Ode to the Zombies in the C-Suite

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

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

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

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

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

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

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

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

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

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

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

Nurses Week Takeaways from DC Part I: Politics and Nursing

It’s Nurses’ Week again.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And every one of us are, also.

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

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

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

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

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

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

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

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

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

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

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

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

photo credit: Andrew Lopez

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

Transcript of my speech from Nurses Take DC 2018

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

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

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

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

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

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

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

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

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

It is, “How do we solve this mess?”

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

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

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

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

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

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

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

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

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

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

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

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

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

Vicarious Vlogging: DoNut Stop...

Last Friday was my friend Connie's 60th birthday. We had a special donut run planned for her, all caught on video. Watch a bunch of runners try to figure out how to light a candle on top of a donut.

Between becoming a card-carrying member of the frequent donut club and celebrating the long-awaited M Day, it's been a busy couple of weeks and we're getting ready to go on vacation soon. We'll be going through Las Vegas on our way to LA. As long as Pokémon Go players don't destroy it by then. As long as Sushi Koma is safe, I don't care.

Some crazy F#$@! was playing this stupid new obsession in the empty Mormon church parking lot last week and nearly ran me over. I was walking on the sidewalk, crossing the exit drive from the parking lot , and this dumbshit in a Subaru screeched to a halt right in front of me. I looked at him like, WTF? and he had his head down, looking at his phone. I don't know if he saw me, or if he was stopping to get one of the characters. I wanted to go over and bash the shit out of the side of his car, Beyoncé style, but I didn't feel like dealing with him. And I didn't have my baseball bat, left it home. Damn.

Exciting news, we are a little closer to becoming parents again. There are four litters expected by mid-August and depending on how many puppies there are, that means by October we will either be near the top of the list for first pick or first pick for the next breeding cycle. One of my favorite girls, Spark, is having her first litter. We'll see what happens there. She's a black tri and the dad is a blue merle.

Last week I spoke to a gathering of about 30 people at a local nonprofit event for cancer survivors in the community, it went well. I could go on and on about healthcare and why we do such a lousy job with post-treatment care for people, and why this moonshot is still missing a huge target: earth. That's where real people are.

Between ignoring the fact that there are millions of people who've been through cancer treatment and need help living with the ongoing effects, and the fact that our horrible approach to educating people about the basics of health and taking care of their bodies is creating more disease that threatens to destroy not only our economy but our entire species...but no one is going to listen to that because the powers that be know they will make more money off of the "moonshot" crap in the short run and their philosophy is "I've got mine, screw you." Sound familiar? Cleveland, anyone?

I'm sure there will be plenty of laughs in Cleveland this week, I just hope no shootings or violence. Seems like the world is going batshit crazier these past few weeks. More shootings...so crazy. People are so stupid. People are just really freaking stupid. Guns don't solve anything. Live human beings could, but that seems to be out of the question these days.

I got my 3D mammogram done, all turned out okay, fortunately. And tomorrow I have an appointment for my DEXA scan. Last week I also had blood drawn for a clinical trial, and a robotic front desk clerk couldn't figure out what a clinical trial was. But it's all done and figured out now.

I've been screened to the hilt, so I hope to be done with being squeezed, poked, and prodded for a while.

I'm working on a grant application I need to finish before I leave. For that, I need to make a video and I am struggling with it. It takes so long to make those damn things. If I wouldn't stumble over my words so much it would take less time.

And I need to pull up all the lettuce that's going to seed and plant more so we'll have some big salads this fall, to go along with the tomatoes and cucumbers that should be out of control by the time we get home. My neighbor is so lucky, she'll be eating our raspberries and cherry tomatoes while we're gone. This year we got some black raspberries, which only happens every couple of years. I can't figure that out.

Last week I slacked off just a little on the running. It was so miserably hot and I had so much to do that I didn't get out in time and it sucked. I still managed 60+ miles but didn't run very much of it. Maybe this week I can get some miles in.

And I am still waiting for my official DoNut Stop Running tank top to arrive in the mail.

Off to brave another week before heading to the desert...

Whirlwind in the Desert: BRA Day

I'm home, looking at the cool fall colors, after a week in Arizona. I managed to catch a nasty cold, probably on the flight down there, so I'm sniffling, hacking and snorting my way through the day, surrounded by piles of tissue and tea cups.

