in Washington in April. There's so much I want to say, I can't fit it in a single post.

For the first post, I want to go back to Pam Robbins’ presentation in DC, Ascend to Political Nurse Advocacy, because she pointed out so many important considerations for engaging all nurses in our cause. I am paraphrasing many of the statements she made and adding my interpretations here.

I’ve talked about some of these points in my book, Navigating the C, in regard to my experiences in healthcare, in an oncology nursing context, but it applies universally to all nurses, and all of healthcare. In my second post of Takeaways, I am going to incorporate some of what I said in my book along with the points I made in my speech in DC.

First, FEAR
Pam talked about fear being the biggest thing that holds nurses back. Part of it is the antiquated, unenlightened approach to thinking about gender and the roles we have associated with gender in the past. It’s time to discard those ways of thinking and be people. Yes, we have differences and that makes things interesting, but we are all first human beings.

Nurses MUST stop being martyrs and stop shortchanging ourselves with self-deprecation. If we want to be leaders we must overcome these fears, placing more value and believing in ourselves. Too many nurses are terrified they will lose their jobs for speaking up.

And I can tell you from personal experience, they will do everything they can, no matter how ridiculous and petty, to get rid of you do if you do. But if we don’t speak up, it means our patients’ safety is forever compromised. We cannot afford to risk their lives.

Nurses need to articulate our value to the public by getting out there, speaking to journalists, being interviewed, being visible on social media. We need to speak up in our professional organizations, who should also be involved in such matters, as unhappy nurses will not be as productive or influential in their careers.

Every professional specialty organization, such as AACN, ENA, ONS, AORN and so on, needs to take a stand WITH their nurses, instead of siding with those who will take advantage of nurses. The power gradient against nurses increases when our professional organizations do things that don’t truly help us. They may talk a good game but it is important for nurses to look closely at the policies they come up with.

That is why Nurses Take DC has offered similar but better legislation that works in nurses’ best interest. Working nurses should be in control, have more control, and right now, many professional organizations do not want to yield that. They mostly support industry interests and will back the administration’s interest over staff nurses. All you have to do is attend a nursing conference and you will see the disproportionate influence of pharmaceutical and hospital industry funding.

The fear extends beyond the workplace to participating and speaking within these organizations, too. Recently, I found it interesting that when I posted my reply to a post about the nursing shortage on the discussion forum of my professional organization, I only received one public reply. But I received several private replies from people, which tells me the level of fear is pervasive, to the point of not wanting to speak out even on these specialized forums.

If you’re one of the many (maybe majority still?) of nurses who say, I can’t lose my job, my livelihood depends on it, I have a family, a mortgage, my kids, or I’m a single parent, here is what YOU need to do.

• In the workplace, form a coalition of nurses so you stand together when you approach management with an issue. Don’t leave each other alone- have each other’s backs.
• You don’t have to necessarily be vocal in your workplace, either- you can be a nurse constituent and contact your legislators with your concern. Your employer won’t know about that.
• There’s Flo’s Whistle, and anonymous reporting tool for unsafe staffing conditions in an easy to use app.
• You can also become active in contributing and leading as a nurse in your community.

Here are some other practical interpretations I got from Pam’s presentation at Nurses Take DC.

Nursing Culture and Education
We need to start educating nursing students in both policy and taking political action. That is a tall order and a giant shift in the nursing school curriculum. Unfortunately, the abusive culture of nursing often starts in nursing school. Instructors exert their control over students and show them the ropes of the eat their young culture. Nurses need leadership skills and we need to start learning these early on in our careers.

Nurses can be, and have been, awful to each other. Nurses get so little recognition and expressions of appreciation. When there’s so little to go around, they fight over it, like a scarce resource, like dogs fighting over a bone. They feel constantly abused and taken for granted, and this feels like another reminder of just how insignificant they feel. It sounds like middle school all over again, and in many ways, it is. Stop it. Don’t be nasty. Grow up, act like mature adults. This applies just as much, if not more, to management. Leaders need to set examples, not be part of the problem.

Public Perception
Nurses need to learn how to stand up for themselves, to have a voice in their workplaces and in their communities, to be visible, audible, and persistent. The public does not have a realistic perception of what nurses do, how important we are, and our potential for stepping up our influence in public policy.

