Welcome home

We spent several hours in the emergency room that night. It was pretty surreal. I’m looking at my brother, closely, for the first time in 10 years but not in a sibling way.I’m looking at him like he’s my patient. Assessing his breathing, watching the monitor, asking questions about the tests he’s having and then asking about the results.

They are all interested in his time in China and the work-up he had there but everything is in Chinese or questionably translated into English to my brother who has no medical training. So all the tests get repeated. CT Scan, Chest Xray, ultrasound of his neck and heart, EKG, Swallow study and the most important test of all-laryngoscopy and biopsy.

My brother continues to hold on to the hope that the translator “got it wrong” or that “tumor” means something different in  Chinese. He vacillates between saying the breathing that sounds like Darth Vader is just a sinus infection or a really bad sore throat.

After they do all the tests and in a roundabout way confirm his diagnosis, they realize he has no insurance. While they acknowledge that he needs chemo-as soon as possible-he will have to go to a doctor that will start that expensive treatment on a patient who is “medicaid pending”. Discharge papers were ready when I went to visit him on the 3rd day.

But we have a secret plan, we had discussed this prior to his arrival and just got sidetracked by the CPR on the kitchen floor.

My brother is a veteran. Back to plan A-off to the VA.

Computers can be cruel

Watching both my sons struggle to get fully employed has been painful for them….and me. The online application process is just out of control. There’s no personal interaction-the applicant tosses their resume into the pre-programmed decision making tree which is designed to scan for key words and employers are inundated with resumes which spit out a few “lucky” applicants chosen to continue to run the gauntlet of virtually begging for a position they are often over qualified for. Such is the current state of the economy and well, rejection is just part of the game.

Yesterday, I applied for a position at a large healthcare hospital system in Chicago… Advocate. I upload my resume and complete the tedious application because I know how it goes. I submit the application and almost immediately I get an email saying I need to take a “Patient Experience Profile” within 72 hours. I know how this works, their computer has scanned my application and determined that I meet the basic requirements. So, I open up the link they sent me and it says there’s no right or wrong answer just try to pick the “best” answer. I go through the 50-60 “questions” -some are 3 words like compassionate, determined and frugal (?) which of these describes you best and which least.  A bunch of other questions ask how many times you’ve had unexcused absences or how would your co-workers/supervisor describe you. It’s all really ambiguous and annoying but I muddle though.

So keeping in mind that they say there are no right or wrong answers- imagine my surprise when I finish and get the following message:

Thank you for completing Advocate’s Patient Experience Profile.

Candidates must receive a passing score in order to continue in the selection process. At this time, you will not move forward in the selection process for positions that have patient contact. You will be eligible to re-take this assessment in six months. Until then, you may apply for a position that does not require patient contact.

Clearly there are right and wrong answers??

I am really starting to understand what my sons have been putting up with. I obviously have  a very good job and this gives me some insulation from the harshness of this message but what about people who are desperately trying to get a foot in the door?

Today I got the same message in an email and here is my reply:

Dear Advocate Health Care Recruitment,
I have provided compassionate and professional care to all of my patients, received positive feedback from colleagues and outstanding performance evaluations from managers over the past 20 years.
I have never been so insulted and degraded in my whole career as to be told by a computer that I am incompetent for a position with patient contact.
I am truly shocked and speechless.
Regards, Tracy A
To think this all took place over the weekend without any human intervention whatsoever. I wouldn’t want to work at a place that treats people like that anyway…

Healthcare 1.0

Strolling through Twitter today after seeing stuff like this_74314465_tim18Blc9ZFgCIAEahhB

I invariably run across the equivalent of saying “you’re fat”~ to paraphrase the usual rhetoric

~healthcare in the USA is more expensive, with shittier outcomes than every other country on the planet and millions of Americans go bankrupt without insurance~

What’s the point?? Every healthcare system is close to the breaking point, held together by the dedication of its staff.

Here’s my 6 ideas for supporting healthcare in any country!

