I don't know how many of your noticed, but it's happened again. People changed their government just by standing in the street. This time it was Nepal...took three weeks, but it worked...King turned the government back over to Parliament. With heartening frequency in recent years, we've gotten demonstrations of the real power of "the people". There's been a government change as a result of standing-in-the-street at least five times since Poland...probably more...(suffering from CRS syndrome when it comes to listing them, but if you listen to world news, you know what I'm talking about)...all the people just go out and stand in the street until the current regime caves...honest...that's what happens. The people go, "I'm just not playing anymore. I quit." And they all just go out and stand there in the street...commerce comes to a screaching halt, everything comes to a screaching halt. They stand there until the current government, usually after trying its usual round of responses like rubber bullets and tear gas and unacceptable political compromises, etc., gives up and gives in. Happened in the Balkans, happened in South America, just now happened in Nepal. Isn't that inspiring?! Makes my heart sing. People forget that they have, in fact, enormous power!! Governments sometimes - er, one might be forgiven for saying, "usually" - encourage the people to feel powerless. But the truth is, that without the cooperation of "the people", nothing can happen...business, education, government...all of it stops when everybody just goes out and stands there....together...for long enough. Bring a lunch.
On the news items front, I wanted to pass along a notice a friend of mine got in the mail about mental health opportunities in rural areas. The Nevada legislature, for example, recently passed legislation doubling the size of Rural Clinics, "creating more than 100 new positions throughout the state". They're looking for "licensed clinical social workers and licensed marriage and family therapists to fill them. They say in their letter "Many out-of-state clinicians are able to gain licensure in Nevada within a matter of weeks." They attach a sample list of jobs with salary ranges of $45K at the low (mental health counselor II) end to $73.5K at the high end (Clinical Program Manager I). The website for these is: www.mhds.state.nv.us or www.nv.gov or www.travelnevada.com. Just thought somebody might be interested. My friend said that Nevada isn't the only state with this sort of program...no doubt there's a rural shortage of doc's and nurses, too. (This is, I guess, for those who take seriously those repeated injunctions to "just quit, why don't you" that we hear from time to time.)
News and rumors of some unfortunate events have circulated at the hospital recently...a loss of protected identity info, a serious narcotics medsheet violation issue, staffing on units with more than half pool staff, etc. But the biggest misfortune from my personal point of view this week was the retirement of another good, experienced supervisor. Just wanted to note that we'll miss her nurturning and support, her good sense and good energy. We'll all have to work just a little harder now that she's gone. Nevertheless, we wish her well...her retirement has been well earned and we know she'll enjoy it. I understand there's another supervisor leaving soon. That supervisor's hall really echos now...what happens, I wonder, if they all leave?
What would happen if we all leave...and what if the admin. asst's, the janitors, the cafeteria staff, the maintainence guys, the safety officers all leave?
It took the Nepalese three weeks to back down their King...but today Parliament's back in session...and we've been reminded once again of how powerful we are. Thanks!, Nepal.
Sunday, April 30, 2006
Thursday, April 27, 2006
Treatment Failure!!
or, When Good Regulation goes Bad
"Government regulation" is a troublesome subject. Quite often, from a consumer's point of view, I hear myself advocating for more regulation, as in medical providers and insurance companies should be required to make their billing practices understandable or banks shouldn't be allowed to charge all those fees. I'm sure I've said my share of things like that. And, as it's generally Republicans (i.e. the affluent and influential) who advocate for less government regulation, I'm reluctant to embrace the concept...we don't want things running absolutely amok, after all...we, at the lower end of the economic scale, know that if you give the rich and powerful an inch, they'll take a mile...and that mile tends to run right through the center of our houses...
Democrats and liberals (whatever that means) in general often make government regulation sound like its designed to help and protect little old me. And I think that is it's original intent.... most of the time, anyway. Like the regulation of hospitals, for example. I'm pretty sure that when JCHAO (probaby have that wrong..never was any good with those things) was established, government's intent was to protect the patients of hospitals from bad practice one way and another. Of course, JCHAO, isn't, itself, a government agency...it's a private business, as I understand it, contracted by the hospitals themselves to provide "certification"...which establishes a norm, and thereby allows hospitals to be rated and compared on a universally applied scale...which helps with insurance reimbursements, no doubt....and provides for sanctions if the hospital fails to comply with the "norm"...thus "helping to ensure quality of care"...at least in theory.
And yet....and yet I keep seeing all these instances in which the regulatory process has had a negative impact on "quality of care" in the place I work. And I've developed an actual list of "complaints" (imagine that) about JCHAO's impact on this particular establishment. Since, here on the Blog, carping is us, here's the list:
1. JCHAO is a business enterprise itself, and has a financial motive for making itself indispensible. It, therefore, finds new ways each year, to cause the system to alter itself to conform to a JCHAO priority thus making itself seem important. The hospitals aren't given a simple set of "must do"s that they can then achieve and maintain with a minimum of fuss and expense. Instead, each cycle brings a new regulation, new training, new paperwork; the old priority becomes unimportant (hardly anyone bothers about refrigerator temperatures these days...we got our thermomoters, our checklists, our instruction about proper temperatures...we're there and we've moved on...whatever the temperature is)... new year, new concern. Which is all well and good...but costs wads of money and time and, inevitably results in new forms to fill out and file and track. And all of it takes yet another slice out of patient care...which, ironically, is what it's designed to improve.
2. As I understand it, (and, as always, please correct me where I'm wrong...and don't just say "you're wrong" this time, tell me how it really is, please), the JCAHO inspection costs the hospital a rather large amount of money paid directly to JCAHO to do the job...i.e. we pay them to come in and regulate us. In off years we hire a consultant to tell us what JCHAO will be looking for next year and what we need to do to pass the next inspection...another chunk of money.
3. It costs huge amounts of staff time and attention to buff the place up prior to an inspection...charts are checked, floors are polished, talking points are reviewed, everyone is counselled to carry his/her hand sanitizor...tensions run high...and patients are an annoyance...continually interfering with our main agenda which is to pass the JCAHO inspection....again...so we can do it all over in a couple of years. And the line staff say, every year, "why are we doing this for JCHAO, when we don't do it for the patients?"
4. But my most insistent gripe is about the reglatory agencies' tendency to take charge of our patient's psychiatric treatment by dictating how things must be done, treatment wise. Telling a professional mental health staff what to do to help a particular patient or to manage a milieu, via regulation, prevents that staff from using its own educated judgement about what is best. The longer a staff is prevented from thinking on its own, the less professional it becomes, the less invested in the outcomes of its interventions, the more resentful in cases where the reguation results in damage to both patient and staff...
For example: JCAHO's regulation of the use of seclusion for psychiatric patients has resulted in a large reduction in the numer of seclusions in the hospital. And I agree that on the face of it, that sounds like a good thing.
To achieve this, there have been a number of JCAHO inspired behavior modification methods employed in recent years, to change staff's behavior about using seclusion as a treatment intervention or a mileau management strategy, including onerous paperwork and administrative oversight, staff re-education via lengthly training modules, etc. The lastest technique is to refer to a seclusion incident as a "treatment failure". Thus, with zero seclusions being the hospitals apparent goal, any incident during which a patient is secluded becomes a "treatment failure"...by definition.
