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.

Obesification Again...

I saw this article today on Modern Healthcare and it pissed me off, and even more so in the context of what's been happening in the headlines recently.

It’s long past time for American politicians to grow up. What a bunch of immature privileged frat boys we have in Washington.

Defending the gun lobby and preservation of a hateful symbol endorsed by state governments. Refusing to tell the truth about what’s going on with the proliferation of mass shootings and racially motivated violence. Lining their pockets from the even wealthier sociopaths and narcissists writing them checks.

But immature, spoiled little boys need more than a slap on the wrist. They need responsible adults to hold them accountable and take away their toys until they clean up their act.

Here’s a laughable thought…what if we could make a scale that was super cheap, purchased at Walmart, where you plug in your height and it calculates your BMI, showing you where you fall in the green, yellow or red or danger zones, corresponding to healthy, overweight, obese, and morbidly obese, since people can’t “see” body mass index.

If only it were that simple.

We’re not educating people about health, physical activity, and the consequences of what they put into their mouths while not moving their bodies.

We’re not teaching kids habits of taking care of their health from an early age, we’re not funding PE and sensible health education in schools.

We’re not building safe communities that encourage parents to let their kids play outside and safe streets for people to walk and commute by bike, not promoting healthy lifestyle habits, reasonable work hours, a chance to get enough activity during the workday, short commutes, healthy foods instead of fast food garbage.

Not only should we curtail the marketing of junk food and unhealthy activities on TV, we should curtail sedentary TV watching. We’ve been irresponsible in allowing corporate lobbyists from junk food industry to influence education, entertainment, and communities. Not only have we failed to invest in our infrastructure, we’ve failed to see that our infrastructure consists of the health of our people.

We've given science a back seat while putting money in the driver's seat. Except money doesn't have brakes.

When are we going to wake up? We have a political problem, and it’s intimately related to our 75% overweight and obese population, our dwindling life expectancy, our number 37 rank in the world on health care, our growing numbers of those impoverished and struggling economically.

We hear about the lack of investment in infrastructure- the things used by the little people- roads, bridges, communities, or the basic things a civilized society needs- public education, a future with promise, not debt and enslavement by a culture expecting people to pledge allegiance to the corporate states holding a noose around their necks.

Killing us with insurance premiums that keep expanding in the name of healthcare, you look down at us from your luxury C-suite seating. While the insurance companies, hospital industries, and pharmaceutical giants keep growing their profit margins, people’s waistlines are expanding just as fast as quality and length of life are declining.

We are headed into another election cycle with a larger than usual assortment of boy clowns with even larger gonads to deny and defend as needed the policies that keep the few and rich safe and secure while ensuring the continued decline of the American quality of life.

These boys continue to lie as their lapel flags disappear into their ever-growing bulk.

Because they know they will get away with it until American adults wake up from our sugar-fueled coma and roll our supersized bodies off the couch…

Haute Hubris Hits the 'Hood

We certainly shoot for the moon around here in Fort Collins. Sometimes we go over the moon and miss our target.

What a week it's been in northern Colorado. The arrogance of power, profit, and politics, pomposity on steroids.

We've been so juiced up in the executive departments that we don't even know where we started, and we sure don't know how to stop.

This week alone, we've discovered:

1. CSU football coach Jim McElwain is leaving to coach University of Florida. (We suspected it all along despite the adamant public denial from everyone at CSU).

2. Tony Frank, president of CSU, saw his wet dreams come true, he got approval to build his on-campus stadium.


3. To keep up with the newbies across the street, University of Colorado Health is proposing to build yet another emergency department on Harmony Road, just down the street from the new emergency department going in at the new Banner Health facility that will open this spring. That's on top of the emergency room renovation at Poudre Valley Hospital.

The other night I was at an event with some people in the community who were familiar with the goings-on in the competing health systems in town. And they asked, "I see they're building a new emergency room. Why did it take so long to raise money to build the cancer center?"

Good question.

I don't think they'll be begging the community with emotional appeals to support them in this capital expenditure.

Why are we paying a football coach a huge sum of money- his original buyout was $7.5 million dollars, which I hear has been reduced, to the tune of $5 million. Couldn't they put that toward the multimillion dollar cost of the stadium? We know they won't put it toward academics.

Why do we have three emergency departments within 4 miles of each other in a city of 150,000, two of which belong to the same hospital system? Wasn't Obamacare supposed to reduce the need for emergency services because people would have health insurance and get preventive care so they didn't end up in the ER? (Hint: follow the money)

Meanwhile, this area is in desperate need of a mental health facility. Hello?

