Health Chaos

Just read an aricle in my local newspaper. (yes; some of us still like to have that rag in our hands!)  my sons (now adults) and I moved to this city from Berkeley nearly 4 years ago. I can’t say the schools are any worse here. They were very “politically correct” to a fault there. But I did do a  9 day stint as a school nurse last fall, with the schools in this city. My application took months to process, to the tune of about $200. I was so disenchanted by the poor, no, incompetent communication within the school health staff. There are apparently 99 schools in

My premise is that there is less expected of health care professionals today. Is it just in this state, that I moved to 3 years ago? I think not. Professional positions that not long ago required at least a bachelors degree, if not a masters, now require an associate degree, or any educational level that provides the person with some very basic education and the employer can pay a LOT LESS in salary.

I see this trend not just in my profession, but in many, many professions. Yet we are told  that our economy is strong and there are lots of jobs! Sure, for slightly more than minimum wage, very limited or no benefits, and no job security. More and more I see contracts for a limited time vs. the days of longevity meaning you can invest in a retirement plan and your position is relatively secure. I live in an “at will” state which means you sign a paper,  a contract, which states that you can be terminated, at any time, without notice, with no warning and no reason given. On the other hand, you, the employee, have the same privilege. And I have exercised this right twice this year. Why?

 Now employers are looking for “technicians” or “specialists” which in health ”professions”  in this state, means a student, or an entry level worker,  who wants to earn a few dollars, with no higher goals, ambitions for professional growth.

 In support of my observations, I must say that I have found that the attitudes of those doing the hiring and firing has become very vindictive and demeaning. Perhaps because the ones “in charge” who have been promoted to the role of supervisor or manager are not qualified, educated, nor experienced for their role. Their communication skills seem to be nonexistent. ?the old “peter principle” at work again?

Until I was hospitalized 1 1/2 years ago for a perforated ulcer,  I was only on one daily Rx medication: the  one pill for keeping my hereditary “borderline” blood pressure under control. However, my “provider” felt she needed to add a calcium supplement to prevent osteoporosis and aspirin to prevent a heart attack and a decongestant, in lieu of just standing upright and blowing my nose. And then, during the hospitalization, Protonix was added (I can live with that). As was Norvasc which resulted in severe hair breakage and loss. I just dumped that one. And a bunch of drugs that caused fluid retention and more drugs to cope with constipation (which I never experienced). Lots of drugs prescribed; few that I took.

Now why did I need all these drugs, and even more that I just didn’t take? Well you know my bandwagon about the pill pushers in this country. And why did I even have a perforated ulcer? Too many inappropriate drugs prescribed for back pain., osteoporosis, nasal congestion!  (I have idiopathic scoliosis and a spinal fracture which didn’t bother me at all for many years when I lifted heavy  bags of books).

So now, without health insurance (yes; one of the 47 million Americans), I am trying more and more to reduce any of this junk, these chemicals, that I put into my body. Why? The side effects. And the cost!  Maybe it is my BP med that is making me a little tired , not the aging process? By the way, the insurance company DID NOT PAY FOR ALL OF MY HOSPITALIZATION AND MEDICAL CONSULTANT EXPENSES.  Surprised? I had to. After a “lay off” due to downsizing at work, with no income, and no insurance. (even though I had worked as a manager for a HEALTH insurance company!). Who pays for all these medications? I go to a local neighborhood clinic that is low cost, for the blood pressure med. But anything else? Well check into Partnership for Prescription Assistance (PPA). They have been most helpful with the drug that will prevent another ulcer.

 As a health professional, I have encountered patients/clients/members who are on as many as 21 medications each day. This is incredible. Who is monitoring this regimen? How can  people keep this straight? How do you do this? And what is really necessary? And what interacts with what other medications?   Contraindications? And what are the side effects? And who is helping to monitor this? No one. Does your doctor/provider/”prescriber” have time to do this? Of course not. And what if all these medications have the resultant side effect of confusion?

 Oh! The answer! Health insurance companies are now providing programs like healthy living support programs that  have nurse case managers who give advice to “members”. The nurse case managers are the gate keepers who help the “members” manage their medications (often from many states away) and keep costs down for the insurance companies (don’t go back to your doctor’s office! that will be a bill that the insurance company will be expected to pay). Just call me, your case manager. the nurse case manager  can talk with you after he/she enters your data into 47 computer  screens.

 So what to do? Think about who you vote for in the next election, and why. No; we don’t need another layer of bureaucracy. We need a WELL THOUGHT OUT PROGRAM FOR NATIONAL HEALTH INSURANCE. So that we can be as progressive as other developed countries. This is just one little step. Think about this.  Don’t just go along with a candidate who says she/he supports health care. You need to look way beyond that kind of statement. What is really in mind? What kind of program? Managed by whom? Who will be in charge? Who will do the oversight? THINK!