Except sometimes it's actually good treatment to seclude a patient. In those cases, doing good treatment becomes a "treatment failure" resulting in sanctions against the treating staff by way of onerous paperwork and oversight. I can think of a couple recent examples of this good regulation gone bad . A developmentally delayed, psychotic patient impulsively grabbed another patient by the hair and punched her in the face. As the patient couldn't be secluded, he was "one-to-oned" - i.e. placed in an open seclusion room with staff sitting outside the door to constantly monitor his behavior. Days later, the patient continued to present a very significant assault risk, particularly to the staff who was assigned to the one-to-one. On one particular evening, the patient repeatedly attacked the staff, who repeatedly deflected the attack, until, finally in order to avoid injury to both staff and patient, the staff "closed the door"....the patient was secluded. Prior to this "treatment failure", staff had called the psychiatrist in charge of the patient who apparently advised "a back rub and a soda". This may have been the point at which the repeatedly attacked staff realized there was no relief on the horizon. He committed a treatment failure, in order to protect himself, the other patients and the patient himself from injury.
And I heard about a manic patient (different unit), wild and intrusive, coming up close, waving his hands in the air, babbeling tangential nonsense, loose on the unit who startled another mentally ill patient so badly that the patient backed up and fell, breaking both shoulder and hip... there was no "treatment failure" here since the manic patient was not secluded....yet...
How many assaults have there been since seclusion became a "treatment failure"? How many workmen's comp cases, how much time off, how many patients traumatized...is JCAHO counting that? How would those regulators know when the psychotic, out of control patient himself feels safer in seclusion? Why, exactly, is it better to let the patient assault or run amok than to seclude him/her? Treatment wise, I mean...and most of all, why isn't it the professional staff, hired to do the job, allowed to make those clinical decisions, based on the actual circumstances...isn't that why they were hired? Aren't they educated and experienced in just these matters? Isn't that, in fact, what they're getting paid for?
This phenomenon... the increase in patient-to-staff and patient-to-patient assaults as a result of the changes to seclusion regulations, is not confined to our hospital.
I know it's happening in other, similar hospitals, in other states. Psyc wards are increasingly dangerous places to work, or to be. Check the lists of "most dangerous jobs" sometime. Good psyc treatment requires a certain environment...it's best, for example, if the patients aren't under continual threat of assault...or the staff, either, for that matter.
To wrap this up, I think this is what happens when the regulatory agency has gotten too full of itself...it oversteps its mandate. There are things somebody should check on...cleanliness, malpractice, adequate staffing, etc. But when the oversight actually keeps staff from doing a good job, it's out of line.
Who regulates regulatory agencies?
Comments since last post on Dead Horses and There's a Storm Coming
"Government regulation" is a troublesome subject. Quite often, from a consumer's point of view, I hear myself advocating for more regulation, as in medical providers and insurance companies should be required to make their billing practices understandable or banks shouldn't be allowed to charge all those fees. I'm sure I've said my share of things like that. And, as it's generally Republicans (i.e. the affluent and influential) who advocate for less government regulation, I'm reluctant to embrace the concept...we don't want things running absolutely amok, after all...we, at the lower end of the economic scale, know that if you give the rich and powerful an inch, they'll take a mile...and that mile tends to run right through the center of our houses...
Democrats and liberals (whatever that means) in general often make government regulation sound like its designed to help and protect little old me. And I think that is it's original intent.... most of the time, anyway. Like the regulation of hospitals, for example. I'm pretty sure that when JCHAO (probaby have that wrong..never was any good with those things) was established, government's intent was to protect the patients of hospitals from bad practice one way and another. Of course, JCHAO, isn't, itself, a government agency...it's a private business, as I understand it, contracted by the hospitals themselves to provide "certification"...which establishes a norm, and thereby allows hospitals to be rated and compared on a universally applied scale...which helps with insurance reimbursements, no doubt....and provides for sanctions if the hospital fails to comply with the "norm"...thus "helping to ensure quality of care"...at least in theory.
And yet....and yet I keep seeing all these instances in which the regulatory process has had a negative impact on "quality of care" in the place I work. And I've developed an actual list of "complaints" (imagine that) about JCHAO's impact on this particular establishment. Since, here on the Blog, carping is us, here's the list:
1. JCHAO is a business enterprise itself, and has a financial motive for making itself indispensible. It, therefore, finds new ways each year, to cause the system to alter itself to conform to a JCHAO priority thus making itself seem important. The hospitals aren't given a simple set of "must do"s that they can then achieve and maintain with a minimum of fuss and expense. Instead, each cycle brings a new regulation, new training, new paperwork; the old priority becomes unimportant (hardly anyone bothers about refrigerator temperatures these days...we got our thermomoters, our checklists, our instruction about proper temperatures...we're there and we've moved on...whatever the temperature is)... new year, new concern. Which is all well and good...but costs wads of money and time and, inevitably results in new forms to fill out and file and track. And all of it takes yet another slice out of patient care...which, ironically, is what it's designed to improve.
2. As I understand it, (and, as always, please correct me where I'm wrong...and don't just say "you're wrong" this time, tell me how it really is, please), the JCAHO inspection costs the hospital a rather large amount of money paid directly to JCAHO to do the job...i.e. we pay them to come in and regulate us. In off years we hire a consultant to tell us what JCHAO will be looking for next year and what we need to do to pass the next inspection...another chunk of money.
3. It costs huge amounts of staff time and attention to buff the place up prior to an inspection...charts are checked, floors are polished, talking points are reviewed, everyone is counselled to carry his/her hand sanitizor...tensions run high...and patients are an annoyance...continually interfering with our main agenda which is to pass the JCAHO inspection....again...so we can do it all over in a couple of years. And the line staff say, every year, "why are we doing this for JCHAO, when we don't do it for the patients?"
4. But my most insistent gripe is about the reglatory agencies' tendency to take charge of our patient's psychiatric treatment by dictating how things must be done, treatment wise. Telling a professional mental health staff what to do to help a particular patient or to manage a milieu, via regulation, prevents that staff from using its own educated judgement about what is best. The longer a staff is prevented from thinking on its own, the less professional it becomes, the less invested in the outcomes of its interventions, the more resentful in cases where the reguation results in damage to both patient and staff...
For example: JCAHO's regulation of the use of seclusion for psychiatric patients has resulted in a large reduction in the numer of seclusions in the hospital. And I agree that on the face of it, that sounds like a good thing.
To achieve this, there have been a number of JCAHO inspired behavior modification methods employed in recent years, to change staff's behavior about using seclusion as a treatment intervention or a mileau management strategy, including onerous paperwork and administrative oversight, staff re-education via lengthly training modules, etc. The lastest technique is to refer to a seclusion incident as a "treatment failure". Thus, with zero seclusions being the hospitals apparent goal, any incident during which a patient is secluded becomes a "treatment failure"...by definition.
Except sometimes it's actually good treatment to seclude a patient. In those cases, doing good treatment becomes a "treatment failure" resulting in sanctions against the treating staff by way of onerous paperwork and oversight. I can think of a couple recent examples of this good regulation gone bad . A developmentally delayed, psychotic patient impulsively grabbed another patient by the hair and punched her in the face. As the patient couldn't be secluded, he was "one-to-oned" - i.e. placed in an open seclusion room with staff sitting outside the door to constantly monitor his behavior. Days later, the patient continued to present a very significant assault risk, particularly to the staff who was assigned to the one-to-one. On one particular evening, the patient repeatedly attacked the staff, who repeatedly deflected the attack, until, finally in order to avoid injury to both staff and patient, the staff "closed the door"....the patient was secluded. Prior to this "treatment failure", staff had called the psychiatrist in charge of the patient who apparently advised "a back rub and a soda". This may have been the point at which the repeatedly attacked staff realized there was no relief on the horizon. He committed a treatment failure, in order to protect himself, the other patients and the patient himself from injury.
And I heard about a manic patient (different unit), wild and intrusive, coming up close, waving his hands in the air, babbeling tangential nonsense, loose on the unit who startled another mentally ill patient so badly that the patient backed up and fell, breaking both shoulder and hip... there was no "treatment failure" here since the manic patient was not secluded....yet...