Ask executives at any of these institutions and they will issue the same platitudes and excuses. But these are both really unnecessary expenditures at a time when we ought to re-think our original purpose, and whether it truly benefits the community, or just a few. Those who are so hypersensitive to criticism might want to explain themselves to the public, who are asking good questions.

What are we doing in this country? Does this make any sense? Do we need another college football stadium and hospital emergency department? Haven't the costs of higher education and health care already gone over the moon?

Where are the grownups? These children who are too big for their business suits need a time-out.

Is Ebola the Cure?

Ebola is shouting at us, but is anyone listening?

This morning I read what perhaps makes the most sense of any of the volumes of material that have come out in the media over the past two weeks since Ebola hit our shores.

I'd like to elaborate on some of the points the author makes and add my own.

Ebola might actually be the cure, if we would just pay attention and listen to what it is telling us about how we run things in this country.

I see Ebola as an opportunity to get things back on track. Will we have the vision and leadership to do this?The way we’ve been operating for so long, my fear is, we do, but we’ve forgotten where to find it. We need to put our ears to the ground to listen.

First, we have gross misallocation of resources in this country. The huge portion of our GDP that we spend on health care is largely wasted, we’re not getting our money’s worth.

We don’t value preventative care or good health.

We have media looking to make a buck off mass hysteria. They stir the pot to the point where it bubbles over to one side or the other, parroting stupidity and spewing hate. Each side is convinced the other side has a conspiracy to destroy those with whom they disagree. Look at the trolls who follow any online article.

We have greedy, profit-centered institutions guide our health care system, looking only to make a buck off our sickness, with lip service to something called wellness.

Companies manufacture more new products every day to make us sicker, from foods to chemicals to sedentary entertainment gadgets.

Specialty-trained health care providers looking to make a buck off the few patients they hang onto when avoiding joining the big guns give advice to patients they don’t really have the expertise to provide, and the patients themselves are not health literate or able to critically think enough to know the difference.

Health care itself is dysfunctional in that there is no communication between the levels of hierarchy that have been created. Nurses, who spend the most time with patients, know the most about the patient. Physicians know how to treat the patient, but do they listen the nurses? Administrators are concerned only with protecting the bottom line of their own little turf, don’t listen to the physicians, and friction develops between the layers.

Meanwhile, the money gets funneled to duplication of efforts and waste. No one at the top of the heap listens to the muffled cries of those at the bottom, those who see reality on the ground.

We have a political system that has completely failed us through inaction and servitude only to the wealthiest entities who feed it. Only self-interest and greed guide our career politicians. There is no coordinated effort in our government to look out for the best interest of the people. Those who seek election think it’s optional to take facts and scientific evidence seriously. If it interferes with profit, who needs it?

Not only have we failed to fund public health, we’ve been failing to fund education, transportation, and other public resources. Look for more crises in these sectors in the near future.

We’ve forgotten how to communicate with respect, how to listen, how to think critically. All of the issues that Ebola has brought into sharp focus should be seen, but we don’t have any leaders who are seeing.

We’re going to face more crises of this magnitude the longer we allow our country to operate in this dysfunction. We need true leadership, an end to the greedy, profit-obsessed way of operating, and a re-focus on the needs of our greatest assets: people.

Leadership is just another word for...

Yes. As in yes men.

One of the things you see in organizations is the habit of naming certain people as part of the LEADERSHIP. They LOVE the L word. They love to hear themselves say it.

They emphasize to everyone that THEY are the designated leadership team. That gives them privilege, they get to sit in on meetings and are privy to additional layers of company secrets that the underlings are not. They also get to escape accountability as a perk. They get to blame other people for failure, but leaders stay clean. 

The moment anyone DOES try to hold them accountable though, they hide behind the other big L: Lawyers.

Leadership has become simply another word for yes man.

What we needed in the face of the Ebola problem, as in so many other events, was a leader. Solid decisive action. We did not get that. We got buddies of the President appointed out of political favor instead.

You won't hear me criticize Obama very often. I don't usually mind when people do, though, because I don't mind other people having opinions that differ from my own, and I don't need to be right.

As long as it's not some troll spewing mindless racist hate or parroting abject stupidity, I just let it be. I have my own political views and I'm not afraid to say I tend to lean very much toward the left most of the time. But I also think it's important to remember that we are talking about public health and safety, and Ebola doesn't care if you're a Republican, Democrat, or Purple. Nurses don't refuse to take a patient based on their political affiliation. We're all human beings and we're all affected by this.

That said, I am very disappointed in Obama for this appointment of a so-called "Ebola Czar." This guy has no health care or public health experience whatsoever. He's an attorney and works with big business, and therefore has no clue about the things that frontline health care workers do or deem important.

