I have puppy brain! We are announcing the arrival of the newest member of our family, Miss Velcro. She is a red tri and she was born 5 weeks ago. We will be bringing her home in another 3 weeks.
We are so excited! As soon as I saw her picture, I knew she was the one. It was love at first sight. I could not stop thinking about her, and as things unfolded with the litters at Sky Blue Aussies, she was available. We have our eye on another pup who is only 3 days old as of today, so I will fill you in as soon as we know everything is certain with our second puppy. Velcro will have a sister, and most likely she will be coming home a month after Velcro.
Running is minimal but more consistent. I'll talk about that below, after I get the shitstorm off my chest.
Recent Random Thoughts
I haven't been writing on my blog much, it's been hard with all the distractions, between puppy brain and it being Pinktober, the month where cancer and pink become intertwined and there are a lot of things going on. I spoke 3 times in one week, and I have more coming up before the month is through.
I had somewhat of an "aha" moment yesterday when I was thinking about my struggles with getting my program off the ground. It's a challenge to get people to want to do something. Everyone I talk to about it, including healthcare providers, sees the obvious and intense need for this type of education for patients and their caregivers. But there are a lot of barriers to people being able to use it in the way it is intended. I've been barking up the wrong tree trying to get it through the traditional healthcare channels.
One thing I am doing, that should help, is writing a book, which will not only have the program in it, but will also discuss why everyone needs to be in on this. Healthcare is so screwed up and it's only getting worse. Absolutely unsustainable. Yet cancer is about to overtake heart disease as the number one killer of Americans, and our healthcare costs are rising at an insane rate, and our health outcomes and general public health are getting worse. We have more obesity and diabetes, more lifestyle-related illness, and our administrative costs of running the healthcare system are exceeding our ability to put our resources into patient care and education.
Healthcare Heretic Again
I am being the healthcare heretic again, and working to make nurse groups aware of a documentary film project. Health 3.0 is a concept that goes beyond this transactional model, we call it 2.0, of healthcare where physicians or providers don't have relationships with patients, instead they are more of a factory, cranking patients through appointments in 15 minute intervals. Check this out for an example.
This short video is being mild about it. What I wish I had time to say is that all of these cancer centers and freestanding emergency rooms popping up everywhere are only being built because the current system incentivizes it. The hospitals get paid more. They can get reimbursed at a higher rate for emergency room visits and can charge a facility fee for setting foot in a cancer center, rather than an independent oncology practice. This disincentivizes patients from visiting their oncologists for follow-up visits. The hospitals can charge up to $400 for a facility fee alone (not including the doctor's bill) just for having an appointment in a room at the cancer center.
Had I realized just how slimy this whole process was, I would never have supported the local facility as I did half a decade ago. The Big Heist is right. It is a heist, to the tune of 20% of our GDP. Not acceptable. But people need to wake up and get off their obesified butts!
Remember how when we were talking about the need for the Affordable Care Act just a decade ago, lamenting the overuse of emergency rooms because people didn't have insurance for primary care and preventive medicine? Well, now we have high deductible plans again, with rates rising, driving people out of the market, but hospital executives can clean up on higher reimbursements and facility fees. And we're not doing a better job for patients. Dumb and dumber.
Here we are again. The vicious cycle of healthcare, now has consumed independent physician practices, has doctors all working as part of the giant healthcare factory, working at the whim of their employers, being told what to do by insurance companies, and nurses are understaffed and miserable again, physician suicide rates are rising, and nurses are leaving the profession because of burnout and injuries from overwork. There's no nursing shortage, just a shortage of nurses willing to put up with the abuse.
And the people who wrote the ACA: lobbyists for the pharmaceutical industry, hospital executives, and insurance companies, have ensured they will rake in big bucks while starving the masses.
General Random Thoughts about Running
I've been running about 4 days a week on the average. About 6 or 7 miles each time.
I know!!!
It feels good to run when I feel like it and I feel refreshed afterward. My friend Emma is training for her first ultra, so doing long runs with her has gotten me out on the trails. I'm so enjoying this.
I miss my hair color. I now have a streak of reddish brown in the front of my scalp. It's a deep brown with a reddish tint, but it's my natural color. People pay a lot of money to get their hair tinted to that color. Now I have just a streak of it to contrast with my grayish white. What are you gonna do?
I refuse to dye my hair. I am getting too many thumbs up when I run, and I need that for the motivation. Plus it keeps the creepos quiet. Nobody catcalls their grandma. Much preferred this way.