The Robert Wood Johnson Foundation published a report in 2010 based on Gallup opinion leaders polls conducted in 2009. Pam discussed some of the findings:

• While opinion leaders nurses are the most trusted profession, the same opinion leaders perceive nurses as having little influence over healthcare reform in the near future.
• Nurses are not perceived as important decision makers or revenue generators, and that we do not have a single (unified) voice on national issues.
• The public views nurses as functional doers rather than thoughtful strategists. We need leadership skills, and we need to start early.

Paternalism in Healthcare
Healthcare is not all about medicine and physicians. Nurses are the ones who keep patients safe and alive, during times when the doctor is not there, which is over 99% of the time. Really. If the doctor is there for 5 minutes a day when the patient is in the hospital, that’s only about 0.3% of the time! So nurses are watching you 99.7% of the time. And nurses check the doctor’s written orders to make sure that everything is appropriate and safe for the patient, and we correct them if they are wrong!

I really think we need to start changing the language around healthcare workplace relationships between physicians and nurses- doctors writing “orders” still sounds so paternalistic, as if they are ordering us around, like we are their handmaidens.

Doctors write a medical treatment plan, and nurses have a nursing care plan, so it should be referred to as something more egalitarian, that can be established mutually in the interest of the patient’s safety. They can’t exist without each other, and they are important, I would even say that without nursing care, patients would be in trouble if they only had the medical treatment. Because nursing care will keep you going even in the absence of medical treatment.

Politics
In our politically divisive times, we also need to make the case that this is not about being pro-union or anti-union, Republican or Democrat, red/blue or purple state- but it’s about issues that affect everyone.

One thing that I add is that nurses wouldn’t think of refusing care to someone because they believe differently or have a different political affiliation, we accept everyone as our patients and give them equal care. This issue is beyond political divisions. Every single person is a potential patient.

And every one of us are, also.

Apathy and Democracy are Incompatible
We live in a democracy, but few of us take full advantage of the power it affords us. As citizens, we have the right to vote and make our voices heard, yet only a small percentage of the voting-eligible public votes! Only a miniscule proportion ever get involved in the legislative process.

If you saw something being done to your patient that would cause them harm, you wouldn’t hesitate to stop it and speak up on behalf of the patient. But when it comes to our country, and public health, safety, and well-being, few nurses use their advocacy skills.

If nurses would think of our country as their patient, insist on only the highest quality care being given, and protect the public from harm, we would make great strides.

Takeaways-What we need to do
1. Lose your fear. It’s power in numbers, and by banding together, you can help each other deliver a stronger message. When a colleague expresses a need to change things, don’t treat them as if they were radioactive. Instead, get behind them, support them, and bring others on board.

2. Don’t downplay the achievements of your colleagues, don’t put them or yourself down. When someone is recognized for an achievement, it’s common for backstabbing, envy, and resentment to well up among those who feel even more diminished if one of their colleagues is being publicly honored. When we raise the profile of nursing through one of our colleagues’ work, we lift all nurses’ profiles.

3. Stop making it about political affiliations. This is about everyone, we are all potential patients. This is about the public’s best interest, all of us.

4. Nursing education must start preparing nurses with skills on political advocacy, negotiation, and articulating the value of our profession to the public. If we can get the public to understand what we do, and articulate that clearly, we can show that healthcare is not all about medicine and physicians, the holistic approach to nursing care is what moves patients away from illness and toward wellness.

5. Research by nurses should hold equal status to medical research. You can give all the medicine you want, but unless there is someone there to make sure they are being cared for safely and that medicine is administered properly, all the medicine in the world won’t save a life. It’s not all about medicine and physicians. Nurses are the ones who keep patients safe and alive, during the times when the doctor is not there (which is most of the time).

6. Look at the different nurse staffing bills in front of Congress. Both the ANA and Nurses Take DC bills are based on evidence, but unless you have regulation with staffing ratios in writing that holds the employers accountable, you have nothing. We must hold our employers, as well as our professional organizations, to account and transparency.

