How the system SHOULD work

At a recent South by Southwest (SXSW) music venue, Phil, my friend and fellow musician, was unloading his drums from a van when a keyboard fell on his hands fracturing both thumbs. Not a good thing for a drummer with 12 gigs booked in seven days. So, Phil visited his local clinic.

X-rays confirmed he had bilateral thumb fractures and the nurse practitioner attempted to refer him to a “hand specialist.” However, after some dialogue, Phil was referred, as he desired—and acceptable, given the type of injury—to an orthopedic specialist.

Moodboard/Thinkstock

In discussing treatment options with Phil, the orthopedic specialist told my friend that his thumbs could be splinted. In addition to banging his oversized thumbs into everything, this approach would result in stiffness, which would require physical therapy, and there would be increased pain, for which pain relievers could be prescribed, although they could result in addiction requiring further treatment.

The alternative? Phil could continue drumming and “let the pain be his guide.” The increased blood flow associated with this treatment would promote healing and the movement would result in greater long-term flexibility. Withholding the analgesics would keep Phil within his limits and potentially out of rehab—not that Phil is predisposed to addiction or has any such history. And the downside? Besides having pain as a governor, recovery time would be slightly prolonged.

I share this story because it’s easy to remember painful situations but hard to remember that pain has its purpose and can be a good thing. It can help us grow in ways we had not considered. In addition to continued musical performance, Phil is adapting a previously scheduled workshop to include dealing with adversity, so others will benefit from my friend turning a negative and painful situation into a positive.

Kudos to the nurse practitioner who listened to the patient and considered his needs and desires—and for convincing the powers that be to allow the patient’s desired referral. That the orthopedic specialist listened to the patient about his needs gives me hope that we truly are on the road to health care reform.

We must celebrate such stories of success so they can serve as models. When all the players come together and assume responsibility for their respective roles, the system can work.

Do you have a story to share?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Looking back while moving ahead

The purpose of this blog has been and always will be to stimulate scholarly dialogue. To that end, topics have fallen into two main categories: controversial and inspirational. Locating controversial topics is never much of a challenge. From the tinderbox that is the Middle East to the British aligning with the Chinese to form an energy bank that could move the world off the petrodollar and destabilize the economy of the United States to the never-ending political cycle that continues to reveal the lack of honesty and integrity in most of our political leaders, who can’t answer a simple yes-or-no question, to issues that affect us more directly, such as implementation of the Affordable Care Act, controversy abounds.

Inspirational topics are a little harder to come by these days—or so it seems. It’s not that inspiration isn’t all around us. It’s just harder to discern above the constant din of bad and scary news. About the time I was ready to give into temptation and pick easy, low-hanging controversy for this post, I was reminded that inspiration can often be found by reflecting on the past, this time prompted by a letter I received:

Pamela Holland, student in the Department of
Nursing at California State University San
Bernardino, is president of Coyote Nurses,
the school's student nursing organization.

“My name is Pamela Holland, and I am honored to say I was chosen as a recipient of the Dion Scholarship for Nursing Informatics. [Awarded by the Foundation of the National Student Nurses Association.] Before continuing with my letter, I want to first send a big ‘Thank you!’ your way. Beyond the general help the scholarship money provides in paying for my education, I consider it a great honor to be recognized. After reading a bit about you and your company, Decision Critical, I have to say I got a bit excited about the changes you are influencing within the healthcare field.

“As a current nursing student, I see a need for education on a daily basis—not only in hospital policy, but also in best-practice methods, in general. It pains me to see that, in an age where technology is in everyone’s hands, nurses are still performing their duties based on old information. I know that there are a lot of moving parts in getting policies changed, but I envision some sort of auto-update and training on evidence-based care of our patients, rather than relying on the nursing educator to decide what policies to act on and to initiate change. I know it’s a little more complicated, but this is certainly an idea I wish to explore further as I gain more education and familiarity within the healthcare setting.

“As I’m sure you can tell, I am very much excited about the role technology plays in the (proper) care of our patients and look forward to the role it will play in future healthcare. I only hope I am as successful in influencing change as you have been. Again, thank you so much for this amazing honor.”

Looking back

I can honestly say that, had it not been for others who saw qualities I did not see in myself and who nurtured those qualities intellectually, emotionally, and financially, I would not have had the amazing nursing journey I have had, nor would I have been as well positioned to give back to a profession that has given me so much. During my tenure as a firefighter and paramedic, we used to have a saying, “As soon as you give a guy a white shirt, he becomes management and forgets where he came from.”

When the opportunity presents itself, pay it
forward, even if it means looking back.