We have a problem in this country and it's lack of true leadership. True leadership is not the fake kind taught at Harvard Business School. Look at the people in Congress, for example. They won't even act on minor issues because it's midterm election season. Where are their priorities? They certainly are not with the people of this country. They prioritize their own reelection so they can continue to prey on the well-funded palms that feed them, the ones who got their money by preying on the public.

We need to string them up by the part of their anatomy that is most sensitive to pain and say, you need to act. Quit protecting your own turf and do what we're paying you to do. Remember we are still paying them, in terms of benefits like health care and retirement, and it's out of our taxes, which we pay disproportionately more of than their rich buddies. The perks from lobbyists and guarantees of golden parachutes are much more lucrative, and as long as they keep it so, the people are screwed.

Career politicians are not leaders, just like the so-called leaders of corporations. Self-interest. Greed. Power. Those are the things that motivate these people. As long as they are safe, comfortable, and profitable, they won't do a damn thing to change.

This is what happens in corporations. I can remember working in the hospital and there would be these "leadership" meetings that always consisted of roughly half the unit staff, while the other half stayed and worked. All of the so-called leaders were in their positions due to length of time they'd been there or the fact that they were the biggest kissasses, and/or the most toxic people on the unit.

This is an aside, but I couldn't help thinking, when I saw what happened to Nina Pham, the first U.S. nurse diagnosed with Ebola in Texas, that she must have somehow drawn the short straw on assignments that day. Or maybe she volunteered for the challenge. I can remember the nasty charge nurse I had to deal with in ICU who would always give me the most distasteful assignments that she'd never give to her buddies. When I was a new nurse, I used to ask for more challenging assignments, but what usually happened was I got the patients no one else wanted. Had Ebola come to the unit I worked in, I probably would have been the one given the Ebola patient without adequate protection.

Who knows what they discussed in those meetings, I was never invited. I was one of those dangerous people who questioned things and might actually think for myself. I stayed and took care of patients while they "led" in the conference room. They never communicated to the rest of us what was discussed in those meetings. Occasionally we'd ask them to, and they'd pretend they would do it, but they never actually got around to it.

There were always a lot of leaders relative to the non-leaders. It was more of a secret club than anything. You'd have to somehow demonstrate your loyalty to the system before you could be granted admission. And just how you did that, was never made clear. There was never a book of rules, or a playbook that was shared with everyone. That's how you keep the underlings in line. People who want to do things and take action are not the ones who are valued in these organizations. It is the sheep who stay, are promoted, and kept.

Do a shitty job, keep your clique in place, and get rid of anyone who thinks critically or has ideas? Get promoted to an executive position, created just for you.

Take action on a patient safety issue? You're fired. We don't want the world to know that we really don't value patient safety, that it interferes with the bottom line.

Business schools and law schools don't produce leaders. Actually most schools don't. They provide didactic knowledge, but it's not applied to any real world situation very well, if at all. Experience and demonstrated decisive action do. That's one reason why we've always valued military service when people ran for president.

I am not sure that the military is any better of an organization but it certainly does provide opportunities to demonstrate leadership. With all the changes in the military I am not sure that it provides what it used to. But I do know that in my health care experience, I have seen the establishment frat boy culture completely diss a newcomer with military experience and common sense, when they could have learned and gained from his ideas.

The frat club of business school-educated "leaders" knows how to work the system to eliminate any common sense or true efficiency from the system. They pretend to implement systemic changes which really only serve their bottom line, and usually result in inefficiencies for the people who do the real front line work.

Some have called for an office of a National Nurse, another ball that has been dropped in our pathetic Congress. If there had been a national nurse (not to mention a Surgeon General and adequate funding) in place prior to the Ebola incident, perhaps we could have avoided this mess.

What's it gonna take? Well first, we have a midterm election coming up. You can start by voting for people who have demonstrated competent leadership. A newcomer, preferably, not an incumbent. We can make sure that anyone running for President who gets as far as the primary is thoroughly examined by the public to look for true leadership ability and experience, not a career politician.

And we need to insist, like National Nurses United has demonstrated so well, on our voices being heard, our recommendations being implemented and taken seriously, and not backing down to the fear tactics currently used in the corporate playbook that result in voices acting in the public's best interest being threatened and squelched.

The one nurse from Texas who blew the whistle and went to the media? She is a hero. She is risking her livelihood but she is protecting the public, and that's more important. She will find work, perhaps not in a corporate health care system, but someplace where she can do meaningful work.

We have got to stop allowing these business school educated, incompetent people to run our health system. We need people who know the health care landscape, who have experience, boots on the ground, and know how to take action in a crisis.

You wouldn't allow the CEO to run a code, would you? Why should they run the hospital at all?