While they are similar in many ways, note the ANA’s bills (S. 2446 and H.R. 5052) do not include a mandate for employers to commit to a staffing plan for their employees, in writing. The Nurses Take DC bills (S. 1063 and H.R. 2392) do have such a mandate, with proposed ratios in different clinical areas. Employers would not be able to avoid the staffing plan mandate. This protects both nurses and patients.

For more information about the Nurses Take DC movement, visit http://nursestakedc.com

The next post will be about takeaways from my speech at Nurses Take DC.

photo credit: Andrew Lopez

(Note: a variation of this post was recently published in Oncology Nursing News)

Nurses Take DC 2018

photo credit: David Miller

Last week, I attended and spoke at the Nurses Take DC rally for Nurse:Patient Ratios Now in Washington DC April 25-26. The purpose of the event is to bring nurses together to support federal legislation: Senate Bill 1063 and House Bill 2392: The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017.

Why do I post about nursing and healthcare on my running blog? Because it is an integral part of my life. Running is what keeps me going, it provides my energy and recharges me for the daily work I do, especially as a solo community figure working directly with people who are going through the trials of the healthcare system.

All of my readers, no matter how fit and healthy, are equally vulnerable to an encounter with the healthcare system, whether through illness, injury, accident, or a family member's experience.

Every person is a potential patient, and it's important to understand what nurses do, the importance of nurses, and why nurses are taking to grassroots advocacy to further our agenda through the legislative process.

For too long, nurses have been deferential to a healthcare system that has treated them as second class and given us less respect when we can not be replaced- the healthcare system would collapse if we were not here. But those in power talk out of both sides of their mouth, while they talk about a nursing shortage, they have not shown the moral or political will to do anything about it.

Nurses' top priority, above all, everything we do, number one on the list, always and forever, is patient safety. You can give all the medicine in the world and use all the technology you want, but nurses are there to ensure that the patient is not harmed in the process of administering that medicine and coming through the healthcare facility where they are treated without harm coming to them.

No matter how sophisticated and cutting-edge the interventions are, no matter how advanced the medications are, there is always, always, always risk involved-potential for adverse effects, mistakes in the form of human, mechanical, or technological error, and someone has to look out for the patient, providing checks on the system from admission to discharge from the facility.

About six months ago I was contacted by one of the organizers, someone I knew only through social media. I was surprised and honored to be asked, as most of my advocacy work has been in the form of writing about nurse working conditions and their impact on the patient experience. I discussed it extensively in my book, Navigating the C, as it applies to cancer care, but the premise is applicable to all of healthcare.

After catching the shuttle to the Denver airport at 2:30 am on Wednesday, I arrived in Washington late in the afternoon, the day before the rally. It was raining. My hotel was the headquarters for the event. That evening I an education offering, called “Ascend to Political Nurse Advocacy”, presented by Pamela Robbins, MSN, RN.

Pam has long been active in political advocacy for nurses and quickly drew the audience in with her explanation of the similarities between the nursing process and the political process, to make it relatable to all of us. It was a useful toolkit all packed into less than two hours. I met many people I've only talked with o social media, including my friend Andrew Lopez, who has been instrumental in encouraging my progress from hospital staff nurse to nurse entrepreneur and advocate.

The first night I was exhausted from traveling and went to bed early. I was still catching up on my sleep from the Palmer Lake 24 Hour, and three hours of sleep before traveling added to my sleep debt. I knew I would see everyone at the rally the next day.

Thursday was a beautiful clear day, perfect for the rally. I shared an Uber with three other nurses to the rally. We were dropped off right smack in front of the Rayburn House Office building- where the House of Representatives offices are. Yes, where the power, money, and influence happens. There was a long line that stretched all the way down the street of mostly white men in suits, with name tags indicating the entity they represented, obviously industry lobbyists waiting to exert influence.

My immediate gut reaction was resentment- I wanted to tell every one of those suits how their money-backed influence was ruining democracy, but I was quickly distracted by my companions who pointed out the capitol building across the street and the fact that we were there on a beautiful spring day that you couldn’t have asked to beat.

I quickly forgot about the lobbyists as we crossed over to Capitol Hill. It was breathtaking, seeing the Washington Monument and the reflecting pool, and the white columns and dome of the legislative seat of power of our country.

There were about two dozen speakers, including legislators themselves- Representatives Jan Schakowsky and Luis Gutierrez from Illinois both made appearances and spoke.