— Vladans/iStock/Thinkstock

A special thank you to this student for reminding me why I support nursing education and that doing so keeps me in touch with where I came from. As Pamela has demonstrated to me, inspiration can be found in those who will follow us in this honored profession. Despite the controversies of the day, we must not lose sight of that.

Upon receipt of Pamela’s letter, I was compelled to respond to her with the same advice I share with you: Remain actively engaged in your professional organizations, because they are as important to your professional growth as you are to the growth of the profession. When the opportunity presents itself, pay it forward, even if it means looking back. Never forget where you came from.

P.S. Attention, Constituent Services Department: I think we have a future member here!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those the promote products or services will not be posted.

The Affordable Care Act and beyond

In today’s frenetic Information Age, the speed at which society is inundated with data leaves little time, or even inclination, to question operational definitions of terms at the center of the most significant social issues of our time—whether on Wall Street, where bankers use “credit default swaps” to bet against clients with their own money, or in health care, which, by definition, is the antithesis of what is provided to the American public. Many economists have stated that the current system is unsustainable. It’s time we get real about health care, before the current system bankrupts the economy of the United States.

We all perform preventive maintenance on things we acquire. From our homes to our cars to our children’s bicycles, all the things that “make life good” require preventive maintenance to perform their functions longer, thereby making life good for a longer period of time. The same is true of the human body.

It's not on my policy!
When was the last time you sent a bill for your oil change to your auto-insurance carrier? My guess is never. If you did, I’m confident your claim would be denied. Does that keep you from changing the oil in your automobile? I assume not. Factors that play into one’s decision to do preventive maintenance on a motor vehicle, which is nearly a necessity in most families’ lives, are that the cost is transparent and within reach of the consumer. I respectfully suggest that the same factors apply to health care. Until there is cost transparency and the most basic services—including an annual physical—are within the ability of 95 percent of the people in America to pay for out of pocket, our system for treating illness will remain on a collision course with collapse.

Nurses need to light the way! 

Photo credit: scyther5/iStock/Thinkstock

There is no doubt that the Affordable Care Act (ACA) has placed more Americans on an insurance plan and appears to be slowing the rate of cost growth, but is anyone receiving more health care? When I reviewed many of the health care exchanges, I found that, for the premiums to be within reach of the average American family, the deductible is so high as to discourage participants from seeking preventive care. (It is true that many of the plans do include an annual physical.) However, I have been unable to locate evidence—perhaps it’s not available yet—that indicates utilization of preventive health care services has increased following implementation of the ACA. I suggest we will not see that benefit in the near future, because the system that we are trying to move away from has not promoted preventive maintenance. It is imperative, therefore, that we, as nurses, promote and model wellness as part of our overall efforts to drive health care reform.

Health care reimbursement reform is not health care reform, regardless if that is how it was positioned. Although the ACA is well intended, without true care-delivery reform with an emphasis on prevention and a system that supports such a model, the ability of the United States, the economic powerhouse of the world, to deliver care on par with nations that have far fewer resources, will remain out of reach. As a nurse, I believe all Americans should have access to basic health care, that it should be as much within their means as oil changes are for their cars. I also believe that this right to health care comes with responsibilities.

Needed: Men and women of the lamp
Our responsibilities as nurses are clear. We must continue to advocate for migration away from the unsustainable system of the past to true health care reform that results in holistic health care, not just treatment of illness. Furthermore, we have the responsibility to educate the public that their right to health care comes with responsibilities and that they must be active participants in their own wellness and health.

The Affordable Care Act set the country’s system of disease treatment on the road to change. We have taken just the first steps on that road. Where that road leads is yet to be illuminated. To assure the health and wellness of our fellow citizens, a holistic approach must be taken. Who better than nurses to advocate for such a holistic approach?

To effect changes needed—delivery, financing, and legal—to stop treating disease and start providing for wellness, nurses must remain knowledgeable about the latest practice and policy evidence and be present everywhere, from the halls of academia to the front lines where care-delivery models are improved to board rooms where resource decisions about care delivery are made to legislative halls where regulatory laws are enacted. We were handed the lamp, and it is our duty to continue lighting the road, because the journey is far from over.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

The Lady in the Cape

I was recently asked by a colleague, “Why do you direct almost all of your philanthropic efforts toward nursing?” I asked in return, “Have you heard of the Lady of the Lamp?” Her reply was, “Of course!” So I asked, “Well, have you ever heard of the Lady in the Cape?” When she responded “No,” I told her about the Lady in the Cape.

