Hospital: a business with a cult mentality

Happy Nurse’s Week

I’m doing my favorite thing in the world; sitting through hospital orientation. It’s difficult not only because I loathe orientation, but also because it’s one I’ve sat through under a year ago. *cue internal screaming*

I’ve come to many conclusions about being a nurse and being in the hospital setting.

1) this is a business.
While healthcare, the administration of care, the care of patients and families shouldn’t be a money making scheme; bottom line is it is indeed a business.

While I don’t like it, hospitals have to make money in order to keep the lights on. Frankly, I’d like to get paid for what I do, so the hospital has to bring in cash (however that looks) in order to pay their bills on time. Part of that is part satisfaction and jumping through hoops to accommodate government entities that control reimbursement.

The unfortunate thing, in my humble opinion, is it makes the conversation more about money as opposed to giving good care. It always comes across as doing something so the doors stay open. Perhaps that’s me being jaded.

There have been so many strides and improvements in healthcare in just the decade I’ve been a nurse. Great advances that I’ve seen in my travels that make me excited for how they increase the health and well- being of patients. Healthcare has to morph to accommodate, but I can’t help feeling that some of the brokenness of the system comes down to how much money may or may not be made. It makes it tough to want to continue in the hospital setting because the last person receiving consideration is the nurse.

Which leads to my next point.

2) nursing is a cult.
Or maybe nursing is a cult because hospitals molded us into it? Stop me if you’ve heard this before…

I remember teaching and thinking that. Like the military, we have rules and a way of thinking far different than laymen. We use terms foreign to most people and process that would make no sense outside of the context of nursing. Even within the different specialties, there is language and behaviors we do. I know a little bit about hearts, but if we start talking arrhythmias then I glaze right over. I know some ICU nurses get weird when you start talking about the fundus.

Where I get kinda, antsy is the loss of self or total disregard of person that comes with stepping into a hospital.

You must do this for patient satisfaction and this to keep the doctor happy. What about me as the nurse? We make up the large majority of the hospital work force, but the once yearly recognition of Nurse’s Day with the occasional gift thrown in doesn’t make me feel valuable or important.

I know, I know I talk about this a lot. Part of why I continue traveling is because no where treats nurses with any kind of respect outside of what must be done to make the hospital happy. For all our knowledge base, no initiatives are geared toward making us important components of the process. Not do this, but you are important.

Maybe this has little to do with cult mentality, but maybe it does. It does have everything to do with satisfaction of nurses. We exit the hospital in large numbers and the shortage is real. Why is that? Why is retention and attrition a continued issue in hospital settings? Why is no one really trying to fix it beyond handing out sign on bonuses?

You want longevity and good patient care? Take better care of your nurses. The hospital that gets me to stop traveling will be special and if they have a good retention rate, I’ll call out all the reasons why.

I can’t help coming back to this point over and over. It seems to bother me more than is should and is part of why I’m constantly debating leaving the hospital setting all together.

Back to orientation. Always back to orientation.

Travel on, road warrior

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The Good, The Bad, And The… Meh?

Another assignment completed. That means it’s time to hit the road and head off to my next assignment. Always to the next one with me.

I travel because being anywhere permanently makes even thinking about staying somewhere makes me break out in hives. While I’ve always known this, traveling has made it more obvious that there is no ‘awesome place to work’. Every place has its issues whether they are frank or hidden. The nature of the hospital setting lends itself to problems that aren’t easily solved. It could be staffing issues, management issues, upper management issues, or just interpersonal issues. Something always make it less than ideal.

Not every assignment is going to be amazing because every place has their issues. Not everyone is going to love me or what I bring to the table when I come there to help them. In their eyes, I’m simply another body where they’ve been incredibly short and as long as I’m capable enough they don’t need anything else from me.

