Never Trust a Teflon Suit and Other Truths about Corporate Healthcare

Hi, my name is Alene and I’m in recovery from the U.S. corporate healthcare system, after another relapse.

The latest relapse was around my husband being forced out of his job where he's been working for twelve years. He did find another job, in a different line of work but still in healthcare, on his own terms, and our lives will be much improved for it, despite nearly a fifty percent cut in pay. But this see-through scheme is becoming all too common for people nearing retirement age.

With barely seven years to go until retirement, and 30 years of experience in the same line of work, and 18 with this particular company, he got the typical corporate healthcare tactics foisted upon him. This shit is so transparent it's a joke, I can't even believe they think these tricks will work anymore.

Side note: For those of you who aren't in healthcare, one new vocabulary word for you: HCAHPS. It means Hospital Consumer Assessment of Healthcare Providers and Systems) and it is THE HOLY GRAIL, the Pope's ring, the GOD of corporate healthcare executives. It is their raison d'etre. It is their data orgasm. It isn't everything, it's the ONLY thing. Also known as "patient satisfaction" scores. It's as if the currency used in the industry has been changed from dollars to HCAHPS. (All about the Benjamins, baby.)

You know, the one where they drop little hints about outsourcing if the HCAHPS (patient satisfaction) scores don't come up. Then the personal snide remarks, "You've changed". Then the one where they suddenly blindside you and kick you below the belt with all the things you're doing wrong, "Do you even know how to do your job?"

And they pretend like they are going to "help" you, via the "performance improvement plan". Which is a way to start gathering data to be used against you at the time it's convenient for them to fire you. But instead of following through, they leave you hanging- no specific timelines, measurable improvement points, or what exactly it is that you're doing wrong. When you try to pin them down, they squirm out of it with vague mumbles "four to six months".

Four to six months of what? Until they fire you? Or until they outsource the entire department? Or until they can find someone to take your place who isn't at the top of the pay scale?

They say they are going to "help" you, but when those meetings are supposed to occur, suddenly they become unimportant, forgotten, or pushed aside.

If you've been working in the same job and place for 12 years and no one has ever had a problem with your interviewing style and your hiring methods and your patient satisfaction scores and then all of a sudden they are- there is an ulterior motive. Especially when your past evaluations haven't reflected any of these things.

And then the barely 40-something snot-nosed, suck-up, little suited asshole who "worked" his way up the teflon corporate ladder-like an endoscope works its way up your colon- he can't even look at you in the eye, as he makes the decision to axe you.

And does it using the convenient excuse, the tool, of HCAPHS scores not high enough, that means smaller bonuses for the snot-nose and since he only makes more money in a year than you've made over the entire decade-plus duration of your time there, that would be really fucking traumatic for him. One less vacation home at a ski resort. The horror.

Infection control? Patient safety? People skills? Attention to detail in these things? No, not good enough for the snot-nose. You gotta have that arbitrary HCAHPS ranking. Why? Because HCAHPS data is GOD, so says the god of corporate healthcare.

Are the snot-noses really that important that they can throw away other people, on a whim, deciding someone has no value- basically saying they contribute no value to the organization and discard them like a piece of trash?

The feelings people experience when subjected to this sort of behavior- the dehumanization, the lack of kindness, appreciation, gratitude, empathy, or fairness, show that the corporation is a machine- as lightweight, yet profit-heavy, as possible.

Why can't executives be honest and straightforward, without eroding trust and someone’s self esteem. How about, “We appreciate that you’ve worked hard for us and sacrificed time with your family for ___ years. We have made some decisions that are going to result in us eliminating your position. Can we help you find another job?”

It's not THAT hard.

Secret Initiation Rites of Corporate Healthcare Executives (not including the handshake)

I am convinced that in the secret initiation rites of corporate healthcare executives, there is a test, and here's a sample question from that test:

Q. Just say, for example, it takes a certain amount of time for a chemical to do its job to thoroughly achieve its disinfection capacity, and the organization has chosen that chemical for the purpose of disinfection because there is evidence for its effectiveness, and is within the budget. The evidence came from research studies allowing the chemical to sit on a surface for a given amount of time. But that amount of time is longer than you are willing to allow staff to take to thoroughly clean a hospital room between patients, and since you, the snot-nosed executive, insist that they go faster and give them fewer staff to work with, then you have to choose between several options: (make sure you pick the right one!)

A. pay for more staff,
B. find a different, faster acting chemical if there is one within your budget,
C. shut the fuck up and let them do their job,
D. face the consequences of a higher infection rate, or
E. pressure the managers of all departments to make their nursing and support staff work harder and faster with fewer people and resources, expect the entire organization to turnover hospital beds faster than the amount of time it takes to thoroughly disinfect, and if anything goes wrong, blame junior management.

The correct answer is________. (fill in the blank)

There are some ugly truths in the corporate world and not only are they getting worse, they are being encouraged by a culture that ignores individual contributions in favor of monetary and tangible wealth-building units of currency. There’s a laser focus on whatever measure translates to more dollars and profit for the organization’s top tier. It is enforced by people hired as pitbulls, masters of deception, and compliant, robotic drones. No one is safe.

The worst thing about it, is that ultimately, it’s the healthcare “consumer”, the patient, who suffers, as well as all members of their community.

The people in a community who provide the labor for a healthcare organization, regardless of the level of skill or status in the healthcare system, are human beings first. They have lives, families, emotions, needs, and are connected to a community. As human beings, they also have basic rights, that seem to be getting encroached upon incrementally, as our democracy has declined into oligarchy and our wealth distribution has become more extremely unequal.

This has been a really hard post to write because my emotions have been so tangled up and so many feelings around past experiences of my own have been triggered by this.

I’ve worked in academia where there was a boys’ club. I’ve worked in the business world where there was sexual harassment. And I’ve worked in healthcare where there’s an insidious current favoring those who don’t question, simply comply, and sacrifice their entire lives until they are physically and/or mentally broken, then discarded.