How many assaults have there been since seclusion became a "treatment failure"? How many workmen's comp cases, how much time off, how many patients traumatized...is JCAHO counting that? How would those regulators know when the psychotic, out of control patient himself feels safer in seclusion? Why, exactly, is it better to let the patient assault or run amok than to seclude him/her? Treatment wise, I mean...and most of all, why isn't it the professional staff, hired to do the job, allowed to make those clinical decisions, based on the actual circumstances...isn't that why they were hired? Aren't they educated and experienced in just these matters? Isn't that, in fact, what they're getting paid for?
This phenomenon... the increase in patient-to-staff and patient-to-patient assaults as a result of the changes to seclusion regulations, is not confined to our hospital.
I know it's happening in other, similar hospitals, in other states. Psyc wards are increasingly dangerous places to work, or to be. Check the lists of "most dangerous jobs" sometime. Good psyc treatment requires a certain environment...it's best, for example, if the patients aren't under continual threat of assault...or the staff, either, for that matter.
To wrap this up, I think this is what happens when the regulatory agency has gotten too full of itself...it oversteps its mandate. There are things somebody should check on...cleanliness, malpractice, adequate staffing, etc. But when the oversight actually keeps staff from doing a good job, it's out of line.
Who regulates regulatory agencies?
Comments since last post on Dead Horses and There's a Storm Coming
Saturday, April 22, 2006
Dead Horses
I've just been re-reading the comments on the last post. Especially enjoyed the "things to do with a dead horse". So bittersweet. Yep. We're dead horses allright.
So I was sitting around the report table the other day, with the other dead horses, listening to the summaries of why the new patients we were about to meet had been admitted. This one guy had gone into a commercial enterprise and asked to withdraw two million dollars from his non-existant account. When the interaction grew complicated, he jumped up on a chair and began to rant and rail against the CIA and its minions. Others were summoned; complicated, tangential explanations were tendered. Everyone was uneasy. Including our guy. Untimately, after some substantial expenditure of time and energy on the part of private and public officials, he was brought to us.
Earlier we received a guy who'd been digging little graves in his basement...and placing barbie dolls in them....
We have patients who have tried to cut off body parts in order to stop the voices.
And ones that represent the Lord in the great struggle of good against evil.
Ok, it's an odd group, I know. I think it's fair to say that the staff that take care of this odd group are odd themselves...and I totally understand that the rest of the city doesn't want to think about it too much. That's OK. They shouldn't have to. These are disturbing things, mysterious and frightening things sometimes. There's enough of that, (mystery and fear) after all, just in the news from the Middle East ..or the Bush Administration.
But the thing is, as I know I've said before, if we don't take care of these guys, everyone will have to think about these things a lot more. There will more more and more bizarre incidents in the city. More citizens will have an uncomfortable encounters with psychosis. Our already overcrowded jails will be filled with these patients...at considerable expense, taking up beds that perhaps should be used for criminals.
Not everyone has to take care of the mentally ill, but somebody has to. Our group is odd because we actually enjoy it...and enjoy the patients...and know how to help them...and want to help them. But everybody needs to make a living. And,too, there are certain other, non monetary needs that accrue to this work.
One of the dead horses around the table on the day I speak of looked strained.
"What's up?" I asked
"I can't go to nights for another month." the horse replied.
"I though you were going at the end of the month." I said.
"Yes, I did too" he said. "I don't think I can do this another month."
"This" in that last sentence refers to being the only experienced staff on an evening shift of an admission team...which means that, although this horse is only getting a minimal reward financially for being a mental health worker, he is, effectively, responsible for running the milieu (25 newly admitted, often psychotic and dangerous patients) while teaching the new staff (all the others) what to watch for, what to do, how to ensure patient safety, unit norms and rules, etc. etc. etc. This is, really, an undoably big job. Normally each new staff member would be trained on a shift where all of his/her coworkers were experienced staff. Here it's reversed...instead of one new to three or four old, we've got one old to three or four new.
The horse in question has patiently endured this for several months; as his headaches and nervous symptoms incresed, he asked for a transfer to nights. Now he's being put off from month to month on the transfer....because...without him, the entire evening shift is new.
Why is this horse in this fix? Is it all because the state has reduced the hospital's budget? That accounts, actually, for the fact that the hospital has closed some units altogether, but not for the stunning mess the hospital, with its remaining units, has become. The "low production, low morale, lack of job satisfaction, group dissension, group ineffectiveness, group boredom, group cynicism, truancy" and so forth listed by Anonymous on "There's a Storm Coming" are the result of something else.
What could it be?
Could it be...the Director? Why, I wonder, are we all so familiar with the term "Peter Principle"? Why, when the Director is mentioned, does everyone tell all the stories about his sexual indiscretions, as opposed to any accomplishments? Why does everyone mumble, "paranoid"?
And then the other Director..why does the Director of Nursing paste paper over her windows so no one can see in or out? Why did she need to introduce herself to staff at the recent Nursing Forum? Why would she say "I don't know" in response to a question about why nurses raises didn't make it to the JBC?
All I'm saying is that a change at the top might have changed everything. Probably too late, now. Too many have left. Nobody left to put it back together. So where does that leave us? I'm afraid the city is in for it. Maybe we could do some public workshops/seminars on what to do when someone experiencing psychosis approaches you.
So I was sitting around the report table the other day, with the other dead horses, listening to the summaries of why the new patients we were about to meet had been admitted. This one guy had gone into a commercial enterprise and asked to withdraw two million dollars from his non-existant account. When the interaction grew complicated, he jumped up on a chair and began to rant and rail against the CIA and its minions. Others were summoned; complicated, tangential explanations were tendered. Everyone was uneasy. Including our guy. Untimately, after some substantial expenditure of time and energy on the part of private and public officials, he was brought to us.
Earlier we received a guy who'd been digging little graves in his basement...and placing barbie dolls in them....
We have patients who have tried to cut off body parts in order to stop the voices.
And ones that represent the Lord in the great struggle of good against evil.
Ok, it's an odd group, I know. I think it's fair to say that the staff that take care of this odd group are odd themselves...and I totally understand that the rest of the city doesn't want to think about it too much. That's OK. They shouldn't have to. These are disturbing things, mysterious and frightening things sometimes. There's enough of that, (mystery and fear) after all, just in the news from the Middle East ..or the Bush Administration.
But the thing is, as I know I've said before, if we don't take care of these guys, everyone will have to think about these things a lot more. There will more more and more bizarre incidents in the city. More citizens will have an uncomfortable encounters with psychosis. Our already overcrowded jails will be filled with these patients...at considerable expense, taking up beds that perhaps should be used for criminals.
Not everyone has to take care of the mentally ill, but somebody has to. Our group is odd because we actually enjoy it...and enjoy the patients...and know how to help them...and want to help them. But everybody needs to make a living. And,too, there are certain other, non monetary needs that accrue to this work.
One of the dead horses around the table on the day I speak of looked strained.
"What's up?" I asked
"I can't go to nights for another month." the horse replied.
"I though you were going at the end of the month." I said.
"Yes, I did too" he said. "I don't think I can do this another month."
"This" in that last sentence refers to being the only experienced staff on an evening shift of an admission team...which means that, although this horse is only getting a minimal reward financially for being a mental health worker, he is, effectively, responsible for running the milieu (25 newly admitted, often psychotic and dangerous patients) while teaching the new staff (all the others) what to watch for, what to do, how to ensure patient safety, unit norms and rules, etc. etc. etc. This is, really, an undoably big job. Normally each new staff member would be trained on a shift where all of his/her coworkers were experienced staff. Here it's reversed...instead of one new to three or four old, we've got one old to three or four new.
The horse in question has patiently endured this for several months; as his headaches and nervous symptoms incresed, he asked for a transfer to nights. Now he's being put off from month to month on the transfer....because...without him, the entire evening shift is new.