Did I love this previous assignment? I started with mixed feelings and ended the same ways. This is one place that I didn’t have a party at the end. Not that a party when a traveler leaves is indicative of anything, but it’s obvious that you’re being there and leaving make a difference when they bother to have something for you. I know I was the only one of my group of incoming travelers that didn’t renew. That’s not necessarily reflective of the place as I always head back east, but I also didn’t want to stay where I felt so indifferent either.

It’s a reminder that you can still be the best you as a traveler even if no one else notices.

I’m rapidly coming up on four years of this travel nurse thing and I’m continuing to learn things. Mostly about myself and what I will tolerate, but also about my skills and abilities. I struggled at times this past few months with feeling unrecognized. As is typical of my personality, I realize I need to at least know someone appreciates me being around to help. That isn’t always possible so I need to remember who I am and what I know. Those things doesn’t change when I go somewhere that isn’t so excited to have travelers outside of filling vacated spots.

So every place, no matter how difficult, has a lesson or a learning point. Whether it’s something that boosts your skill set or something that increases your emotional awareness, every place will teach.

So I’ll keep on to the next thing as usual. Travelers gotta travel and I’m a traveler to the core.

Travel on, road warrior.

Is it too late now to say sorry

First week in da bag. It was looking iffy as to whether or not I’d start on Monday in hospital orientation. They are part of a large hospital system, which is fine until I’m hassled right up until Friday about minuscule paperwork. You’d think a big system would be less complicated and difficult, but what have we learned when anything gets too big? No quick movements and you tend to make a mess of things you won’t bother to clean up.

Anywho, I was able to start and did get to sit through the ever repetitive and ever boring Hospital Orientation. The upside is there was plenty of coffee.

I worried what with the snags I had leading up to starting that the floor was going to be where I’d truly regret my decision to work at the facility. So far (and this is day shift!), no one has been mean and I haven’t had to call my best friend to beat anyone up or my mom to come get me. Hehe.

In the course of my first three 8 hour shifts on the floor, I noticed something. I say SORRY an awful lot.

Now, some of that apologizing stems from my need to project an aura of perfection. Not good, but I want to be and seem more than competent at what I do. I’m always concerned there will be doubt when I start someplace new and I strive (overly so) to squash that perception within minutes of interacting with me. It leads to a certain level of constant anxiety that I have to work through and is a constant struggle. I notice that when it may seem I missed something obvious even when I may not have truly known, I say sorry.

I thought I was just me though. No, everyone says sorry unnecessarily. We apologize for behavior that is natural and doesn’t require it. I caught myself telling others to stop saying sorry. It was something that just stuck me as wrong.

Not that apologizing isnt a good response when you’re truly wrong, but perhaps we should change that to something else.

I’ll work on alternative phrasing, but in the meantime I’ll try not to work so hard at being perfect. No one is capable of it outside of God and I’m afraid I’m only made in His image.

Back at it for week two and off day shift. Waking up at 5:30am ought to be illegal. Hopefully this hospital gives me good experience in all its busyness. I’m here to help and learn so let’s get to it, shall we?

Travel on, road warrior

 

 

Jesus Take The Wheel

So begins my trek cross country. It started rather abruptly yesterday as the worry of snow and ice sent me out the door a day early. I’ll get to that in a sec, but first…

In case you didn’t know, I loathe the snow.

A little background on me (for those who don’t know me), I was born in Maryland and spent the first 10 years of my life in the D.C. Area. As a family, we moved to Bridgeport, WV when the FBI made the big transfer so I’ve spent the large majority of my life in WV. Love it, claim it, call the Mountian State my home. I went to college in the area and worked the first 7 years in a 30-40 min distance from my childhood home. It snows in WV. Pretty much can count on that happening every winter without fail. Most people cope with it well and for a long time I just worked to grin and bear it. Nurses are essential workers so…

And then I started traveling for a living. I love Boston, which is the first place I traveled, but it’s terrible in the winter. One of the worst places during winter months actually. So, when considering where to go next, of course I opted for a place that’s typically warm – meaning no snow. And a yearly tradition is born. The east coast is my place from April through December, but after the new year I’m a Cali girl for 3 months. This is year 4 of heading west

That means, I drive out every other year. So I beg my best friend to drive out with me, we try desperately to avoid the snow, and we sightsee. And eat all the good food. This year is Nashville, Oklahoma City, Sante Fe, Utah, Vegas, and up to San Fran.