I think they’re all reprehensible, but healthcare is completely out of control and it’s the industry that directly impacts whether people live or die.

None of this is a new discovery, these are things we’ve known and understood, and quite consciously, for a long time. We’ve been living in the United States our whole lives. It’s just that over time, things in the working world seem to have gotten a lot more ruthless and anti-human. There’s a complete lack of acknowledgement and appreciation of the value of individual human beings and what they bring to the workplace.

Two Things On My Mind

One is people’s basic needs, and another is human rights. I’m going to talk about Maslow’s hierarchy of needs and the Universal Declaration of Human Rights, not because these are perfect models or documents, but because most people are at least vaguely familiar with them, or have at least heard of them.

When I talk about human rights I am quite aware that no one is being coerced to work in these increasingly abusive situations, but there are very few alternatives if you want to work in nursing or the healthcare discipline in which you were educated and trained, and the mass exodus of nurses and ongoing nursing shortages are a direct consequence of this abusive behavior on the part of administrators. People do have a choice to leave, at great personal financial peril, but they can leave freely if they want to. But think about what people need in the U.S. to maintain a certain standard of living.

If you think about a visual model of Maslow’s Hierarchy of needs- there are three levels, all of which start from the bottom and build into a pyramid. Basic needs include the physiological safety and shelter needs, Psychological needs include belongingness & love and esteem, and at the top are self-fulfillment needs, also called self-actualization.

Look at the universal declaration of human rights and you will see throughout the document that there are multiple instances of violations here in the United States with regard to everyday life and especially in these healthcare workplaces. Look carefully at Articles 24, 25, 26, 29, 30. Then think about how corporations treat their employees. I think in the U.S. workplace we are coming dangerously close to practices, that in a setting without choice to freely leave, even in the face of financial ruin, would be called human rights violations.

Some of the language in the human rights declaration includes phrases such as:

• act toward one another in a spirit of brotherhood,
• no person shall be subject to...degrading treatment,
• freedom of political or other opinion,
• all are equal before the law and entitled without discrimination to equal protection of the law
• Everyone has the right to freedom of peaceful assembly and association
• Everyone has the right to economic, social and cultural rights indispensable for his dignity and the free development of his personality.
• Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.

It seems that in this country, we’re toeing the line on human rights violations in many ways. Making a profit is not a basic human right, and really, if it means you have taken away from someone else’s ability to fulfill their basic human needs, that's not good. Not cool. No bueno.

I propose ending the declaration of human rights with something to the effect of: The right to profit should not supercede anyone’s basic needs, abuse their psychological well-being, or violate their human rights as stated above.

And we need to have a new code of ethics around business operations in this country. Because most corporations are ethically challenged to the point of being out of control.

Think about this, for example: in a healthcare organization, employees pay the same for their benefits whether they earn $12 an hour or $500 an hour, as CEOs do. That is not right, either. Since we don’t have universal healthcare and employers provide private insurance for many working people, they should also consider that there is a gap in affordability and apply a proportional deduction from paychecks. Then healthcare would be a real benefit, helping the lower paid employees avoid a poor tax on their health insurance.

A Few Solutions

So let’s look specifically at a few of the places we could make improvements. This is just a tiny list- my wish list is massive. Corporations and big business should:

1. Be good citizens-take responsibility for the communities they impact. Pay full taxes, nonprofit status is not allowed to be exploited. No more disguising profits as expenditures.  Stop outsourcing, cutting jobs without taking care of people they displace or push out, no matter how much they have given to the organization. Be mindful that these people have families who have also been impacted by the employees' sacrifices and will be impacted by the displaced workers' status.

2. Eliminate golden parachutes and "special" status for executives. If you leave for another job, you get your last paycheck from the old job, and then collect your first paycheck from the next job. No more padding in between. All benefits should be equally distributed and should not disproportionately cost lower paid workers more. No VIP treatment if the CEO or family members get sick. They get treated the same as any other patient. No picking their nurses, no special accommodations, no altered staffing ratios for that purpose.

3. Be transparent about the organization's plans and practices. No secret meetings or huddles, have representation of all levels of workers in decision making and on boards. No surprises for the masses.

4. Be banned from using money to influence the political arena- no more lobbying to protect self-interest and industry interest.  Stop union busting tactics, stop using deterrents to organized labor.

Some takeaways:

1. Old ideas of retirement and planning for it are no longer applicable. You need to assume you won’t live up to your full earning potential in the last 10-15 years before retirement, and most likely will be making less money at that time.

2. Don’t put up with abuse from your superiors at work. Fuck them. They have plenty of excuses and they’ll use every last one. Be brave, get out. If you live a "middle class" lifestyle, you can figure out a way to get by on less.

3. Their game is to pull in as much money as possible, cut costs and minimize risk to the organization, no matter what, even if it’s detrimental to patient and worker safety.

4. Healthcare is neither. In this profit-obsessed industry we have lost our humanity, and our ability to care. And that’s not healthy.

5. Your job is a job. It is a tool to bring you financial assistance in addition to contributing to society and furthering your own self- actualization/esteem. It is not something that should hurt your health or where you should sacrifice beyond a reasonable workday. And you should be compensated fairly for it. You should do the work of one person, staying reasonably busy for 8 or so hours a day. Not 12 hours. Not 7 days a week. Not for a period of time that does not allow you to do the basic things to take care of yourself and your health- eating, sleeping, seeing your family and caring for your own and their needs, rest time including mental rest. You should not feel threatened that you will lose the roof over your head or not be able to feed yourself. You shouldn’t be coerced into working more hours or taking on two or three people’s jobs.

6. I am unapologetic to those who somehow think the corrupt and distorted market can fix itself without regulation. Or to those who think that if you’re poor it’s your own fault and all the other lame excuses about pulling yourself up by your bootstraps.  I look at the rest of the world and the countries where they care for their people and don’t let them slip through the cracks, have socioeconomic safety nets, and provide universal healthcare. They have a better standard of living overall because they don’t have the wealth disparity that we do and people are cared for from birth until death and there isn’t the degree of extreme poverty as we have here.