Why is this horse in this fix? Is it all because the state has reduced the hospital's budget? That accounts, actually, for the fact that the hospital has closed some units altogether, but not for the stunning mess the hospital, with its remaining units, has become. The "low production, low morale, lack of job satisfaction, group dissension, group ineffectiveness, group boredom, group cynicism, truancy" and so forth listed by Anonymous on "There's a Storm Coming" are the result of something else.
What could it be?
Could it be...the Director? Why, I wonder, are we all so familiar with the term "Peter Principle"? Why, when the Director is mentioned, does everyone tell all the stories about his sexual indiscretions, as opposed to any accomplishments? Why does everyone mumble, "paranoid"?
And then the other Director..why does the Director of Nursing paste paper over her windows so no one can see in or out? Why did she need to introduce herself to staff at the recent Nursing Forum? Why would she say "I don't know" in response to a question about why nurses raises didn't make it to the JBC?
All I'm saying is that a change at the top might have changed everything. Probably too late, now. Too many have left. Nobody left to put it back together. So where does that leave us? I'm afraid the city is in for it. Maybe we could do some public workshops/seminars on what to do when someone experiencing psychosis approaches you.
Thursday, April 20, 2006
There's a storm coming!
In the Nursing Forum yesterday, nurses were apparently told in no uncertain terms that there will be no raises. Sorry. Absolutely not. Can't get there from here. But nurses were encouraged to stay, if stay they are determined to do, because of "collegues and patients".
This would seem to overlook the fact that there are "collegues and patients" in every nursing job...and some nursing jobs pay a whole lot better, and come with annual raises to boot. This is because nurses are people, too, and have families and household obligations. In fact, they work primarily in order to take care of their families and household obligations; if they didn't HAVE to work, they wouldn't. In other words, nurses are not a charitable non-profit organization, donating their time entirely out of love. They do, in fact, need to make a living...and can make a better one everywhere else in town....and can have collegues and patients there, too.
The nurses are annoyed that the most woefully underpaid among them, the 1's and 2's, will see a "cost of living" (that's not quite the cost of living) raise, while the physicians get a 33 1/3% raise and the managers already are making several times what the 1's and 2's are making. There's a feeling of unfairness in the air, exascerbated by the fact that there is a nursing shortage, that nursing turnover is quite definately high enough to adversely impact quality of care, and that all they have to do to get paid more is work for somebody else.
So how did the HS Department achieve those physician raises? They submitted a "Supplemental" request to the Joint Budget Committee. This included several paragraphs like this:
The Department indicates in its request that the institutes have recently lost several psychiatrists: one to a community mental heath center at 40 percent above current salary, one to a private health insurance provider in an inpatient setting at 36 percent above salary, and one to DOC at 11 percent above salary. Currently, the turnover rate is 20 percent at Fort Logan (of the positions even filled) and 23 percent at Pueblo (again of the positions even filled). More important than the turnover, however, is the fact that the institutes are having trouble even filling the vacated positions now. This appears to be the real supplemental issue in staff's opinion.
A salary table is shown, reasons to fund and not to fund are given.
Under "reasons to fund" we have:
While turnover rates are an important indicator of a management and salary problem, quality of care, including quality of client evaluation/assessments are factors that are not evidenced in turnover rates.
and
The Neiberger lawsuit and the corresponding need to maintain appropriate staffing rations for lawsuit settlement compliance, along with the need to ensure metro area beds by keeping units open at Fort Logan are weighty and serious issues for the mental health system.
So, although these remarks are given in response to a request to increase physician salaries, they apply as well to nursing staff, don't you think?...Yes, we need good Doctors, no doubt about it...but the Doctors don't do the day to day care of patients; we need nurses just as badly. Nurses directly affect patient quality of care enormously and quality of care is the stated objective in these funding priorities.
Now, under reasons not to fund there's this:
The mental health institutes have requested a 0.2 percent base cut ($120,117 GF) in personal services in its November FY 2006-7 budget. This is an executive common policy; however, it is staff's understanding that the Department did not request or consider an exemption to this policy. This requested decrease would appear to run counter to the supplemental and budget amendment request.
and this:
The mental health institutes are given a budget each year to manage and have the opportunity to do a comeback through the Governor's Office if the funding is estimated to be short.
And,finally, this:
The institutes report a funding shortfall that exceeds this request (e.g. nursing). It is hightly likely that those areas will request funding in the future as well.
At last! nursing is mentioned...and we see that no request was made for nursing this year.
Each of these things speaks to the concern nursing staff have about management and their administration of the hospital...Why didn't the Dept of HS "request or consider an exemption" to the 0.2 percent base cut??? Surely, by the look of things, we need every penny...why just let this go? If the mental health institutes are "given a budget each year to manage", aren't they then responsible for how the money is divided up? Why the huge gulfs between the salaries of line staff and their supervisors? Why didn't anyone ensure that there was a funding request for nursing salaries? I imagine the process involves people talking to people, doing salary surveys, pointing out the vacancies and turnover rates, talking about how quality of care has been impacted...making the argument to the JBC, as was done for physician's salaries. I'm pretty sure the physicians themselves didn't get together and produce the request...the administration did...why didn't it do the same for nurses?
In the staff recommendations section of this document it says:
Staff's methodology for this budget is to consider impacts on patient care as the #1 requirement with other areas secondary to this goal. However, because having psychiatrist on staff at the mental health institutes is necessary, the lack thereof could threaten a unit's closure. This is a concern in Pueblo because of the competency evalutaion backlog. This is also a concern in the metro area (Fort Logan) where the shortage of psychiatric hospital beds is beginning to present itself as a crisis.
It seems to me that nursing staff have two points of leverage here. One is our impact on patient care - seen as the "#1 requirement" in the budgeting process; the other is the metro area shortage of psychiatric hospital beds, which is "beginning (!) to be a crisis."
Nurses are important. Our nurses are underpaid and leaving daily. Without nurses this facility cannot operate. Period. It can't. And, apparently, not even the most rudimentary effort was made by management to get nurses realistic raises; worse, management has not inspired confidence in its management of the available budget.
Nurses feel adrift on a rudderless ship, with a captain who's "thinking of other things"; the first mate is playing solitaire in his cabin; the cargo in the hold is beginning to shift; there's a storm brewing way out on the horizon....the rats have begun to leave the ship.......and there's this damned fly buzzing around...
Comments since last post on The Easter Bunny Blog"
This would seem to overlook the fact that there are "collegues and patients" in every nursing job...and some nursing jobs pay a whole lot better, and come with annual raises to boot. This is because nurses are people, too, and have families and household obligations. In fact, they work primarily in order to take care of their families and household obligations; if they didn't HAVE to work, they wouldn't. In other words, nurses are not a charitable non-profit organization, donating their time entirely out of love. They do, in fact, need to make a living...and can make a better one everywhere else in town....and can have collegues and patients there, too.
The nurses are annoyed that the most woefully underpaid among them, the 1's and 2's, will see a "cost of living" (that's not quite the cost of living) raise, while the physicians get a 33 1/3% raise and the managers already are making several times what the 1's and 2's are making. There's a feeling of unfairness in the air, exascerbated by the fact that there is a nursing shortage, that nursing turnover is quite definately high enough to adversely impact quality of care, and that all they have to do to get paid more is work for somebody else.
So how did the HS Department achieve those physician raises? They submitted a "Supplemental" request to the Joint Budget Committee. This included several paragraphs like this:
The Department indicates in its request that the institutes have recently lost several psychiatrists: one to a community mental heath center at 40 percent above current salary, one to a private health insurance provider in an inpatient setting at 36 percent above salary, and one to DOC at 11 percent above salary. Currently, the turnover rate is 20 percent at Fort Logan (of the positions even filled) and 23 percent at Pueblo (again of the positions even filled). More important than the turnover, however, is the fact that the institutes are having trouble even filling the vacated positions now. This appears to be the real supplemental issue in staff's opinion.