  1. Support fundraising events at your local hospital. Call and see what’s going on. At my hospital we have supported charity events like St Baldrick’s, but we also have volleyball  & baseball games between departments to raise money
  2. Organize, join, participate in and support healthy habits- a 5k run, smoking cessation, a walking club
  3. Take your business (doctor’s appointments) to your local hospital instead of to the fancy, shmancy hospital across town. Sure, be vigilant, ask questions but if you have insurance they will be glad you are there.
  4. Find out what their infection rates are. In the US, that would be on Hospital Compare. Be educated about current best practice-visit the CDC website for lots of healthcare resources.
  5. Support Nurses!!! Say please and thank you, ask questions and listen to what they tell youalways-thank-your-nurse
  6. Stop complaining about your wait, the waiting room chairs, the foreign staff~unless you are seeing a witch doctordownload (1)

Let’s stop pointing healthcare fingers-images (4)

who’s best, cheapest, slowest…take responsibility for your health and respect those that dedicate their lives to helping you stay healthy.




Did you say healthcare?

I guess it’s been awhile since I laid out my traumatic patient care experiences on my blog, experiences that at times were so emotionally painful and shocking that I saw a counselor through my employer.  Experiences that cross two countries and healthcare systems.

After working about 50 hours this week preventing infections, talking to patients, nurse and doctors to determine how these infections can be prevented then developing the guidelines and education to make sure that happens. I still have homework I should be doing including a critical analysis of an ethnographic study of dementia patients in nursing homes and a paper/presentation outlining a recruitment/retention plan….

I was slightly dismayed to see a comment from this religious professional that began as his rant about how he couldn’t afford “Obamacare” on his salary. He (or one of his supporters) felt compelled to bring Cesear into the discussion…

This is the last word on this:

  1. It is not “Obama” care it is called the Affordable Care Act (ACA). It is a law. It has been upheld as constitutional by a panel of smarty pants judges you might be familiar with called The Supreme Court. It is not going away, it can and will be improved. Get used to it.
  2. No matter who you worship it is wrong…WRONG…to let anyone suffer because they do not have the ability to pay for healthcare.
  3. Let me repeat -it is NEVER okay, permissible or excusable to allow suffering based on ability to pay. ACA is a step towards more equitable access to healthcare in the US.

So then in my rare forays into twitter I ran across a gentleman who tweeted a broad sweeping generalization about how there is a long list of countries with better healthcare than the US. I am very familiar with this data, in fact the Quality person at my hospital uses it in her orientation presentation to say that we need to improve our outcomes. It measures core measures, outcomes to common conditions like heart failure, cancer etc and costs…..yes, costs. I responded to this tweet saying – then why do people come here for treatment? he said with an air of authority that they do not.

At first I thought maybe he was a doctor but no. He doesn’t seem to have any healthcare experience at all. He does have OBE after his name which gives a clue to a possible British connection. I’m sure he’s a competely honest and reasonable guy  (edited after reading his response) pompous ass-but honestly when if you have dedicated 20 years of your life working in healthcare, taking care of patients, watching them die, watching family members cry their hearts out and thankfully watching the vast majority of them regain their strength and go home…. I take it personally.

I am not defending the US healthcare system, it’s majorly fucked up. I moved to England to work for the NHS, looking for a system that ticked all the boxes including being free at the point of service. I was very disappointed. I found an extremely low paid, disgruntled workforce, limited access to relatively basic equipment and a very low threshold for witholding treatment.

If it’s my child, spouse, parent who needs a unique, specialized treatment that is not available in my hospital, city or country what difference does it make what some longitudinal, multi-center study shows??? I want my family member to have that treatment regardless of the cost!

I would illustrate the contrast between the two systems by describing 2 cases.

In England on a Saturday morning they brought in a patient who had been out drinking, he’s fallen, hit his head and bled into his brain. Unlikely to recover, they sent police to his apartment to try to contact next of kin, the police would not break in so no family were contacted. The doctor’s took the patient off the ventilator, re-positioned him on his side and told me to start a morphine infusion. The doctor came back a few hours later and saw the patient still alive and told me to turn up the morphine because they needed a bed.

In the US we recently had the case of the 13 year old girl who suffered an anoxic brain injury and despite brain death tests conclusively showing brain death her family insisted on keeping her artificially alive.

Both of these cases are revoltingly, sickeningly wrong. They are a gross manipulation of life.

Am I opinionated and judgmental?? Yes, absolutely. But I don’t have these conversations with my colleagues because there are millions of healthcare workers, heads down, in the trenches day in and day out taking care of patients in every country with whatever resources they have available to them.