7. No corporation should have the power to impact communities and individuals’ lives in this way. We need to get money out of politics. And we need a rebirth, reinforcement, and then actual enforcement, of antitrust laws.

8. We need to stop our addiction to wealth, fame, money, and power. We need to reform what’s become a national culture of shallow, lazy, self-absorbed, materially-obsessed, apathetic people. If something doesn't affect you directly, that's not a pass. You need to see yourself as a citizen of the community, your country, and the planet. What affects one person affects us all. When one person suffers injustice it impacts everyone. That bubble you want to keep living in, pretending like it's someone else's problem, is really the walls of your rectum. Get your head out of your ass. And once you pull it out, get off it and do something for the good of humankind.

9. Then, and only then, will our lives will be so much better and so much less stressful. And this country and world will be worth living in.

Social Conscience...Wake Up and Smell the Autumn Roses

I don't have much running news to report since I'm into my taper. I had some enjoyable runs over the weekend because I was accompanied on Friday by Emma, on Saturday by Laura, and on Sunday with the Fort Collins Running Club for the annual fall club breakfast and run where we elect board members.

The Fort Collins Running Club happens to be a nonprofit, or not-for-profit, as we say now. And that is an important point. The Fort Collins Running Club truly does use it's proceeds to benefit the running community. No one makes any money off the club. It is purely for social benefit.

Not for profit means that the purpose of the entity is not to make a profit. The purpose of the organization is something other than making a profit. That doesn't mean it's a charity.

But organizations with nonprofit status often do make profits and enrich certain entities within their ranks, namely, people. Rather than go on too much about that, I'll get to the point.

I don't normally write about sports other than running, but this whole deal with Ray Rice and other domestic abusers in the NFL has me thinking about all of the questionable activity and abuse that goes on, not just in professional sports organizations, but in other so-called not-for-profit entities. As far as I'm concerned, I think the NFL should not be allowed to be nonprofit. Their main purpose as far as I can see, is to line the pockets of too many overpaid criminals and sociopaths within the ranks of the organization, from football players to owners. Same could be said for many other "professional" sports.

The good ol' boys club makes excuses and defends their members who get away with whatever they are able to hide, and often they don't even need to hide it.

Something happened the other day that got me thinking about nonprofits. I was out and about in town, distributing some flyers for a cancer exercise support group I'm starting. I'm doing it with the help of a local athletic club, they are donating the space and materials, and I am facilitating the group. Neither of our businesses are making a cent off of this. The only monetary benefit to either of our businesses is if someone joins the group and decides they'd like to either join the health club as a member, or hire me for private coaching services, but there is no obligation to do this in order to fully participate in the group.

There is no cost to join the group, we are not charging anything, and neither of our businesses have nonprofit status. However, we are offering it for the benefit of people in the community, to improve their health and well-being at a time when they need help.

As I was out distributing the flyers, I'd go into coffee shops and other places with bulletin boards and ask if I could post my flyer. 95% of the time, the answer is yes, sure. And many of the people I spoke with in the businesses were supportive of the idea of the group and even thanked me for doing something like that.

However, there were a few who said no, or "we have to think about it", their reason being, we only post flyers for nonprofits.

Fair enough. I can understand that if every business tried using their boards for marketing, they'd be inundated with garbage on their walls.

However, two of the entities who said no were Starbucks and the local public library. Starbucks has it's own policy and they are a privately held business so I can understand that, but when I looked at the other flyers on their board, there were several that I thought didn't fit the nonprofit category, for example, an author trying to sell a self-published book.

With Starbucks trying to promote itself as a socially conscious company, I just felt that something offered free to benefit the community in this way would be more appropriate for the board, but that's Starbucks' decision. Even though as two small local business doing something for the community and regular customers of Starbucks, maybe there would be some consideration, in light of the author flyer up there on the board. I let it go.

At the public library, however, you would think they'd want to promote community health. We are two small local businesses. If the big healthcare organizations in town, which have nonprofit status, put similar flyers up with free offerings for community health, there wouldn't be a problem. However, those organizations rake in multimillions of dollars in PROFIT each quarter. Yes, PROFIT.

Yet the people at the tops of these organizations often have very exorbitant salaries and benefit packages while they skimp on the bottom of the organization, namely, the people who do the work. The top brass ask them to work harder and harder for less and squeeze them, they lose jobs and livelihoods when staffing is cut to reduce costs, when those at the top have no worries about paycheck to paycheck subsistence. If they get fired, they have a golden parachute to a new multimillion dollar salary.

Then we have the recent issues with health care IT security. Computerized systems at health care organizations throughout the country are being breached by hackers. Personal, private information is being stolen. The big organizations that claim their clients' information is protected by HIPAA are now soiling their shorts to stay ahead of the law.

All those expensive consultants they hired to help them adjust to the demands of health care reform somehow conveniently ignored the costly legal expense of protecting their electronic health record systems in their rush to grab money. Security is expensive, but somehow these smart guys forgot to include that little detail. Funny how that works. And when these organizations have to start spending megabucks on security upgrades and experts, guess where the costs will be passed along?

The consumers. Yes, you and me.

If we would invest in the needs of the people, instead of the wants of a few criminals and sociopaths, maybe we could justify having nonprofit professional football leagues and health care organizations, that generated money for real health, education, and addressing poverty.

All I have to say is, think. Wake up and smell it.

Just saying...

Oligarchy Meets Theocracy...

And they didn't use birth control, so now we're living with their offspring.

Wow, Supreme Court men, thanks a lot from the women of the country. We appreciate that you hold the gender majority in the highest judicial branch of government, when the majority of the population are women. We appreciate that you don't consider the precedent you've created when your job is to carefully scrutinize your decisions in light of the precedents they set.