This blogpost isn't much about running, although I'm proud to announce that I have now been consistent with running most days of the week for the past 6 weeks. This coming week I'm sure I will cut back in order to get over this crud, but I feel like I've finally reached a point where the running is habitual again. I was up to nearly an hour and a half of running 4 or 5 days a week with some 2 hour runs thrown in there. Still no interest in ending my current hiatus from doing any running events, but we'll see how that goes...

I went down to Scottsdale to visit my dad and stepmom, and speak at an event in Tucson. Wednesday October 21 was BRA Day, Breast Reconstruction Awareness Day. It's intended to educate women about a full range of options for breast reconstruction following mastectomy.

Most women don't find out that they have a range of procedures to choose from that include using their own tissue to reconstruct breasts after a mastectomy, often they rush into immediate reconstruction with expanders and then implants, without being informed about all the possibilities because of microsurgical techniques that allow the patient's own fat and skin to be harvested and a blood supply established to create a more natural appearing breast.

More about that in a few... I flew down and the weather was un-Arizona-like. It rained like hell two nights in a row, a deluge of rain and hail in different parts of the valley. I ran early Monday morning with my running friend Chris and another friend of his on the canal, before the sun came up. It felt more Florida than Arizona with the humidity.

I hung out with my dad and stepmom, my dad is doing somewhat better and it appears that chemo is working. We won't go into the details of the possibility of relapse, which is fairly high, but he's feeling better and things are going well overall. Things are looking up now. It's great to see him getting his old energy back. Not quite himself, but he's improved dramatically.

I met with a social media expert while I was down there and will be using his services as I move forward with my business endeavors. I finished a big chunk of work before I left and now I'm switching gears from developing content to marketing.

Then it was time to go to Tucson for BRA Day. I met Terri online, now I can't even remember the exact circumstances of our connection but we started corresponding last summer and Terri wanted to make a BRA Day event happen in Tucson and she perservered along with the help of some nurses and social workers in Tucson who convinced the powers-that-be that it would be a worthwhile event to host.

Terri assembled a panel of speakers and the backing of local businesses to support the event and it came together despite many hiccups and speedbumps along the way. I agreed to help in any way I could despite being out of town.

We set it all up in the lobby of the U of A Cancer Center, which looks and feels remarkably similar to the Cancer Center we have here in Fort Collins. It was dumping rain as we carried all the supplies and donated gifts from Terri's car to the lobby of the Cancer Center.

We didn't have a room, podium, or formal presentation set-up, just some lobby furniture and a screen, and a microphone. But we did it, and it worked. One of the nursing staff members bought the refreshments herself. Local businesses donated prizes. Terri's son recorded all he could on the Periscope app on my phone. Of course my phone battery died even with the extra battery pack, so we didn't get to record most of the speakers. We have a learning curve with Periscope, which has some glitches itself.

I spoke on "Reconstructing Well-Being", about some of the overall wellness, prehabilitation and lifelong habits to adopt regardless of where a person might be with regards to cancer treatment and reconstruction decisions. Terri talked about her experience as a patient, there were nurses, social workers, tattoo artists, a plastic surgeon's PA and a breast surgeon there. Topics ranged from sexuality to surgical options to cosmetic appearance to more personal experiences from a patient who is also a nurse.

We had no idea how many people might show up for the event but we hoped it would be at least a couple of dozen. As it turned out we had a good 40-50 people in attendance. Afterwards we cleaned up and moved the furniture back to where it was, and it was time to party!

Afterwards four of us, the three nurses and Terri, went out to a Mexican restaurant for food and margaritas and got serenaded by a mariachi band, and decompressed. It is so amazing how every health system, nurses, cancer centers, and administration work the same everywhere.

This event only happened because of the work of Terri, a patient advocate, and her backing by a nurse and social worker who wanted to do something needed, useful, important, and meaningful for patients. It wouldn't have happened otherwise.

This is what it takes, people need to speak up and be vocal. Advocating for yourself as a patient, and for others who face similar experiences, as Terri does, and health care workers advocating for patients' needs and filling the gaps in information and care, all of that only happens at the grassroots level. With the corporatization of health care, the people up high are running a business. To use an overused term, there is a disconnect yes- I hate cliches too - between the business of health care and the service of health care. Service is what it needs to be about, otherwise we won't be serving anyone's best interest except the people who stand to profit.

The only way to make things work for the people who need the services is to do the footwork, be vocal, don't back down, and persist. It takes effort to make worthwhile things happen, and if at first it doesn't fit, make it fit.

