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Jul 11

KITTENS are cute.

kittenWhat? A RANT about kittens? Who on earth would rant because everyone thinks kittens are cute?? You know what other things are cute? Babies. Yes indeed, babies are cute. Puppies too. Who can resist melting and saying awwwwwwwwwwwwwwwwwwww….ADORABLE!! You know what’s NOT cute? My mom. She’s been called feisty, funny, stubborn, charming, independent, irritating, opinionated…even downright difficult. But my Mom,before or after she became aged and developed dementia, WAS NEVER CUTE. And God help anyone who called her that! Now, my darling Mom is in long term care. She is cared for by health care aids, LPNs and RNs, and I know that these good people have tough jobs. The other day, I was there as two well-meaning caregivers assisted my mother from her wheelchair to the toilet. She was looking over one of their shoulders at me, with those laser-blue eyes of hers, as they talked to her… “OK honey…that’s it sweetie…you can just sit down now…that’s a good girl” and I watched my mother’s eyes draw into angrier slits with each endearment. She still has a pretty sharp tongue, and she retorted “will I get a lolly pop if I am really good?” to which the response was “Oh Mary you’re so cute”…oh boy…first of all, when we were kids…we cleared out when Mom’s eyes got slitty like that…and second of all…NOT CUTE. I closed my eyes and prepared for the response, but when I looked up, mom just looked straight ahead. Had she forgotten the episode already? Maybe. Or was she just resigned to the indignities of her age, her disease, and her situation? Once she was comfortable again, I left her for a moment and asked to speak to each of the caregivers–not to bawl them out, just to try and help them understand how their intended terms of endearment had indeed had the opposite effect, they diminished rather than endeared…embarrassed rather than embraced. They seemed to understand, but I see this behavior repeated over, and over again. Academic literature dubs it “infantilization”. I call it the “cute baby” effect…or maybe the “kitten effect”.

You know who else is not cute? Nursing students. What I mean is, they aren’t cute just because they are nursing students. This hit me just the other day, as I sat in a meeting with a number of very experienced nurses, and a few nursing students. One of the students, an erudite young woman, spoke with a point of view that ran counter to the view in the room. She demonstrated critical thinking, and confidence. All good. An RN sitting next to me (who is an excellent nurse, and well-liked by the students), turned to me, smiled an indulgent smile and whispered “that’s cute eh? Out of the mouths of babes…!) Yikes…CUTE?? BABES?? It occurred to me that this must have been what it was like to be in a meeting full of men in the 50’s, and be the woman in the room with a contrary view. I know that I am not the first to observe this form of ‘reverse discrimination’, and to note its demeaning and disrespectful message–I just never connected it to nurses relating to nursing students before–it was a surprise to me. What’s more, I need to add that in this particular case, the student, while articulate and confident, was in error (she didn’t have all the information). Yet, others in the room were reluctant to challenge her thinking because of this “kitten effect”; they didn’t want to hurt her feelings! Oh my.

Have you seen this “kitten effect” in action? Have you been on the receiving end of this kind of condescension? I’d love to hear your comments. Thanks for letting me rant!

Apr 21

Election update 2: Meeting my WR candidate

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I was able to meet with my local Wildrose candidate on Friday, April 20th, and spent about 30 minutes with him discussing topics of concern to this Registered Nurse.

I asked him about the implications of his party’s stand on dismantling Alberta Health Services, and what he thought that might accomplish. He admitted that he had heard from many RNs and other health care workers that the system could not support a move that would create even greater instability in the system. Therefore, his party proposes doing this slowly, and with the guidance and input of all stakeholders. Seems reasonable enough, although I find myself wondering how those in AHS must be feeling right now as this election unfolds: a little trepidacious I might assume.