This is a wart that's grown out from the Citizens United decision, and it's destined to get worse, now that you've given fodder to every corporate religious zealot out there who wants to impose their beliefs on people's personal lives. Corporations clearly now have religious beliefs, because they are people. Freedom of religion doesn't mean freedom from religion. I really wonder these days why we have a first amendment at all. The media have been weakened as a force to protect citizens, and corporations use their balls to duct tape over anyone's mouth who points out their corruption.

The Voting Rights Act, Title IX, and EEO laws are being regularly eroded and abused by corporate bullies and their lobbyists. The Good Ole Boy network is alive and well, and so is white supremacy for that matter. We are still struggling with recognizing non-heterosexual people as worthy of full status as equal human beings. We go back and forth in a tug of war and never seem to make forward progress.

We need to get rid of Citizens United before it completely erodes anything left of our rights as citizens, and in many cases, our human rights. I'm not sure if we've completely lost any hope of ever taking the government back from the 1%. There is a group that's organized to raise money to get rid of Super PACs. It's a grassroots effort and in this country grassroots efforts don't get nearly as much traction as big corporate-backed muscle.

I am trying to live off the corporate employment grid as much as I can, but it's difficult, and to say that I am is hypocritical since my significant other works for a big corporation.

Not really sure how much more I will say about it. Because I could go on forever. I'm not really that surprised. Just disgusted.

Snark Alert! Nursebots' Week: Humanity is a Doormat

lion image credit: Nathan Nitzky

We now interrupt our regularly scheduled programming for this important public service announcement:

Readers, consider yourselves forewarned: You knew I couldn't possibly make it through a Nurses' Week keeping my mouth shut. So here it is, my thought for the week...

I haven't been on my soapbox about health care in a while, but this is a time of year that always lights a fire under my butt. I'm not having to deal with it directly anymore, which has done wonders for my physical and mental health, but I have many friends and colleagues who are still being rocked seasick on the tsunami of health care reform in the age of corporate dominion.

You've read my other posts and rants about nursing, I've said these things before, as have so many other people. Here's my take this time.

Patricia Singleton's excellent blog about abuse and healing from incest has much that is applicable to the corporate workplace. In a recent post she was writing about healing and educating, and stopping the abuse.

She writes, "It is through silence that...abuse has been allowed to continue and flourish for so long and become an epidemic in our world."

She further states, "If we don't educate people, who will...Abusers thrive in the silence. They count on the silence of those that they abuse. They count on the subject to continue to be taboo in society. The silence gives them free reign to do what they want. I refuse to be silenced again."

Workers are scared, they want to keep their paychecks, they have seen how the system handles dissent or differences of opinion. Retaliation is rampant, I experienced it the minute I opened my mouth. When the powers that be don't get blind allegiance and compliance, they do things to try to get rid of people. They threaten them with unsavory working conditions and force them to quit.

Someone has to talk about it, former coworkers tell me the old trick of writing letters doesn't seem to get any traction, and these people are so exhausted and defeated that they have no hope that their efforts will work. Conditions keep getting worse. Staffing won't get any better thanks to the dumbasses at the top, who cut regular staff and then have to hire expensive travel nurses to replace them, so that they can slide their Teflon-coated tactics just under the wire of getting dinged for dangerous work conditions. On what planet does this make sense?

The privileged and tone deaf executive class's planet. To be a fly on the wall at an ACHE conference...

It's outright abuse of health care workers. But it's part of the big picture of what we're doing to people everywhere in this country, the old, over-repeated story of the rich getting richer and the average people getting squeezed to death. People accept it because they feel powerless to change it, because they are too exhausted.

It's not a "caring profession" like the nursing school instructors tried to impart to us in their pathetic attempt to sell us a line of bullshit. Nursing schools are part of the problem, they keep the dysfunctional cycle going.

What kind of caring profession allows it's members to be lucky to make it through a work day without making a mistake? Who can care when they don't have time to look at the patient because there's so much charting to do? Not being able to take time to pee or eat for a 13 hour shift? Throwing pills in front of the patient and running out of the room? Clocking out and working for free after 12 hours because you didn't have time to chart everything but you'll get in trouble if you go into overtime?

I ran into a former coworker from the ICU in Starbucks last week. She was getting off night shift. She gave me an earful and she's always very animated and expressive about what's going on. Nothing I hadn't heard already from the others I keep in touch with.

I saw another hospital worker in there recently, early in the morning. I can remember those mornings, going in for my shift and walking across the bridge from the parking garage, seeing the downtrodden body language and frowns of people who used to smile and greet each other.

It was interesting listening to my former coworker talk. I was able to keep a detached and very occasionally amused distance from it, that means I am healing and not so personally wrapped up in it anymore. But I still feel the anguish and the frustration. It is a horribly stuck feeling. I see it in the twisted foreheads and heavy shoulders of these defeated, exhausted people. This is what we're allowing to happen to our fellow human beings. The same ones we expect to take care of us when we're sick.

Is there anyone out there who sees this and will take a sane approach? I will not see that in my lifetime, I doubt it. Elizabeth Warren talks about the parallels in the banking industry and how the little guys are getting abused by the way the system is stacked against them.

I do have hope that the millenials will turn things around. They will have to, or they will be doomed to a miserable existence. No one is investing in their future, instead, the older generations are sucking them dry, making money off of their futures. You can't prune the tree and expect it to bloom when you don't water the roots.

I am constantly amazed by the fact that the health care industry has no leaders who recognize that in taking all these steps forward, then panicking over missteps, staying focused on cutting costs, they are killing the workers and that leads to worse health care.

From physicians to nurses to techs to the people who take out the trash and serve the cafeteria meals, if they take the fast track to overworking everyone and burn them all out then what will we have? Richer CEOs and no health care. Mistakes. Injuries. Deaths.

The whole thing makes no sense whatsoever. Nursing doesn't even make sense anymore in this health care debacle. Keep on burning out physicians and making them leave medicine or preventing the brightest ones from entering it. Keep on grooming nurse practitioners, until there's a glut. Keep on relegating registered nurses to the status of court reporters.

