Gratitude, Anger, and Healthcare. My new beginning.

My friend  told me recently to change the way I’m looking at something so that I make it a positive. She said it frees you up from being angry or wasting your energy on useless emotions that serve no purpose. She told me that she tries to approach every aspect of her life from a position of gratitude no matter how difficult the position seems.

I’ve heard stuff like this before, usually typed in a fancy font on some inspirational meme paired with an image that I wish I had taken with my own camera.

See what I mean?

I wish I had taken this picture, but I did not.

While I agree that taking things and putting a positive spin on them is probably the best idea, I can’t actually say that I’ve really exercised the ability a whole lot in my daily life. Maybe I’ve always had more fun wearing my (admittedly boring) righteous indignation as a shield.  Unless I’m in a really good mood or have put away a bottle of wine, my outlook is not glass half full OR glass half empty, it’s more like, “Hey, there’s a glass there, technically it’s half full of something and half full of air and there’s a fruit fly dying in the liquid and lipstick on the glass.”

After my latest rant against the dismal state of healthcare in the US and the ridiculous situation I was put in by my most recent job, she said it again. “Choose to see things as a blessing”, she said.

See, I got fired from my last job. Yeah, fired.

Again.

I’ve been trying to write about this for 3 months and quite honestly, it just keeps coming out completely wrong.  I hate reading reviews that are fueled by anger, they’re usually more like rants than reviews. I certainly don’t want to have my blog start out like a rant! Nobody will read it let alone follow it!

If I can’t reign my bitterness in, I’ll never get this documented and it’s actually a very big part of my story.

Maybe I should back up. I wasn’t always bitter and angry. Once I was happy, outgoing, hopeful, and possibly the most shining example of caring and kindness you could ever hope to meet. Then I became a nurse. It was supposed to be a back up career since I didn’t really know what I wanted to do for the rest of my life. At this point now I’ve been a registered nurse for 20 years. Ironically I’m only now figuring out what I really want to do when I grow up. Most of my jobs have been in emergency medicine so I’m pretty comfortable with that pace, but I’m nowhere near as happy or as ‘shiny’ as I once was. I know what to do when somebody is dying in front of me or throwing something at me or spitting and kicking as the police drag them in for treatment involuntarily. I know what to do when somebody shows up after having been run over by a truck and is hanging on to life by a thread. I’m great at that part of the job. I even enjoy it. By now, I should be really good, right?  Heck, I should be so experienced that much of the job is practically easy, right?

Wrong.

(Cue the ‘Soapbox’ signal. I’m about to get on mine.)

Constant changes, cutbacks, and general mismanagement of money toward profit management and away from patient care has done exactly the opposite. We work harder today than we ever have and, honestly, the patients are worse off for it. Maybe we have better technology and medications, but without someone to make sense of it for the patient, non compliance is through the roof.  In school we were taught that patient education is an indispensable priority.  Heck, it’s even one of the questions on those nifty patient satisfaction surveys! This stuff matters. Oh yeah, patient satisfaction. We’ll get to that one in time.

So why are we allowing ourselves to do only half of our job but still collect a whole paycheck? Because we are actually doing more, just not half as much for our patients. Why are we, as healthcare providers, allowing a system to make it all but impossible to provide adequate care, explanation, support, and comfort measures without killing ourselves to ‘fit it all in’? I’m not saying it should be easy, humans rarely are, but it shouldn’t always be a race that leaves us missing meal breaks for 12 hours at a time, skipping potty breaks, and in general causes us to ache mentally, emotionally, and physically by the end of each day.

Where is the outcry?  

Hello?  Nurses?  Where are you?  I know you’re reading this and I know a lot of you personally who really do care and strive every day to give excellent care. Why are you tolerating this constant road block from your employers who value money over patient safety and wellness? Why are you allowing yourselves to consistently be pushed to do more with less?

