Labor of Love

Last week I was talking to a new nurse - 3 months out of school - who has chosen to work at our facility.

Her first clinical 'job' experience and she's spending it caring for homeless clients with high levels of acuity, multiple conditions, behavioral and social deficits - the list goes on.

Needless to say the respect I feel for a staff member with the maturity and guts to take on this type of assignment is almost off the charts.

We had a rare few minutes to chat at a welcome function, and were hashing out the typical who are you, where are you from, what-do-you-want-to-be-when-you-grow-up type questions.

When I mentioned my goal of entering hospital administration, New Nurse paused for a moment, put her hand on my knee, and said with a completely straight face "oh Jen, I'm so sorry to hear that." (As you can probably infer, she's doing just fine with our tough crowd of patients using that sarcastic wit).

After some laughs, we talked about how New Nurse really hates hospitals, and was dreading working in the hospital environment right after school. Luckily for all involved, she found us - an alternative environment of care that will allow her to develop one-on-one relationships with patients in a supportive setting.

Her ultimate goal is to care for patients who can't care for themselves - to be a medical partner for those who are underserved. Perhaps the most valuable part of our conversation (for me) included a discussion about how a focus on the end (caring for the underserved) rather than the means (nurse in a hospital versus a clinic setting) allows you to not become bogged down in searching out your next step on the career ladder, but rather seek out opportunities that help you get closer to your 'end.'

We talked a bit about her feelings of discomfort and from whence they arose. Some of the things she mentioned had me up late at night thinking about why I love hospitals, and how that drives me towards wanting to get my hands on one and shake things up a bit.

I've arrived at the conclusion that I probably am a bit crazy to 'want' hospital administration as my 'end' - in these times of multiple challenges and relatively low rewards compared to other administrative/executive paths, you'd have to be a bit on the strange side to think you can ride in on a white charger and organize methods of positive system growth/change.

But perhaps all labors of love germinate from an unwillingness to let the difficulties sway you from your 'end.'

In honor of Labor Day, let's head back to the concrete for a moment - examples of some things that create an 'undesirable' hospital feel but that you can labor to change include:

1. Focus on sickness/dying.
2. Lack of privacy.
3. Lack of respect for individual personhood and decision making - not involving a patient in their continuum of care via full disclosure of DX and treatment options - ie not taking time to really talk to our patients because we're so busy performing the 'technical' functions of healing (med administration, dressing changes, etc).
4. Yes, the food.
5. Lack of activities for patients who are relatively awake and aware to continue pursuit of their personal goals.

What components of your facility's operations/approach contribute to the undesirable portion of the "hospital feel?"

Can you modify any of these things to create a more constructive healing environment? The answer is probably yes - just ask some of your new nurses...they've got plenty of valuable ways to help you achieve your 'end.'

1 comment:

Mark Reynolds said...

I think your point is an important one. I approach this issue from the perspective of a patient. I have been hospitalized on 4 occasions due to recurring heart problems. It is my observation that starry-eyed individuals enter the medical field, with a view to making a difference. Once there however, they find that there is much more work than they have the time or energy to complete. Furthermore, that much of what they do seems unrelated to patient care, such as documentation and internal politics. Unfortunately I believe this is more a general workplace symptom rather than something unique to healthcare or the hospital environment. When people gather together in pursuit of a common goal, no matter how laudable, the mob mentality takes over and hierarchies develop. This leads to morale problems and lack of organization. Eventually, the original goal of the group becomes obscured and the subject of the work-in this case the patient-suffers.

The only way I see out of this problem is to shift society's focus away from interventional healthcare to preventive health management. Idealistically, this would eventually force the closure of many hospitals due to the lack of clientele and those still interested in helping others would re-align their efforts as individual consultants, like nutritionists and exercise therapists. This would dismantle the healthcare system as we know it, de-centralizing health maintenance and bringing practitioners back into the home, like in the old days of the visiting doctor. A quaint notion, but not all together unrealistic I think.

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