Not that court reporting isn't an important job. It's just that when you're dealing with people's life and death situations when they are sick, you need to be able to focus on the sick person and not the transcription process.

Hell, court reporters make about as much as nurses do, with a lot less stress. They don't have to worry about killing someone.

I am sad to say that I no longer recommend that anyone take up nursing as a career. Recently someone asked me if I would attend a middle school career day to talk about nursing. I couldn't attend due to a prior commitment, but after thinking about it I realized I couldn't live with myself if I contributed to the lie.

The next time someone considering nursing wants career advice, I know what to suggest!

We will now return to our regularly scheduled program...Adventures in Iowa...

Peeling Onions

Act I. Speak.

What would you say to the people who hold the cards if you got a chance to bend their ears?

I've said plenty. I don't take to the six walls of a box very kindly. I'm just not that kind of girl. I don't believe in blind loyalty to anything, either. I will not kiss the ass of someone who abuses me. You can't piss on my head and tell me it's raining. I know the difference. (I'm a nurse.)

The other day I had a chance to speak. I definitely said my piece and followed up with more information after I talked. Serendipitously I was walking out a door and there was the receiver of my message, walking by. It was a conversation that was long, long overdue.

Leadership is a funny thing. It requires superhuman vigilance. When there are not enough people watching, underlings get away with things that are self-serving, but often short-sighted. Or just plain stupid. Being a leader also means you need to remember that while you are out in front, you're not above.

At conferences where corporate executives meet, like the insurance industry and the health care industry (btw the acronym for the American College of Health Executives is ACHE. Yeah, cute.), I wonder, do they ever have any sessions where they discuss moral and ethical obligations to the public they serve? I doubt it.

From what I've seen, they seem to have lost their sense of service. It's a disservice, what they do most of the time. It often seems like they have a pretty good sense of entitlement though.

Like the other day, someone I know needed surgery for complications from cancer treatment and they had already paid for their insurance, but the insurance company denied coverage, saying the policy had been cancelled, which it had not been, and it was paid in full. The person who was the unlucky recipient of the insurance company's incompetence was on the phone for hours. It still wasn't resolved, the surgery was cancelled, and if this procedure doesn't get done soon it could be a major health threat. As if it's not stressful enough going through all the hassles of cancer treatment.

Speaking with the insurance company, they shrugged it off at first until some attention was called to it on social media. When the company was called on their indifference, suddenly their tone changed. Big companies hate bad PR. They are terrified of it.

When you have that sense of entitlement, it's easy to sit on your throne and say, smile, don't ask questions, say yes, and swing your ponytail. Everything is wonderful. Why is a four letter word. Even when we fuck with you.

That event, plus my opportunity to speak, reminded me again that realistic attitudes are healthier than false positives. That's a lesson that leaders need to remember.

I'm all for having a positive attitude, because I think it does help. But there are times when a dose of reality is healthier, and if it carries some negative weight, well, that's a good thing. It helps balance things out and correct the course. If you never look at yourself critically, you're not being realistic.

If I didn't believe in myself and think in a positive light, I wouldn't be able to do all the things that I do. You have to maintain a basically positive outlook in order to achieve anything. At the same time, you have to be realistic, or you'll miss your mark most of the time.

When someone loses something significant, whatever it is, their good health, their ability to see the future, the promise of opportunity, a relationship, or the life of someone important to them, they experience grief. It's important to acknowledge all feelings. Denying that there are problems, that things are wrong, leads to continuation of the conditions that are heading downward.

Denying shock, disbelief, hurt, and anger at injustice is additional injury on top of the one that occurred in the first place. Eventually it all crashes at the bottom.

When you read about healing from trauma, of any kind- serious illness, abuse, adverse events, the healing is often described as layers of an onion. That's how it feels, you peel back a layer and discard it, but then there are others underneath. And it keeps going, there are many thin and thick layers to be discarded before you get the core, and many people never do completely heal.

It's amazing the amount of healing that needs to be done after you repress grief. It's only been 5 months since I left my old job and the triggers still take me by complete surprise.

So when I had my opportunity to speak my mind, I said some of what I needed to say, but I'm finding that there's more, so much more, an onion.

After that happened, I went for a run. My route took me past a memorial to one of my former patients, and I always stop by and say hi.

Well by that time I had processed quite a bit and had found plenty more to say and instead of the usual high five and run on by, I stopped to talk. Like a crazy person, there I was, talking to the air, blurting out my thoughts to my dead patient. The emotions were bubbling over, and then I started to cry, just as if I were talking to an actual person there. That's because he would have understood how I felt. This isn't usual behavior for me, but this one particular person supported me and would have been outraged by what led to my feelings.

It looked crazy on the outside, if anyone had seen me speaking, but it was necessary for me to process my feelings and emotions that came up, in another peeling of a layer of the onion.


Act II. Science is Awesome.

I got this mug at the Sternberg museum in Hays, Kansas. I don't know why, I am rarely into trinkets, but I thought this was cool.

I'm an old-fashioned scientist. I like reasoned and critical thinking, and reality. I don't like falsified data, biased results, or undue influence/corruption of money. The world has changed, or maybe we're just unable to hide things like we could before the advent of the Internet and widespread availability of information. There's also much more acceptance of the influence of money in all sorts of things. It's mainstream and acceptable to be on the take. That's why we're in so much trouble, because we've allowed it to get to the point where the haves have too much and the have nots have nothing.

I have learned not to accept or believe anything on it's face. You have to weigh the pros, cons, different sides. You have to listen to all the sides, you can't just rely on your own opinion or the opinions of those you think are on your side. At the same time, it's important and affirming to express your opinion. Hiding your opinion is repressive and oppressive.

But before you can say the earth is round you have to make reasonably sure you're not looking at it through curved lenses. Science reporting in the mainstream media drives me crazy for that reason, as does drug advertising on TV.