Health care and public health are not a business. Stop running it like one.

Curse The Nurse: Not Gonna Fly

The chickens came home to roost. The old knee-jerk response out of the administrative playbook, blame the nurse, it's the nurse's fault, is not going to work anymore. Playing the game I call Curse the Nurse.

National Nurses United had the cojones to address the situation head on, instead of the pathetic response from the American Nurses Association. No wonder no one joins the ANA. They don't do a damn thing for nurses, they are part of the problem.

Just a few brief thoughts here as I am busy today with other things, and I want to attend the teleconference being hosted by National Nurses United about the Ebola issue.

Playing Curse the Nurse: It's a problem that happens from the lowest levels of management to the highest levels of national agencies. If you as a nurse let your manager know that there is not enough working equipment on the unit, they are likely to say, "Well, what are YOU going to do about it?" (implied: in between caring for 4 or more patients)

From a foot-dragging response to concerns about patient safety on the unit that could easily be fixed with an inexpensive solution, to passive-aggressive spying tactics and manipulation of coworkers to skew employee reviews, to playing dumb "I don't recall having that conversation", management plays this game flawlessly. They get away with it.

And as the CDC has shown us, it's a convenient tactic at any level of the health care industry. Blame the nurse for all the problems. Blame the people with little power and few resources for the missteps of those who hold all the power and all the resources.

Blame the nurse for breaching a virtually nonexistent, and at best, totally inadequate protocol. Tell other nurses, when your mistake is discovered, that they'll be fired if they say a word to the media.

Profit-mongering, covering your ass, and playing these big business games are unacceptable in healthcare. When it comes to public safety and patient safety, nurses don't operate like that. We are there for the patients first. No big executive bully is going to tell us we can't go to the media or we'll be fired. Being fired is better. Who wants to work for scumbags like that?

Provide the right equipment and training, quit screwing around and counting your beans, and take people's lives seriously.

The truth comes out. Oops.

Here is my friend Andrew Lopez on the issue.

There are additional public health issues coming to light as we discover that a second health care worker in Dallas has Ebola, and may have flown on a commercial flight with 130 other passengers. There are the issues of flying & travel, e.g. surfaces in airplanes, poor hygienic practices of staff who easily cross-contaminate the public: flight attendants, airline companies, restaurant workers, hotel housekeeping staff.

But we aren't even there yet. What I am hoping is the silver lining, in this Ebola outbreak, whether it is contained at a handful of cases or becomes something larger, is that the public will be made aware of just how dangerous a big-business profit model is to their health and safety.

I'll have more to say later.

The Big Picture

There's a lot going on in the world right now and I was thinking yesterday about all of it, trying to put it all in perspective. I really need to get back to running posts, and I will.

I don't mean to sound negative here, because I spend my days now doing work that I feel is important and valuable to real people, and I live in a beautiful place and environment, and things are generally good in my life. I am fortunate to be where I am at the moment, and I enjoy it.

The things I see and read on a daily basis are so disturbing that I have to put it out of my mind in some way, and I think that's true for most people who pay attention to things, care about things, and live with this onslaught of information about insanity in the world. This whole Ebola thing really gets to me for some reason, and I think it's just the images of government and health officials flapping their arms and wringing their hands and looking so indecisive and lost as to how to handle it.

There is so much distrust of government and authority that the efforts to educate the public with health information are often wasted. People don't listen to sources they don't trust. The anti-vaccination movement is one example, but over the past week, look at Ebola and the information coming out of the CDC, all of the things we try to teach people about taking care of themselves and preventing cancer and chronic disease, so much of it is not being listened to.

I was writing a piece for the local paper yesterday on breast cancer and I mentioned prevention, like exercise, eating right, managing stress. These are things basic to decent health, for prevention of any disease. And so many people don't even have a grip on those basic things. We are a society hurtling toward self-destruction by our own self-neglect.

Do people have an underlying death wish? Do they really think it's a comfortable way to go, by self-inflicted obesity, septic and bloated to 500 pounds from a diabetic foot wound and hooked up to a ventilator with families surrounding them praying for a miracle? I've seen this more times than you could imagine. I can still remember the smells. Should we provide guns to these people instead? It certainly would be cheaper.

I think there is such an atmosphere of distrust here in the US because of our divided government and everyone's self-interest at the top, the focus on profit. Think about it, we are trying to prevent a disease epidemic, whether it's flu or measles or Ebola, and some for-profit hospitals are so cheap they don't even provide adequate protective materials for their staff like gloves and gowns.

