Facilities' Motivation Programs Don't Always

Some months ago, I noticed a nurse-friend had a Care Bear sticker pasted to her uniform. She works in a physician’s office – one of several affiliated with a large health care system. Since she didn’t work in pediatrics, I thought the Care Bear a bit strange. After she explained it, I was angry.

The sticker, she said, was a way of singling her out for a job well done.

Managers throughout her health system, which includes several hospitals, three physician groups and a few other facilities, are recognizing doctors, nurses and ancillary staff with stickers. The Care Bears were in keeping with some theme the system had chosen.

I’m not making this up; I was incredulous – and angry. It was utterly absurd that this health care system was treating adult professionals in such a manner.
But it didn’t end there.

Several months later, a physician in this same health system showed me his latest “reward.” It was a pair of sunglasses that looked as if they had been stolen from Elton John’s closet. The glasses were fire-engine red with long flames jutting out from either side. The doctor said that he’d been given the glasses because someone had nominated him as a “fire-starter” – a person who got things done. (New theme, I guess.)

And that’s not all.

Twice a year, this health care system stages Amway-like rallies at some conference center, then hires buses to haul in system employees from all over the county. Most must take off work to attend, so that leaves other employees (who will go on another day because attendance is mandatory) to carry the load for that day. With the cost of the shuttle buses and rental fees for the facility, these rallies are not inexpensive.

A couple of the physicians have refused to go.

“I don’t need someone telling me why and how I’m doing the job I’m already doing,” said one, “and I don’t need them to tell me I need to be motivated. I already am.”

But the nurses with whom I spoke felt obligated to attend the rallies.

They thought the events were utterly stupid, but feared they’d be penalized at evaluation time if they didn’t go. They also resented being treated like children, and were angry that the health system spent money on these rallies – not to mention these “motivation packages” with their banners, slogans, stickers and silly rewards undoubtedly dreamed up by high-priced consultants.

Do you work in an environment with motivation programs?

If so, do they work?
How do you feel about these programs?

Does your employer demand you take time from work to attend rallies, or attend them on your day off?

Does this made you angry or do you just brush it off?

What do you think?

Does Cultural Competency Make a Difference?

Does understanding that Haitian men prefer pajamas instead of hospital gowns and that a hard-grip handshake is inappropriate for Native Americans mean these patients will receive better care?

Some states think so, according to a story recently published in USA Today.

For instance, California wants doctors to take continuing education courses in cultural competence and linguistics, and New Jersey has made cultural-competence education a requirement for physician licensure.

Some nurses think so.

Editors Juliene G. Lipson RN, Ph.D., FAAN, and Suzanne L. Dibble DNSc, RN, think so, too. They have produced a text on the topic: “Culture & Clinical Care” (UCSF Nursing Press; $33.95). The soft-cover book is an encyclopedia of information about cultural mores and beliefs of ethnic groups. Each chapter is written by nurse experts who are often from the respective country. The editors call it a “handbook to help practicing nurses give more culturally sensitive care.”

Some doctors think so, too.

About six years ago, the American Academy of Orthopaedic Surgeons compiled a “culturally competent care guidebook” for physicians that address the needs of African-Americans, Asian-Americans, Native Americans, Latinos, women and religions.

The federal government, however, is not so sure.

It is currently “financing studies examining whether [cultural] training can help health care workers get diverse groups to comply better with doctors' orders,” according to the USA Today story. So far, “no study has proven cultural competency training works, either by improving doctor-patient relationships, increasing patient compliance or reducing disparities.”

Does being knowledgeable about various cultural customs and beliefs help you give better patient care?

Can a nurse with “cultural competency” produce better patient compliance?

Should you be obligated to become educated on the cultural mores of minority patients?

What do you think?

Insurance companies: What were they thinking?

It was over before it started, but still bears discussion.

Perhaps you read about the attempt of Blue Cross of California to ask doctors to report pre-existing medical conditions on their patients so that the health insurance company could cut the subscribers from their rolls.

Blue Cross actually thought doctors have the time and ethical inclinations to search patients’ charts, fill out the necessary forms, then mail them to the company so that their patients would no longer be covered.

I was outraged when I read this story and also questioned the sanity of the executives who made this call. And none of the physicians with whom I spoke said they would do it. One said, “I’m going to toss the requests in the wastebasket.”

This episode sadly confirms what we already know about health insurance companies: that they are in it for the money and care little about their customers. Still, I’m surprised at the boldness and arrogance of this move. A spokesman for the California Medical Association said a few days ago that the policy is "deeply disturbing, unlawful and interferes with the physician-patient relationship."

And according to the Feb. 13 Los Angeles Times, CMA President Richard Frankenstein said, "We're relieved that Blue Cross is ending this particular tactic, but continue to have serious concerns about this company's practices looking forward."

California’s governor, Arnold Schwarzenegger, used the occasion to nail Blue Cross for asking doctors "to rat out their patients," and to point out that this incident is an example of the need for health care reform.

Regardless of where you live, other health care insurance companies could try the same thing, or create other inventive tactics to cut from their rolls the people who need insurance the most.

What do you think?

Parents' Rights or Public Safety?

The headline caught my eye and it seemed like an anachronism.

It read: Three siblings diagnosed with measles.

This story ran in the first week of February in the San Diego Union Tribune. I couldn’t remember the last time I had heard of someone having measles. Two of the three infected children attended elementary school, one in which 10 percent of the students are not vaccinated. This is an incredible number because, according to the spokesperson for the school district's nursing and wellness program, that number is 1 percent to 2 percent in all other California schools.