I've said a lot about corporations and their abuse of power. I don't care if someone makes a lot of money, it's what they do with it and for it that is important to me. If you have the resources and power, then do good with it. There's nothing wrong with living a comfortable lifestyle. But if you've accomplished that by stepping on people's heads and have a total disregard for the plight of people who are just trying to get through each day, I don't like that. The lack of acknowledgement and disregard of that is injurious. I think that having power and resources at your disposal carries with it a lot of responsibility to your fellow human beings.

The insurance companies don't have enough competition and they are going to be raising rates next year, and many people are going to find themselves paying a lot more money for very little ROI, to use a corporate term (return on investment). While in theory the ACA was supposed to lower insurance rates because of a competitive market, those insurance company execs and their lobbyists knew better. They have almost a monopoly in some markets.

I think we're moving backward in terms of civil rights, and people's rights. I grew up in a time where people were just getting used to things like Title IX and the EEOC and were realizing that there were consequences if they didn't heed the law. Not that they still didn't find ways to get around it. But people were more sensitive and awkward about it. Now, it seems like corporations hold all the power and make new rules, because no one can challenge them. Average income people can't afford to, and there are so few decent-paying jobs out there that they are afraid to make noise.

It's amazing, some of the shenanigans used in order to get rid of the people corporations don't like (who question things) and bring in people they do like (the ones who went to the right church or college, or show other promise of being a good ole' boy or gal). If you're the wrong color or your partner is the wrong gender, or you showed an aptitude for critical thinking, forget it. If you ever use the dreaded four letter word Why. It's not uncommon to see the collusion to sneak people into positions without providing fair opportunities for other people. It's like bad science, it hurts us all. The results are biased. The end result is myopia. Important ideas and viewpoints get missed, and the organization loses in the long run.

So I laugh sardonically when people accuse the poor of being on "entitlement" programs, because whatever they receive is so miniscule compared to the people in positions of power and influence. Like those insurance company execs who can not only afford half a dozen homes and yachts, but can afford to buy lobbyists and politicians, and buy their comfort into perpetuity. While someone needing cancer surgery to avoid a life-threatening infection can't even get the services delivered that they paid a significant chunk of their hard-earned income for.

These things happen with a sense of entitlement, that you're above the law, and above your fellow human beings. I've taken care of some big wealthy powerful men who are afraid of needles and can't look when they get stuck, and need someone to hold their hand. Their eyes get big and round and they look like a child. I don't care who you are, we all bleed the same stuff and we're all made of the same flesh. THAT is science.

Suffering From PTTSD: Neither Health Nor Care

I have been feeling really good lately, I've been getting physically and mentally better all the time since I quit my nursing job last fall. I've been moving forward and feeling great about things. So today was the first setback in a long time and it really took me by surprise. I have Post-Traumatic Tax Stress Disorder. Triggered by doing my taxes.

I decided to take the day off from running because I hit it hard over the past 4 days and I plan to get some good miles in this week. I needed time to get some work done, I'm meeting with our accountant later this week and I want to have all the papers and numbers organized to give to her.

The way I do my taxes is organized chaos. All year I save the necessary hardcopy receipts and papers in a folder and by the end of the year it's overflowing onto the floor in the corner of the office. I take one day and I go through everything, organize it into piles and go through every single item and write down the numbers, then discard or shred the unnecessary stuff and place the important receipts in a neater, more organized form into the folder to store.

This year it's a little more complicated having started a business, but I was much more organized with the business stuff than I was with our personal stuff. I whipped through the business tax items in about 30 minutes, and then was ready to dive into the messy pile of everything else.

It started out okay, a few utility bill receipts, mortgage and real estate taxes, W-2s, you know, routine stuff. But as I got deeper into the pile I started finding things.

Continuing education receipts for classes I took. Donations to charitable organizations. Okay, I can deal with that.

Receipts from rollovers of my retirement funds.

But then: continuing education classes required for my job that I wasn't reimbursed for, in-kind and other donations I made to the hospital's foundation and payroll deductions for the same, supporting the Cancer Center. That reminded me of all the speaking engagements, marketing pitches, cheerleading and other support I gave, only to be treated with cold indifference by people running the show in the end.

A receipt for the ACLS class they wouldn't pay for (never mind that I was doing moderate sedation, chemotherapy, and infusing other IV meds like Rituxan and blood transfusions...that people commonly react to). I kept up my skills anyway, just paid for it out of my own pocket. Reminded me of the patient who had the transfusion reaction and I called a code and we started CPR and he had a good outcome. And the other patient who had a medication reaction when I was working alone at night and I had to deal with that all by myself. She had a good outcome too. And the safety presentations I did for my unit for emergency preparedness.

Then I came across the receipts for health care expenses I had that are directly attributable to the stress of my old job. Reminders of the distress, being in a doctor's appointment and having a total meltdown when she asked what was going on. Receipts for antidepressant medication. Measuring my blood pressure at 160/100. Labs to rule out other things. It cost me big.

And then when they switched our health insurance over, we had even less coverage so I had more out of pocket expenses. Yeah, mergers are great for the employees.

It's all had the effect of giving me flashbacks and it feels horrible. I feel the old anger bubbling up and the resentment, of feeling discarded, unappreciated, disrespected, used, etc. It makes me mad that nurses, as professionals, are treated like this: they expect you to give your life up for them for such low pay and dwindling benefits, yet they won't support you in your professional development.

I posted about it in a nursing support group on Facebook, asking, Has anyone experienced this while working on their taxes after they quit their nursing job?

The dozens of responses I got were filled with fire, bitterness, resentment, and echoes of similar PTSD experiences. So many nurses experience these things, wrong on so many levels. People who have suffered from the destructive, bullying, mean-spirited behavior of the minions of those corporations claiming to be about patient care.

Minions who will do anything to boost their patient satisfaction scores so they get more reimbursement, but the things to boost patient satisfaction in their eyes have nothing to do with providing more quality nursing care. No, they'd rather spend money on decorations in the patient rooms or bigger TV screens. That's what six and seven figure administrative salaries will do for patients. Meanwhile, the nurses and other staff are reduced, being forced to exhaustion and stress, and PTSD-like experiences.