I am sure this article, and I will try to keep it brief and not too inflammatory, could really upset some folks. But I make my statements following 39 years in my profession, with a lot of observation, experience, and education.

There is nursing education, and then there is nursing education. I happened to be an undergrad student in nursing at one of the leading universities  in the country in the 60s. We worked at being professionals, taking courses along with med students. We wanted to be the best of the best. And those that didn’t succumb to organic chemistry and anatomy and physiology persevered. Our class diminished from 300 to 99 over four grueling years! But as the years have gone by, I have observed the disintegration of this professional education.

In the state where I now reside, continuing professional education for nurses is not even required. How embarrassing to the profession. Just send in your 50 bucks each year. It wouldn’t take much science to figure out where I live. Not that it matters. My first position in this state was to spend 2 months teaching maternal and child health, because if I had not been hired that summer, the students would not have been able to graduate in the spring. This was an LPN to RN program. I had 12 students (4 men; 8 women). I tried so hard to motivate them to look toward higher education, to think about what opportunities they might have in their careers. But their sole motivation seemed to just make a few more dollars in the hospital. I found this most disappointing.

And maternal and child health? I was to follow a rigid curriculum and monitor clinical practice. The curriculum was labor and delivery, with clinicals in the hospital. No curricula about maternal health. No curricula about child growth and development.

In my work since then, I have met some young nurses who are truly enthusiastic, motivated, wanting to grow professionally, hopefully into a specialty. I would do anything to help them, even if all it means is a great letter of reference and a lot of support. It is of interest that they came from major universities, but not in this state.

I am still trying to make sense of this state that I have been living in for 3 years. Is it the education in this state? Is it the value system of this state? Or is it a more systemic problem that I have lost track of, despite my staying on top of professional literature. The political climate? At any rate, would you really, in good faith, encourage your child to study for the nursing profession? Is it even a “profession” anymore?

 Well here is my arm chair diatribe, and again, I would like to say, I have no intent of offending anyone, but I am very disappointed in most of my nursing colleagues. Which explains, to a degree, why I left 3 positions this year. I was embarrassed to work for colleagues that I could not respect.

To those of you who have read my blog, I apologize for repetition. But some issues just don’t go away.

I just heard an ad on tv for health insurance plans to supplement what medicare offers. First of all, just what does medicare offer? And what about the 47 million of us who have no health insurance and are not yet ready for medicare? The ad was about a certain supplemental insurance company, and it was recommended that you discuss this plan with your “doctor” who will help you decide if this plan it right for you. Yah sure! Since when do “doctors” recommend health insurance plans? Well, someone is getting a kick back here from an insurance company. You need to count on your friends and colleagues for this kind of advice: not your “doctor” and not the insurance companies!

All research must be taken with a grain of salt. I was recruited, years ago, for the Nurses’ Health Study. After filling out their questionnaire, I received a letter informing me that I was ineligible as a participant since I had taken steroids. I had  never taken steroids in my life! I didn’t write back because I didn’t have the time (full time working mom, grad student, with two little boys). So now I look at all health care research with more acute skepticism.

As for HRT (Hormone Replacement Therapy), I did that for about 5 years, then quit cold turkey because my gynecologist told me she could not in good faith prescribe it anymore. I have a friend who has been “tapering off” HRT for the 3 years I have known her. Tapering off HRT? No need to. Doing this will not affect your blood pressure and heart rate, and will probably do nothing except have you discontinuing HRT.  I can only suspect that her gynecologist is her age as well, and the looks of skin and hair are more important than the total health picture? Or maybe not? Maybe it doesn’t matter if we do HRT or not? Once again, conflicting conclusions from research.

There is a lot of spurious, and confounding, information in these studies…I am a medical professional, but also a skeptic. I have attended prestigious universities, have worked at prestigious universities. But that doesn’t mean anything. What is important is the integrity of their representatives,  their scientists, of their reporting of results of their studies. They need to be honest, not just writing what the public wants to hear.

So now we need drugs to fall asleep, drugs to stop restless leg, drugs to make us “regular”? Soon we will need drugs to wake up, get our legs going, and be able to use the bathroom normally?

Have we forgotten to eat a normal, well balanced diet, with fiber,  that would prevent some of these “problems” in the first place? Have we forgotten to just go to sleep to some nice music at 10pm after walking the dog in fresh air? And though I am lax myself about taking vitamins, popping a pill or two each day, if it doesn’t burn up your stomach (drink plenty of water), you won’t have legs that fly around or get stiff and achy, most likely.