The spokespeople at the tops of government or worldwide agencies are often viewed as shills for an already distrusted government, and those suspicions turn out to be right. So that just strengthens the case for distrust of agency information, and promotes more reliance on untested, unscientific sources such as the so-called health gurus who claim there is a natural cure for everything if you take the right supplements (a multi-billion dollar industry), you can cure cancer with a daily kale and wheatgrass smoothie, people who still believe childhood measles vaccines cause autism, and it goes on.

What if they came up with a vaccine for Ebola? Or a vaccine for breast cancer?

All over the world there is so much unrest, I think it has always been this way but there was less ability to follow it and draw attention to it due to the Internet and technology. Having those mouthpieces available like social media, makes it more attractive to rebels to get attention and be seen by the world, bringing attention to their cause. People are always going to have their attention grabbed by the extreme, so these groups resort to the extreme and show it on video over Instagram or Facebook.

There are the very rich countries and the very poor countries, and the US can definitely take the blame for it's role in creating a good bit of it. But a country that is seen as a world leader, or was once seen as one, has serious problems at home within it's own people. Poverty, wealth disparities, greed, corruption in all levels of government, capitalism taken to the extreme that it robs the people of resources that would make their lives so much better, all of the things that the US always claimed to be above, those are all spreading like an epidemic and there is no leadership to correct these things.

I have always been politically left-leaning and socially liberal, but these days I find myself understanding more about why the people on the right feel the way they do, and the anti-government sentiments they express are often valid, even if they don't follow the same logic to get to those that I would. I hear the right wing complain bitterly about Harry Reid and Nancy Pelosi and when you listen to them talk, the criticisms are warranted. I recently heard an interview with Nancy Pelosi that was absolutely nauseating, I wanted to kick her out on her ass. There are so few Democrats I view as being above the fray that I can't say I support the party at all.

Not to say that John Boehner and others are any better. The Republicans have their own full lineup of bozos just waiting to embarrass themselves and the rest of us in the upcoming 2016 primary election. Between now and then none of the politicians on either side will do a thing because it's an election year, or we're coming up on an election, so they do even less than they do regularly. The government does not at all represent the people, and here we are, the taxpayers, paying their salaries, benefits, healthcare, and all they do is act in the interest of the corporations and wealthy individuals who don't pay their fair share of taxes.

There must be a playbook somewhere that instructs the people who are groomed for so-called leadership positions: in government, finance, industry, professional sports, that teaches them how to be liars and slimebags, how to steal the public blind, and the language of corporatespeak or leaderspeak. Maybe it comes from Harvard business school or there's some kind of a secret club.

Not only are these things happening at top levels of government, but it goes all the way down to communities and local agencies. Corporate speak and lies, everywhere.

There are days when I think we would all be better off if a giant meteor hit the earth like a reset button. That would cure all of our problems! I am so glad I don't have kids because I would hate for them to be left in this world. I don't know how parents these days are preparing their kids for the kind of world they have inherited.

I look at my niece who is 17 and a senior in high school, and she's so smart and talented and I think the future of the world rests with her and kids like her. I hope they have the tools to confront it. I hope it doesn't hurt them too much to care.

What Color is Your Crisis?

Pretty freaking amazing. Now the news media are going batshit over the Ebola story. What I find interesting is that none of the administrators of the hospital in Texas have come forward to talk about their own culpability in the "systems errors" that have been blamed for the discharge and re-admission of the patient with Ebola.

You'd think it was Ebola Awareness Month instead of Breast Cancer Exploitation Month. Instead of the Pink Scourge, now it's Purple and Yellow.

Yup, the so-called health care world is going to hell in a handbasket, and none of the people at the top can take any responsibility. No one seems to hold them accountable. They do make the big bucks.

Point the fingers: at the nurses, the doctors, the computers, the "systems". But who makes the systems? Someone has to. They don't create themselves. Someone has to make the decisions to follow certain protocols and set things up the way they are. Someone is benefitting from things being the way they are.

Well eventually the Ebola scare will pass, just like AIDS and HIV freaked everyone out at the beginning until they understood how to control it and contain it.

I watched this short little interview on MSNBC with the head of the Texas Nurses Association and I had to comment. It was just too much for me to keep my mouth shut. Watch the whole thing but especially the end part when they interview the Executive Director of the TNA.

I wrote this in the Joy Reid Facebook page. I haven't heard a response, but then I don't expect to. The media wants sensational stories, not reality.

"In your interview with the head of the Texas Nursing Association I could not help but notice that this woman hemmed and hawed but refused to address the real issues in health care that threaten public health. The rushed environment, chronic understaffing, and the second class citizen status of nurses all contribute to these “systems” errors, to which she kept referring.