My thought is that the job has become so impossible to do WELL without killing yourself, missing every lunch, and burning yourself out, that many of us have just decided to ignore the truth about how bad patient care in this system really is.  We’ve settled with being simple gears in the machine and we just do the best we can. But fix the system?  None of us really has time for that in our days.  This complacency and ignoring the elephant in our patients’ rooms allows us to keep good paying long-lasting careers in a field that will always be there for us. I can’t say I blame anyone. Surely, it has not done me well to be so overly moralistic in my approach to patient care. My relentless demand to be allowed to give excellent care even if it consistently takes a few extra minutes of my time has not helped me get to retirement. Or stay sane. Being ethically proper is a hell of a lot more difficult than punching a clock and  just doing your damned job ‘good enough’.

On a side note, Nurses take DC is actually happening in Washington right now. (Clever timing for this blog, don’t you think?) There is a thriving group of us trying to make a difference.  It’s a long drawn out political fight to enact safe staffing ratio laws and hospitals and the money makers are fighting against it tooth and nail. After all, Administration stands to take home significantly lower bonuses every year if they’re forced to staff safely. But, maybe things will change for the better because they really can’t get much worse out there, folks. If I were still employed, allowed any time off, and less burned out, I’d like to say that I’d be there with them, learning about politics and pressing for safer situations for all of my patients. The truth is that I am so worn out by it all that I couldn’t even begin to get to that rally. Besides, I’m pretty broke after getting fired when I asked to take medical leave. Since I went ahead and had the surgery anyway, a trip to DC isn’t in my financial plan.

So, I guess I could address that getting fired thing now. I took this job thinking it might be less painful for me than the ER was. I  had been suffering with a steadily deteriorating hip for over a year at the point when I decided to make this change, and I could barely walk. I came to try a new area of the hospital out, hoping to make the hip last longer. What’s that line about the best laid plans not going as expected? Not only did this new job not make my hip better, it actually accelerated the deterioration. I was miserable and in more pain than I’d ever been. Every day, all day, every night while trying to sleep, I was in pain. I snuck away in between patients to cry at least 3 times a week because I hurt so bad! Of course my coworkers saw me wincing or red-eyed and knew I was hurting. It wasn’t hard to see. My whole attitude became shades of black. I finally decided to talk to a surgeon who said I should get a replacement as soon as possible. The day I asked for medical leave, I was terminated from the job. I was let go immediately. Claiming they had ‘reports’ that I seemed, “Unhappy with the Organization” they dismissed me. (I thought we were a hospital, not an organization. No wonder I had a problem!) Though there were probably complaints, they wouldn’t allow me to see any of the ‘reports’, nor did they have me sign anything upon my dismissal. Nobody asked if I was ok, and nobody, at any time from management or HR ever expressed any concern for my obviously visible distress and grim demeanor. Better than that, they didn’t even train me for this new job. I had learned ‘on the fly’ as best as I could! Consistently, I was thrown into emergency cases with zero nurse back up and a near paralyzing amount of fear that I could kill someone.  What sort of Organization does that? A healthcare one, that’s which sort.

Our hospitals are physically dirty and money-grubbing, our nurses are overworked, and our patients are left to deal with it alone. It’s become ‘wealth-care’ and I don’t care who in the world hears me say it anymore. The focus has turned from patient care to corporate profit. I think the burnout has actually affected not just the long timers but even new grads have this sense of, ‘We’re doing just fine, and so shut up and stay in your bed and off that call light.”  They actually believe the drivel about click boxes and over regulation being important.

I loved when patient satisfaction became a real goal for the nation and a tool with which to judge facilities by. But I’m about the only one. Just listen to all professionals in health care whine when patient satisfaction is mentioned, as if that’s not part of their job and shouldn’t be considered. I was a patient 2 months ago. I wanted to get good service. Who wouldn’t expect good service for what hospitals in this country charge?