Just like you have to move and make some effort to improve your health, changing the way the system works will take real effort toward movement. Sedentary habits won't create change.

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.

Happy Re-Birthday: A Year Out of the Dungeon

It's been one year since I left my corporate nursing job.

Just one year. Seems impossible that the time could go by so quickly, and so much could happen. But it seems like forever, really, like a distant nightmare. I was reading over some of what I wrote last year, and I am happy to say that I'm able to look at it without the emotion engulfing me. I've done a lot of healing in that time.

At first I missed the patients and some of my coworkers. But I've stayed in touch with the coworkers that mattered, and have more meaningful relationships with several. I've run into many of my former patients in town, and continue to work with a few of them, but in different ways now.

The work I do is so much more satisfying, I don't miss sticking needles in people or filling their veins with poison one bit. And I certainly don't miss punching a time clock so I could get a steady paycheck but feeling like I would have to sell my soul in order to keep getting one.

I have learned so much more since I left because I have more energy to read and research information on what's going on in cancer care far beyond the confines of a dingy little windowless cave subjected to the whims of toxic people who made decisions without considering the people they would affect most or asking for input from the nurses who worked with those people every day.

There are thousands upon thousands of nurses out there who have left what they felt were oppressive conditions in the workplace and moved on to something else. And I am just one.

Before I left corporate nursing I was surrounded by other nurses who were afraid. Some of them did not-so-nice things to each other, and to me. I no longer take it personally. Now my true colleagues are nurses who are not stuck in the system. They are not afraid. They have found a way out, and many of them have suffered great pain and loss to get to where they are now. Much worse than I did. They are a diverse group, some are employed in the profession, many are self-employed, many are out completely.

There is a common thread among most of these nurses, they love nursing and they would like the profession to change for the better, but there is a long climb ahead and it seems we lose ground on most days. Occasionally there is a bright moment, but then we fall back into the void. 

There is a definite hum that's picking up in intensity, the misplaced blame on nurses in the Ebola situation fueled it, but that's only a glimpse of the problems. Nurses have HAD IT.

I've been listening to and talking with a lot of nurses over the past year, all over the country, and in other countries too. I've been thinking about ways to fix things, ways to improve things, and most of the work I've done has focused on individual people, which is good on my own, but always knowing that in the big picture of health care, most of the work nurses are doing in those workplaces is like building sandcastles at low tide.

And when the tide comes in, it's more of a rip current, a crashing of water with overwhelming force, an undercurrent that knocks you off your feet and threatens to drown your breath and silence your voice forever.

And the damage it does comes from all of the following forces and more...

1. A two-tiered system where managers, administrators and executives answer to money and quantitative data (numbers that are now called "metrics") that have everything to do with what they like to call "quality" but really mean more busywork for the people who are supposed to be doing patient care, but that data really translates to "reimbursement" aka money. Meanwhile the other tier, nurses, physicians and other health care staff, take seriously their professional oaths and training to not do harm, and the two tiers have little mutual understanding of each others' obligations to their own callings (money/boards/shareholders/stockholders vs. moral and ethical obligations to patients, oaths and licensure), each speaking it's own language not fully understood by or ever truly communicated with the other tier.

2. Lack of leadership in the highest ranks of nursing organizations, which consist of leaders from industry and higher education who protect their own turf which goes against the best interest of working nurses.

3. A great amount of fear among workers that has been exacerbated by the past three decades of eroding workplace protections, a mainstream media that fosters unrestrained hate and divisiveness and fosters paranoia and misinformation, ignoring facts in favor of hype. Attacks on free speech (in the craze over the second amendment, seems we've forgotten the first) and organized labor, and legislation that favors the big corporate money interests, giving them the rights of individuals.

4. A system on steroids that intensifies the poor people skills and lack of empathy held by a great number of those who advance to administrative positions and executive power, leaving the staff at the bedside populated by people who care about patients' best interests but without a voice or support to help them.

5.Lack of advocacy or assertiveness by nurses for their own interests in their workplaces in the face of strongarm tactics used to intimidate and dismiss their concerns.

6. Eroding job security as employers look to part-time hiring, reducing staff, decreasing benefits, and electronic spying on employees both in and out of the workplace.

7. Increasing burnout due to the task-oriented nature of nursing work and increased demands to do more with less staff, working equipment, support, training, at the same time being faced with expectations to increase the amount of documentation time and checklists, taking away clinical judgment opportunities and interpersonal connection in patient care duties.