Oh, and one more thing- one day I was actually able to reach my mouth with the toes on my left foot. I haven't been able to do it again, must have been a good flexibility day. I'll keep working on it until I can do it consistently. Then I will post pictures.
(Disclaimer: I don't speak for the concept or creators of Healthcare 3.0 but this is a stab at explaining what it might do for nurses, and we need to make sure nurses are included as this idea is fleshed out)
The other day as I was having a conversation over coffee with a local colleague who is a psychotherapist, our conversation shifted to healthcare. There's been a lot of talk about Healthcare 3.0 as an answer to the problems of our current escalating and unsustainable costs that aren't making a dent in our health as a society. As a nurse, I get asked on social media what healthcare 3.0 could do for nurses, who are understaffed, burned out, ready to burn their scrubs and walk out. Let's start at the top.
My colleague said something interesting about people who have executive jobs. Often they think it works for them, but the way they are functioning is not working well. They make a lot of money, they may have status in their communities and workplaces, but they are deeply unhappy. They are unable to connect with the underlying source of their unhappiness. So intently focused on what they think they have to do to maintain their status, money, and power, they can’t face how it affects other people around them: their spouses, children, community, or their own health and well-being.
In healthcare especially, people who have executive jobs often are fostering the climate of creating more work and finding justification for filling positions that contribute little to patient care and outcomes. They are contributing to the problem of the providers’ agony of having to spend more time in front of the computer than they can ever spend talking with their patients.
It’s disruptive to patient health and satisfaction, provider health and satisfaction, public and community health, the economic sustainability of our healthcare system, and our entire national economy as a whole. As healthcare costs have soared along with administrative costs, so has the distress in communities over healthcare access and availability, jobs and security.
We are all connected to the greater community. And when someone is sucking the resources away for their own benefit and not sharing, it hurts everyone.
Look deep into the eyes of a healthcare CEO. It’s been said that CEOs can be ruthless, sociopathic people. You might be able to tell in their eyes if they are truly sociopathic or just in deep denial of what their everyday decisions and actions are doing to those around them.
I believe many, if not most of them, are human beings who have taken to heart the myth that status, power, privilege, and money are what defines a person’s worth, especially for men, and while they might on some level know this is a myth, feel too entrenched in the status quo and fear the discomfort of change, believing that the price they might pay personally and professionally would be too steep.
Eventually they start to pay for it in their own health- mental, emotional, physical, and spiritual health. They might get sick, be depressed, get divorced. Or they might realize it when a family member has a serious illness.
It takes courage to take risks, to make change. They might think they are more comfortable sustaining their standard of living, with the vacation homes, the disposable income, sending the kids to college without financial strain. Their financial security is well-padded with the promise of a golden parachute.
On the other side of the fence in healthcare are nurses. Near the bottom of the totem pole in the direct patient care hierarchy, nurses do the heavy labor physically and mentally. Expected to function as well as machines, they are given the near impossible expectations of being able to safely care for a number of patients of varying acuities, safely administer medications and other interventions, and document everything that happens all day, with every patient.
Nurses have the most responsibility, the least power and authority, and often are abused, bullied, and disrespected, even by their own peers. They are not included in decisions made at the top of an organization that directly affect their working conditions and may pose a risk to their safety, their patients, and their licenses.
When more work is piled on nurses, if they complain, they are told they are not managing their time well, or can’t multitask. If they complain about unsafe conditions, they can be fired. When things get out of control, or a mistake is made, they are the first to be blamed.
The only reason nurses are in the position we are in today is because we’ve allowed ourselves to be lulled into a lie. We have never challenged the old guard of dinosaurs who live in the days when nurses couldn’t be married, never questioned the doctor and could only wear white caps, stockings and dresses.
The fact is, today, nurses need to stop making excuses that we can’t make change or speak up because we are powerless and we’ll get fired from the jobs we need. How badly do you need a job that leaves you insulin resistant, overweight, hypertensive, with back pain, foot pain, or headaches. A job that leaves you sleep deprived, grouchy, unable to spend quality time with your family, but spending a day or two each week uncompensated while you recover from your 12 hour endurance shifts?
Just for raising this point I’ve been attacked by nurses who get defensive, usually because, “I have kids. I’m a single mom. My spouse is unable to work, disabled, etc. I’m supporting my parents, my kid is in college, I’m in debt…” and so on.
We all have choices in life, and there are no guarantees! What if you got injured or sick? What if you got fired? What if the hospital burned down? What if you lost your job for some other reason? What would you do? You’d have to find another job, but what if you couldn’t? You would have to come up with some kind of contingency plan, right?