I’m in an ER Nurse group on Facebook. Granted, we, as ER nurses, are jaded and thick-skinned, but that’s no excuse for being assholes to the very people we’re trying to help. We have sick senses of humor (it’s a survival mechanism), and we love our depravity. But, on that site, let someone talk about a patient complaint. The going response is, ”But did you DIE?” as if that makes it all better. I can’t believe that that’s the prevailing attitude out there. Not dying at the hands of a hospital should be the LAST thing our patients should have to worry about and not dying in our hospitals should be the bare minimum of expectations. To hear well trained individuals so caught up in their own bullshit that they spit these words out in the face of patient complaints as if the words alone somehow justify absolutely shitty service is perverted.  Yes, my dear population of non medical people, this is a very prevalent attitude in many of our nurses and doctors. The, ‘But did you DIE?’ snarky response to those that dare complain is echoed throughout ED’s everywhere. We’re working as hard as we can, but all that effort goes to clicking boxes and asking pointless questions that mean nothing to our patients and, in fact, leave the patients completely out of the whole ‘care’ equation. The, ‘But did you DIE’  attitude somehow excuses us from feeling obligated to go the extra mile.  What a harsh situation we are in, and I’ve been watching it get worse, not better. I know I am not the only one that realizes that these are actual, physical, real human beings in my care.  But to care and want make change means putting in a lot more effort than those who just ‘do their jobs’  put in. It’s exhausting.

Well, this has gotten pretty serious, hasn’t it? Here’s an interesting fact to lighten the mood. Obviously, I’m a registered nurse.  I had the other hip replaced 7 years ago (lucky genetics).  I was so disgusted with the way patients get the short end of the stick in our hospitals that I chose to fly to India to have surgery. You read that right. I had more confidence in the ability of the hospital in India not to infect, mistreat, or even kill me than I did our own US facilities. And I made a very good choice. This time, however, since I got dumped from my income providing job before surgery, I got stuck here in the US for the procedure. India was definitely a 100% better experience. You can expect a less wordy blog coming soon about the comparison of that vs the care I got here in the States.

I have a question that I don’t expect a real answer to by anyone:  Why the hell SHOULDN’T our patients feel satisfied?  Maybe they don’t like what they have to go through, maybe they would rather eat cake than carrots, and maybe they would rather watch TV and not do that painful physical therapy. It’s our job to encourage them, to foster them, to teach them, and to help them arrive at a point where they can (and WANT to) take care of themselves as well as possible. They should feel satisfied with how we assist them to get to that point. Of course some people are misanthropes who are always dissatisfied and that reality will exist in all scenarios, but it shouldn’t be the norm that every single patient has at least one horrible experience to share that will make you cringe and shake your head when you hear it. With the money that is spent on our services in health care, nobody should ever be stuck sitting in their own piss in their bed because all the staff on the floor is too busy to answer the damned call lights.  Period. Nobody should ever get a hospital acquired infection because attention to detail and cleaning is lacking, or because the push from the top is to turn those beds over faster so that cleaning takes a back seat to profit. Nobody should feel like their request for help is an imposition or inconvenience (like I did while in the hospital) because it is obvious how busy their nurses are.  Nobody should feel guilty that none of their staff gets lunch breaks which was how I felt.

“But, did you DIE?”  Well, I would fucking hope not. But my dad did. In 2009 an ‘Organization’ disguised as a healthcare facility gave him an infection that killed him. Thanks for that, by the way.

 Really, they killed my DAD!

Here’s another side note that I have to present in the interest of fairness: There are times where, “But did you DIE?” might be an appropriate response. For example, when someone complains that they have sore ribs after we did CPR and brought them back from the dead. Or, when somebody is pissed as hell at us for taking away their high after we bring them back from a heroin overdose in which they had forgotten to keep breathing.  Or when a person complains that his throat is sore after we put a breathing tube in when they were unable to breathe for themselves. That’s where the whole, ‘But did you DIE?’ phrase really originated and even I once loved the phrase because of what it meat. Now, however, I see it out there in cyberspace among providers all the time. Sometimes I hear it spoken from coworkers while on shift. It always makes me cringe. Tone your egos down a few notches. Sure, you’re all working hard, but at least have the common sense to realize that you’re working hard at all the wrong things from a patient’s perspective. Sorry, staff. Patients have a right to be pissed off. We’re supposed to be their advocates.

