Health Chaos

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….

A national newspaper printed an article today about health care issues, including HRT.   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 have 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, even though public health is my love, I look at all research with more acute skepticism

As for HRT, 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 a relatively innocuous drug? 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?

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.…

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?

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.

One of the most difficult tasks that I have had as a manager is hiring and firing staff. I would like to share a few tips.

 Hiring: trust your instincts at the interview. Have a second interview. Try to avoid phone interviews. We all make such different presentations in person.  Don’t ask all the questions. Keep the forum open and encourage questions and comments. It is not even worth your time to contact references, but if you do, the only question worth asking is “would you hire this person again?” Be wary of letters of inquiry that say “I am the perfect person for your position”. Nobody knows this but you! Walk them through the work area;  introduce them to the current staff; show an applicant  the potential work area.

 Seriously consider the employee’s orientation. Make it thorough. Meaning, introduce a new employee, or an applicant,  to staff. Give them a packet that you created with the agency’s (of whomever) history, needs, current situation, mission, goals, funding sources. Include a list of staff with phone numbers and email addresses. Include a detailed, long list of acronyms. Tell them where to park, where to get lunch. Tell them the good and bad (yes; the bad things too) that they should be aware of. Make it clear that you have an open door…any time…

 And as I have said before, have the workspace CLEAN AND PREPARED. Have flowers. Be welcoming. Have the keys ready.

 Firing is much more complicated. One may have to go through all the union rules, and civil service rules first. One must document and document and document, while mentoring and trying very hard to save the employee. And it is best, when the day comes, to make it as pleasant and supportive as possible. I would suggest forgetting an exit interview, unless you really plan to listen intently and be willing to make changes in how you hire, supervise, manage. I would also suggest that you offer to be supportive, provide a reference that you feel that you can comfortably provide, and make suggestions that  will be helpful, not critical. I have had employees, upon firing, who cried and thanked me. Be prepared for this possible scenario too.

 Good luck