I first met the Lady in the Cape when I was about 4 years old. I remember her standing on the steps of a brownstone. She was pressed and dressed in white, her cap, with its design and ribbon identifying Bayonne Nursing School, perfectly placed on her head. The only thing from her head to her toes not spotlessly white was the long, flowing, navy blue cape she wore over her uniform. She explained to me that she was going to participate in a disaster drill. At my age, I could not get my mind around the concept of a disaster drill. I just heard the word “disaster” and pictured the Lady in the Cape walking straight into danger. I just could not understand how someone would leave family and put his or her life in danger for others because “it is the right thing to do.”

The Lady in the Cape

As I grew a little older, I sometimes saw less of the Lady in the Cape. To put me in a school where I would receive the best education, she often worked nights or double-shifts. What little time I saw her was further decreased by the fact that she was working to attain her first college degree. I told her I would gladly go to public school if it meant we could spend more time together. She explained to me that life is hard and, if we wanted a good life, it required sacrifice by both of us. She also reinforced the fact that the important things in life—the things that really make a difference—come from hard work and not cutting corners, that we were making the sacrifice together.

I grew into what must have been a challenging teenager for the Lady in the Cape who, by now, you probably realize is my mother. I was bright, but lacked focus. I never got into big trouble, except for the ‘67 Chevy and the telephone pole, but will save that story for another day. Meanwhile, I was discovering, that, in the world as it was, there were many things with which I was not happy. So, every morning on the way to school, I would BMW (bitch, moan, and whine) about the latest burr under my saddle, whatever it happened to be. One day, the Lady in the Cape turned to me and said, “If you don’t like something, don’t just whine about it, get out there and change it!” Coming from anyone else, this would have sounded ridiculous to a 15-year-old, but this was coming from a woman who had a child, house, mortgage and no husband, and she had recently lost her job because of standing up for her patients. I bought in, and that one statement changed my life!

The Lady in the Cape went on to obtain advanced degrees. When I asked her why, she said, if you are going to get a seat at the table to try and make a difference in the world, you have to have the credentials to be there. I did not realize it at the time but the Lady in the Cape was modeling lifelong learning. She has continued this practice and instilled it in me.

The Lady in the Cape has still not stopped learning or trying to make a difference in the world. After several successful careers within the nursing profession—staff nurse, nursing executive, and legal nurse consultant—the Lady in the Cape, now in her ‘70s, recently embarked on a new journey. With the support of several colleagues, she has established the Nightingale Society in Naples, Florida, USA. Wearing their uniforms, this group of retired and working nurses conduct ceremonies to recognize and honor nurses for their service to society, either before they part this life—so they can appreciate the recognition—or, after their passing, at the graveside on the day of the funeral. The Lady in the Cape never stops doing the work of her profession!

The act of nursing embodies everything that is good and decent in this world. These values were instilled in me and have been reinforced throughout my life. When I am asked why I chose nursing as my profession, the answer is simple, “The Lady in the Cape taught me many things, among them: Physicians treat diseases. Nurses provide care for patients and their families.” And when asked why nursing is the primary recipient of my personal philanthropy, the answer is also simple, “The Lady in the Cape.”

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Where are we getting our messaging wrong?

I recall attending a statewide meeting of nursing leaders about 15 years ago. The topic of discussion was nursing’s recognition by the U.S. public as the most respected profession. The Institute of Medicine’s (IOM) landmark report, To Err is Human, had recently been released, acknowledging that more than 100,000 avoidable deaths were occurring annually in the U.S. health care system. I wanted to find a way to pull the IOM report into the discussion, specifically nursing’s response.

When I asked if it was not our role, as nurses, to inform the public about the report and potential untoward outcomes that might arise as a result of our interacting with the health care system, my remarks were met with a resounding, “Yes, but ….” The “but” was, “We can’t scare anyone in the process, and we can’t anger anyone.” Confronted with what appeared to be substantial resistance to my effort to effect positive change, I determined it best to let my line of inquiry expire.

Where are we getting our messaging wrong?

Fast forward to today. Our ailing health care system is currently center stage due to fear of a pandemic. Because nursing’s proximity and frequency of exposure to the currently feared pathogen is higher than that of any other profession, we stand squarely in the spotlight. To stem the tide of this infection, nurses have put themselves in an unknown line of risk and have been proclaimed heroes by the media for their efforts. So when I hear nurse leaders, speaking on the subject of Ebola, state publicly that “we have been warning you for years we are not prepared for this,” part of me just wants to scream, “Florence!” or something else.

Nursing is the most respected profession in the United States, and it represents the largest single group of licensed health care professionals in the country. The profession’s very origin is public health. And yet, according to some of our nurse leaders who speak to the media on our behalf, we are not being heard. Which brings me to the question about which I would appreciate your thoughts: Where are we getting our messaging wrong?