That is neither health nor care. It's wrong and it shouldn't be happening to people who bust their asses daily and are expected to go without meeting their own personal, human needs to care for other people. One nurse on Facebook wrote about how two things saved her: her dog, and quitting her job. I can relate to the dog therapy. Iris and Isabelle did a lot of licking my tears during the time I worked at the hospital.

On the bright side, I'm out of there. But it doesn't feel very good having all these reminders today.

Neither health nor care, I tell you...

We can do much better than this. I'd rather make a difference for a few individuals in my own practice, than do things half-assed for thousands and let things slip through the cracks, which is all our current health care model allows.

Onward and upward.

F is for flashbacks, W is for weirdness

A flashback to healthcare...

"When an organization ceases to look at itself critically it no longer has the credibility it once had..."
This is a quote from a nurse.

He was speaking in the context of a hospital's Magnet Status not being held to any accountability standards. But it applies to many things, and it struck me personally tonight when I read it.

It is definitely the essence of why I left the job I did, and sums up why I don't want anything to do with corporate nursing anymore.

In fact, it sums up my non-existent exit interview. I tried to get one, but they informed me that they no longer give exit interviews. When I asked why, the human resources person could not tell me. She said she didn't know. I guess they are uninterested in improvement or change. Which was pretty obvious to me anyway, especially over the past couple of years.

Nurses don't have any protection, and physicians are rapidly figuring out what it feels like to be a nurse. It's pretty amazing and mind-blowing to find out that people who are responsible for keeping you or your family member alive- the most important job in the world as far as you're concerned- have no employment protections, no protection from retaliation or whistleblowing when they find and report a threat to patient safety, no backing to ensure that safe working conditions are provided by their employers, and so on...

Oh yeah, and I found this too...Amanda Trujillo continues her battle with the Arizona State Board of Nursing. The State Board is on a mission to destroy her. She will not be destroyed. Even if they strip her of her license, they will lose the war.

I made my first trip back to the world of the Cancer Center last Thursday night. The Survivorship Advisory Council (which includes me) had the opportunity to tour the construction site and sign the beams as the building is constructed. When I got the invitation I had a mixture of feelings. I really WANTED to tour the site, and I really WANTED to see most of the people in the group, in fact, all of them, with the exception of my former boss. But she's not my boss anymore and I really didn't give a shit what she did or thought, because she's been avoiding me for over a year and I didn't expect anything different.

I needed to do this to break the ice, to step back in and at least get a feel for things. I wasn't quite sure how it would feel. When you leave a place and there are unresolved feelings, you wonder if you're seen as the enemy. I know that I'm really not seen as the enemy as I've had an enthusiastic response and reception from everyone I've told about my new business.

But I truly felt like I might be crossing into enemy territory, just from the feeling I had from the cold reception I've had from my old boss, but she's always been like that. She did say hi to me, a very fake greeting, overly friendly, and that was the only thing she said all night.

After that she avoided my eye contact. Before I went in there I thought I might attempt a conversation, but she managed to cling onto someone else each time there was an opening and started an overly involved conversation, complete with dramatic body language and turning her back. I decided it wasn't worth it. I feel so much better, much freer being there when I'm not tied to the organization.

That was the only weirdness I experienced. Everyone else is really nice and supportive of what I'm doing, and they understand that it is a community effort. I signed the wall a couple of times, I wrote "bless the nurses" on a beam in the infusion area and I wrote an inscription on another wall in memory of a friend's wife who died from cancer.

While I was there, I also ran into one of the executives, no longer at the hospital, but is in a different branch of the same overarching organization. He greeted me as he always did, very friendly, and genuine. I quietly mentioned that I am no longer with the organization. He looked surprised, said he wishes me well in whatever I'm doing, and told me to stay in touch. I will let him know what I'm doing in the near future.

It doesn't have to be this way. The Pope is onto something...

Back to running.

Morning Fury

I woke up at 2 am, the usual time that I seem to start sweating and throw the covers off. But this morning I could not get back to sleep. My mind was cranking along with the gut-ripping dread of going back to work today.

I kept going over in my mind the thoughts from my talk yesterday with a former coworker who is also getting out of nursing, and watching the tears spill down her cheeks as she described how hurt she was by her coworkers in her current job who backstabbed her, lazy nurses who would sit at the desk and gossip, complaining about my friend taking too much time with her patients.

I am sad that it's not about giving good patient care. It's about who talks to whom and what they say and who believes it. It's about how a gang of people can bully their way into someone's life, health, and total existence and damage or ruin their livelihood. My friend is an excellent nurse, far better than the other nurses she worked with. That's what happens if you stand out, if you're praised by the patients, if you insist on being thorough and conscientious.

By 4:30 am I wasn't sleeping and I decided to get up and run. I have to be at work at 8:00. I made coffee and got my butt out the door by 5:15 and ran for an hour in the dark streets. As I was running through one neighborhood, I was in an absolute fury, venting out loud to no one in the dark. It occurred to me that if someone heard me they'd probably call the police and think I was off my meds...

I've had half a dozen conversations with other nurses in the past week since I got back from Arizona and keep hearing similar things, about the things that have been done to them, about the things that were the final straw before they quit, and the things people said about them: calling them lazy because they can't get their call lights (because they were taking time in a room with another patient) and other people have to answer them, can't multitask, spends too much time in the patient rooms.

Yesterday as I listened to my friend talk about the suffering she witnessed in the patients and their families, and how she felt at a recent patient memorial, and why she does the things she does in her nursing practice because she truly cares about those patients, it makes me wonder, is there any humanity left out there?

How do people live with themselves? How did we get to this point where we care so little about people?

I'm absolutely dreading the day, and I know I'll be wiped out by the end of it, but here goes...the first of my last 5 shifts as a nurse in the corporate world, I hope with all my heart...

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.