Dr. Laura Gasparis Vonfrolio was the keynote speaker, she's been involved in the movement for more than 20 years and reminded us to raise hell. “If you don’t fight for what you want, don’t complain about your situation!”

As the speakers took the podium, their tone ranged from powerful and inspirational to exhausted and shell-shocked. The stories of some of the nurses who had been fired, harassed, and threatened for speaking out were both maddening and heartbreaking. It still strikes me as beyond the pale that administrators should be so fearful of nurses who choose to speak their minds, but it happens all the time. And that is why we’re here, to support each other so no one has to be fearful.

I felt that my speech went well, I included some takeaways for nurses to go back home for effecting change in their own communities. I will discuss those in the next blogpost. If you want to listen to my speech, it is here.

Nurse staffing ratios are critical, but there needs to be regulation of the hospital industry, because without mandates, they will find workarounds, and nurses will continue to find themselves understaffed and compromising patient safety.

I remember 2012, when some well-staffed hospitals, in the middle of merger mania, experienced notable changes in their attitude toward nursing. Where the independent hospital might have had top-notch staffing and support, as well as respect for nurses, nearly overnight, nurses were told the staffing ratios were changing, their benefits would dwindle, and older nurses started disappearing left and right. Nurses were told point-blank, if you don’t like it, you can leave. I left. Why should I work in a place where I’m not respected or valued?

As time went on, it became apparent to nurses that they were making good on their threats, and no longer valued us for what we brought to the workplace. They only wanted us to fill the staffing matrix, keep our mouths shut, smile, and nod as they nickeled and dimed our benefits and job satisfaction away from us.

And we are always told it’s our fault if we can’t multitask, that we can’t be in two places at once, or remember everything because we are doing the work of two nurses.

Nurses are asking for national legislation to hold decision-makers in the industry accountable, so that our patients are not in harm’s way when we care for them in a facility that is supposed to be helping them.

After the rally was over, Pam and I went to lunch at Union Station, which is an amazing building, where the Amtrak trains come through and the architecture is mind-blowing...we headed back to the hotel via the Metro, which I learned was not a good means of transportation for me. All the lurching and stopping left me seriously nauseated!

Back at the hotel, we had an after party with nurse humorist Terry Foster, who is hilarious. It was a chance to talk further with some of the organizers and discuss future action, as well as relaxing and getting to know a few people better.

Friday it rained again, and I had some time in the morning before I had to catch my flight, so I went to get Starbucks and then walked along the Mt. Vernon bike trail along the Potomac.

I posted a couple of videos on social media about my thoughts and experiences, and said goodbye to the people who were still around in the lobby of the hotel.

I headed back to the airport to fly home with a sense of empowerment, a tool kit, some great advice, and feeling much less alone. For me, the best part of attending the rally was the new friends I made- colleagues who share my passion for making change, ready to work hard and not give up, willing to go back home and spread the word, bring more nurses along next year, and help others lose their fear.

I learned about turning your concerns into political action and how nurses can effect change in our profession. Despite what you might think about political divisions, apathy and fear are truly our biggest enemies. Here is a link to the House Bill 2392 sponsored by Rep. Schakowsky.

We can use technology to our advantage when talking to legislators, because there is new app called Flo's Whistle that helps report unsafe staffing conditions by legislative district. Nurses can show their representatives in Congress what is going on in their districts and they'll have data to back it up.

My next post will be about Takeaways from my speech to the DC rally, to keep nurses motivated and focused forward all year. For more information about the Nurses Take DC movement, visit http://nursestakedc.com

Transcript of my speech from Nurses Take DC 2018

I am honored to have been asked to speak here today, thanks to the Nurses Take DC organizers for the invitation. I want to make this short but not sweet. There is no sugar coating why we’re here. I want to suggest some ways to kill two birds with one stone in our own communities- back home, wherever we all came from.  We can solve the nursing shortage AND create safe staffing for patients by living up to our values around nursing care. But first, I want to tell you a story.

When I left my hospital job they didn’t give exit interviews. They didn’t care what their nurses thought of working there- what experiences led to their leaving- or how they might have done better to retain that nurse. There’s a lot of talk coming from above about shortages and retention, but no action. You’d think they’d want to find out how to keep us around- right?  How can you expect to retain employees if you don’t find out why they are leaving? 