I commented on the decimation of nursing leadership in the system, a matter of great concern to me. At this point we had a great discussion–he asked me what nursing leadership would bring that is now missing from the system. I responded that we now have a system that has been “blown up”, and leadership that is now focused on the different fragments–acute care, long term care, community care, and the new fair-haired child, primary care. What nursing leadership brings, I explained, is focus on the connections in the system, the “seams” where many people fall off the radar. RNs and NPs, I explain, are the “glue” in the system, and their care is the care that forges bridges between primary care and community care, between supportive living/long term care and primary care, between home care and acute care–I argue that if we spent as much time, and as many resources on the seams of the system, we would be in a much better place in Alberta.

We spent quite some time discussing the wrong-headed and expensive systems we have in place that require seniors in residential care environments to be transported to emergency via ambulance for concerns that could easily be dealt with by an RN working to full scope or an NP, and a responsive primary care system. I told him of the hopeful progress in places like Brooks where an NP is working hard in partnership with local primary care physicians to bring such care to the long term care and assisted living environments in that community.

Lastly, I told him that their party’s position on private, independent options for health care struck a negative note with me, and with many RNs. This answer was interesting. His response was honest, and informative. He responded:  “What can I say? That’s our position.”

All in all, a very informative discussion. I keep trying to connect with my Liberal candidate, and so far no luck–a bit of phone tag has taken place, but that’s about it (and it’s not all his fault, the day he could meet me I was the one out of town). But, I will keep trying, and if I am successful, I will post here.  Just in case this is my last election post, remember: VOTE on April 23rd!!!!



Apr 15

Election update 1: meeting my candidates

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UPDATE: Alberta Election 2012

So, today I met with my local candidates in the Progressive Conservative and New Democratic parties. I’d like to bring you up to speed on what I learned. My focus in each meeting was to share some information from a registered nursing perspective, and leave them with a question to ponder.

I learned:

  • Politicians are people too. I found each of the candidates a little tired; they are all working hard to connect with as many voters as possible–no one is more aware than they are that this election will be the most hard fought in decades.
  • The Progressive Conservative candidate in my riding is an RN, and responded well to my suggestion that to date, her leader, Alison Redford, had not done a very good job of speaking to and about Registered Nurses to this point in the campaign–and she tells me that the Progressive Conservatives are very well aware that RNs play a key role in any model of health care one happens to believe in. (She pledged to pass the word along, so I’ll be listening to see if the silence on RNs continues). She expressed unequivocal support for universally accessible, public funded health care, and shared my concerns at the state of Senior’s Care in Alberta. The information I shared with her is how concerned RNs are with the lack of “connection” in the health care system–the siloes in care continue, with few paying attention to the SYSTEM part of the health care system. The question I left her with: how can RNs engage more frequently and regularly in policy level discussions, especially given that senior nursing leadership has been hit so hard in the restructuring of the health care system?
  • The ND candidate in my riding is eloquent on the environment, and much more informed on the broader determinants of health (income, education, etc), and how those might be reflected in policy. He admitted that he knew little about the “health care system” per se, but expressed repeatedly that an ND government knows what it doesn’t know, and pledged a philosophy of engaging stakeholders in addressing issues. The information I shared with him was that RNs continue to be concerned with the ever-worsening nursing shortage, and the growing lack of RN presence/oversight in long term care and supportive living environments for the aged.The question I left him with: if we have a minority government and the NDs hold the balance of power as some predict, how with they engage with RNs to help them learn “what they don’t know” about health care?
  • NEXT WEEK: PART 2–Wildrose and Liberal candidates.

Apr 15

RNs and Alberta Election 2012

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This is the election of the decade, maybe of the last couple of decades in Alberta. For the first time, the status quo is being challenged, and voices from all sides of the political spectrum are being heard…and votes are being courted. Couple that with the leading place of health care on the agenda and the recent press about the severity of the nursing shortage in Alberta and it is not difficult to see that RNs have an enormous opportunity for influence in this election. How will you leverage that opportunity? Not sure? Confused about what party is saying what?

