I'm having a little trouble deciding what to blog about this week...find I'm torn between contemplating the possibilities for political action which could result in increased wages for nurses, and various personal actions which have (in the past) or might (in the future) result in some direct improvement for some individual patient or other...and then there's the relationship between those two. What really is the relationship between better working conditions and better patient care?
From a patient's point of view, a valued "provider" makes him feel valued.
It's like when you have a "heart event", for example...you're needing professional help; you seek out the possible providers. You look up two cardiologists and go to "interview" them. The first one works in a dingy little office on South Broadway, has stains on his lab coat, bloodshot eyes, and drives a 1986 Ford. He forgot to shave a patch on his cheek. He knows what to do...he's done it a million times. He doesn't seem to be interested much in your individual issues, and focuses on the main themes. He seems a little preoccupied and spends part of his time with you on the phone or writing something in the chart. At one point, his receptionist yells in that somebody's towing his car and he runs out. But his prices are the best in town...in fact, they're lower than anybody elses. And he knows his stuff. His wall decor shows a good education at a good school; he tells you of course he can fix your problem, it's no big deal...probably 65 or 75% of his patients live through it...he'll have you in and out in a week. A nurse hands him a note about the guy with the infection and he leaves, telling you to make an appointment for labs.
The second one works in very comfortable surroundings in Cherry Creek. The receptionist smiles and offers you a heart healthy drink while you're waiting. Your Cherry Creek Cardiologist is bright and busy, he looks well nourished, he smiles and drives a jaguar, which is tucked away in a secured parking area. He looks you in the eye when he talks to you; he explores your personal issues. He thinks of questions that might shed light on your chest pain and shortness of breath. Nobody interrupts him. He remembers your name. His prices are on the high end of the range, and he quotes them with pride. He treats you like you matter...to him...to the world. He tells you you'll live and prosper. He gives you his diagnosis and prescription and checks to see if you've understood it. He asks if you have any problems with it. He tells you what to expect. He orders follow up appointments, and hands you off to the office person who makes them all for you. You're given a card with the info and a mint on the way out. You forgot to look at his Medical Degree.
If you can afford the second guy, you feel "valued". You're important. You're worth it. You speak to your friends of your doctor with pride. You approach the coming treatment with confidence...you're going to get the best care available...and you have every expectation of recovery.
If you can't and you have to go with the first guy, you're on your guard...anxious and watchful. You have to repeat your name to him and remind him why you're there. You doubt you'll live through it, but you've got to do it anyway because you'll die for sure if you don't...not that anybody would notice if you DID die. You feel like you need a cigarette even though you quit years ago...and when you leave the appointment, your car has been towed.
One could say, with some accuracy, that the relative financial positions of the two doctors has nothing to do with how good they are. The stressed and distracted cardiologist might, in fact, be the better doctor, at least on a mechanical level. But in health care, we know humans require more than purely mechanical adjustment. "Mechanical adjustment" can be administered with comparatively little attention...it's a set of skills that, once learned, can be done on "automatic" ...like driving in rush hour traffic...leaving the mind free to wander. But healing, "getting well", also has a psychological component.
In mental health care, patients require a lot more than just "mechanical adjustment". In Mental Health, our version of "mechanical adjustment" is medication. We just need the general picture (voices? insomnia? lethargy? an unnatural preoccupation with trash?) to know what to do. The administration of meds is routine and is done with a minimum of fuss...(or accuracy if recent reports are to be believed)...leaving plenty of space for filling out forms, fending off bill collectors, and perseverating about how in hell you're going to pay for college.
But in our facility, we've got darn little in the way of "feeling valued"...that intangible that promotes healing and gives the "mechanical adjustment" a context in which to work.
Wages are part of it. Sounds like various people are working on that issue and that's lucky for us. Competitive wages would help that feeling that we're all a bunch of losers here. And there's that intangible, "psychological" side: being included in decision making, being heard and having input on budget priorities and policy decisions, etc. would help. Having one's own needs recognized and accomodated would help. Having a culture of valuing one another ... respect, honesty, that sort of thing, would help. Having a culture that is really engaged in improving the lot of all of our patients...as opposed to "get them stabilized and move them on" could be energizing. I understand that there are a lot of "system" problems that, although they are community based and appear to be out of our control, could be tackled much more aggressively than they are now...we're pretty fatalistic about what happens to patients after they leave us...and about having to keep people for years beyond the point that they've received maximum benefit because there's "no place for them to go". Engaging in a battle for good is both energizing and bonding.
I think if we want what's best for our patients, we have to work at getting what's needed for us....it's like that little talk in the airplane at the beginning of the flight: when the oxygen mask pops down, get your own on first, then help others. Cheers to Working Woman, who apparently has got her O2 on already...and to the guy from the Labor Right Coalition...soon as the rest of us get our masks on, we should help them all we can...before you know it, we'll be able to actually help our patients, too.
Almost forgot, Comments since last post on: CLR's Labor Rights Ammendment, Treatment Failure, There's a Storm Coming!, and Inspiration.
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5 comments:
Hey don't you know you are just blowing steam out of your buttox. They don't care about any of us. They actually plan on trying to get nasty with the old workers to pay for new ones at half the cost...even though they are incompetent in some cases...
I just wanted to say as a worker at the madhouse, i know it doesnt have to do with nurses or paitents or maybe it does. But why is so hard for employees of the madhouse to say hello or smile at other employees instead of looking at them like they were a patient there or a plague of some sort. Patients at least say hello and smile more than the employees do. Sorry just had to vent at the madhouse. I just think its sad.
The Director's fourm..... The boss is going to start to come to a unit a month...Big deal it will take months for him to get across the whole hospital..Are you kidding...how about going to all the units next week..How lazy can you be???? How sad is that.....
Hello blog author and bloggers,
In response to anonymous who wonders why folks at the madhouse don't smile, it might be related to the notion that linestaff work a whole shift only to be greeted by managers and administrators who want them to understand there is no money to staff a unit properly, only enough, apparently, to give a hefty raise to the administrator saying there is no money; some staff need to account for their whereabouts when they take a sick day, but others of a more shapely nature, can be off more than they work and not be terminated; a manager can comprimise the people who work for him by being careless with their confidential information, but a mental health worker is treated severly for mentioning a patients name, supposedly inappropriately, nurses are working so many extra shifts to cover for call-ins that they can't apparently count narcotics correctly, or give the correct patients the correct medications and instead of addressing this issue properly for the safety of all, the infamous incident reports lie around long enough to be lost; and lastly, those same manangerial types who don't have to account for their time away from the Fort, who have the raises, who don't do the extra shifts, who get only a slap on the hand, instead of a proper wack for indescretion, who hired the people who shop online instead of doing computer training, are telling the linestaff to smile, it will get better, and to use your skills to cope! Maybe anonymous passes some of these people in the halls at a bad time. If that's not the case, then anonymous has a point, people at the Fort should smile more, just not at the administrators.
Hey I didn't even get past the first paragraph without feeling compelled to respond. I completed the required computer training last evening about confidentiality and one of the questions on the competency exam was about protecting employee's personal information. It was referring to protection of even just a phone number much less everything needed for identity theft. Which is likely the only reason one would steal paperwork. Gotta move quick on that one before crimes and false accounts show up. As the victim of idenity theft I now have to carry around a letter from the CBI that states I'm not associated with the crimes committed using my name in case I get pulled over. Also all of the alias names this criminal used that included mine are now affiliated with my identity in the National Crime database. A huge hassle for me even getting cleared to work.
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