A salary table is shown, reasons to fund and not to fund are given.
Under "reasons to fund" we have:
While turnover rates are an important indicator of a management and salary problem, quality of care, including quality of client evaluation/assessments are factors that are not evidenced in turnover rates.
and
The Neiberger lawsuit and the corresponding need to maintain appropriate staffing rations for lawsuit settlement compliance, along with the need to ensure metro area beds by keeping units open at Fort Logan are weighty and serious issues for the mental health system.
So, although these remarks are given in response to a request to increase physician salaries, they apply as well to nursing staff, don't you think?...Yes, we need good Doctors, no doubt about it...but the Doctors don't do the day to day care of patients; we need nurses just as badly. Nurses directly affect patient quality of care enormously and quality of care is the stated objective in these funding priorities.
Now, under reasons not to fund there's this:
The mental health institutes have requested a 0.2 percent base cut ($120,117 GF) in personal services in its November FY 2006-7 budget. This is an executive common policy; however, it is staff's understanding that the Department did not request or consider an exemption to this policy. This requested decrease would appear to run counter to the supplemental and budget amendment request.
and this:
The mental health institutes are given a budget each year to manage and have the opportunity to do a comeback through the Governor's Office if the funding is estimated to be short.
And,finally, this:
The institutes report a funding shortfall that exceeds this request (e.g. nursing). It is hightly likely that those areas will request funding in the future as well.
At last! nursing is mentioned...and we see that no request was made for nursing this year.
Each of these things speaks to the concern nursing staff have about management and their administration of the hospital...Why didn't the Dept of HS "request or consider an exemption" to the 0.2 percent base cut??? Surely, by the look of things, we need every penny...why just let this go? If the mental health institutes are "given a budget each year to manage", aren't they then responsible for how the money is divided up? Why the huge gulfs between the salaries of line staff and their supervisors? Why didn't anyone ensure that there was a funding request for nursing salaries? I imagine the process involves people talking to people, doing salary surveys, pointing out the vacancies and turnover rates, talking about how quality of care has been impacted...making the argument to the JBC, as was done for physician's salaries. I'm pretty sure the physicians themselves didn't get together and produce the request...the administration did...why didn't it do the same for nurses?
In the staff recommendations section of this document it says:
Staff's methodology for this budget is to consider impacts on patient care as the #1 requirement with other areas secondary to this goal. However, because having psychiatrist on staff at the mental health institutes is necessary, the lack thereof could threaten a unit's closure. This is a concern in Pueblo because of the competency evalutaion backlog. This is also a concern in the metro area (Fort Logan) where the shortage of psychiatric hospital beds is beginning to present itself as a crisis.
It seems to me that nursing staff have two points of leverage here. One is our impact on patient care - seen as the "#1 requirement" in the budgeting process; the other is the metro area shortage of psychiatric hospital beds, which is "beginning (!) to be a crisis."
Nurses are important. Our nurses are underpaid and leaving daily. Without nurses this facility cannot operate. Period. It can't. And, apparently, not even the most rudimentary effort was made by management to get nurses realistic raises; worse, management has not inspired confidence in its management of the available budget.
Nurses feel adrift on a rudderless ship, with a captain who's "thinking of other things"; the first mate is playing solitaire in his cabin; the cargo in the hold is beginning to shift; there's a storm brewing way out on the horizon....the rats have begun to leave the ship.......and there's this damned fly buzzing around...
Comments since last post on The Easter Bunny Blog"
Sunday, April 16, 2006
The Easter Bunny Blog
I heard this story at work this weekend, and thought I'd pass it along.
Once upon a time there was an older, retired Easter Bunny named Harold. Harold had given up regular Easter duties years ago and had spent his retirement traveling around the country, seeing the sights, sampling the carrots, and napping. When Easter rolled around Harold typically contacted an actively practising Easter Bunny who would give him a few colored eggs to leave around wherever he happened to be...it wasn't a real job, but it satisfied that urge he had to give things to others - which is practically a genetic component of an Easter Bunny.
In the year we're speaking of, Harold had run into his nephew, Bob, not long before Easter and had persuaded Bob to give him a few eggs in time to pass them out wherever he happened to be. Bob hadn't made his eggs yet, but promised to send one of the kids with them in plenty of time.
Unfortunately that year there was a late snow the week before Easter, and Bob just couldn't send any of the kids out in that....plus he needed the whole family on Easter himself, if he was going to get all the eggs out in 12" of the white stuff.
And so, Harold's eggs were late.
Harold, at the time, found himself in the outskirts of a little town on the plains. He'd been hopping around, sampling the carrots and taking naps. He was sorry he didn't have any eggs for the people on Easter, but was philosophical about it. When they arrived the week after, he went ahead and distributed them. From his perspective it was a case of it's better late than never.
Bob had only sent a few eggs anyway. Not enough, really, for everyone in town. So Harold gave an egg to the mayor and the town council, the newspaper man, the sheriff's department...what he thought of as the "central" functionaries and then started in on the blocks...he only got around a few before his eggs were all gone; only some of the townspeople got their belated egg...some got none at all.
On the morning the eggs were finally delivered to the lucky ones, Mrs. Dunsworthy came out onto her lawn to get the morning paper and found an Easter Egg. Mrs. Dunsworthy was the head of the PTA...and a busy, no nonsense sort of woman.
"Who left this Easter Egg?" she demanded of the front yard. "This wasn't here yesterday!" She looked up and down the block and, sure enough, there was an Easter egg on every lawn. "This is most peculiar" she thought. "I'm going to get the bottom of this!"
Mrs. Dunsworthy immediately called her friend Norma on the City Council. "Did you get an Easter Egg?" she asked. "Yes!", said Norma. "What do you think of that?"
"I find it most disturbing" said Mrs. Dunsworthy. "Easter was a week ago. Why are these eggs here now?? For one thing," she added, a child could have found one and eaten it and died...they must be week old!....or thrown it at a car! or another child!...these things are dangerous! Who would just leave them lying around like that?"
"Oh, I hadn't thought of that" said Norma pensively. "Dangerous, eh? Oh dear." Norma had a special friendship with the newspaper editor so she called him. "Elmer" she said. "Someone is threatening us...threatening the town! Edna Dunsworthy just got a poison, exploding egg in her yard...I got one, too, but mine was a regular one (she didn't tell him, that, in fact, she's already eaten it)...but Edna thinks we're all in danger and I wondered if you'd heard about it."
"I got one, too" said Elmer...."my whole block did. Everybody's asking me about them and I don't know a thing. It's driving me crazy. I'm going to send out my reporters immediately and we'll get to the bottom of this!"
Pretty soon the whole town was talking about the frightening eggs that had turned up on their lawns a week after Easter. People were taking sides, people were getting angry. The City Council held a meeting; the sheriffs told people to use the annonymous tip line; Elmer wrote editorials daily.
Harold the Easter Bunny, meanwhile was both appalled and fascinated. He'd been on the edge of the Mayor's lawn, nibbling grass, when Elmer and the Mayor discussed how to handle the egg crisis. "Egg crises?" thought Harold. "I'd better listen to this". He hopped nearer the Mayor, under the edge of the weeping forsythia, so he could evesdrop. When he heard that everyone was frightened of his Easter eggs, he was dumfounded...then rather frightened himself. "If they ever find out that it was me who left them those eggs, I'm a stew my nightfall" he thought.
