Health Chaos

Having been unemployed for over a year, I have no medical or dental insurance. Pretty scary, as Barack knows. So I decided to go to my local dental college. It was pretty amazing. All the recommendations made by my local money mongering dentist were nixed by the student and her professors who are in the business of good service and care, not retiring next year with a fat income.

Having been a health professional student myself, years ago, I admire the interest in learning, interest in providing optimal care, integrity, not to mention learning how to navigate the halls of academia, without getting lost, before you graduate.

And all at reasonable cost. Takes more time, but it is worth every minute and every penny.

About 3 months ago I applied for a position with a 3 month asthma research project. I stayed in touch, looking forward to an interview. They wanted to interview me yesterday. Only yesterday. Well too bad, I had plans that I could not cancel or change. So, how nice. They would interview me today at 10, by phone. Guess what? No call. No call of apology. They offered the position to someone else at the end of the day yesterday. Would you really want to work for that place? This is how they treat their applicants? That was as bad as the realtors who need me and my dog to get out of my house, then they never show up. Doesn’t make you feel good about people. Stay positive. Can’t live without it!

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?

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.

My new position lasted 9 days. I did not sign the contract. Why? Because the salary I was quoted in my interview was 20k more than what the contract stated. Not livable. And again the demeaning and accusatory attitude of persons who don’t have basic management/supervisory skills.  I asked to “think about” the contract for a day or two before signing, and was told “oh, you’ll sign today” but I didn’t.  And the next day I received a call from my manager who said if I did not sign by 3pm, she would have to find someone else. Okay. I was out the door. I felt bad about the sites that I was committed too. But I had to look out for me.

 All this is after I interviewed in August, but all the beaurocratic red tape didn’t allow me to begin work till the end of October! They are lucky that I bothered to show up at all. And I spent more than $200 just getting through the application and certification process, never to be reimbursed.

So this is the third health care position that I have quit this year. Who do I think I am? I am not independently wealthy. But I am no longer willing to work for persons that I do not respect.

 I have a friend who has been a free lance writer for years, who now is recently employed by an insurance company, and struggling with the politics. Here is my ongoing advice to her:

Keep practicing the mantra “let me think about it and get back to you.” Then it sounds like you are cooperative.

As for parties and holidays, “oh thank you for letting me know; I will do my best to be there.” Then do whatever you want to do with NO excuses. If they ask “where were you? why didn’t you come?” “Oh; I am sorry. But I had something come up.” Don’t provide personal/family information.  Be vigilant about who you trust. Maybe you had a deadline.  “I am sorry; I am really busy today.” Doesn’t matter what.  As for costumes and Halloween, come as yourself. So what.

 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….

Thankfully the democratic party candidates are in tune with the fact that we have 47 million Americans without health insurance, sometimes due to job elimination, like myself. And health insurance is not affordable without assistance from an employer, except for the very wealthy, and those that have spouses and domestic partners whose insurance they can tag on to.

And why is health insurance beyond our reach? Obviously, the insurance industry wants profits by driving up rates. And I believe that the pharmaceutical companies are creating diagnoses, and recommending drugs, that we all “need! “Just ask your provider,” whoever that is…

And who are two strong lobbies: the insurance industry and the pharmaceutical companies? And who is helping to finance most of the presidential aspirants?

What on earth is a “nervous breakdown”? why can’t people sleep at night? what is “restless leg syndrome”? Where did this stuff all come from? We should all be taking 21 drugs each day? Oh, and you need a stool softener, and laxative for breakfast that may make you “regular”. And a daily decongestant, whereas just being in a vertical position and blowing your nose in the morning may work just fine. Why? Why not choose a healthy lifestyle instead?

Why not jog or walk your dog (you would both benefit), stretch, swim, eat properly i.e. a diet rich in fruits, veggies, grains? Try to avoid anything but the essential drugs that you really need to stay alive.

All of these drugs, too many drugs, interact with each other, and can kill you. Less is better.

Finally, after a lay off happened to me in October of 2006, my applying and interviewing has paid off, or just about. Looking for work can be harder than working. I have been offered two positions: one with a great salary, a 2 year contract, with NO benefits; the other with a lower salary, with a 1 year contract (open for renewal) with great benefits.

Which one do you think I decided to accept?

 Since last October, I have been one of those Americans with no health insurance, a very precarious and scary place to be, especially as I am getting older. Maybe that would be okay if I was 21 and in my prime. I have no major health problems, am not old enough for medicare, don’t have a spouse whose benefits I can share, and suppose someone decides to run me over as I cross the street? Or shoot me? A real possibility in this city where, from my observation. drivers do not seem to know the rules of the road. (they speed through yield signs, brake going up hill, lose track of the width of lanes, have no clue what to do if two or more cars come to an intersection at the same time) So I liquidate all my assets to pay medical and dental bills, and ask my sons to buy me a shopping cart for Mother’s Day!

 This is an issue to think seriously about in our next presidential election. I have worked as a health professional for 39 years, paid my taxes, paid into social security. It seems like I have a right to a relatively comfortable life, with health insurance. Or don’t we have rights anymore? I might do better moving to a foreign country where there is national health insurance. We are LONG OVERDUE for this here.

 When I was an undergrad student in the 60’s, I had a professor who said that we would have  a national health insurance program by the time we graduated in 1968. What a dreamer…I hope, if she is still teaching, that she has become jaded and doesn’t say this anymore…

I believe, from my years of experience, that health professionals, more specifically supervisors, educators, mentors, and managers have a very hard time admitting mistakes.

In how they handled a difficult client/patient. In how they handled strife in staff relationships. In how they handled their supervisory role when they should have been more inquisitive, supportive, rather that critical and demeaning.

In how they handled staff meetings. Staff meetings to me, are for sharing new information, but more importantly for team building. The more the staff talks and shares, the better. You will learn a lot! I have found that frequent staff meetings are extremely important. And the longer the agenda, the shorter the meeting. And the shorter the agenda, the longer the meeting. Staff is often very pleased to have a forum to be heard and respected.

A good manager, supervisor, mentor always gives the benefit of the doubt, and then shares similar experiences in order to help the staff persons grow, rather than become angry and disillusioned.

This concept leads somewhat to evaluations of staff. Why not allow “self evaluations” on which you can comment. Do not make these events a crisis and frightening. Make them a growth experience for both of you. Don’t make them long and tedious. See if you can prepare a somewhat brief, and to the point, evaluation. Just as your initial interviews should be. Let the staff talk. You will learn a lot more that way. Generally forget exit interviews. When that time comes, egos might be so bruised that you don’t hear the truth. I have occasionally left before the exit interview. I knew I would not be heard anyway. And I once had a lengthy interview, trying to be honest about the management style, and after I left several staff were laid off and/or fired and/or left because they couldn’t stand the place.

So what kind of manager/supervisor/mentor do you want to be?  One who is rigorously honest and willing to listen, grow, be even more supportive of your staff? Do you want your former staff to not fear asking you for references? Do you want to be respected and respectful?