No one is saying you should give up your job and stop supporting your family. What I’m saying is, you shouldn’t have to be abused while you’re trying to do it. You shouldn’t have to fear for your job and be forced to do things that are not safe, that damage your health and well-being and compromise your own ethical standards just to keep your employment. You ARE NOT powerless, you can do something. The fact that people do make excuses for not speaking up is reason enough for making change. There is ALWAYS a way.
Nurses need to quit attacking each other and having turf battles in the workplace, social circles, on social media, and in the community. We are all connected. Again, we’re not powerless, but we need to be more courageous. True leadership moves us forward, is not regressive, and requires courage. We have to be willing to take risks, to put our ideas out there, expose our ideas to the light of day instead of hiding behind private conversations in quiet corners.
If we were allowed to do our real jobs: to advocate for the patient, educate the patient, and navigate so the patient and family could find and access the resources they need, in addition to providing basic but highly skilled nursing care, we’d be able to practice like the professionals we are, not as wait staff on roller skates. We could each be experts on our own patients and bring in specialized, available experts when needed. We’d have time to have conversations with the patient and identify issues so we can collaborate with physicians, who would get the full scoop on what we’ve seen in our assessment and concerns we have about the patient, resulting in better outcomes.
To lead this change, we need share our vision for nursing, establish we want to see, and make it happen, through policy changes, influencing public attitudes and understanding, and working together instead of at odds. Here’s a partial list of some of the things nurses would like to have:
•Safe staffing ratios that are not just marginally safe, that truly allow us to provide GOOD care.
•Time to think about what we are doing instead of rushing from task to task
•Time to collaborate- with nurses, other staff, physicians, managers, administrators
•Time to give attention to patients, to have conversations with them where we can listen
•Time to take breaks, lunches, vacations
•Adequate time to get our work done within the hours of our shift
•Getting paid for all the work we do
•Feeling safe in expressing concerns
•Not being rushed
•Having our needs acknowledged and addressed and met.
•Not facing bullying or disrespect from peers, other providers.
•Having access to decision making input
•Getting feedback
•Being communicated with
•Transparency from the administration in matters pertaining to our own jobs
•Support and time for professional development and growth and education
•Opportunities to lead, advance, contribute, change specialties or positions, or back down, cut or increase our hours when we want to or need to
•The ability to take time off when we are sick without being penalized
•The ability to work at a human pace without being replaced by robots
•The ability to use technology in the workplace that works for the patient’s best interest and supports our ability to do our jobs well, but doesn’t detract from the quality of our work with the patient.
What is leadership? Instead of an entitlement, it should be a privilege that is earned and kept through service to those you are charged with leading. Instead, many executives see themselves as entitled: to high salaries, nice perks, golden parachutes, and all sorts of other protections and padding.
Poor leadership consists of insecurity and fear of losing one’s job, the unwillingness to support others out of fear of exposure of one’s shortcomings. Instead of allowing people to shine, insecure leaders avoid creativity and keep the innovators out.
Toxic leaders poison the entire organization layer by layer. Morale drops, turnover goes up, and patients suffer. It’s not just a trickle-down effect throughout the organization, it’s a full stream raining down on their heads, like a burst sewer pipe upstairs from the hospital cafeteria.
Leading is not proselytizing, it is not enforcing the blind following and worship of a megalomaniac. It is not about overseeing a passive audience of yes men and women, or the intolerance of dissent. It requires independent, critical, and creative thinking that comes together to make improvements.
We need to clearly define what nursing would look like under 3.0. We must have a place at the table, as equals. Nursing is no less important than medicine. What is less important, is all the administration and extra fluff that does not improve relationships around the level of care.
Healthcare 3.0 would bring nurses fully into leadership, to an extent to which we have never been included or taken seriously before. Healthcare 3.0 is an idea that can be implemented and can save us from the impending healthcare Armageddon. There isn’t a single person who won’t be affected.
We need courage, we need everyone with a stake in this to face the fact that we are humans taking care of humans in healthcare. Outcomes matter, but we can’t lose sight of the real human condition that “outcomes” represent.
We cannot exist solely for the sake of constructs like technology, efficiency, or productivity. The relationships must drive these constructs, not the other way around. Those things can happen as a result of doing our one-on-one patient/provider relationships well. Let’s stop making constructs the holy grail and get back to focusing on relationships.
For more information on the Healthcare 3.0 concept, you can read Dave Chase's article here, or you can also watch ZDoggMD's rendition, Lose Yourself, below.
