What is the Role that Could Heal Healthcare??? 5 Ways Nurses can be the Answer to Reform

Nurses have a long legacy of caring for our fellow citizens.  From the originator of our profession (Florence Nightingale) to modern day men like me, nurses everywhere hold this privilege to care for the needs of others as what defines us.  The role of the nurse has expanded greatly over the years as our influence has impacted almost every aspect of medicine.  Nurses have become versatile professionals that can be the answer to healing our current system.

Here are 5 ways that nurses could make an impact in changing the face of health care:

We are the Advocates - Currently there is much discussion in health care about empathy and patient centered care, but nurses have been providing a holistic approach that focuses on delivering care to the individual since the Crimean War.  We know what it is to provide dignity in undignified moments, and to care for that patient as your own family.  With this knowledge and experience we serve as the best advocates for knowing what patients and their families need when they're in our care.

We are the Balance - Our schooling requires that we grasp the concepts of what makes a body healthy and sick, but we also come to understand that sometimes the answers may be elusive unless you stop to listen to the patient.  Many of us have learned over the years that patients are the best diagnosticians, and believe that trusting what patients and families tell you versus what may be in a published study or book.  As nurses we provide the balance necessary to humanize medical science, so people are able to receive competent compassionate care.

We are the Continual Presence - Very few other health care professions interact with patients and families like nurses.  We are found in every aspect throughout the continuum, which leads to our thorough understanding of what is necessary to create positive outcomes for those in our care.  We are found at every stop along the path because we care for both those being born and those leaving this world. 

We are the Foundation - Our long and proud history has caused us to be the only discipline who is asked to function in multiple capacities.  At times we may be the social advocate figuring out how to keep the lights on for those we serve, or may be the spiritual presence as we hold the hand of one who's life is moving on.  As the foundational role in medicine we represent the largest number of any health care profession.  Therefore, we need to use our voice to build the foundation of a system that will meet the needs of all we serve.

We are the Answer - Nurses are continually put in autonomous roles where they have to think and lead quickly to save lives and resources.  Most of us are comfortable in these situations, and have used this ability to move into greater roles of responsibility.  Now is the time for nurses to take a more important role in changing health care by becoming the leaders of tomorrow.  We need to provide our expertise in caring for patients, our understanding of what is necessary to give staff the tools to effectively deliver care, and our perspective of what the answers are to creating a system of both quality and satisfaction for those we serve.

It is my duty
Dawn Butler, RN
(Pennsylvania)
I walk through those doors with pride,
Who's life will i save tonight?
Someone is waiting for me,
Someone is alive today because of my duty.
Sometimes we cry cause we can't save them all,
God sometimes won't let us interfere when he calls.
A baby's first breath when he looks at me,
The joy of my first delivery.
The tear i wipe a way with my own hands,
The life ending of a gentle old man.
The night seems so dark and the morning so bright.
Being a nurse you see life in a different light.
Who will i save tonight?
Who will hold my hand during their last breath with no fright?
Who will enter this world on my shift?
How many mothers will greet their babies with a kiss?
I don't know who these special people are
but i will meet them with every call
I will hold them tight and help the pain
I will hold them up when they feel faint.
I will be strong when i am needed
That is my job, I am a nurse..that is my duty. 

My hope is that those who read this believe as I do that nurses can be the positive force to drive change in America's health care system.  I would encourage my fellow nursing professionals that each of us look for new and innovative ways to create a greater impact in our spheres of influence, and step up to the plate if you really want to see things change.  

Take care.   Dave

Breaking Addiction to Missiles to Improve Healthcare

“During the Korean War, the Navy kill ratio was twelve-to-one. We shot down twelve of their jets for every one of ours. In Vietnam, this ratio fell to three-to-one. Our pilots depended on missiles. They lost their ‘dog-fighting’ skills.”*

~ Jester, Top Gun, 1986

I remember seeing the movie Top Gun in the mid-1980’s and how this quote struck me … and believe it or not … it has informed much of my work in healthcare.

Fifty-one years ago (1964) the Hippocratic Oath was rewritten by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, to include (excerpts):

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.

… may I long experience the joy of healing those who seek my help.

With this is mind, and in the blog post How a lack of empathy affects our healthcare I made note …

“Thirty years ago, medical schools taught that the most important component of a mental health healing encounter is empathy, human connection, and authentic relationship between a physician and patient.” 

And yet more recently we healthcare leaders have evolved the healthcare delivery system to include:

·         Clinicians triple booked every 15 minutes

·         8 to 12 minute office visits

·         The I-Patient (to borrow from Dr. Abraham Verghese) replacing the actual patient

 

·         Patients being dehumanized and becoming a diagnosis rather than a whole person

·         Clinician focus turning away from the human being before them and toward electronic health records, target organs and test results

·         Technology becoming the solution focus rather than a tool

·         Care teams held to the same productivity standards as clinicians (as noted above) and yet providing less continuity for a patient with “their” clinician

·         A model which rewards excessive tests and invasive procedures

·         Physicians and nurses burningout and worse

We have switched from “dog fighting” i.e. avoiding overtreatment, establishing and ensuring human connection and authentic relationship, and finding joy in healing to “missile dependency” i.e., the “evolved” model described above.

In our effort to make things better we have forgotten why we are here in the first place.  We have sought “missiles” to improve the broken system. We have lost our way. And we are harming those we are honored to serve.

If we truly want to improve the health of our patients, families and communities, it is time to break our addiction to missiles and reconnect with the Hippocratic Oath, what was taught in medical schools thirty years ago, and to our patients, families and communities. 

For only then will we truly innovate healthcare.

It’s not too late and yet long overdue. 

 

 

* As both an animal lover and someone who desires peace this analogy was challenging and yet hopefully lends itself to creating a compelling argument for the need for dramatic change and improvement to our healthcare delivery system.

Healthcare Odyssey - A Patient's Perspective

What is it the makes the current health care system so challenging for people these days?  I believe it truly boils down to one phrase, "I know how you feel".  Here are 4 ways that people struggle with a health system that isn't listening to what their consumers are saying.

1).  Care is directed - How many times have you been asked by medical professionals what you want for yourself?  Does that occur when you go to purchase a new car?  The first hurdle faced as a medical consumer is that care is not a collaborative process, but a directed issue that uses consents to give the impression that it was a joint venture.

2).  Lack of knowing - How much do they know about you and your family?  Is there an effort to understand the support system you have or the factors that will influence recovery?  There seems to be a disconnect in the desire to know the customer's needs.  Not surprising why continual readmissions to hospitals occur.

3).  You need me mentality - Does it ever seem like the medical care you receive is provided like it is a privilege rather than a right?  How many other businesses treat you that way as a paying customer?  None I would guess because you would no longer be frequenting their establishment.  This prevailing attitude that you need us may change with the new pay for performance model, and give power back to the consumer.

4).  It's your problem - I think the fundamental issue facing a patient today is the pure lack of empathy and compassion at times.  Much like the staff that walk into a room after a patient and family have received bad news, and say "how are you doing?".  By not being able to readily show concern and empathy it's like they are saying, "it's your problem" which results in a lack of coordination and disease management for the patient and family.

Until the health system can began caring for their populations like they would care for a loved one, consumers will be battling a system where care is directed and not collaborative.  It would be amazing to see what would occur if the providers and decision makers had to wear the hospital gown for a week.  I'm sure the personal experience may create some enlightenment and drive quality changes.  Thank you for listening.  Dave.