What’s Wrong with Health Care?

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Customer service.

We’ve turned taking care of the sick and injured into fucking Burger King. Everyone wants it “their” way. Sorry folks, life isn’t like that especially in my house. When we turn patients into consumers, they begin to expect to treated like customers and hence have no skin in the game. This leads to unrealistic expectations and our administrative “leaders” play up that we are in the business of providing customer service instead of healing. That then becomes our problems on the floors and our “customers” think that “their” way is the only way.

Yes, I will be disturbing you at midnight to check your vitals and then doing it again at 4am.

Yes, you will have blood drawn, probably several times through the day and night.

No, you can’t have your hydrmorphodemerolepam every hour, even if that’s how you take it at home – which is probably what got you here in the first place.

No, burger and fries are not part of your heart healthy diet to help treat your congestive heart failure.

Yes, lasix makes you pee. And, yes, I will be giving you a dose tonight, as the doctor ordered, every 8 hours so that you can breath and not have a hugely swollen scrotum.

Yes, it would be nice for your family to come in to learn wound care techniques so they can care for you at home.

No, not all of them can stay the night with you in a double room.

No, you can’t go out to smoke, even just for a minute. And I’m definitely not giving you an oxygen tank and wheelchair to do it.

Yes, you are more than welcome to leave AMA because we’re all racist assholes who won’t give you IV narcotics every hour, please just sign this form.

No, you don’t get a cab voucher, discharge prescriptions or fresh clothes if you do leave AMA. Sorry.

Yes, Dr. First-Year Intern, they just left AMA after threatening the entire staff, but you might catch them by the ED if you hurry. I’d bring Security with you though.

I will be polite and respectful, but I will not fawn over ingrates, feed into those with unreasonable expectations or take the crap from the dis-respectful. I refuse to be turned into a cashier clerk at the local fast food joint or a Pez dispenser of Oxycontin. There is difference between customer service and letting the public run wild in our house.

It’s time to take it back.

To set expectations.

To educate our patients.

To let the world know that we are not there to be exploited, abused and disrespected.

It’s a long journey, but it starts with a single step, for nurses and other health-care providers to stand up and say, “NO MORE!” and start to expect our patients to be active and involved, to care about their health, to put some skin in the game and start behaving like responsible adults.

But that will never happen. Sad.

Alphabet Soup and Leadership

Alphabet soup. Y’know, all the wonderful letters after ones name that proves to anyone who can read that you’ve persevered though multiple rounds of education that are supposed to make you a better nurse. Does all that make you a leader though? Mother Jones asks a similar question in Are you smarter than a nursing leader?.

I’m with her. I’m not sold on the idea that more advanced education makes one a better nurse or leader. Sure you may have more classroom time learning all of the concepts and theories, but from what I’ve learned in life (not just nursing), theories and concepts tend to go out the window when the shit hits the fan. There is a developing caste structure in nursing based on degrees, that somehow nurses with “better” degrees are better nurses. BSN vs. ADN, MSN vs. BSN, where does it end? In all reality, one doesn’t need a MSN to be a bedside nurse and all this caste structure does is to further reinforce the idea of otherness and exploit the differences between nurses, rather than the commonalities and allow institutions to let education trump experience.

Advanced education has it’s place and in all likelihood I’ll be headed back to the classroom soon, but not because of a need to prove myself, but to improve my ability to move behind the bedside. But an advanced degree does not make one a leader. Sure you learn all the wonderful catch phrases, managerial double-speak and organizational ideals, but when it comes to it, leadership is inborn talent. Some have it, others don’t and no amount of education will fix that.

Writer’s Block, Again

I can sit down write, but I get half-way through a (in my mind) scintillating post sure to change the world, but get bogged down, insecure and, well, pretty whiny and stop.  I’m having the discussion in my head to just shutter this damn thing and move on to new pursuits, but each time the thought drops in my head I get an idea for new stuff.

It’s like I can’t finish what I start.

Maybe that’s a symptom of the rut I’m stuck in…I need to get out, but can’t.  Or it’s just that I’m too lazy to finish.

I need a mind-operated dictation machine so that when I’m at my best I’ll have the drivel to edit later.  I come up with the best stuff when I can’t remember it.

Thanks for sticking with me.  I’ll be around.

Not Even a Thousand Words

Went out on the bike the other day, just a map, some snacks and water. Too much stress lately, too much bullshit to deal with, too much loss to work on coming to grips with, all lost beneath the sound of rubber on the road and the roaring quiet, and drowned out by the amazing scenery surrounding me. I lost 6 hours that day, but gained a good bit of me back.