Here’s some things you can do. Compare the party promises/platformsclarify your own views on some of the pressing issues (and get ready to be surprised to find out where you sit, I was!) and find out what your nursing associations are up to (and how they can help you!).  The College and Association of Registered Nurses of Alberta (CARNA) councilors are meeting with their MLA’s, and CARNA President Dianne Dyer is meeting one to one with the party leaders to ask a number of questions that Alberta RNs want the answers to. For example: what are the priorities in Seniors Care? How will primary care move forward, and what role do the parties see RNs playing in primary care? What strategies are envisioned to address the nursing shortage?  CARNA has also prepared a very informative page of resources and information to assist you in getting involved, and I encourage you to visit the site to equip yourself to advocate for health and better health care in Alberta.   Local 115 of the United Nurses of Alberta (UNA) is holding an election forum in Calgary this next week, and if the pattern holds true to what has been experienced with other forums so far, it should be a packed house! Election forums are a great way to get heard, but go with your questions/information in hand, so you are ready to jump to the head of the line when the microphones open up for the crowd–and always identify yourself as a Registered Nurse–never underestimate the power and credibility of that designation.

I’m off to meet my local PC MLA for a quick lunch date, and then coffee with my ND candidate. Next week, I’ll pop in and have a chat with the Wildrose and Liberal candidates for my riding. I’ll post what I learn in each of those conversations.Challenge yourself to do ONE thing, just one, to bring your voice to the issues–and then post a note here and tell us what you did ok?

This is the election of the decade, maybe of the last couple of decades in Alberta.  “Ready, Aim, Fire”?: it’s time to Learn, Engage, Vote!

Apr 03

“Safe” care and crumbs of kindness: NOT NEARLY GOOD ENOUGH

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The other day a colleague told me how grateful she was for the “positive” experience her family had in the acute care sector. I quote: “my husband didn’t get an infection in hospital, and the nurses were mostly kind to us”. I ask you: how did things get to the point where this bare minimum (and some would say sub) standard became something to be “grateful” for? In the days of surgeon/obstetrician Ignaz Semmelweis (1818-1865), people were terrified of staying in the hospital because most developed infections after procedures, and most died as a result. No one expected good things out of a hospital stay. Now we have the thin (and growing thinner) line of antibiotics, and the knowledge of asepsis standing between us and the same fate as hospital patients in Semmelweis’s era. Yet, I still read in the literature how the simplest of procedures–proper handwashing–eludes many of the health care professionals of today! We are in trouble. Big time. And no one expects good things out of a hospital stay.

Now for the other bit. “…the nurses were mostly kind to us.” When did the public learn that they had to settle for crumbs of kindness, and even worse, be grateful for them? Probably about the time that we decided that we were much too busy in acute care (or health care in general) to bother with kindness or good communication, or family-centred care. Evidence-based care?? What evidence are we attending to? Have we truly lost our way ? When did “safety” become the gold standard, (a standard that we are not so good at meeting BTW) when it should be the absolute minimum level of care? At the CNA biennium in 2006, I heard the that eloquent Newfoundlander, Rex Murphy, say something so profound. It has stuck with me ever since. I may not have the wording quite right, but it was something like:  “Those of you in health care better get the quality thing figured out, because the public has, quite rightly, precious little patience with paying billions of dollars for health care that has no care in it.” Believe me: many politicians think they have the answer–privatize health care and treat the patient like a customer–that’s how you work out the service problem. I don’t think they’re right–I think high quality, compassionate and caring health care is more than possible in a publicly funded, universally accessible health care system. But that’s not where we are, not right now, not from my vantage point.

Now, if you are reading this and you work in an environment where there is no “quality chasm” and all is as it should be, forgive this rant and please comment IMMEDIATELY and tell the rest of us the secret.  But, if you work in an enviroment where you see families treated like intruders, patients treated like widgets and evidence used as a justification for forgetting we are in a human service–start asking yourself what YOU can do to change things in your corner of the health care world. Quality care starts with each of us. Challenge the status quo–ask questions–don’t settle.  The future of our health care system might very well depend on it.

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