As much as change doesn’t bother me, I like change under careful circumstances. Admittedly, when things change abruptly, I become grouchy, flustered, and incredibly uncertain. Yesterday’s abrupt departure definitely put a kink in all my plans for the week. Not only that, but once I arrived something went awry with the hotel and they had no power. That means I was sent to a different hotel. It was one little thing after another that kind left me extremely… not a nice girl.

I was trying to look for a lesson in it. Heck, I’ve been looking for a lesson in the entirety of this year. Here’s kind of what I’ve settled on.

Not a huge Carrie Underwood fan, and really I don’t like the song for a lot of reasons, but Jesus Take the Wheel is one of my favorite things to say when things get a little out of control. Sometimes I say it jokingly and others it’s a true prayer for patience.

Here’s where my Christian roots show even in the midst of my backslid ways. For all I struggle at times, I believe God has the proverbial wheel. I’m the queen of uncertain and right now I’m battling anxiety and obsessive tendencies, but I trust that even still God is working things out. That doesn’t protect me from death, disease, or pain, but it reminds me that His hand guides. This world isn’t a fun place and we can’t avoid the not fun parts even if we’re staunch believers who are kind, love others how they need it, and pray without ceasing. But His hand guiding is still a surety.

Things can go from great to awful in an instant. Life is that way and that won’t change. As much as we complain this year and our privilege in country had insulated us from many of the awful things that could occur. I never want to downplay grief, loss, change, or hard times. This year has been full of it. Next year may not be different, but I can set my mind where it needs to be in order to remind myself of the good. I’m thinking of doing a photo a day next year to help remind me to look for the good things.

As for this trip? I’m going to trust God with the things that make me uncertain. I’ll also keep my hands on the actual car steering wheel because we may run into *shudder* snow.

Travel on, Road Warrior

The End

Sorry for the radio silence over the last few months. As time has ticked by from week one to week 17 of this last stint, I think I have a great idea for something to say, but then life would get away from me. In the end, what started out as something I wasn’t so sure about ended up being an assignment that I found enjoyable. Having not worked with the demographic common to my home state in a long time, it was good to be closer to home and get reacquainted with the issues of Appalachia.

But being done, the approaching end of the year, and life in general has had me thinking of ending.

Things always end. Always. The recent death of someone I knew drove home how sudden the end can come. Life is finite in ways I forget until confronted with death. How we don’t consider meeting our maker until we are step out of this life into the next. It makes me take account of how I’ve led my life so far. 32 years is long enough to make mistakes, have regrets, have great accomplishments, and joys. What can I say about myself in the end?

On a less morbid note…

I talk often about leaving a legacy. Even if I never return to a place I’ve worked at, I hope I leave behind the impression of a person who works hard. More than that, I hope I leave the idea of kindness in some form. I admit I gripe at work, but I hope my attitude with my patients and coworkers overall is one of helpfulness and giving.

There’s joy and sorrow in endings, but life continues on even in the midst of both emotions. 2016 (a not so fun year) will end. It’ll usher in a new beginning with its ending. It’ll have left its mark, for good and bad.

Remember me fondly even when my mistakes are unearthed. Remember my care, my compassion, my concern, my humor, and my smile. When I’m gone, remember those things because that’ll be all I can leave behind.

On to new beginnings. San Jose after the New Years! Too soon to be worried about anything except vacation.  I’ll try blogging a little more often now. Until then, thinking on your legacy.