Nurse informaticists’ concerns are not listened to when they are working on these EHRs but even worse, most nurse informaticists are not currently working at the bedside and are unable to see what is happening NOW.

Furthermore, nurses are silenced and their jobs are threatened for raising concerns about safety issues, they are treated like second class citizens in health care, they are not represented on boards, those who do the front line work of taking care of patients are not the ones whose ideas are tapped for making common sense developments of EHRs, the workflow is separate for nurses because doctors don’t want to be bothered reading nursing notes even though they contain lifesaving information.

What about the failure of administrators and executives to be held accountable for "systems" failures? Isn’t that why we pay them the big bucks? Shouldn’t they have a duty to protect the public from faulty “systems”?

The head of the TNA sounded like she had no clue about what really goes on in the hospital setting. I would like to see the press interview a nurse who could really tell it like it is. The ANA nationally has a tiny fraction of our country’s 3 million nurses as members because they simply don’t represent real working nurses’ interests."


Yup. We've got ourselves an epidemic on our hands, but it ain't pink, purple or yellow. It's black and navy suits. Hiding out behind their "systems".

They need a good disinfectant. Like, sunshine.

The real crisis is the failure to hold any of these suits accountable for their actions that harm public health.

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...

Obesification: A Suicide Mission

Kevin Pho's blogpost on the proportion of executive and administrative salaries in our sick health care system, along with the VA scandal, got me fired up again.

Conservatives and liberals alike are mad as hell...oh, the outrage.The light on the VA scandal made public the problems of power and corruption, mistreatment of employees and whistleblowers. Again. The shameful treatment of veterans whom the agency was supposed to be helping. Again.

Obama knew about this problem when he took office. The problem was already there when Bush was in office. Obama caused it by promoting big government. Bush caused it by starting wars we couldn't pay for. It’s the Republicans. It’s the Democrats. It’s Bush. It’s Obama. It’s Fox News. It’s MSNBC.

STFU.

It's us, all of us. We have our voices, we have our votes, most of us have two legs, two arms, two hands, a mouth, and a brain. We can be cognizant of our world and act in it. Use the damn resources you've got instead of sitting on your fat ass texting.

When you look at problems such as the VA’s actions that do come to light, it’s really just another day, another dollar, another power broker. Bullies and greed run the show. The government has acted no differently than private industry or nonprofits.

Apparently it’s okay to bully people who point out injustices, or who criticize the status quo, no matter what sector you work in. Wouldn’t want someone to have an independent thought. Talk out of one side of the mouth about providing value for the patient, while stealing value blind?

The value they talk about is only about how well it serves the interests at the top.

We approved it, yes we did.

Is it because we are working ourselves to death, doing the jobs of two or more people, working longer hours with less pay, fewer benefits, and less compassion than ever before? Auto-piloting through our jam-packed workdays, stacked together into a blur. Stuck in our self-imposed commutes, bound to our inflated mortgages, reliant on our vehicles, ruled by our electronic gadgets.

Whose fault is that?

We were complicit in underfunding public education, we didn’t provide physical or health education that prepares kids to be healthy, informed and functionally literate adults. We succumbed to our reliance on processed, fast, convenience foods laden with sugar, simple carbohydrates and salt to seduce our tastebuds, drain our wallets, and addict our minds.

We approved of the behavior of executives and those with power who run public, private, and so-called not-for-profit companies, corporations, agencies and health care systems, who siphon off financial resources into their own pockets, personally risking little as they have a golden parachute to back them up.

Where’s the golden parachute for the rest of us? What if we are all forced to jump into thin air, and no one will rescue us. We’re being taken by gravity, and no one will be there to pick up the pieces when we go SPLAT!

Instead, we think our golden parachute is the next weight loss drug, the next diabetes drug, or the next New York Times Bestseller Diet Fad.

Will we not stop until every single citizen of this country is impoverished, obese and Type II diabetic?

Eventually there will be a breaking point where the people will no longer have the resources to passively support this system. We’ll be too old, sick, fat, exhausted, and poor. Only when we’re dead will we cease to support the system.

Except for the unfortunate recipients of our stupid genes, if we passed them along to the next generation. But the way things are going, they won’t have to suffer as long as we do.

They won't live as long.

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.

On Banning Bossy

It's snowing today and I'm catching up on some of the thoughts that I placed on the back burner all week.

There's been a lot of hype about the "Ban Bossy" campaign in the news lately, and the talk is all over the map. I was thinking about the Ban Bossy campaign in regards to health care, especially nursing, since nurses are notoriously "bossy", or at least referred to as such.

I can even remember being a nursing student and talking with a physician about a patient during my clinicals. He told me, "You nurses are all alike: bossy". He was joking, and it was actually meant in a complimentary way, because he took my idea seriously. But in general, I think the "bossy" label is stuck to nurses like superglue.