Detox Day Three: The Fear Factor

A good friend of mine from ultras recently did something out of character for himself. He was running an ultra with some pain and took too much of an analgesic and landed himself in the hospital.

I really like this guy, and he's been through a rough time for the past few years, a divorce, soul searching, and so on. I worry that what he's doing is self-destructive, so I contacted him to let him know that I'm here for him and he can talk with me.

I've been there. I've had my rough times in life. I've been depressed before. I'm going through some now, but even with the pain I'm experiencing at this time, I am so excited about my opportunities to go forward that I know I'm really okay. I am having a low energy week this week so my progress has been slowed, but that's temporary.

Still, it doesn't feel good to go through a crisis like this alone. People tell me that I'm such a "together" person, that I have my priorities right. That I have my shit together. You know what? I think I basically do, but I'm not immune to depression and feeling down, alone, and lonely. I can't tell you how many times in the past 6 months I needed somebody to call me to go out and do something that doesn't involve running.

One of my longtime nursing friends who is probably the least socially outgoing of anyone I've ever met in my life, has kept my head above water. I've learned a lot through this rough time about my support network. On the other hand, people I've never met in person and only interact with through some mutual interest group on Facebook have been a lifeline.

One thing I've noticed is that there's so much reliance on social media for communication and then when you're in real time and real life, and you need some support, it's hard to get. Add the fear factor of working in the corporate world and you basically shut things down.

There are so many nurses I worked with who I liked a lot, I always wished we could have done more things together. I was always busy training for ultras and had very little energy left over for social engagement. Until recently, I was not much of a drinker, I prefer to go out and do active outdoor things, or at least go places where you can walk around a lot.

I know that people are afraid to be associated with me when it comes to work, because now that I'm shitlisted they don't want to be categorized as a rabble rouser. So they are very careful on social media. They private message me. That's okay, I understand that they are not in the same place as I am and need to stay where they are right now. I don't want to disrupt anyone's personal perception of safety.

They are afraid of what will happen if the wrong people see they are allied with me. People talk, and the chain of command is not lost on me one bit. I know that backstabbing is a function of management style and an organization's toxicity that allows it to exist. It could easily happen to anyone.

Today I'm still having that stabbed in the gut feeling, but it's a beautiful fall day and Iris and I went for a long walk, and I have shit to do and I'm going to do it. It hurts to breathe deeply, when every sigh feels like it could turn on the faucet of tears. Don't hug me unless you've got a plumber nearby!

Nurses should buy stock in Kleenex.

Detox Day Two: Eating Their Young for Breakfast

It feels like a jumble of emotions today. I'm up and down, but mostly in an even keeled, buzzed out fog of exhaustion.

I slept until 9:00 this morning. Then I got coffee and took Iris for a walk, then went out to do an errand and came home to the girls again. It was such a beautiful day I kept going outside to walk. I took Iris for four walks and Isabelle only wanted to go once.

My calf was too painful to run on it. I'm still sore down the inside of my thigh, too. Those were some wicked cramps. Maybe by tomorrow I'll be able to run.

We were at a Mexican restaurant tonight, where we eat frequently. As we were sitting there I saw one of my patients come in the door, fortunately they seated him in another area. I like him, but I don't like running into patients outside of work, it's too awkward because you can't say much, especially if you're with someone else.

I realize how much I will miss the interaction with the patients, and the social interaction of the work day with my coworkers. But then, it's hard to think about the conversations you've had with people, and then you wonder which of them stabbed you in the back. After seven years in a place you get to know a lot of people and it will be strange to bring an end to that, too. I'll have to find new ways to network and talk with people, that will be one of the challenges of my new line of work.

The somatic and psychic pain seem to be competing with each other for attention inside the little world of my body. I can literally feel it in my gut, it's this heavy feeling like someone wrung out your insides. There's a lump in my throat that rises when I think about certain things. And there's a burning anger that flares behind my eyes and in my chest when I think about other things.

When I read this morning's medical newsletters that I get on email each day, it was funny, there was a lot of talk about corporate wellness programs. And I thought, what an oxymoron that is: corporate and wellness in the same sentence. I think that the most effective corporate wellness program out there is quitting your job!

I don't understand why it is acceptable to foster an environment where psychological violence toward others is acceptable. It's not unique to nursing, but it does seem to be almost omnipresent in workplaces, especially in large organizations stressed by trying to turn a profit, who do stupid things to sabotage their own profitability. They spend money on wasteful and extravagant things, and then squeeze the life out of their people by overreliance on cutting staff to control costs.

They like to control people. If they can't control you, YOU are deemed out of control. If you question anything, YOU are perceived as a threat. If you have an independent thought, if you speak up, if you think critically about the status quo and the need for change, YOU are put on the chopping block. Especially if you are visible or perceived as a potential leader and have these characteristics. YOU might lead the masses astray, they might start thinking for themselves!

If you have a brain and a personality, you're the one who has the bad attitude, while the people who are supposedly leading things won't even talk to you and act like you don't exist, except for when they are looking for things to use against you. They can never say anything positive, but they can always find things to say that are negative. But instead of saying them to you when they happen, they save them up for once a year in your annual review, where they can be anonymous. And those reviewers are hand-picked, of course, by management.

When this same scenario repeats itself all the time, it's important for people to realize that it is not them, it's the warped, abusive system that treats them this way. It's a sick way of operating and it's sad that so many people suffer from workplace stress. Ever seen the bumperstickers: "Creative people must be stopped" And: "I think, therefore I'm dangerous"

As a nurse, they want you to think critically about your patients, but not about your workplace or working conditions. Be a good little Stepford nurse, smile, swing your ponytail and just say yes. Have the personality of a cardboard box and you'll be fine.

It's too bad that nurses are among the most trusted professions by the public. If only the public knew what goes on behind the scenes. The expression "eating their young" is well-known among nurses. It is a very true thing about nurses. Sad and ugly, I know. But so true.

Yes I am outspoken. No I won't shut up. I think this workplace crap needs to change. Let's make it happen. People shouldn't have to heal from working in health care.