Harold left the Mayor's lawn poste haste. He should have just left town, but the whole situation was so facinating, in a creepy sort of way, that he just couldn't. Instead, he stayed in town but out of sight, hopping from shrub to shrub and listening in. He turned his ears towards the council chambers during town meetings, listened through the open windows to the PTA, heard Edna harranging the sheriff on the telephone, caught the Mayor and his secretary holding hands in the lilacs behind the City Building. The talk was all about eggs....dangerous eggs, subversive eggs, possibly illegal eggs...
and what to do about it.
Harold noticed that the town was so preoccupied with the eggs, things weren't getting done...the trash hadn't been picked up for days...the High School graduation ceremony, which should have been planned by now hadn't even been thought of...hardly anyone had mowed their lawns...which was a good thing as far as Harold was concerned..more food, more cover.
One day, Harold ventured a little farther afield, up to the town's water supply, thinking to eat a little watercress. The city fathers had built a large reservoir above the town that this time of year was usually still a little icy. This year was different, however, because after the big Easter snow, it had warmed up...way up...all that snow had melted fast and the reservoir was full...very full, Harold noticed...so full, in fact that it was beginning to trickle over the top; the dam itself seemed to bulge...the whole business looked unstable to Harold.
It made him nervous and he hopped back to town, thinking he might get someone's attention...get somebody's dog to chase him, perhaps, so the owner would chase the dog and see the bulging, dripping, straining dam...poised, as it was, right above the town...
But, of course, nobody noticed the Easter Bunny...they were all too busy dusting the eggs for fingerprints. So Harold decided that it was time he moved on...he'd heard Witchita was nice this time of year. And he vowed NEVER to leave eggs a week late again!
The moral of the story is Timing is Everything!
Comments since last post on Projection, a quick review, News Items, Outsource It!, and Links
Thursday, April 13, 2006
Projection, a quick review
In view of recent events, I thought it might be helpful to review a couple of psychological concepts:
Psychological projectionFrom Wikipedia, the free encyclopedia
"Psychological projection (or projection bias) can be defined as unconsciously assuming that others have the same or similar thoughts, beliefs, values, or positions on any given subject as oneself. According to the theories of Sigmund Freud, it is a psychological defense mechanism whereby one "projects" one's own undesirable thoughts, motivations, desires, feelings—basically parts of oneself—onto someone else (usually another person, but psychological projection onto animals and inanimate objects also occurs). The principle of projection is well-established in psychology.
To understand the process, imagine an individual (Alice, for example) who feels dislike for another person (let's say Bob), but whose unconscious mind will not allow her to become aware of this negative emotion. Instead of admitting to herself that she feels dislike for Bob, she projects her dislike onto Bob, so that her conscious thought is not "I don't like Bob," but "Bob doesn't like me." In this way one can see that projection is related to denial, the only defense mechanism that some argue is more primitive than projection. Alice has denied a part of herself that is desperate to come to the surface. She can't flatly deny that she doesn't like Bob, so instead she will project the dislike, thinking Bob doesn't like her. Another, and an ironic, example is if Alice were to say, "Bob seems to project his feelings onto me."
Peter Gay describes it as "the operation of expelling feelings or wishes the individual finds wholly unacceptable—too shameful, too obscene, too dangerous—by attributing them to another." (Freud: A Life for Our Time, page 281)
Common definitions
"Projection is the opposite defence mechanism to identification. We project our own unpleasant feelings onto someone else and blame them for having thoughts that we really have."
"A defense mechanism in which the individual attributes to other people impulses and traits that he himself has but cannot accept. It is especially likely to occur when the person lacks insight into his own impulses and traits."
"Attributing one's own undesirable traits to other people or agencies, e.g., an aggressive man accuses other people of being hostile."
"The individual perceives in others the motive he denies having himself. Thus the cheat is sure that everyone else is dishonest. The would-be adulterer accuses his wife of infidelity."
"People attribute their own undesirable traits onto others. An individual who unconsciously recognises his or her aggressive tendencies may then see other people acting in an excessively aggressive way."
"An individual who possesses malicious characteristics, but who is unwilling to perceive himself as an antagonist, convinces himself that his opponent feels and would act the same way."
And, (again from Wikipedia), this one:
Denial
"Denial is a psychological defense mechanism in which a person faced with a fact that is uncomfortable or painful to accept rejects it instead, insisting that it is not true despite what may be overwhelming evidence. The subject may deny the reality of the unpleasant fact altogether (simple denial), admit the fact but deny its seriousness (minimisation) or admit both the fact and seriousness but deny responsibility (transference)."
And, in closing, I like this from Davy Crockett, that quintessential American and King of the Wild Frontier:
"I leave this rule for others when I'm dead,
Be always sure you're right - then go ahead."
Blog On!!
g.f.
Comments since last post on Links and News Items,"
Psychological projectionFrom Wikipedia, the free encyclopedia
"Psychological projection (or projection bias) can be defined as unconsciously assuming that others have the same or similar thoughts, beliefs, values, or positions on any given subject as oneself. According to the theories of Sigmund Freud, it is a psychological defense mechanism whereby one "projects" one's own undesirable thoughts, motivations, desires, feelings—basically parts of oneself—onto someone else (usually another person, but psychological projection onto animals and inanimate objects also occurs). The principle of projection is well-established in psychology.
To understand the process, imagine an individual (Alice, for example) who feels dislike for another person (let's say Bob), but whose unconscious mind will not allow her to become aware of this negative emotion. Instead of admitting to herself that she feels dislike for Bob, she projects her dislike onto Bob, so that her conscious thought is not "I don't like Bob," but "Bob doesn't like me." In this way one can see that projection is related to denial, the only defense mechanism that some argue is more primitive than projection. Alice has denied a part of herself that is desperate to come to the surface. She can't flatly deny that she doesn't like Bob, so instead she will project the dislike, thinking Bob doesn't like her. Another, and an ironic, example is if Alice were to say, "Bob seems to project his feelings onto me."
Peter Gay describes it as "the operation of expelling feelings or wishes the individual finds wholly unacceptable—too shameful, too obscene, too dangerous—by attributing them to another." (Freud: A Life for Our Time, page 281)
Common definitions
"Projection is the opposite defence mechanism to identification. We project our own unpleasant feelings onto someone else and blame them for having thoughts that we really have."
"A defense mechanism in which the individual attributes to other people impulses and traits that he himself has but cannot accept. It is especially likely to occur when the person lacks insight into his own impulses and traits."
"Attributing one's own undesirable traits to other people or agencies, e.g., an aggressive man accuses other people of being hostile."
"The individual perceives in others the motive he denies having himself. Thus the cheat is sure that everyone else is dishonest. The would-be adulterer accuses his wife of infidelity."
"People attribute their own undesirable traits onto others. An individual who unconsciously recognises his or her aggressive tendencies may then see other people acting in an excessively aggressive way."
"An individual who possesses malicious characteristics, but who is unwilling to perceive himself as an antagonist, convinces himself that his opponent feels and would act the same way."
And, (again from Wikipedia), this one:
Denial
"Denial is a psychological defense mechanism in which a person faced with a fact that is uncomfortable or painful to accept rejects it instead, insisting that it is not true despite what may be overwhelming evidence. The subject may deny the reality of the unpleasant fact altogether (simple denial), admit the fact but deny its seriousness (minimisation) or admit both the fact and seriousness but deny responsibility (transference)."
And, in closing, I like this from Davy Crockett, that quintessential American and King of the Wild Frontier:
"I leave this rule for others when I'm dead,
Be always sure you're right - then go ahead."
Blog On!!
g.f.
Comments since last post on Links and News Items,"
Sunday, April 09, 2006
News Items
****AFSCME (One of the Unions for Public Employees), along with the other AFL-CIO Unions, is meeting with Legislators on Monday (April 10th) to voice concerns about STATE PAY and "PERA" issues. Everybody is invited. Time is 8:30-5:00 p.m. at the Colorado State Capitol in Denver, meeting at First Baptist Church at 14th and Grant.