 This entry is about orientation of new staff, etc.   The moral of this story: it is really important to ask all the questions, have a contract, and don’t do a thing, don’t commit to anything until you meet with Human Resources, which should happen on your first morning, if not before you start.  And, if you are a manager or supervisor, please spend your first week telling your staff (or providing them with) your history, their rights, their challenges, commonly used acronyms, an organization chart, a list of necessary phone numbers and email addresses, how to use the phone and the computer, the politics, not to mention introducing them to other staff, providing them with a CLEAN equipped working environment, and a vase of fresh flowers.

 I have had a week from hell. First week in my new position. The incompetence and the accusatory style of communication amazes me. The worst I have experienced in my 39 year career. I still don’t know what my salary is, don’t know benefits, don’t know about my 1 yr contract. Will find out at 3 on Halloween. Bad omen? Good omen? I SHOULD NEVER HAVE STARTED without knowing salary. Why can’t anyone tell me? Well, if it is not livable, I will just have to decide not to sign the contract and walk out the door. 

And on the way to work on Tuesday, I could not avoid some metal debris on the freeway (typical highway shlocky maintenance where I live) and blew out 2 tires and bent a rim. For almost $1000. Didn’t report to insurance cuz my deductible in 1k. So I hear “you were late!”. Yah; well I am alive! Went out to my car for 5 minutes one day to change my contact lens and was told “you never came back”. What!?  And the week before I even started I was asked by my “mentor” how I planned to allocate my time between my job sites.  What? I didn’t even know what sites I would have assigned to me. Most staff have 1 or 2 sites. And I already get the picture. They “drive” between their sites, presenting the fiction they are working when indeed they are not. I was given 17 sites! I will spend 2 days a week at an ethnic academy. Was told they are hard to work with. Nice intro, huh? But I find them VERY pleasant. Cuz I am not naive. I have been around the block a few times. I think THAT site will work out fine, if I ever get paid.

Are you expected to use your personal cell phone and not be reimbursed for mileage? I will just keep my cell phone off. Why should I pay for this service for them?

Take care of you, because often your employer will not….

Do these really go together? Of course not!  

I once thought that my little 2 year old grandson, like many other little children, were overly dependent on their pacifiers. (that  may be because my sons rejected pacifiers; though one son was dependent on his thumb, or biting his nails, and the other son on breastfeeding till age 3 years! for comfort).

 As you have probably heard, childhood lead poisoning is back in the news. I worked as a case manager in childhood lead poisoning for 4 years, not so long ago. We found out about lots of tainted imported toys, and food treats.  So I am now much more supportive of pacifiers! Better to put that in the mouth than a leaded toy.

But, PLEASE remember to wash those little hands before eating snacks and meals!!!! just in case the toy played with before meals and snacks had lead in them!

 Lead poisoning is something you need to be concerned about if you live in an old house, in an old city. Worry if you live in a big city on the east or west coast, or even an old city in between. If you are doing any renovation to an old house (tearing out the wallpaper, scraping paint) do consult someone from your local  health department, specifically environmental health.

 Why be concerned about lead? Because its ingestion  or inhalation can lead to serious developmental problems in little children whose brains are rapidly developing and susceptible to toxins. And how do they get lead in their bodies and brains? Scraping paint for renovation. Chewing fingernails that scraped lead painted walls. Chewing on windowsills in old houses. I did that when I was 2 years old. I am lucky to have some brain cells left. Oh. I also loved that sweet smell of lead in gas stations. Glad that is gone now!

 Beware of Mexican candies and those beautiful painted pots and imported toys. Beware of toys from China. Beware of using Kohl from India on eyelids. There is a lot more to tell you. Stay tuned.

In my years of experience as a nursing supervisor, coordinator, manager, I have learned a few things (self taught,  by experience; not in the books, not in classes) that have been very valuable and that I like to share with my colleagues.

Keep in mind that the role is to be supportive of the professional growth of the staff. That means encouraging them to move on, to grow, not stay with you forever.

Keep in mind that a micro manager is not good; sometimes the more freedom that you give staff, the more they will knock their socks off to help you.

Keep in mind that regularly scheduled staff meetings are very important for team building and loyalty. Weekly. And generally my experience has been that the longer the agenda, the shorter the meeting. The shorter the agenda, the longer the meeting goes on. It is the time to give staff the liberty and respect to share ideas and experiences. I have never felt that staff meetings should be just a forum for announcements and dictates, but rather for their agenda and participation as well.