8. A work culture that values "yes-men and women" more than clinical skill or attention to safety, that provides disincentives to speak, disagree, or otherwise question the status quo, motives, or actions of "leadership".

9. A capitalistic system run amok where the distribution of wealth becomes more skewed all the time with no brakes to stop it.

10. A legal system run amok with power that works in favor of the wealthy white collar criminals who can afford to buy their own teams of attorneys, and can buy lobbyists to buy politicians who will work even more in their favor, with no brakes to stop it.

11. A health care system that enriches the top-end insurance companies and pharmaceutical companies, but makes no investment in the base of the pyramid: health education in schools to teach children how to manage their health from an early age, universal basic health education for people at all stages of their lives with and without disease, teaching chronically OR terminally ill people about palliative care, the options not to treat some illnesses, death education so it is accepted as part of life and not so feared and avoided at all costs.

12. A public health system that has been underfunded to the point of endangering public health by promoting misinformation and being embarrassingly unprepared for a crisis.

13. A for-profit so-called health care system (even though some of it calls itself not-for-profit but it is still working for profit) that results in competition to a degree that hurts patients' best interests by withholding information about options and resources available to them outside of an organization's domain. Health care is not at all about health, and it is not about caring. It is about making money off of chronic illness, of various types and trajectories.

14. The collective personality-disordered nature of "leadership": with it's insecure, narcissistic, sociopathic bent that has no empathy for patients or their families true needs, or the needs of direct patient care workers. This distorted method of leadership pursues matters in the interest of building their egos, power, status, bonuses, perks, and the ultimate perk of all, the insurance policy of guaranteed future personal economic security via outrageous sums of money upon leaving an organization regardless of the reason.

There's a lot to say, and I'm not done saying it. Just getting warmed up.

I'm not dead yet, and I won't be done until I'm dead. I don't know how long I'll live, but if I died today, I'd be okay with it.

Because at least I will know I tried, I spoke from my heart, I called out what I saw, and I felt the passion and the horror, witnessed the suffering and the relief, and I know I lived true to myself and my own principles.

And unlike those narcissistic shadows holding nooses around the necks of hardworking direct patient care nurses, I didn't look the other way knowing what I was doing, despite what I claimed and hid behind, was really not about caring for people but instead lining my own pockets and enriching myself at the expense of other people's well-being.

There are at least three differences now.

One is that I can say these things calmly, without the raging anger that I felt a year ago.

Two, I am on the lookout for solutions, and I know I am not alone, as I felt a year ago.

Three, I am pursuing my passion, and I have no one holding me back, I have lost the shadow and the noose of a year ago. 

Every day I wish the same for my fellow nurses who are feeling alone, stuck, and fearful in those oppressive environments. I hope they find their way out of the dungeon, because they already have the key, they just have to turn it.

Live From The Woman Cave: False Start

Only three days into the week and I can tell I need a long rest. Monday and Tuesday were crazy jam-packed days with work and I got out for an hour run on Monday followed by a very brief half mile run with the tire.

I could feel the tire in my low back just slightly on Tuesday when I woke up, but it went away over the day. At noon I met several people from the Fort Collins Running Club at noon at the Fossil Ridge High School track. I jogged easy laps while they did 400s. I just wanted to be there and meet some of the new members of the club. I ran about 4 miles and did a short ride on the bike, mounted on the trainer, that afternoon.

Today I went up to Horsetooth Mountain park and did two Rock Repeats, something I haven't done in months. I figured it would be good to get some climbing in, all I did was hike the uphills and jogged the downhills, I know I will be sore as hell even from that, but I needed to do it.

On my way out there I ran into some old running friends I hardly ever see anymore, they were out with their dog to hike the rock once. We talked for a while before we got started and again before I went out for my second climb, they were finished with their hike.

There were deer out everywhere, on the roads and trails.

Tuesday before I went to the track I had a long conversation with an acquaintance from some of the cancer-related organizations I've been involved with in town. We had not talked much, just briefly when we ran into each other at social functions, since I left the hospital, nearly a year ago. It was a great conversation, ranged from local cancer politics to life and death existential issues to our mutual dislike of the profit-focused lack of care in health care.

It's the kind of thing that sticks with you, and when I was running on the track afterwards, I couldn't wait to get to a quiet place to process what we had talked about, it fit perfectly into a piece I'm writing now.

This week I've been working mostly from home and been spending time with the girls. Iris was waiting for her dad to come home from work in this picture.