(Steps off soapbox to sounds of crickets and gasps from former coworkers.)

Well, now you know where I’m coming from, at least. I’d like to say that this job that I took in Tucson was different, but it was more of the same. One absolutely horrible experience after another but in a completely different field than the emergency room-a field in which, remember, dear Reader, they actually failed to orient me for. I wouldn’t want a nurse who had been given little back up or orientation in a critical care area. I didn’t want to be that nurse. Caring just isn’t enough sometimes. I’m lucky I didn’t lose my license or, worse, make a horrible error that hurt someone. My patients are also very lucky for that.

There’s some gratitude. I’m grateful I didn’t hurt anyone with my lack of expertise in this scary new field for which I was left unprepared. I’m hearing Jennifer’s voice again. “Approach it with gratitude. It’ll set you free.”

That WAS my intent when I sat down to write this. I guess in that regard, this whole blog has been mostly a fail. I’m grateful for the knowledge I have. I’m grateful for being able to interact with all sorts of people on what could be the worst day of their lives. I’m grateful that nobody got hurt under my care. I’m grateful that the coworkers (who were not nurses, but amazingly supportive) helped back me up as best they could. But I’ve always been grateful for those things in my job. Those are not the things that make me get up on my soapbox and complain.

Healthcare in general in this nation and the way it has turned into a profit driven horse and pony show, well, there’s just not a lot about it that I can find to be grateful for.

In fact, I’m so decidedly ungrateful that I’ve decided to leave nursing. And I’ve decided to leave the country! I’ve always toyed with the idea, now it’s time to go.

Before I go, though, there is one thing that I can do that is very important.  I can educate you, my dear Reader.  I can help you help yourself if you end up in one of our ‘Organizations’ seeking health care. Let me tell you how to be less likely to be mistreated in a hospital.  Take a few minutes and use that awesome Google tool to look up Independent Nurse Patient Advocates in your area.

What is that, you ask? An independent nurse patient advocate is not an employee of the hospital, or the insurance company, and certainly not of the Organization. They’re nurses who have become specially trained in being YOUR employee. They’re nurses who have said, ‘Enough!” and gone into this new field. They’re out there, it’s a growing field. They generally take payment directly, bypassing the pesky insurance companies who think that they somehow know more than the doctors who treat you about what you need. You pay these nurses directly to stand up for you, to explain everything to you that’s happening, and to help you make choices that are right for your situation. They make sure hands are washed and your room is clean. They talk to doctors and staff nurses as needed. Some of them fight insurance battles for you. Some of them go to your doctors appointments with you. Sure, it’s a little extra out of pocket in an already outrageous market, but paying them directly makes them beholden to nobody but YOU and YOUR welfare. Honestly, if I weren’t so burned out, I’d be studying to become one. But I am too burned out right now, and I don’t know if that will change anytime soon.

And hey, you know what?

If I were any less burned out, or any less angry, I wouldn’t be going to practice Spanish in Colombia and then on to learn how to be an English teacher in Nicaragua. I wouldn’t be bothering to try to start a new life that I can fall in love with. I’d still be trying to fix myself as a nurse and likely beating my head against a wall. I certainly wouldn’t be finally reaching out for my seemingly impossible goal of being a permanent world traveler and living internationally. I am actually very glad that I finally got pushed to this point.

Ooh, did you read that?

There it is. Gratitude. I guess I am grateful, after all. And yes, I do feel more free now after being able to finally get to this point.

It doesn’t change the way I feel about our broken system, but it does set me free.  Dalai Lama said ‘If you can, help others; if you can not do that, at least don’t harm them.’

I hope the Nurses in DC are finding success. It needs to be different. I hope that you find success and a good nurse patient advocate. I have a lot of hope for a lot of things again. It feels really great.

Please stay tuned for much less angry posts all about travel, teaching, culture, and the human condition across the Globe.