Well I finally got my exit interview. Six months after I left, completely by chance, I ran into my old CEO- I was coming out from my mammogram- and ran into him in the hallway at that exact moment. I grabbed his ear (so to speak) and we went out in the parking lot and that’s where I had my exit interview.

I had to explain to him the difference between a leader and a ringleader. Because that’s what management was at the hospital- ringleaders. And you know some of our professional organizations use that same style of leadership. They have so little respect for us, value nurses so little, that we are just another production unit… it’s such an inconvenience that we cost money to train and replace. Gets in the way of profit. 

When leaders don’t act in our interest, and their actions don’t match their words, it’s time to get new leaders!!

These hospitals are built with mortar mixed with blood, flesh, sweat and tears, even lives, of patients, and also nurses and physicians. (If you don’t believe me- watch Dr. Pam Wible’s documentary- Do No Harm- about physician suicides- but physicians aren’t the only healthcare professionals who kill themselves.) We work ourselves to bone-deep exhaustion while executives sit in their suites, dining at nice restaurants and playing golf at 5-star resorts at their ACHE meetings. They have second homes, while we get second jobs to make ends meet since our nursing job doesn’t earn us a comfortable living.

They ask us to be responsible for the lives and safety of our patients, and document everything so they won’t get penalized, while we can’t even go to the bathroom, eat lunch, or finish two nurses’ work in one 12-hour shift. Every time we are understaffed, we are doing the work of two nurses. Or more.

They have no idea what they are asking of us. Have you ever had an executive shadow you for an entire shift? Have you ever tried asking them to?

So…The million dollar question is NOT, “Thank you sir, may I have another?”

It is, “How do we solve this mess?”

I don’t know why so many nurses sit behind the nurses’ station whining about work but never do anything about it. I know I’m preaching to the choir here. The point is, we have to do more. Let’s make nursing a career worth keeping!

So here’s what I want each of you to do, myself included.

I want you to go back to where you came from and convince at least one of your colleagues to get off their butt and do something about safe staffing- grow a pair, say something, step out of their comfort zone and take a risk. Then…

I challenge each of you to have three conversations this year, out of your comfort zone. I want you to talk with that nurse colleague, and a physician, and with someone in administration, preferably an executive. I want you to find common ground with them as a human being and have a conversation. Break the ice by asking them, what is the most difficult part of your job…  Let them know you’re interested in what they have to say. And then… creatively propose a way to start solving the problem of safe staffing. Together. Follow through. Commit.

When we have those conversations, there are a few points I want you to take away, remember, and use.

1.     There is a difference between safe staffing to avoid sentinel events and staffing that is adequate to improve a patient’s health after being hospitalized or being treated in a healthcare facility.

2.     Today’s nursing jobs are not the equivalent of a regular desk job. They shouldn’t be compensated like a desk job. Hour for hour, we put in a lot more work and have a lot more responsibility than your average paper pusher. It beats us up, physically, emotionally, spiritually. 36 ≠ 40! Think about that.

3.     Nurses need to be able to do our jobs without sacrificing our physical or mental well-being. We need to see that we’re not stuck forever with only lateral options for career moves. We need to know that by advancing ourselves, we don’t have to sacrifice our integrity.

4.     Keep your intellectual curiosity alive- don’t rely on dumbed-down, pharmaceutical and hospital industry-funded continuing education for all your career needs. They won’t help you go above and beyond. Strive to grow personally, strive to grow beyond the scripted, measured, limited status quo that keeps us stuck.

We hear a lot about VALUE-based care these days, it’s one of those favorite buzzwords that the scripted bots of the healthcare industry love to hear rolling off their tongues. But healthcare won’t be successful unless those who deliver the care have human qualities to care. And exhausted, burned out, chronically understaffed nurses can’t care. Let’s start using value and care as verbs instead of nouns. How about if we VALUE nurses so we can CARE?

But most important of all- let's get back to value- each of us should think about what we value. We’re here for patient safety. We can’t live our values if we’re not authentic. When we know who we are, what we value, and why, we are grounded, and are less likely to be swept away by the strongest gust. 