Keep in mind that you need to get to know each staff person well. Have individual meetings to understand their goals, needs so that you can make adjustments. Don’t just meet with them to dictate schedules and do the annual reviews. And speaking of annual reviews, do let the staff do a self review, then compare your notes at the face to face discussion.

 Keep in mind to not be rigid about time schedules and dress codes. Make reasonable adjustments.  The staff have a life outside “work” and they will reward you with dedication and going beyond the call of duty when needed.

Keep in mind to treat your staff to nice thank you gifts. No paper stars or certificates or plastic roses. How about making sure that they have an equipped and welcoming desk on their first day. And include a vase of flowers, for the men too!! And introduce them to all the other staff. I once accepted a position that did not last more than a month. I was told that there would be a welcoming breakfast for me. Well, it never happened. No one introduced me to the other staff.

Keep in mind  that a thorough, considerate welcoming and orientation is essential. Don’t start throwing acronyms. Provide a packet that includes the mission and history of the agency, a staff list with names, phone numbers, emails, positions. Provide a list of acronyms that explain whom the staff will interface with. Provide a list of relevant agencies. How about a rolodex full of essential numbers, along with paper, pens, phone, computer, and whatever else is immediately needed.

Keep in mind to try to personalize the interview, and not ask the same boring 5 or 10 questions that do not really help you get to know the candidate.

Keep in mind that the exit interview might not be worth anyone’s time. Unless you are genuinely willing to listen and respond and make changes.

I have an unemployment hearing with a judge on August 1st. Now that will be a challenge I am not used to. I tried to find info about the judge on line, but could only find her office number. So here is what i plan to say, if they even give me the time of day…

UNEMPLOYMENT HEARING, AUGUST 1, 2007

• Except for technology, I was overqualified, overeducated, and over experienced for this position.
• My 39 year career has been in public health or academia (sometimes both at the same time). This is where my heart is and where I thrive, contribute, and can be creative. I am trying to develop “connections” and “find leads” in these areas and believe that I will find something. I just need to expand to a broader geographic area.
• I was unemployed for a short time (8/04 until 3/05) because my temporary position ended. I did not collect unemployment at that time.
• The position was advertised as nursing supervisor. However, I was expected to be a clinical expert and fill in for nursing staff. I was expected to use clinical skills that I do not have and have not practiced since I was an undergraduate student. This is not where my professional strengths lie. Since I left the position, it is now advertised as Nursing Lead, a clinical position. I did not in any way misrepresent myself in the interview process, and my curriculum vitae are very clear and accurate as to my education, abilities, and experiences.
• When I arrived in this position I sought out several staff, since they did not have the respect and consideration to introduce themselves to me. And the usual comment I received was “wow; I am surprised you were hired, since our director only wants us to hire “fill in ethnic group”. Yet I was expected to be culturally sensitive, which I have needed to be in all of my positions and have always supported, and taught that ideology.
• My communication from the unemployment offices has always referred to an incorrect address. There is no such place.
• My most recent communication from the unemployment offices has also referred to “name withheld “as my employer. I have never heard of, nor met, this person.
• I also have been misquoted as to why I left my position. It was NOT for personal reasons, but rather due to “our management and communication styles are incompatible”. I spoke, at length, in my exit interview, about how I felt this position should be represented, because I felt that it was misrepresented to me. I have noticed that it is no longer described as a nursing supervisor position, but now rather as a “lead nurse” to provide nursing services.
• As one can tell from my curriculum vitae, I am very well educated and have been employed for 39 years as a health professional in high expectation capacities and have been extremely successful prior to my move to Washington.
• I now find myself disconnected from a world in which it is “connections” that lead to the best positions. I feel that I am getting “closer”.
• Since I was the victim of a major lay off at (insurance company) in October of 2006, I have applied for more than 150 positions and have had several interviews. And I have also accepted two positions that were not a good match for me, technologically.

I just recalled a horrible memory from a recent interview . “Do you have blahdy blah certification?” and I said no I do not. But what I wanted to say is I do not need any certifications. I already have 3 professional degrees and 38 years of experience. But she said that if I was hired ( which I won’t be) that I would need to take 70 class hours (at my expense) to get some nonsensical certification, within the year. Well I am not getting the job anyway; no fear. So here goes my next blog entry into HEALTH CHAOS.

So having degrees from major universities is not enough now. Because now some entrepreneurs have figured out how to provide special certifications to nurses, for lots of $. (yes; make money; that is the object). Anyone who has a degree from approved universities, big name places like the ones I went to, don’t need more certifications. That education (required for certification) is inherent in a professional degree program. This recent concept of certification is a scam.