Leadership means you help raise all ships. You encourage people to be their best. But the corporate world's aims are at odds with this. Maximizing profits and cutting costs does not encourage people to be their best. Nurses working short-staffed become short-tempered, even if they aren't "bossy" to begin with.

Managers find ways to cut staff, undermining people's efforts and encouraging backstabbing among peers to get people to leave, especially those who might question (threaten) the wisdom of their decisions.

There is a large gap between true leadership and bossy in nursing. There are so few real leaders, who help people to improve. Of course there are always the constructs of improvement or success to contend with. In the corporate world, they mean profits. And the way health care is reforming, with the conglomeration model, it's getting worse. It's a human factory, both on the patients' and staff's sides of the coin.

There's no time for real leadership activity when your staff are out there running themselves into the ground, and when your management duties require you to attend time-consuming meetings for additional propaganda "training", learning how to script your words to obscure the newly merged organization's pursuit of the bottom line despite it's carefully and expensively crafted mission statement.

The other thing management has to do in the new health care model is worry about numbers. Scores on every possible measure you could imagine. Patient satisfaction, readmissions, meaningful use, those are only a few of the newly coined terms that fly around in the hallowed hallways of the muckety-mucks in health care.

Bean counters and consulting firms are the gods, they are prioritized over staff who carry out the drudge work. The most valued players in the organization are the consultants who show shaky-handed executives how to navigate the new world of health care and preserve their well-paid spots backed up by golden parachutes.

You can either stuff your feelings and toe the line or get out. Simple as that. It doesn't matter how good you are with people, or how skilled you are as a leader. Doesn't matter if you're a good nurse with the patients. You have to keep your mouth shut and nod your head.

Yesterday I was in the parking lot of the grocery store and ran into a former colleague from the hospital. I liked working with him, and he was good at his job. He apparently didn't know I left. I asked him how things were going, and he replied, "still hanging in, coming up on 17 years. What else are you gonna do?"

I said, "I got out". He looked surprised, he obviously didn't know.

"What are you doing now?"

I told him about starting my business. It was like someone pulled the curtain back. I could see the amazement in his face, it was something he never even considered for himself. He had resigned himself to being stuck in that job and employer forever, according to his slumped shoulders and lowered head.

An old friend of mine was in the hospital across the country after having a complicated laparoscopic hysterectomy, and they kept her for just 23 hours post-surgery. It wasn't a simple procedure, the surgery took a few hours longer than they had anticipated. Still, they discharged her according to the insurance company's coverage and the original plan.

She was sharing a room with another patient whose behavior was not conducive to my friend's healing. Not only did my friend realize, in her post-anesthesia and poorly controlled pain -induced fog, that the nurses were understaffed and working their butts off, and unable to stay on top of her pain, but she saw other things too.

My friend noted the behavior of some people to milk the system. She noted that the family of an elderly person with dementia were trying to get the doctor to keep the woman there when there was nothing justifying her hospitalization.

The family probably just needed respite, and we don't do a good enough job providing resources for people who are caregivers. As the population ages we need to be able to provide these resources, but the system is busy cranking out dollars and minimizing costs, so the extra care and the services that are less profitable get cut, and people suffer.

When organizations are so focused on profit, bossy becomes the rule. Bossy in the sense of bullying and controlling. It's top down, hierarchical, and domineering. Those with poor people skills get ahead in these organizations. Time will tell how the new health care model pans out for the recipients (dare I say victims?) of it's excesses of profiteering. I predict we'll soon be circling the drain.

I'm not a fan of "Obamacare", because it is truly flawed. I never thought I'd hear myself using the derisive term "Obamacare" but I'm oh so skeptical, and not for the same reasons that conservatives use to bash it.

Insurance companies and health care executives are benefitting, but we have yet to see how much the people who were formerly uninsured benefit. Personally I think we need health care for all in a single payer system.

So in my opinion, banning bossy is a lot more complex than the effect of labeling on people's ambitions. I think we need to start by banning our love affair with power and greed.

That's my $.02.

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.

Just a Thought for Cyber Monday

Not just for Christmas anymore. Let's make this last all year, and into eternity. Start by not buying anything online today, but that's the least you can do.

All of our biggest problems are caused by feeding into the greed of people who amass too much money and power. And by our silence and complacency, we allow it!

We all suffer from it here in the U.S. with our corrupt government, the system of corporate and private interest money going into lobbyists and sources of influence to tweak the system in their favor and not the people's.

It's one thing to make money or turn a profit, but when it's at the expense of millions of people's lives and well-being, that's greed. Our healthcare system is a good example of that, the insurance companies and pharmaceutical companies are perfect examples.