State law mandates that everyone born after 1956 must have at least one vaccine for measles, mumps and rubella or show other evidence of immunity – except when parents object for religious, medical or personal reasons. Even though the Centers for Disease Control and Prevention says that there is no evidence of a link between vaccinations and autism, some parents still fear that their children will develop autism after receiving vaccines.

As I write this, a radio broadcast by a local station is saying that there now are 11 children in the county who have developed measles. The school is handling the situation by forbidding any non-vaccinated children from attending until the infection period has ended. Several of the parents of these kids have agreed to vaccinate, but most haven’t.

There’s no doubt that vaccinations have resulted in better health for all. In San Diego County, there was only one case of measles in 2006, down from 985 in 1990. There also were three deaths from the virus that year. I respect the rights of parents to make decisions about their kids’ health care, but are the consequences of these decisions fair for their children and others in the community?

What do you think?

Not a Multitasker? Don't be a Nurse

The other night I tried to turn on the television with the cordless phone.

Hey – it’s an easy mistake to make. The phone and the remote both have the same panel of numbered buttons – and besides, I had just been talking on the phone, loading the dishwasher and thinking about what I had to do the next day.

Multitasking. You know the drill. Nurses must do this or die.

Who hasn’t tried to chart, answer the phone, tell the doctor you’d be there in just a minute – all while wondering if your 10-year-old remembered his lunch and soccer shoes for after-school practice for which you are the transportation?

I’m told women are better at multitasking than men, who are linear thinkers and aren’t expected to do more than one thing at a time. (Perhaps some male nurses would like to dispute this.) But one of the problems I see is that when the sun goes down, it’s sometimes difficult to turn off my brain.

I have a couple of ways to chill out.

If the small muscles in my eyes are still functioning after all those hours on the computer, I read. If not, I watch a movie (thank you, Netflix) or watch those clever HGTV designers make over their home for $500 or less. And I walk – with a friend – and we talk – about everything and nothing. Better that I pound the pavement with a buddy than do it alone and start mentally constructing that to-do list. That’s no way to relax.

Should we be expected to multi-task and are you adept at doing it? How do you unwind?Help all of us; share your opinions and secrets for holding it all together.

The uninsured: Got a solution?

The uninsured have got it doubly tough.

Not only must many wait to see doctors until their medical problems get really serious, but when they finally end up in the emergency room, the hospital charges them more than insured patients.

In one hospital system in San Diego, that meant up to 400 percent more.

It seems unconscionable, but according to a current class action lawsuit, this hospital system (which has five hospitals in the area) has been overcharging the uninsured since at least 2002. The system has now agreed to a $73 million settlement with as many as 60,000 patients. In reality, however, “only a fraction of that amount would go into patients' pockets as refunds because most of them have paid little or nothing on their outstanding bills,” according to the story in the San Diego Union Tribune.

Sixty thousand people is a lot of uninsured, but those are only the ones who came to area emergency rooms. There are many more without insurance – 47 million nationally – and the number keeps growing as people lose their jobs, change jobs, retire, have babies or work for employers who have discontinued offering coverage.

Health care insurance – and the millions who don’t have it – is a huge issue in this year’s presidential election. I’m glad I don’t have to come up with a solution for such a complicated problem, but it seems that everyone ought to have some basic coverage the minute they come into the world. This universal health coverage wouldn’t pay for things like heart transplants or experimental surgeries, but there would be an unequivocal list of benefits like the hierarchy of covered treatments that citizens of Oregon developed a few years ago.

Our current non-system provokes so many questions:

Why should so much of our insurance premium dollar go to the insurance company?

Why should insurance company CEOs be making millions while their companies continually cut back benefits, raise deductibles and refuse to cover those with pre-existing conditions?

Why should insurance employees be rewarded for dropping coverage on customers who have made claims? (Congress is working to make this illegal.)

Many nurses are in the thick of the fray; they see the uninsured every day and the consequences of our non-system. If you could have a presidential candidate’s ear for 10 minutes, what would you tell him/her?

Movie Brings Flood of Nursing School Memories

I finally saw “Atonement,” the powerful film nominated for Best Picture at this year’s Academy Awards. I went with my nurse-friend, Donna, and the scenes we liked best were those in which one of the film’s main characters, Briony Tallis, attends nursing school during World War II.

There’s Briony marching in formation with the other students, scrubbing floors, scrubbing metal bed frames, scrubbing bedpans, and… wearing a navy blue, gold buttoned cape with red taffeta lining.

“I still have my cape in my cedar chest,” confessed Donna as we left the theater – after which we began reminiscing about attending nursing school in the mid-1960s. She began her career as a licensed vocational nurse (she’s now a nurse practitioner); I attended a now-extinct three-year program.

We didn’t march in formation or scrub floors, but Donna and I agreed that a lot has changed in the last 40 years when it comes to educating nurses. So at the risk of sounding like one of those we-never-wore-seatbelts-and-we-lived e-mails aimed at aging boomers, here are some of the things we remember from the good ol’ days but will rightly never see again:

• Student uniforms: white seamed stockings, striped dresses, white pinafore sand starched caps.
• “Pincushion patients” (all those antibiotics and analgesics were given IM, not IV).
• Urine tests that determine insulin doses.
• HIPAA? Ha!
• Male nurses? Never!
• Working extra shifts for $2.65 an hour.
• Sneaking into the student dorm after hours.
• Senior year: Being charge nurse for 25 patients on the night shift with no supervisor.
• A middle-aged Mercy nun, sleeves rolled up, demonstrating for a roomful of 18-year-old female students how to insert a Foley on a male patient.

Do you have snapshots-in-time of attending nursing school or stories of days-gone-by? Share your memories – the good, the bad, the ugly – and don’t forget the funny. Then we collectively can be glad that all these things belong in the memory books.