If you've got the day off (or if you find yourself suffering from the blue flu, along with all of your co-workers) this would be the place to spend the day.
***The Director has a new boss. Our Director's new boss tried for the Director's position and was passed over in favor of our Director...now he's the Directors boss. Success is sweet.
There is both hopefullness and cynicism from the linestaff about this appointment. Maybe he really likes patients and staff (hope glimmers)....or maybe he's just a company man (hope fades)...the proof of the pudding is in the eating, of course. We'll just have to wait and see. It would be a really good sign if he'd blog in a greeting to introduce himself and tell us his priorities. Of course it would have been a good sign if the Director had done so, too...and we can see how that went. Communication is the key to relationships...really it is...we know that...we're mental health professionals. I sure would like it if HMG would put their money where their mouth is, so to speak, on this issue...instead of....
***SWAT IT! Everybody at the MadHouse was issued his/her own personal flyswatter this weekend! Those whose name ends in "Fly" feel somewhat apprehensive about this. ... thinking about what happens to flys when they are swatted...(ugh! ...that's enough of thinking about that!)
Let's take them with us to the Capitol tomorrow and swat legislators and lously legislation instead!!!
G.F.
Read comments since last post on "It's Private", "ETRAC", "Links" (I think) and "Obsolescence"
If you've got the day off (or if you find yourself suffering from the blue flu, along with all of your co-workers) this would be the place to spend the day.
***The Director has a new boss. Our Director's new boss tried for the Director's position and was passed over in favor of our Director...now he's the Directors boss. Success is sweet.
There is both hopefullness and cynicism from the linestaff about this appointment. Maybe he really likes patients and staff (hope glimmers)....or maybe he's just a company man (hope fades)...the proof of the pudding is in the eating, of course. We'll just have to wait and see. It would be a really good sign if he'd blog in a greeting to introduce himself and tell us his priorities. Of course it would have been a good sign if the Director had done so, too...and we can see how that went. Communication is the key to relationships...really it is...we know that...we're mental health professionals. I sure would like it if HMG would put their money where their mouth is, so to speak, on this issue...instead of....
***SWAT IT! Everybody at the MadHouse was issued his/her own personal flyswatter this weekend! Those whose name ends in "Fly" feel somewhat apprehensive about this. ... thinking about what happens to flys when they are swatted...(ugh! ...that's enough of thinking about that!)
Let's take them with us to the Capitol tomorrow and swat legislators and lously legislation instead!!!
G.F.
Read comments since last post on "It's Private", "ETRAC", "Links" (I think) and "Obsolescence"
Wednesday, April 05, 2006
Obsolescence
Disclaimer: All persons, places and events described below are fictional. Any resemblance to real persons, places or things is purely coincidental, unless directly attibuted.
Perhaps it is this specter that most haunts working men and women: the planned obsolescence of people that is of a piece with the planned obsolescence of the things they make. Or Sell. (Working (1972) Studs Terkel)
Or do.
There are four closets in the dayroom on the assaultive ward of the Enchanted Castle. One is the "utility" closet where the mops and brooms are. One is the linen closet...sheets, blankets, scrubs. One is the "comfort" closet, where they keep shampoo, toothbrushes, slippers, the kind of stuff that absolutely everybody, no matter who you are, needs if he's going to spend the night...or, more likely, the month somewhere. I think that the contents of this closet provide food for thought. No matter who you are, what your educational level might be, your sex, your age, your mental illness, you'll need the things in the "comfort" closet: slippers, hand lotion, deodorant, toothbrush and toothpaste, shaving items, combs. I find this interesting...with these three closets plus food and a change of clothes, no personal possessions are necessary for months.... years, even. It like, we all really require only these few things.... No matter if you're the President or a brain injured murderer, you'll need these items....but only these items.... in order to succeed in community life. It says something about the essential nature of human beings.
I'm thinking about this as I sit at the Isle of Sanity, gazing blindly down the hall at the men coming out of their rooms. Some universal component of human identity is revealed by what these mental patients can get by with. That's at least something,...something true of all of us.
And then there is closet number four. I have been in and out, working on that unit for 9 years and I've never opened that closet. Never had any call to. Never needed anything that was in there, apparently. Never gave it much thought. Far be it from me to to intrude.
On this particular day I'm telling you about, Humbert, patient and old friend, asked me to get him one of his sodas. In all the years I'd worked there, patients' sodas had been kept in the patients' kitchen....it was the natural, obvious place. Food item - kitchen....patients' food item - patients' kitchen...seemed right. This year, however, the storm of the State Regulatory process had come through with hurricane force and had blown all the patients' sodas into Closet Number Four. When Humbert asked me to get him one of his sodas this time he was asking me to open Closet Number Four.
He's got black curly hair that sticks wildly out in all directions; and he's missing his two front teeth. He's still handsome in a roguish sort of way...his toothless smile is definitely endearing, engaging. He looks you right in the eye and he twinkles when he talks to you. Humbert's looking' good.
"I wish I could fly", he says to me. He pauses a moment and grins...."Don't YOU wish you could fly?" he asks.
"Yes." I said. "Yes, I do wish I could fly. God. Wouldn't that be great?"
Humbert laughs. "Yea, " he says. "That would be great.
Would you get me one of my soda's?" he asks.
"Sure" I say, heading for the patients's kitchen.
It's dinner time and there are a lot of people milling around the area. There's five or six guys at the med window, getting meds. There's a few who've already gotten dinner, sitting and eating at the dining room table...A few lined up at the kitchen door getting their plates....Guys are going in and out of the bathroom...a few guys with status are heading down the hall, heading for the door, waiting to go to the cafeteria.
"No...they're not in the kitchen." Humbert says
"Yes they are" I say. I'm used to patients not knowing where their sodas are. There's one guy who's been there for years and he doesn't know what city he's in, what hospital, why he's here, nothing...even though staff tell him at least 500 times a day...the only reason he even knows there is such a thing as soda is because it existed before. He certainly doesn't remember anything current...including where is soda's are...or, if he has sodas....
"No, they moved them." Humbert says. "They're over here" . He's pointing to Closet Number Four.
"Really?" I say. "Wow. I've never looked in here. Are you sure?"
"Yep" he said.
"OK"...and I waded back through the crowd to Closet Number Four.
I opened the closet, and there it was. A little closet, barely enough room for a couple of shelves....and a sink. A roomy sink - a big bathroom sink, with a nice looking chrome faucet. Sodas were stuck up on a shelf above the sink...and on the corners of the sink cabinet...one six pack was in the sink itself. Nothing else in there...
"A sink" I said.
"yea" said Humbert.
"Hmm" I said. "Ever use it?"
"No, I never do" he said.
"Ever see anybody use it?"
"no".
"Hmm". I said. "Go ahead and get your soda"
Humbert's six pack of sodas were in the sink. He reached into the sink to get one and the water came on. He jerked his hand back..."Hey", he said.
"What?", I said....
"Look..its one of those seeing eye sinks", he said, and ran his hand under the faucet again. The water came on as he passed his hand in front of it...went off when his hand went away. I went over and tried it a couple of times....sure enough....pretty upscale faucet ....electric eye....fully hooked up and ready to go....in closet number four.....which nobody opens....or uses...and there is not another sink in the entire hospital like it...that I know of, at least. Not one other "electric eye" anywhere....
Later, during an evening of eating, football, and drugs ("pretty much like every other place in town", remarks my co-worker. "The drugs are different, is all") the off shift Supervisor wanders through. I show her the electric eye faucet in closet number four. Wow", she says. "What's that for?"
"No idea", I say. "Thought you might know".
