I have some wonderful down time these past days. The weather was warm enough to sit out on the deck, albeit next to the house instead of my usual spot. It has given me some real time to think about a few things and I thought I would share them here. The thing that has been weighing heavy on my heart and soul is what the heck am I doing with the short time I have left on this earth. This has been a growing concern which has become primary in my thinking. When I have tried to discuss this with anyone, it is dismissed usually before I can even get my thoughts out. People do not like to face mortality, even when it is not their own.
I am in-charge of all the educational needs of the all the staff including clinicians for two agencies. I was also hired to create a leadership program and a career succession program. I manage a nurse who does the actual clinical training and PT who does the body mechanic training. Within a year, I was in charge of the Patient-Family Centered Care initiative. What I was not prepared for in any manner was the ostracization I received.
Things were fine until I started looking under rocks. And what slithered out was pointing directly at people who unfortunately had a lot of power and time there. It was all they had ever done. They did not want change and especially from someone who they deemed not qualified because I did not have a RN after my name. No one understands that an administrator in a school system does not know every subject, but they know good education when it happens.
I am beating my head against a wall. Close friends say “just get out.” It is not that easy and what I am going to say is going to make me sound like a sap. I am bolstered to talk about this after reading a post from fellow blogger, and a physician, Victo Dolore in her blog Bridging the Gap With Silk Draperies.
I really care about improving health care. However, I will never be a clinician. This has haunted me for the past three years. I have felt there was something wrong with me because I am so passionate about a situation I am never going to be accepted in. The good Doc mentioned above wrote another post entitled Yes, Vagina, there is a Santa Clause… (let’s see if I get more hits for the word, ha!) It is hysterical and I fell in love with her writing. But she said one thing and it went right through me like an electric charge. And I quote: “For instance, if you are worried about spreading your legs for me because you did not shave your hoohah that morning, I can reassure you that I DO NOT CARE. Not one iota. If you think your doctor does care, you should run away. You should run very far away very, very fast. When we look at your vagina, we are looking at it clinically”
This is a truly hysterical post and you should read it in its entirety because it has a strong message. But the words “looking at it clinically” hit me hard. I get it. To be successful as a clinician there has to be some disconnect from human to human. You have to be able to look at the body as the biological miracle it is but also completely disengaged. It is pure science. And it hit me. I cannot do that.
The classes I teach in orientation are the touchy-feely stuff like customer service and diversity. I feel I do a good job of motivating people to see others for who they are. Many of our new clinicians come from a hospital floor where they never see the personal side of their patients. They do not start the healing and most often, they do not finish with them either. In home care, you are there to the end, whether it is recuperation or hospice. You are immersed in the family. You are the stranger in their environment. It is a big change for many. You do not have the same control as you do in a facility or clinic. Home Care is hard work and it takes a special type of clinician.
One of the new classes I am teaching is working with them to understand motivational interviewing, which is another new buzz name for coaching. We are trying to get them to incorporate the patient and family in building the care plan. I am trying to undo some of the disengaged clinical aspect of care and omnipotent thinking that is so engrained in their training and more easily facilitated in a clinical facility than in a patient’s home.
I took hospice training last year and then completely chickened out when it came time to volunteer. I have been asked many times by one of the clergy on staff to come up to our hospice facility and volunteer. He feels I would be a natural. The Volunteer Coordinator got me in my office last week. She pleaded with me to come up with her. I was honest and told her I was afraid. I said I do not handle death well. She said, “no one does. We all cry.” She wants me to work on a project called “Loving Hands.” I would be taking pictures at the request of the family of the hands of the soon-to-be parted with their loved ones. It is a beautiful concept and I would like to do it. But I am afraid. I know I will be thinking no one held my mother’s hand thirty-six years ago. I still feel the remorse that she died alone in a hospital bed. Will I be able to disconnect and just shoot the photo? I am pretty sure I cannot do hands on care. I KNOW I cannot change anyone nor actually deal with the many bodily functions that become disabled.
So to round back to the beginning of this post about what am I doing with my life… Just writing this very long post helped me round back and focus on what is really important. I will not ever be accepted there because I am not a clinician. That is not what is important. I am a change agent and that is important. But do I have the strength anymore?
I have done some really good things there. My Core team fought for two years to get update electronics and air cards for clinicians in the field. They used to have to go to a Starbucks or similar to get Wi-FI to download new case information and documentation. Ridiculous! We had to gather data and do report after report to the point there was no argument left. We now have a standard nursing bag we had field staff design. We have skills competencies yearly that receive great reviews. The annual mandatories I write are completed with much less complaints and staff actually learn something from them. I instituted New Managers Operational training which has created opportunities for staff to be promoted successfully from within the agency. This year we are incorporating more Leadership classes. I reinstated a Clinical Ladder program for all clinicians that had forty-eight staff members complete this year and is growing. What was once a favoritism reward for a select few popular nurses now is available for all clinicians from LPNs to OT and Social Workers. The Ladder has now has an air of accountability and the significance of being a member of an elite group. I brought in nursing schools for a day for a college fair and had many staff sign up including five nurse managers to return to school and get a higher degree. I brought in Nurse Leadership classes which were jammed with participants. The grant provider who offers the classes said it was the biggest turn out of any agency they have in the state. It cost us nothing. I brought an organization in that does culture change for hospitals. I simply wrote them and began a dialogue and ended up having them create a unique survey for the agency on accountability and patient safety. They issued the survey and have created a summary which will be presented to the Administration team next month. This process usually cost about $50,000. I got it for FREE. This was almost not to be as one of the people I spoke of previously tried to put a stop to it. What will happen with this, I do not know. I am hoping it will reinforce a Patient Safe Handling Committee, which I have on the drawing board. One of my new projects this year is to bring an on-line training system up and get it running. Once up it will save hours and money in training costs. This has been a three year struggle for them to see the value. I am also revamping the content of much of the existing training. It is many years old. I was so shut down and afraid to do this because the ramifications from the old birds who wrote the stuff had me intimidated. Even though the Core team is disbanded, our study and report is shaping the possibility of a new pay structure. There is more. But my point is made.
But every single thing mentioned was with massive struggle and conflict. People are taking credit for things I did, and although it not the accolades that make me fight for things, it does discount my work. There is more discord and misery in any job I have been in and it permeates the building. The week of Christmas, people were dropping like flies from exhaustion and fatigue.
My New Year promise this year and in the past years is to work on not being so afraid of things. I tried Indian food for the first time yesterday. I liked it and it got rid of some incorrect beliefs. I have some other things in the fire too. But looking towards the future….am I to continue fighting the fight at work which leaves me drained, stressed and fatigued? Some nights I come home and I am so worn down I sit in my car and cry. It takes a toll on my body as I am so physically tied up in knots from the fear and stress that when I sleep and relax, I spasm into Charlie Horses that Roy Rodgers could ride on. Because of the physical issues going on I have only so much energy. Is this me and will I be the same elsewhere? That is a big possibility. At the age I am at, I really do not want to start over.
I really have something in mind that I would like to do but it is not panning out. I am going to hang on for a while as there are proposed changes that are coming, including a complete redirect of Clinical Operations. I am really hoping that this will make a difference.
Sorry for the rant, but that is what this blogging thing is about.