International Woman’s Day II: A DAY WITHOUT A WOMAN

I’m punchy today.

I’m cheering on the Alexandria City Public School teachers for shutting it down. Go on with your bad selves, and thousands of VIP parents now have to figure out who’s going to take care of their kids while they make dollars. Disrupt the system.

As for me, I’m working. I’ve got no-union and a no-call-out job, I support a child with my income, and I think we’re discovering the layers to this problem.

BUT MOST IMPORTANTLY here’s what I’ll keep in my head today: Pasteur through Lister, god rest their man-souls, get the credit for the discovery of germ theory which is the foundation of the science behind the successes of modern medicine. This happened between the 1860s and the 1900s. Yes it arrived later in America because we are refractory to evidence, I digress… In 1854 FLORENCE “MY QUEEN” NIGHTINGALE was saving thousands of lives by cleaning up the literal shit. Check this piece out, and beware the unfortunate typo–it’s 1854, not 1954. Blockheads.

The soldiers were poorly cared for, medicines and other essentials were in short supply, hygiene was neglected, and infections were rampant. Nightingale found there was no clean linen; the clothes of the soldiers were swarming with bugs, lice, and fleas; the floors, walls, and ceilings were filthy; and rats were hiding under the beds.1 There were no towels, basins, or soap, and only 14 baths for approximately 2000 soldiers. The death count was the highest of all hospitals in the region. One of Nightingale’s first purchases was of 200 Turkish towels; she later provided an enormous supply of clean shirts, plenty of soap, and such necessities as plates, knives, and forks, cups and glasses. Nightingale believed the main problems were diet, dirt, and drains—she brought food from England, cleaned up the kitchens, and set her nurses to cleaning up the hospital wards. A Sanitary Commission, sent by the British government, arrived to flush out the sewers and improve ventilation.

So keep talking about the end of the world. I’m going to be with every other person called woman getting it done.

ALSO: Florence freaking invented data science and was a persuasive and prolific writer who though she was practically housebound in later years changed the GD world from her desk. *Spikes football*

 

Culpeper cardiologist accused of striking hospital nursing director | News | dailyprogress.com

A Culpeper cardiologist faces a misdemeanor assault and battery charge stemming from a reported confrontation with a female nursing director inside Novant Health UVa Health System Culpeper Medical Center

Source: Culpeper cardiologist accused of striking hospital nursing director | News | dailyprogress.com

Hi Doc! I hope you get fired. And fined. Props to the nurse admin who pressed charges. I’M WITH HER.

I trained at this rural community hospital. It was not an extraordinarily hostile environment. In my limited experience it was probably a 4/10 on the pain scale of abuses nurses suffered at work. Still, I’m not surprised by this repulsive development. Workplace violence, mostly verbal, is a reality of hospital work. At UVa Culpeper there was almost no interaction between MDs and RNs. The general view of nursing was that this was a group of low class, poorly educated, lazy to the point of obstructionist women. A recipe for disaster.

Nursing should be a force to be reckoned with, different but equal to medicine. Respect and autonomy are harder to come by in community hospitals–but this is a battle worth fighting. It should be noted that difference between community hospitals with minimal nurse autonomy and governance and large academic medical centers, particularly Magnet organizations, is massive. Wherever they are, nurses must be empowered as professionals to participate in advancement of their own practice. We have an important job and we have to be nailing it: know the orders, read the notes, understand the clinical picture (plan even!), be engaged enough to know the why of every drug and intervention. Be twice as good as the doc. You know what I’m saying. Do it backwards in high heels.

I see two practices for improving our situation as a historically subordinate profession: 1.) (Dare I say it?) We are stronger together. Active nurse governance at your hospital. Sit on committees. Insist on getting paid for this time, because this is not the PTA and we are not volunteering. THIS IS A PROFESSION. 2.) Get to know each other. Inter-professional education has shown anecdotal promise, even if the studies aren’t strong. Hospital administrators, you can facilitate this at non-teaching hospitals. If you work at a teaching hospital you’ve got the advantage of working with baby docs. Share your experience, and they will often share their shiny new medical knowledge. Either way, just talk to people. Regardless of their credentials they are in fact people. Here are some topics of discussion to get you started: kids, dogs, mortgages, food, car repairs, patients. It’s hard to hate (or hit) someone whose humanity you recognize.