If you take nothing else away from this rally, resolve to define your values around your work. Why did you become a nurse in the first place? What’s your number one priority as a nurse? Live and work in accordance with those values. Encourage your fellow nurses to do the same.  Moral distress is not good for your health, or your patients’!

Patients and nurses alike, each of us only gets one life for sure. Let’s make sure each of us can live it fully.  Thank you.

What Needs Fixing!

Speaking of things that need fixing, it's Nurses' Week.

Don't EVEN get me started, because that's not what I want to talk about.

What I do want to talk about is the awesome performance by John Oliver (see video below) the other night talking about the mockery and entertainmentization of science.

This is the thing that gives me fits, day in and out, as a healthcare professional. But it applies to running too!

Cancer is one of the most heavily affected areas of commerce and research when it comes to bad science. There is more misinformation than good information, and it's a uphill battle to fight it. I hate the battle terminology around cancer. I am using "battle" in the sense of beating back the onslaught of scams and pseudoscience that prey on fearful, vulnerable and desperate people.

This applies not only to healthcare but also to anything- these trends that come and go, the popularization of things like supplements or products or running shoe designs, running techniques, what an elite runner swears by so everyone follows along regardless whether it is backed by evidence or common sense, like a bacon diet or running with one eye closed.

Here's what I thought after watching John Oliver.

The problem is that the meaning and purity of science have been diluted by a “science as entertainment” approach in the media. Since everything in the media is based on selling-, which is attracting viewers for advertising, they are going to use sensationalism and eye-catching headlines.

There is no integrity in what they report. And this lack of integrity extends to the people who are putting out press releases that reach the wrong media outlets.

It’s one thing for knowledgeable readers who understand the meaning of “a study”. But the lay public does not. And this has led to the dilution of and confusion of important information, and no one knows what to believe, as Oliver points out so perfectly- cherry picking what you do or don’t want to believe.

And that is what is so frustrating- for health care providers and for people who are trying to provide good information- it gets diluted and washed out in the tide of pseudoscience.

Like the whole gluten thing. People just deciding to be gluten-free because they heard or read somewhere that it's bad. Then a gazillion "gluten-free" products and services become available, and everyone jumps on board, whether or not they understand it. Then you get a bunch of contamination, and the people who truly need to be gluten-free (those with celiac disease), are hurt by it. And the people who don't need to be gluten-free end up enriching the coffers of those who sell the product without any demonstrated benefit to their health.  

Oliver goes on to explain that repetition of a study, having enough subjects, stringent methodology, being published in a peer-reviewed and edited journal combined with the lack of funding for research and the pressure to produce results that are provocative or will sell things, create a problem for the quality of the research that creates a body of evidence.

Then we hear about agencies making decisions based on political appointments, or ties to industry, or other means of corruption. And people are not science-literate enough to understand the difference between scams and real science, and they only know to listen to the media entertainment version, so the most provocative-sounding, attractive, entertaining, and eye-catching content is going to catch the viewers' and customers' attention instead of what is science.

How to solve the problem? Do we place stricter standards on what can be told to the media? How do you stop a train with no brakes? There’s no regulation or control over what happens to the information.

My preference would be to educate the public and increase their science literacy. But our education system is suffering from similar problems: lack of funding, and people who don’t understand what happens on the application, human-interactive level making the decisions. Just like in healthcare.

When it hits them in  the wallet, people do seem to understand. So perhaps showing them the kind of mistakes they could make and how much it could cost them would help.

What we really need is critical thinking. People, whatever divine being you believe in, or not, gave you a brain, so use it. Damn it.

 

Gone Postal!

Lately it's been getting to be too long between posts here. Sorry.

I've been busy. Suddenly got an uptick in interest in my business, and I've been trying to become more of a social media butterfly, which doesn't come naturally to my introverted self. I have been scrambling to get a lot of work done while I still had my student around. She graduated this weekend.

Life's been pretty boring from a running point of view, but I feel like there aren't enough hours in the day when it comes to work and getting my workouts in. I did manage to get over 70 miles on my feet this week, but only about half of that was running.

I spend a lot of time walking these days, doing my brain crunching exercises. Most of the work I'm doing now requires a lot of thinking and creative ideas, and I do that best while walking.