"Nope." she says. "Never knew it was there." They stood together for a few minutes, each trying to work out the purpose of it.
"You just wave your hand by it and it comes on", I say. "It's pretty cool."
"Yeah", says the supervisor. "Too bad it's in the closet".
"Yeah, too bad" I say.
The enchanted castle is the controllable space for a certain subset of humanity. And in a closet there, in the most inner reaches of the castle, is an electric eye faucet ....that nobody uses.
I think it's a symbol. Of us. The cool thing that nobody uses. Somebody put us in a closet and nobody even knows we're there.
Comments since last post on "Links" and on "Etrac"
Perhaps it is this specter that most haunts working men and women: the planned obsolescence of people that is of a piece with the planned obsolescence of the things they make. Or Sell. (Working (1972) Studs Terkel)
Or do.
There are four closets in the dayroom on the assaultive ward of the Enchanted Castle. One is the "utility" closet where the mops and brooms are. One is the linen closet...sheets, blankets, scrubs. One is the "comfort" closet, where they keep shampoo, toothbrushes, slippers, the kind of stuff that absolutely everybody, no matter who you are, needs if he's going to spend the night...or, more likely, the month somewhere. I think that the contents of this closet provide food for thought. No matter who you are, what your educational level might be, your sex, your age, your mental illness, you'll need the things in the "comfort" closet: slippers, hand lotion, deodorant, toothbrush and toothpaste, shaving items, combs. I find this interesting...with these three closets plus food and a change of clothes, no personal possessions are necessary for months.... years, even. It like, we all really require only these few things.... No matter if you're the President or a brain injured murderer, you'll need these items....but only these items.... in order to succeed in community life. It says something about the essential nature of human beings.
I'm thinking about this as I sit at the Isle of Sanity, gazing blindly down the hall at the men coming out of their rooms. Some universal component of human identity is revealed by what these mental patients can get by with. That's at least something,...something true of all of us.
And then there is closet number four. I have been in and out, working on that unit for 9 years and I've never opened that closet. Never had any call to. Never needed anything that was in there, apparently. Never gave it much thought. Far be it from me to to intrude.
On this particular day I'm telling you about, Humbert, patient and old friend, asked me to get him one of his sodas. In all the years I'd worked there, patients' sodas had been kept in the patients' kitchen....it was the natural, obvious place. Food item - kitchen....patients' food item - patients' kitchen...seemed right. This year, however, the storm of the State Regulatory process had come through with hurricane force and had blown all the patients' sodas into Closet Number Four. When Humbert asked me to get him one of his sodas this time he was asking me to open Closet Number Four.
He's got black curly hair that sticks wildly out in all directions; and he's missing his two front teeth. He's still handsome in a roguish sort of way...his toothless smile is definitely endearing, engaging. He looks you right in the eye and he twinkles when he talks to you. Humbert's looking' good.
"I wish I could fly", he says to me. He pauses a moment and grins...."Don't YOU wish you could fly?" he asks.
"Yes." I said. "Yes, I do wish I could fly. God. Wouldn't that be great?"
Humbert laughs. "Yea, " he says. "That would be great.
Would you get me one of my soda's?" he asks.
"Sure" I say, heading for the patients's kitchen.
It's dinner time and there are a lot of people milling around the area. There's five or six guys at the med window, getting meds. There's a few who've already gotten dinner, sitting and eating at the dining room table...A few lined up at the kitchen door getting their plates....Guys are going in and out of the bathroom...a few guys with status are heading down the hall, heading for the door, waiting to go to the cafeteria.
"No...they're not in the kitchen." Humbert says
"Yes they are" I say. I'm used to patients not knowing where their sodas are. There's one guy who's been there for years and he doesn't know what city he's in, what hospital, why he's here, nothing...even though staff tell him at least 500 times a day...the only reason he even knows there is such a thing as soda is because it existed before. He certainly doesn't remember anything current...including where is soda's are...or, if he has sodas....
"No, they moved them." Humbert says. "They're over here" . He's pointing to Closet Number Four.
"Really?" I say. "Wow. I've never looked in here. Are you sure?"
"Yep" he said.
"OK"...and I waded back through the crowd to Closet Number Four.
I opened the closet, and there it was. A little closet, barely enough room for a couple of shelves....and a sink. A roomy sink - a big bathroom sink, with a nice looking chrome faucet. Sodas were stuck up on a shelf above the sink...and on the corners of the sink cabinet...one six pack was in the sink itself. Nothing else in there...
"A sink" I said.
"yea" said Humbert.
"Hmm" I said. "Ever use it?"
"No, I never do" he said.
"Ever see anybody use it?"
"no".
"Hmm". I said. "Go ahead and get your soda"
Humbert's six pack of sodas were in the sink. He reached into the sink to get one and the water came on. He jerked his hand back..."Hey", he said.
"What?", I said....
"Look..its one of those seeing eye sinks", he said, and ran his hand under the faucet again. The water came on as he passed his hand in front of it...went off when his hand went away. I went over and tried it a couple of times....sure enough....pretty upscale faucet ....electric eye....fully hooked up and ready to go....in closet number four.....which nobody opens....or uses...and there is not another sink in the entire hospital like it...that I know of, at least. Not one other "electric eye" anywhere....
Later, during an evening of eating, football, and drugs ("pretty much like every other place in town", remarks my co-worker. "The drugs are different, is all") the off shift Supervisor wanders through. I show her the electric eye faucet in closet number four. Wow", she says. "What's that for?"
"No idea", I say. "Thought you might know".
"Nope." she says. "Never knew it was there." They stood together for a few minutes, each trying to work out the purpose of it.
"You just wave your hand by it and it comes on", I say. "It's pretty cool."
"Yeah", says the supervisor. "Too bad it's in the closet".
"Yeah, too bad" I say.
The enchanted castle is the controllable space for a certain subset of humanity. And in a closet there, in the most inner reaches of the castle, is an electric eye faucet ....that nobody uses.
I think it's a symbol. Of us. The cool thing that nobody uses. Somebody put us in a closet and nobody even knows we're there.
Comments since last post on "Links" and on "Etrac"
Monday, April 03, 2006
Links
Thought it might be helpful if I made the links sent by "Shine the light" active, so you can just click on them. Here they are:
Pera
State Legislature
SEIU (Union)
CAPE (Union)
AFSCME(Union)
Services for State Employees
Dept. of Human Services
Rights and Benefits as State Employee
Healthcare concerns
JCHO
US Dept of Health and Human Services
Use 'Em!
I know I'm using the Joint Commission's to ask why they are requiring that we all retake competencies that we just completed in November....(even if our CPR certs are not expired, we are to retake them...and our wadaya callit...CBI, CMI...the one where we learn how to fight safely with patients...that, too)...Now why would the Joint Commission demand that the hospital spend this money and this time, when we've just done it???? What a waste of our already stressed resources...why do they want this? I just don't get it. Waste of taxpayers' money, I think.
See new comments since last post on Inspected, Detected and Reflected and on ETRAC.>
Pera
State Legislature
SEIU (Union)
CAPE (Union)
AFSCME(Union)
Services for State Employees
Dept. of Human Services
Rights and Benefits as State Employee
Healthcare concerns
JCHO
US Dept of Health and Human Services
Use 'Em!
I know I'm using the Joint Commission's to ask why they are requiring that we all retake competencies that we just completed in November....(even if our CPR certs are not expired, we are to retake them...and our wadaya callit...CBI, CMI...the one where we learn how to fight safely with patients...that, too)...Now why would the Joint Commission demand that the hospital spend this money and this time, when we've just done it???? What a waste of our already stressed resources...why do they want this? I just don't get it. Waste of taxpayers' money, I think.
See new comments since last post on Inspected, Detected and Reflected and on ETRAC.>
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