The good and the bad of leaving home 

I’m off to my next assignment soon. Not heading far, as I’ve mentioned. It’s not at home, but it’s close enough to home that my mother is pleased as punch and is already planning visits. Other than pushing my start date back a smidge, it’s not been much that’s made me more worried than normal about beginning a new assignment. Except… 

One of the things I’m distressed/worried/wondering about is how my appearance will be received. My hair is natural and colored plus I’m proudly sporting a nose ring that I have no plans on removing any time soon. Will that cause issues? 

There’s talk of the appearance of the nurse affecting care, or the patient’s  perception of the nurse’s ability to provide care. I’ll save this topic for another post, but where I stand on that is if I treat you with the dignity, respect, and care you deserve, what does a nose ring and hair color have to do with it? 

This brings me around to the topic that’s been brewing in my head since I’ve been home. 

The Good and the Bad of leaving (and coming) home. 

Many new travelers struggle with leaving the first few times. One of the biggest issues travelers face is homesickness. You’re somewhere totally new with people who don’t know you or what your capable of doing a different routine than what you’re probably used to from home. Add to that being in a new city all a lone and you run the risk of spiraling into depression and succumbing to homesickness. Most people quit if it gets too bad. I’ve always loved being on the road so it’s never been too big of deal to up and leave. I battle the anxiety of a new routine, but have learned to remember what I’m capable of and that makes the first few weeks easier to get through. 

I’ve mentioned that I’ve been traveling for three years, and while I like being home, I find it exceedingly difficult. I’ve been examining why and settled on the conclusion that I’ve changed so much that being home reminds me how much. 

Some of the changes are great. I recognize my worth, I know what I can take on without getting overwhelmed, I know what I won’t tolerate, and I know I’m a good helper. I’m a good nurse. Even when I’m anxious about so many things, I know that. I also know I can be an independent person who goes out and explores without needing someone else there with me. 

Some of the changes haven’t been so good. I’ve grown impatient with others, I’ve fallen into some habits that aren’t healthy (physically or spiritually), I’ve developed a potty mouth 😳, and another of other things that I don’t feel comfortable splashing over my blog today. And let’s not talk about my backsliding as a women of God. Everything has consequences 

It’s also tough on relationships, traveling. I find it easier to move on than take a chance when dating is the way it is currently. It’s hard coming home and seeing everyone in solid relationships, having babies when not sure it’ll ever happen for me. Side note: I’ve wondering how my mother would do arranging a marriage for me. Hm… 

Working at home gets tough because I see clearly what needs changed and I can’t tolerate when I see how poorly the staff is treated by those high in leadership. Church is tough too because they know how I was before and I feel like I’m struggling too much to pretend I have it together like I used to. When you’re out in the world that’s when the test of who you’ll be is given. Who am I right now? Human. Admittedly, I know God can use everything and I need to let Him led. I’m still learning. 

Traveling has helped me become someone better and different. That’s what happens when you’re on the move. Am I where I’m supposed to be, doing what I’m supposed to be doing? Yes, I believe that in spite of the struggles I battle against on many levels. I’m stronger in too many ways and I feel like more strength (as a nurse, as a woman, as a Christian) are coming. 

Leaving and coming home is an experience every time. And while I’d much rather stay on the road, everyone has to come home to rest. 

Travel on, Road Warrior 

Bias, stereotypes, and prejudice. Oh my?

In case you didn’t know (and because I’m a closet selfish person who thinks it’s a holiday), tomorrow is my birthday. 

The older I get the more I contemplate things in my life. No need to recap my history, but I’ve been alive long enough to understand some things just by observation. 

Like we can be good, but the bent toward evil plagues us all. For all my backslid ways, I recognize and acknowledge the hand of God and our innate battle to do the right thing. I battle it everyday. 

I also recognize that many times there’s something good that crops up out of terrible situations even if we can’t see it until years later. 

