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 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.