Even not-for-profit entities turn profits and instigate violent knee-jerk reactions to anything that might interfere with their money-making ability. Case in point: Health Care Systems. Anyone who strays outside a narrow set of lines is removed as quickly as possible by whatever means necessary, by a culture of corporate bullying that the law allows, because the law favors those with money and power.

Nurses are a readily available, exploitable source of labor easily manipulated by threats to their livelihood and licenses. Amanda Trujillo's case is one notable example, but there are many others, too numerous to track. The collusion of management, corporate culture, state-run licensing boards, and legal impediments to organized labor all contribute to an impossible situation for anyone who questions their motives or points out their hypocrisy, or worst of all, identifies a hazard to the public and tries to do the right thing to fix it.

In a conversation with a number of nurses recently, someone pointed out the analogy of a jumbo jet. If we treated airline pilots the way we run health care and nurse labor practices, any jet that took off would stand no chance of landing without crashing because there would be so many unresolved safety issues.

Make your new year's resolution something that will help all people. Resolve to make a statement, put your energy into changing the balance of power. It takes a lot of people, not just a few vocal ones. Instead of using the Internet for shopping, use it for social change. Write a letter, spread the word, don't just make people aware, motivate them to take action.

That's my $.02 for the day. Back to work...

Double Holiday Miles and Good Advice

Hanukkah and Thanksgiving, together. What a perfect day, warm, sunny, the massive white peaks of Longs on the west horizon, great day for a run, listening to the geese arriving home for the winter in giant V formations across the sky. I did 7 miles, plus a few walks with the girls. Not many miles today, saving it up for the next few days, when I'll want to be out there in the quiet.

The cottonwoods are just as impressive bare as they are with their leaves.

Early Thanksgiving morning I will go over to Windsor and help with registration and packet pickup for the Pelican Lakes 5K, and after that I might run the race. Probably will, but not 100% sure.

I figure I will get plenty of short runs in between cooking spells all day Thursday. That's the plan- put something in the oven, go for a run, come back and check on it, go for another run.

I always love running around the holidays. There's less traffic and the streets are quiet. Except for Black Friday. Ugh. "Corporate Greed Friday". I try not to spend any money on Black Friday and try not to drive anywhere, either. I like to run, far away from the busy sections of town where shoppers might be driving.

Today I stopped by the liquor store, something I haven't done since before I stopped working at the hospital. I have not even wanted beer or anything since I quit work. Amazing. I thought I'd get some beer in case we wanted some on Thanksgiving while the liquor stores are closed.

I found this new organic lager by New Belgium, called California Route- they collaborated with Patagonia- speaking of corporations- and produced this citrusy hoppy beer that is pretty good for a lager, in a can. It reminds me of a tamed-down version of Dale's Pale Ale. Very tame. But I like it. And they are donating proceeds to flood relief in Colorado after our September flood.

So I partied with the girls this afternoon, and Iris went crazy over the new beer. She had to check it out, she protested not being able to taste it and then when I finally let her smell it, she didn't want it. She doesn't like hoppy beers, she's more of a dark, chocolatey stout, porter or dark ale drinker.

Isabelle doesn't like beer all that much. She prefers to hang out with her mom and watch Iris throw a temper tantrum.

It's Hanukkah, and I don't do Hanukkah. We don't do Black Friday. I don't do Christmas, and Dennis barely does. I'm not into religious holidays, and certainly not the spending and consumption that goes with them. I do Solstice, and New Years. They are running holidays for me. Might as well be my religion.

But speaking of religion...

while I'm on it, what the Pope said.

I like this Pope. I wish people would listen to him. He has some good messages that really ought to be listened to by more than just Catholics. Because there are a lot of people who really need to hear this message. I know it will go in one ear and out the other for those people with no social conscience.

Times like these make me extra thankful that I never had kids because I wouldn't want to try to raise them in this world the way things are, and I certainly wouldn't want to leave them in this world that my generation has screwed up so badly. At this point things are so screwed up that I don't think anything can fix us. Unless we drop a bomb on the whole planet and obliterate it and whatever life form is left starts over.

But I hope the kids like my niece and nephews, the so-called Millenials, will be different, and find a way to salvage their world after their greedy, shortsighted predecessors from my generation and the one after mine die off.

And speaking of religion, here's the best quote ever from the running legend himself, snagged this one from my Badwater buddy Chris Roman's Facebook page today.

"My advice is that you should use your brains more and train less."
- Yiannis Kouros

Might as well be the Pope speaking.

Happy Thanksgiving, Hanukkah, or whatever you want it to be. Just be happy.