Another thing that is always apparent to me is the role bias/prejudice can play in how we deal with people. We are human and mentally require a way to understand things in our lives. We are prone to classify things in boxes to keep things sorted and that sorting can end up with labels that affect how we interact with our world. 

I’ve harped on stereotype and prejudice because they aren’t the same. One can be harmless and the other can lead to lynchings and shootings. I’m going to give a short, sparkly talk on what’s on my mind and perhaps one day I’ll do a better post on this. 

First my definitions of things. 

Stereotype: super simple view of a group. All women… All little girls wear pink. All men… 

Prejudice: when those views are morphed into something not found in truth leading to hostility, fear, and violence. 

I expect people to have some stereotypical views especially when you’ve never encountered that people group. What gets hard is when people refuse to recognize and let go of those stereotypes. When you can’t see how you may be biased, you can’t understand the struggles of the other group. 

Let me mention my own bias that I recognize. When I’m at work, I automatically see all doctors as nasty demagogues who treat nurses like crap. That’s my experience and it’s hard to shake that particular bias and how it affects my relationships with physicians. When I work with drug users who put their newborn at risk, I also struggle. I also see my own fear and bias when I live in a predominantly white/rural area. It was in a rural area that I had my run in with someone shouting racist epithets. Nothing is scarier and isolating than a true terror that comes when you aren’t sure if your skin color could result in someone attacking you. I’ve met many welcoming people, believe me! It’s not an unfounded view, but it’s hard to shake it when I’m somewhere more rural. 

I struggle against my bias. Mine is more of how the behavior of others can hurt me, but I’m sure I hold other beliefs that make me avoid helping those I should. 

Our current social climate is tense. We as a people group don’t realize how deep our collective bias/prejudice runs. We can’t see it so we don’t change it. In movies, it’s the automatic roles that those of color or women fall into and the way we don’t question it. The gangster, the bimbo, the ghetto queen. Those stereotypes stem from our own incomplete understanding of people.things rutted in age old beliefs. 

Bias can and does affect certain people’s ability to get a job. How many studies exist showing how equally qualified individuals are side by side and interviewers don’t even give the person with the more ethnic name a chance. People argue that it’s the company’s right, and I’m not disputing that. What I’m trying to get people to see is that the bias exists and people are ignored and put at a disadvantage because of it. 

We all like to believe we are sinless when it comes to sexism, racism, any ism but the truth is some of our isms are societal and taught. It’s engrained and subtle. We are not absolved just because we say “society made me think it”. We have a responsibility to recognize and change our prejudices. There is no free pass simply because you are a Bible believing Christian. You need to open your eyes and see if your bias is making you treat others as less than. 

For example…

If you ever said,”they should get off their butts instead of leeching off the government and support themselves.” What makes you say that? How is it changing your willingness to be a possible champion? How does it help you to ignore the need in this group? 

I’m no wrist slapper and I’m not here to shine a light in anyone’s eyes except my own. But… If your pupils dilate and you see a little better, everyone wins. 

So, back to traveling, huh?

Travel on, road warrior 

The cost of resentment 

Adios, Plymouth! 

I’ve made my way home which means I’ve completed another assignment. This was one of my best assignments even with the usual crazy staffing situations we ran in to. And after how difficult I found my previous location, I needed somewhere welcoming. 

Quick plug: any licensed Mass travelers, look into Beth Israel Deaconess in Plymouth labor and delivery. In 10 years of nursing, they have the best providers I’ve ever worked with in my career. Nothing but respect and comradery amongst nurses/doctors/midwives. If I wasn’t such a rolling stone (and didn’t possess such an aversion to winter), I’d put down roots. I never felt like “the traveler”. My help was appreciated and that made me feel like an asset. I do plan to return AFTER winter because I think it’s a good place to work. 

There was a little bit of a shake up right as I was leaving. It made me think of things that happen in our lives that breed hard feelings. 