Tonight I indulged in a seasonal beer from New Belgium, Accumulation IPA. It has a light body, a mildly citrusy hoppy taste without being overpowering, and hardly any bitterness compared to most IPAs. I like it. Okay, maybe the hard core beer connoisseurs would say it's girl beer. Girl IPA. Girls appreciate the good things, we don't have to drink tar or acid to prove ourselves.

Speaking of girls, they had an extra little treat tonight before we came out to the woman cave, while I opened my beer. They love to lie down at my feet while I work, but occasionally they'll want in or out of the cave.

The rest of the week has some walking, time on the bike, a swim or pool run, and the Tortoise and Hare 5K, a Fort Collins Running Club event which is low key and I will jog it, just to be there. I got a text from Wheaties Boy today asking me if I wanted to meet for speedwork on Friday! I said, you're dealing with a geriatric runner here, how about a beer instead? I don't think I'll be ready for speedwork of any type until 2015.

I can tell how tired I am, I can run and feel decent one day, but then the next day I feel like death. Not ready to jump back in yet, this week has been an experiment with short workouts to see how everything feels.

Definitely far from being ready to get back to anything called training. That's okay, I have enough deadlines and projects to keep me busy.

Tonight I made chicken-spinach enchiladas with a new recipe I invented, sort of. I borrowed a salsa recipe from a restaurant in Manhattan Beach that the owner gave me, and adjusted it just a little.

There is this breakfast place we go to when we're there and it is amazing, it's right next door to a very popular restaurant that people wait in line for hours to get into, but just down the hill there is this tiny café that serves the most incredible food, and they make this fresh salsa that they put at the table and I think I go there for the salsa as much as I do for the food.

The owner is from Mexico and he made this salsa from dried chiles and it has oregano and bay leaf in it, and the flavor is too good to describe, you have to eat it to understand.

I had some chicken breasts that I cooked a few days ago, ground those up in the food processor, sautéed some spinach and onions and red bell pepper, and threw it all together with some nonfat sour cream, and corn tortillas, and a little cheese. I baked it in the oven while I made the salsa.

I added some hot chicken broth to it. About 10 minutes before the enchiladas were done I took them out and poured the salsa broth over the pan of enchiladas and stuck them back in the oven. The enchiladas were mild, with almost nothing spicy, but the salsa was super hot and spicy, and it was a perfect combination.

Eventually I'll remember to post this on Bitchen Swill, but maybe I'll keep it a secret for a while. Good thing I made a big pan, we'll have leftovers tomorrow.

Iris is staring at me from outside. I think she's telling me to quit for the night and come in the house and go to bed.

She gives good advice.

The Fallout Continues...

Tonight I did a radio show on breast cancer awareness month and pinkification of October. It was fun, especially when I was scheduled for a 30 minute show and the host suddenly, a few seconds before we started, saw something that erroneously told her we were on for 60 minutes. I was fine with that, I had plenty of material and I could talk forever about these topics. We slowed everything down to stretch it out, and then suddenly, 5 minutes before the 30 minute mark, someone tapped on the door to tell her the show was only 30 minutes, so she let me get my last words in and I scrambled to say all of the important points in the last 3 minutes or so. Crazy, but fun anyway.

After the show we talked for a little while casually about health care and I mentioned my challenges in getting my business off the ground. One of the biggest assumptions I made at the beginning was about how I'd market my services. I thought doctors would be interested in what I was doing and welcome it. Well, getting to talk to a doctor face to face has only happened enough times to count on one hand, and most of those were by accident when I ran into them in town somewhere by chance, like in the grocery store.

The way I see it is, I have this great service that would be so good for their patients, but I can't even get 5 minutes of their time to talk with them about it. They just don't prioritize that, it's a different way of operating than they are used to, and now with fierce competition in town, everyone is protecting their own turf and profits. They see anything outside of what they do as competition.

The host of the radio show, who works in health care herself, told me that a doctor she knows thinks physicians are slow as snails to adopt anything new, she said on the order of 17 years (about as long as a new drug patent used to last before the generic could be marketed).

We are still being inundated with Ebola everything, and I have read some highly astute observations from people at the direct care levels of health care, physicians, nurses, infection control specialists, and techs on the state of health care in this country. Many of the things I have discussed in past blogposts with regard to patient safety and how nurses are treated in the workplace and when they raise concerns about safety issues in the workplace have surfaced in the Texas Presbyterian flap.