One of nursing’s prime directives, and what the public expects of us, is patient advocacy. How can we advocate for our patients when our trusted voices cannot be heard over the din of verbal finger pointing and a message muddled by fear of alienation or retribution? By rising above the fear and mudslinging, I respectfully suggest.

At a pivotal point in the history of health care in the United States, nursing indeed stands in the spotlight. Given the limited time we have to occupy this enviable position, it’s crucial that we as a profession focus on the needs of the nation and not just ourselves. To benefit our patients and society, we must shine light on the U.S. health care system, even if it means illuminating situations that may not benefit our profession.

I am not suggesting we descend to the lowest common denominator and resort to fear mongering to achieve our goals. Quite the opposite. Without fear of retribution, we must embrace the evidence and share it with the public in a rational manner. We have a track record of credibility, the highest of any profession. We cannot and should not fear being messengers of truth. It is our duty!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

What's not to like?

Everywhere we turn we are being asked to “follow” or “like” something on social media. We all understand that the more “likes” a site gets, the more “Google juice”—higher search ranking—it gets. Companies hope that higher search rankings will help them achieve business objectives. Our likes, follows, and other electronic activities allow profiles to be built on us by anyone from marketers to employers to government agencies.

In return for sharing information, our searches are optimized or we are given things. More importantly, we are given the opportunity to offer personal opinions on everything from politics to products.

Recently, language has appeared in the terms and condition statements of many websites—even service contracts—stipulating that any negative statements made by users or their associates, anywhere on the Internet, will incur monetary charges. What used to be “likes only, please” has become “likes only, or pay the price.”

Igor Stevanovic/iStock/Thinkstock

As net neutrality has declined, so too, it appears, has the right to free speech. Having paid for my “free speech” through erosion of my privacy, I now get to pay more to honestly say something negative about a product or service. What’s next, a sliding price scale based on how unkind my opinion is? What about web services that provide recommendations based on customer feedback? What will they do in a world of nothing but likes? I sense the edge of a slippery slope.

I recently came across an article in the British media in which a general-practitioner surgery facility requested that all comments be directed to the administrator and not be posted on social media. A sign to that effect was even displayed in the waiting room. I wonder how long it will be before that same language makes it onto the hospital’s consent form? And how long will it take for the practice to “cross the pond” to the United States and other countries?

Have we indeed come so far that we have to pay if we express a negative opinion about what is truly bad service or an inferior product? I have searched Facebook high and low. Can anyone tell me where that darn “unlike” button is?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Colossal misdirection play?

We have learned of the games held in the Roman Colosseum, either through recorded history or as replicated by Hollywood and embellished for the viewer’s pleasure. To outshine their predecessors, Roman emperors would expend vast sums enhancing the imposing structure. There is evidence, according to some archeologists, that it was even modified to enable flooding for the purpose of reenacting victorious Roman sea battles. And, as people watched the games, for which no expense was spared, that great society fell into decline.

Sound familiar in a scary way? It does for me, too. It’s called the “misdirection play.” I learned it in fourth grade while playing “the game” of peewee football. It scared me then, too, just as it does today, because every time I was deceived by the misdirection play, I got hurt.

As I observe the world today, I wonder if I am witnessing the undoing of another great society. There are certainly many parallels that can be drawn between today and Roman times, and there are certainly many more coliseums. If history is on a path to repeat itself, what will the role of technology be? Savior or contributor to the destruction?

As people watched the games, for which no expense was spared,
that great society fell into decline.

The reason I ask this question is because of a recent vacation experience I had with two children, of whom I am not the parent. The purpose of this vacation was to expose these kids—ages 6 and 9—to the “Great Outdoors.” I applaud their parents for choosing this option over a theme park-based trip. But, as it turned out, when given a choice between going inside to play with technology or going outside to take a walk in the woods and experience nature—perhaps to see real animals in lieu of stuffed ones at gift shops in town—they chose technology.

As I processed these children’s interactions with technology, my mind was flooded with questions: Will they use it to cure cancer? Will they use it to go to Mars and back? Will they use it to find a way to solve the problem of the world’s ever-increasing demand for energy? One could ponder many other questions about the dark side of technology. But the question I kept coming back to was not how they might use technology, but how technology would be applied to them?

Recent events reported in the media have put “Personal Big Data” front and center in the public eye. There is no doubt that social media with all its underlying and associated technologies—one source of big data—have been demonstrated to have positive social benefits. But, in all fairness, we have also seen its negative social impact. So, two questions: 1) “Is technology in the hands of future generations going to have a net positive or negative effect on the future?” And 2) “Will technology, in this coliseum of the future, be a big misdirection play where everybody feels like they are in the game, but where no one goes outside to see the animals until, finally, they’re not there to see?”

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.