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Friday, February 28, 2020  

Winds of ChangePublished 8/26/2008

Last week I told you a story about how changing jobs changed my outlook, my attitude, my commitment to nursing and my disposition. All for the better. To the great relief of my family and friends. I probably don’t have to tell you that if you either burst into tears or explode into a tirade of fury every time someone asks how you are, they are going to become a little wary of asking. Or of wanting to have anything to do with you at all. At the end of the column I said that if you were unhappy with your job or with where you worked you ought to change. You ought to make like a Nike and "just do it."

I also said that life is one lesson after another, if we pay attention. And when I finished writing that column something occurred to me. You do not have to work in healthcare for very long to see that there are problems. Lots of problems, and few of them are very easy to solve. Additionally, you do not have to read very much in the media or healthcare literature to realize that one of the things we find most difficult to deal with is the sense of powerlessness to effect any change. When there are very real and significant problems and nothing is done, when at meeting after meeting issues of concern are given lip service and no change takes place, people become discouraged and cynical. I think that we can agree that healthcare workers often have a flair for discouraged and cynical.

I think I have shared the anecdote about the manager who, when confronted with serious staffing issues, declared, "We are not going to solve this problem by throwing people at it." And then ordered new curtains. That’s the kind of thing that can get a guy who is working in the trenches down. Make him question the whole system. It can also make him feel pretty helpless and unheard. Disregarded.

But not every healthcare company runs their business that way. There are companies who, despite the fact that they are in business and that the object of being in business is to turn a profit, remain aware of the fact that they are providing a service to living, breathing human beings. There are administrators and CEOs who understand that the fewer nosocomial infections there are the greater the margin of profit. They know and understand that patients whose needs are met quickly, efficiently and effectively are satisfied patients. They know that good outcomes are cheaper than bad outcomes. This makes me think of a line from a song by Tom Leher, ". . . doing well by doing good."

How does that effect us? What difference does that make to us in our daily practice? Well, it occurred to me that if we choose to work for companies who understand that good patient care means good business, and choose not to work for companies who continue to view patients as some kind of unit of measure and staff as the adversary, then any healthcare company which wants to stay in business, which wants to make money, will have to change for the better.

We have been going about things all wrong. We have been thinking that we can express our concerns and that our concerns will be shared by the companies we work for. This is often not the case. As you know. There is nothing wrong with making a buck, or a million bucks or a gazillion bucks, if you are efficiently and appropriately providing the service you are supposed to provide. Nor is there anything wrong with trying to make positive changes where you work. But if things don’t change, if there is a lot of head nodding and, "I hear your concern," talk, then my friends, maybe it is time to walk the walk.

If we continue to work in situations where problems are not being addressed, aren’t we condoning that? If we come to work knowing that we will be assigned a number of patients for which we can just barely manage to provide the most essential care, aren’t we saying to the companies we work for that it’s okay with us? And if we quit "expressing concerns" and go to work for companies who provide adequate staffing, the appropriate equipment and materials, and above and beyond that, companies who know and understand that the patients are not only their bread and butter but are people who require and deserve, who are paying good money, for our diligent care, our kind attention, our respect, and all the benefits of our education and experience, won’t every company, by necessity, sit up and pay attention?

I think so. I don’t think we have to hoot or holler or get up in arms. I think we have to set boundaries. I think we must state our case, whatever it may be, reasonably and intelligently. And if things don’t change, if you are not able to practice your profession the way you want to practice it, the way you feel is appropriate, then there is a simple answer and an easy solution. Take your skills and your expertise someplace where they will be used to full advantage and in the most appropriate way. Eventually our message will get across. I have said it before and I will say it again, if healthcare can be done "right" one place, it can be done "right" every place.

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