I also read with interest this article about how things are being handled at the Biocontainment Unit at the University of Nebraska medical center, one of the hospitals where Ebola cases are treated and they have a solid and effective plan in place for their workers to prevent transmission of the disease. If you go to page 2 they talk about breaking shifts into four hour blocks when dealing with the extreme conditions of having to work in hazmat gear, and on page four, they discuss how they pay attention to the needs of the caregivers.

Some of the things they do could be applied in general, such as allowing time for breaks, to eat and drink and use the bathroom, having behavioral specialists to help people deal with the stresses of working. If you're not in health care, you might think, what? Of course you need to take breaks and eat, drink, and go to the bathroom. If you are a nurse, you're thinking, what a novel common sense approach, and you're already googling on U of N Medical Center to see if they have any open positions on their employment site. You're thinking, hell yes I'll work with those patients in a space suit if it means I get to pee and eat every four hours!

Just think what we could accomplish if safety was our top priority. We'd have to slow down, and maybe take care of the needs of the employees who are taking care of patients. And then maybe we could have zero hospital acquired infections, and instead of thousands of medical errors they would be as rare as Ebola in the U.S.

Why is it that in health care, when we should be staffed by smart people making good decisions because we are relying on them to take good care of our health when we are sick and dependent on them, that it turns out we are at the mercy of irresponsible, detached, myopic decision-making at the highest levels of the organization which trickle down to the front line workers being abused and working under inhumane conditions?

The other thing I noticed was that under the CDC new guidelines, which they released after a bunch of health care workers (namely nurses) made A LOT OF NOISE about the inadequacy of the first few messes they sent out...the new guidelines clearly state that management and leadership (ha- see my blogpost from a few days ago) are responsible for seeing that the guidelines are implemented and followed. Read: Five Pillars of Safety and I quote:

Five Pillars of Safety

CDC reminds all employers and healthcare workers that PPE is only one aspect of infection control and providing safe care to patients with Ebola. Other aspects include five pillars of safety:
•Facility leadership has responsibility to provide resources and support for implementation of effective prevention precautions. Management should maintain a culture of worker safety in which appropriate PPE is available and correctly maintained, and workers are provided with appropriate training.
•Designated on-site Ebola site manager responsible for oversight of implementing precautions for healthcare personnel and patient safety in the healthcare facility.
•Clear, standardized procedures where facilities choose one of two options and have a back-up plan in case supplies are not available.
•Trained healthcare personnel: facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment.
•Oversight of practices are critical to ensuring that implementation protocols are done accurately, and any error in putting on or taking off PPE is identified in real-time, corrected and addressed, in case potential exposure occurred.


A culture of worker safety. Hmm. And what culture is that? It's the one that is greatly exaggerated by most corporate leadership accounts. If something interferes with the bottom line, there will be a workaround. Somehow...

And somehow...University of Nebraska seems to get it, but that safety culture needs to expand throughout the health care system in this country, and profit-centered models of health care are not going to welcome it.

Certainly that culture was nonexistent at Texas Presbyterian, where they couldn't figure out that their PPE was inadequate or spend the money to transport a patient to where someone knew how to take care of him...yet they had plenty of money to hire an expensive PR firm to tell them how to handle their image after their disastrous mistakes that repelled patients to the point where their hospital is nearly empty now.

The culture at Texas Presbyterian, the same one that has administrators telling nurses not to go to the media or they'll be fired, the same one that resulted in one nurse blowing the whistle and we know she'll never be able to go back to working for that hospital again because of the retaliation she will face. Lawyer or not, the hostility directed at her after speaking the truth will make it impossible for her to carry out her duties, as they'll be watching her every step and finding ways to harass her until they get rid of her.

This is the reality of health care, folks. And it needs to change. If you're not in health care, this is what goes on behind the scenes when you or your family member is being "taken care of". This is what the nurses endure. This is what physicians are forced to work with, administrators who are unresponsive to their needs too.

This is what I've been screaming about so passionately for a long time, and finally we have a crisis that has brought these issues directly to the surface. And a lot of organizations are going to deny that they do business this way, and defend their own practices with lawyers, PR tactics, and doing whatever they feel they can get away with. "We're not like Texas Presbyterian" will be the cry of protest. But right now, every one of these organizations is scrambling to give the impression that they are prepared and trying to minimize their expenses to protect their profit. Some are more prepared than others, but the culture is what needs to change across the board.

This is health care in the U.S. naked.

Do you care yet?