Can’t fix broken system from the bedside
Yesterday I was sitting in on an interview for a new oncology nurse manager at the hospital where I’ve worked as an RN the last four years. Right off the bat I thought the prospective hire was doing well. He projected sufficient confidence and humility. He seemed likable enough. After about 2 minutes I turned to my coworker and said “Yea, he’s got the job.” He had the appropriate experience, and by the time a candidate has interviewed with higher ups and is brought back to interview with us it means the offer is all but extended.
As we churned through questions about his past experience, career accomplishments, and pedantic “leadership style” questions, all his responses were appropriate and predictable. He would be hired to tow the line as a middle manager, in a successful corporate hospital, in a failing national healthcare system. A successful hospital in a failing national health system... So the job is akin to that of the conductor leading the string quartet on the deck of Titanic going down.
In our present day there isn’t a single lucid American soul that could truthfully describe our national health system as effective, let alone successful. Byzantine, kafkaesque, and inequitable are the first descriptors that come to my mind. Any healthcare provider could tell you about the inordinate amount of time they spend explaining and apologizing for a health system that’s inadequate and failing, and any patient could corroborate it. So that leaves the question: who wants the job?
I framed a question to the interviewee. “The problems that we have here: the turnover of management, turnover of staff, short staffing, inadequate training, burnout, equipment shortage, communication failures, etc — they’re not unique to us. It’s all a symptom of our greater failing national system. Is there anything you do to advocate for a more equitable, more effective health system beyond the walls of the hospital?” As I asked him this (with less skillful words), I became emotional. I could feel it swelling in my chest and head, though I don’t think my coworkers noticed. I knew how important my point was and that the only accurate answer could be: “Not enough.” (That would be my own answer too.) Rather though, the interviewee reiterated how important that question was, talked about the illusory “community” a bit, and I don’t remember much at all specifically about what he said.
Being a good nurse, going the extra mile for patients, forgoing my break to spend more time providing care at the bedside: none of that’s enough. And attending BLM rallies, supporting and donating to progressive political campaigns, writing my congressperson to receive back form responses the equivalent of a shrug: that’s not enough either. Because at the end of the week I collect a paycheck from the offal too.
By the time I was graduating high school I had enough knowledge and insight to see that our health system wasn’t working... and beyond that: our education system, our criminal justice system, our financial system — all different arms of a deformed, undeniably racist, unjust society. But eventually I became a nurse, one occupation largely beyond reprove when tracing the lines between all the systemic injustices of our society. On occasion people with no personal knowledge of my life will learn of me being a nurse (like when I’m wearing scrubs on my way to and from work,) and tell me how it’s a noble profession. Few professions are awarded the same universal regard. And I enjoy that regard too. But I also recognize myself as complicit when I spend that paycheck and weeks pass without me taking any concrete action to improve upon the status quo.
I write all this because I know I’m not alone in these thoughts; I’m hopeful for change in the future; and I know open communication is the way forward. I’m looking to keep talking and get moving!!!!!!
I've had a tumbler account for ages and I think this is the first time I've used it. I came across this blog put together by one of my most valued of friends and figured it would be a good place to start. I really enjoyed reading this, Ian. Never realized how much we agree on this topic. Hope you don't mind but I may share this on other social media.