I don’t try to tell a soldier what it’s like to be on a battlefield…I wish people who are not involved in healthcare would keep their opinions to themselves.

What’s that saying? Lead, Follow or get out of the way.

out and about

today i went to leicester for this meeting…i got there a little early and had a walk around the high street. nothing spectacular or new but it is nice to see new things. the weather turned out to be partly sunny but very windy and i enjoyed the walk to the university. i actually said a thank you~to my lucky stars, allah, whoever that i have this job now rather than being cooped up in that hospital for 13 hours a day…..

i met the ethnographer (psychologist) and her assistant the sociologist, they treated me to lunch and we had a discussion about the project and a secondary aim/outcome which is:

To determine barriers to and facilitators of best practice by conducting a detailed ethnographic study in a small subset of ICUs.

when i first met them M D-W said so you’re a nurse? um, yes….

so you’re on the front lines? um, yes…

that is so interesting! um, yes it can be…..

the meeting was brilliant! besides the delicious fish pie i had…i would find myself talking (too much i thought) and then they would both say ‘that is so interesting ‘ or ‘that is fascinating’  um, i guess so….

imagine me be fascinating?? i’m not used to anyone valuing my opinion or experience. ha! what a turnaround!

 i suppose coming from such different backgrounds i find what they do fascinating also. the end result that i can report back to my boss is that we will be undertaking a study of the behaviour of icu healthcare teams…the communication, interaction, underlying emotions and power struggles. my job will be to keep my own diary, ask other nurses to respond to questions anonymously, set up and facilitate focus groups…at my hospital and then later at 3-4 other hospitals.

they want me to keep a diary…a kind of blog they said….they started to explain to me what a blog was….um, i have a blog…..oh you have a blog….yes, but not the kind you could use for the study, it’s for my mom and i just posted pics of slugs this morning….but i get the idea…

all in all, it was areally productive day and once again i have met two very educated women that i like and can work with…

the one annoying part of the trip? the man sitting across the aisle from me, the one with ‘ganja’ tattooed on his arm…who drank 3 cans of stella on the less than one hour train ride while talking with various people about shady activities on his phone…could have done without that…

my new favorite topic

Come On, Is There Really a Nursing Shortage???

–by Susan Hassmiller

Health reform policies that aim to increase coverage must also address the long-term capacity of the nursing workforce to provide high-quality care. Nurses are the largest segment of the health care workforce; they’re the professionals who spend the most time providing direct care to patients. Nurses are indispensible to patient safety, and the current shortage (and it’s growing, with a projected shortage of 500,000 nurses by 2020) threatens the quality of care that patients receive.

But an article in this Sunday’s Washington Post notes that, even with the shortage of nurses, in today’s economy it’s increasingly difficult for nurses to find jobs. The article points out, and I certainly agree, that this situation is a “blip” that is masking the true state of the nursing shortage in this country.

Today, there are forces pushing nurse supply and demand in directions that were unanticipated:

  • In this uncertain economic climate, many nurses planning to retire are postponing those decisions and staying in their jobs.
  • Non-working nurses with spouses who’ve lost jobs are returning to work. Part-time nurses are seeking more hours.
  • Meanwhile, the American Hospital Association reports large layoffs of hospital staff, with some anticipated nursing layoffs.
  • There are definitely some areas of the country where new RN grads are having difficulty finding jobs. We don’t have data (yet) that indicate exactly who within the RN field can or cannot find work (or if they are indeed finding work eventually, just not in their preferred field or geographic location).
  • State budgets are under severe pressure, and in some places nursing faculty positions are being cut, resulting in far fewer students being accepted into nursing schools. The inadequate pipeline of new nurses, fueled by the bottleneck of too few nursing faculty, might actually be getting worse.

So you can see that, ironically, the current economic crisis might very well be provoking a short-term set of changes that mask the nursing shortage temporarily, yet exacerbate it over the long-term as the economy turns around.

However, we do know that in some regions, like Texas and Rhode Island, the nursing shortage is persistent and very much alive today.

Demand for RNs will outpace supply. But, I’m worried that some executives and policymakers might reach the wrong conclusion – that a shortage is no longer a problem – and fail to consider the critical need to address the long-term capacity of the nursing workforce.

So: what does the shortage look like in your part of the world? And what are the promising solutions you see for addressing the nursing shortage in the context of health reform?