More sexy nurses than you can handle

and by sexy I mean dogged, intelligent, intuitive, creative, and progressive. When I started my nursing education I was looking for the technical skills to care for those in need. Learning more about the field I’ve come to realize that being a nurse is a call to be a strong advocate, influential progressive, and great humanitarian. I can’t describe how thrilling (and daunting) it is to be a part of this heritage.

MY TOP 5 (of so so many) FAVORITE NURSES IN HISTORY:

1.) Florence Nightengale (uh duh): Left life in the lap of luxury to minister to soldiers on the front of the Crimean war, way ahead of the times advocate for sanitation and hygiene, foundations of nursing education, kickass poison pen letters.

2.) Walt Whitman: Volunteer Civil War nurse, recorded dying soldiers’ narratives and wrote letters to their loved ones, fell in love with everything and wrote best poetry of all time forever.

3.) Clara Barton: Fought the man to get supplies to the front in the Civil War, founded Red Cross, sustained bullet holes in petticoat. The only nurse I’ve ever been for Halloween (I was like 10).

4.) Lillian Wald: Visiting Nurse Service of NY providing home visiting nurses to immigrant tenements, Henry Street Settlement House (comprehensive health and social services), foundations of public health nursing and social work.

5.) Margaret Sanger: Women’s health advocate of the century, THE PILL (offering it, doing research on its safety and efficacy), Planned Parenthood, ballsy civil disobedient. Her flier is even multi-lingual! <3 <3 <3

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Falling into the gap.

Midsummer 2012 the supreme court upheld the majority of the provisions of the ACA, and people like me who had made every major life decision since turning 22 based on where I could get health insurance (hello preexisting conditions) breathed a deep sigh of relief, wept one tear, and took a long nap.

Fast-forward to now and the part of the decision that made it optional for states to decline to expand their Medicaid programs is taking it’s toll. In states where Medicaid was not expanded, the majority of adults making under 100% of the federal poverty level have no options for health insurance. They do not qualify for the incentives available through health insurance exchanges. They cannot afford private coverage. Unethical.

Just for fun, here’s the states by political party in 2013 (source):

governors 2012

Uninsured people will still use emergency departments and be inpatients, putting hospitals in a tough position as part of the ACA takes away the pre-ACA measure of DSH (disproportionate share hospital) funding (federal dollars) that hospitals needed to account for the absence of reimbursement from these uninsured folks. DSH dollars were supposed to be replaced by payments from Medicaid insurance dollars. In states that did not expand Medicaid, DSH dollars are being replaced by zero dollars. IMHO this is on the state–but Obamacare takes the knock. From the patients denied access to affordable care, the hospitals that are in dire straights financially, and the communities that are losing their hospitals (and often largest employers) as they just can’t stay afloat.

I’m working up posts describing how one qualifies for Medicaid in non-expanded states, the state incentives offered by Medicaid expansion, and the burden on local communities with large numbers of uninsured people in poverty. This is a mire, but I can’t think of one more worthwhile to wade through. PARTY TIME!

RAM: Remote Area Medicine

RAM is well know within the VA healthcare community. Clinics are held in tents, trailers, and the Wise County Fairgrounds’ livestock stalls. Lines are legendary. People sleep in cars and on the open ground for days to get a chance to have teeth pulled, rudimentary diagnostics, and the scant amount of education and management of chronic conditions that time allows. Efforts by medical and dental staff are herculean and all volunteer. Patients are nearly all uninsured (which does not at all mean they are not working if you must ask).

This is an access issue, people! RAM was developed to provide care to remote villages in South America. Over 60% of RAM clinics are now in the US. It is the primary source of healthcare for thousands of people in Southwest. WaPo did some great reporting on it this year,  and now we’ve got an independent film coming out.

The WaPo article is titled Misery that Shouldn’t Exist. Cough Medicaid expansion cough cough. More to come on the politics, the policy, the people.

The struggle is real.