I am considering doing a long run next weekend, it could be some creative adventure but I haven't had time to think about it. So it will probably be unannounced until I post about it.

Nurses' Week
I've had some fun too. It was Nurses' Week and I wrote an opinion piece in the local paper. So nice to be able to speak freely. I got a lot of positive feedback via email and private messages after that one. Just another indication of how fearful nurses are.

Going Postal

I've been entertained, sadly. I hope none of my readers are postal employees who are genuinely good people and hard workers. Unfortunately there are a bunch who give y'all a bad name.

Maybe I shouldn't laugh at this, but we have a community mailbox in our front yard. About a week and a half ago someone left a note on the outgoing mail slot saying that mail was not being collected. "Mailbox broken" written in sharpie on a post office slip.

After we didn't get any mail for three days, and none of the neighbors were getting theirs either, I called the post office. It took four different numbers before I actually spoke to a human being. Then the human being gave me another number to call, which lead me to a dead end.

It was a voice mailbox, but the greeting said no one is checking this mailbox. Hell of a lot of good that does! So I called the human being again, who reluctantly gave me the mail carrier phone number at our post office.

I called the carrier line and they told me that the lock on the back of the box was broken and our mail was being held at the post office until the box is replaced. I asked how long it would be. "Could be a week, could be a month. They have to come up from Denver to fix it."

Helpful. I asked why no one had informed us that this was the situation and she didn't have an answer. All we got was a notice that the outgoing mailbox was "broken" but no one left a note about the incoming mail.

A week ago Saturday early in the morning I decided to brave the line at the Post Office. It felt like I wandered into the Zombie Apocalypse. They have blank looks on their faces, and only speak to give expressionless greetings. All that's missing are blood and brains. There are four people working behind the counter, a line out the door, but only two are serving customers. The other two don't even look up from their gaze at the desk or whatever they're doing back there. One of them was sitting there working on passport applications.

Don't they have the sense to go in the back to work on that so people don't feel like they are being ignored? I guess customer service is a concept that is completely unheard of.

When they walk back to fetch somebody's mail, they move at a snail's pace. Someone needs to give these people a racewalking lesson. They obviously do get paid by the hour, in a very protected job, and it shows.

Just when I got to the front of the line, the customer in front of me had paid for something with a check. He filled out the check and put the amount in the little box, signed it, but didn't write the amount out on the line. The doofus postal worker looked up in my direction with a blank stare on his face, and said, "That guy didn't fill out his check." He looked around, as if asking for divine intervention. I said, "Did he sign it?"

He looked down at the check. "He signed it, and he put the amount in the box but didn't write out the amount on the line. I need to go ask my supervisor." He turned around and high-snailed it, like he had lead orthotics in his shoes, to the unknown territory of the giant back room.

OMFG.

Requirements for postal worker counter employment:
1. No independent or critical thinking skills, or initiative
2. Emotional intelligence= ZERO
3. Slower than dog snot
4. Personality of a piece of discarded gum on the sidewalk

And they love to wait on the customer in front of you, get finished, then walk away without making eye contact or saying anything. So you have no idea if they are coming back, or if it's down to one worker serving a long line of people waiting.

Finally the guy came back and called out an emotionless "Next." I felt like I was in the line for the Soup Nazi.

By the time I walked out of there, I felt like this.

I think I'll just pick up my mail once a week until this is over. It's too creepy and unpleasant in there.

I called one more time to the carrier line to find out if they had an ETA on the new mailbox. The following Wednesday, this sign appeared on the front of the box, with the dead end voice mail number (I checked again). Oh so helpful.

So we're in mail limbo, until who knows when.

Iris's 14th Birthday
Last Wednesday was Iris's birthday. She was so happy to be the queen for a day. Not that she ever is anything less than a princess. I baked pupcakes and we had a little party for her with the student I've been working with. She and Iris have become quite fond of each other over the past semester.

Iris got a new orange Frisbee. She has the energy of a dog half her age. I'm so lucky to have these two around after 14 years and still doing so well. Every day is a celebration with them, from butt rubs first thing in the morning to cuddling at night in the bed with us, and all the walks, singing, dancing, playing, talking, chasing, spying, and begging in between.