No relationship is perfect. Things irritate us about our loved ones and its hard to not let resentment build up. In a love relationship I can be feeling unappreciated or taken for granted or not listened to. In a working relationship it can be making decisions without regard for staff or a lack of team work or punishing the whole staff for the behavior of one employee. 

But looking broader, resentment can come when someone voices a hurt, concern, trauma and instead of responding with compassion or action you ignore, belittle, or downplay the pain by pointing to something that has little to do with what’s being brought up. Looking at some of the issues facing our country today, it’s evident we have a serious resentment problem that’s exploding into something dangerous. People who aren’t heard tend to react with anger, sadness, violence. Why keep trying when you simply disengage and shout your anger to the world? 

So what’s the answer to resentment? Aside from Jesus and a bat to the back of the head? 

Listening: always the first step. If someone keeps saying they want something or are hurting, don’t add your two cents! Open ears and shut your mouth. 

Checking in: ask how they are and care about their answer.  Don’t let what they say be about how you feel. Let me repeat. DO NOT LET WHAT THEY SAY BE ABOUT HOW YOU FEEL. If they are talking about issues in their life, your response should never be explaining how you feel about it or how it has an effect on you. 

No excuses or apologies, but action helps: we want better relationships. It’s easy to say it’s not your problem and they need to open their mouths or fix their lives or stop complaining. That doesn’t change anything. You’ve added more anger and resentment to an already tense situation. Instead be an advocate, counselor, teacher to others on their behalf. Be a champion. 

That makes change. Listening and hearing and acting make change. 

Where to next? I’m actually headed closer to home. I’ll be in Charleston, WV until the beginning of December. So I’ll be in WV for a while for those in the area. They are going through and medical records conversion which increases their need for staff. 

I’m nervous because I’ve not truly worked in the state in over 3 years. I’m not used to the people or the issues anymore. I’m also not sure how I’ll be received. I want to be liked and seen as someone there to help. How will things be? We’ll see soon enough!

Travel on, road warrior. 

“I’m so glad you’re working tonight.”

Hello from New England. Summer has officially crept in, which means I’m down to 3 weeks remaining on this assignment. It’s all downward slide from here. For me, it means I’ve reached that point where I’m not quite coasting, but I’ve hit my stride and see the light at the end. 

This hasn’t been a bad assignment. Once my anxiety from the previous assignment diminished, I was able to see how this could be a good place to work once they fixed their staffing issues. Honestly, hands down the best physicians/clinicians I’ve worked with ever. Respectful, collaborative, and not condescending. It’s like a dream. I’d take these docs and midwives and add them to my dream hospital. Seriously, you should come work for me because my dream hospital is going to be Ah-Mazing. 

I’ve oriented a lot on this assignment, which is strange. I’m a traveler, how am I going to teach you what you need to know to do well at this facility? I mean, I can show you how to manage a labor, but the individual intricacies of your work place? I just know enough to make sure I don’t overstep my boundaries as a temp worker.

I have knowledge and experience specific to L&D, but I’m no teacher anymore. Okay that’s not true. Once a teacher, always a teacher especially as a nurse. I just don’t always feel comfortable teaching as a traveler. Telling you what I know to be true in labor and what your facility wants isn’t the same thing. 

A girl I’ve oriented here told me the day before she was always glad to see me at work. She said she felt better because she knew I knew what I was doing. That made me feel… Like a grown up. Haha. 

I’ve turned into someone a younger/newer nurse could look to for advice? When did that happen?? 

What I am is an encourager. I like to cheerlead new hires or transfers to a floor. I like to tell them they can do it because they can. I like to offer words of advice and a smile that says go get ’em. I like to ask if they are doing okay and need help because it’s nice to know you have back up in a crisis. 

I’m still learning and my true teaching days are on hold, but (like I said) you’re never truly done teaching. It’s exciting and challenging to realize that 10 years in, I’m not a baby nurse anymore. Someone is glad I’m working that night because they know I’ll help. 

Here’s to teaching and being always teachable. 

Travel on, road warrior