Health Care Conundrum

There is a quandary that comes up frequently for me as a visiting nurse.  It occurs when a patient has been hospitalized for a life threatening illness, recovers and is sent to a rehab/skilled nursing facility to convalesce. When discharged home the patient is given the meds that remain from a 30 day supply used in the SNF, but no prescriptions.  It is expected they will see their own doctor to get their prescriptions.  Usually, these patients have not had a primary care doctor prior to this event.

I call and plead with the physician to call in scripts to the pharmacy so the patient will not suffer a relapse.   Most insist on seeing the patient first, I can understand that. What frustrates me most, is when the patient sees a provider who is not the pcp, and they do not write the patient any scripts. The patient is told to get them from the PCP. The number one reason patients get re-hospitalized is not taking their medications correctly or in this case not at all.

This reminds me of our yearly safety teaching.  Every year we are asked "Who is responsible for safety?" The answer is " everyone".  So I ask, who is responsible for making sure there is continuity of care? All of us. If health care providers truly care about improving outcomes and lowering the cost of medical care, they need to stop passing the buck. There has to be a change in the culture of medicine that puts all the responsibility on the primary physician. No patient should be left behind.  No patient should have to navigate our complicated web of health care alone.  Everyone is accountable. Everyone should treat the patient in front of them as if they are their primary patient.

This happens in nursing, too. How often have patients been told they have to wait for their assigned nurse to minister to their needs? Too often.  It also happens in home care. Nurses visiting patients as a substitute for the primary nurse sometimes leave important tasks for the primary nurse to complete. This is not the expectation and holding those accountable has proven difficult.

What is the solution? I think we need to hold each other accountable and making the commitment to putting the patient first and foremost.  When we do all we can to assure the patient is going to be successful in mastering their health challenge, patient satisfaction will rise, emergency care will decrease, and costs will become more manageable.

Its not difficult, and its the right thing to do.

Learning from mistakes

Failure is a great teacher and motivator.  We are all afraid of making mistakes or looking foolish, myself included.  But I have to remember that no one tries something new and masters it on the first attempt, so why should I expect learning about blogging would be any different? 

I am no stranger to taking on challenging assignments. When I graduated nursing school I started out working in the Operating Room of a community hospital.  I had no idea what I was getting myself into.  Many a day and night I was terrified I would make a mistake.  I did not have a preceptor and I was expected to figure it out.  After 6 months, the head nurse informed me my performance was sub par.  I had to agree with her, I offered that I was trying as best as I could to learn the job by reading OR texts and observing as much as possible, but without more support, I could not learn the job.  She agreed and with more support I was able to take on any assignment with confidence.  Eventually, I moved to Boston, where with support and experience, I mastered the role.  Several more times in my career, I moved into areas that required special skill sets. The key to success for me has been to get past my fear of failure and working hard to mastering new skills.  

I have lived through the dawn of electronic charting.  For those of you who have always charted in a computer, you may not be aware of the difficulty it was to transition.  Great and experienced nurses were reduced to tears and some even quit nursing.  Even for those of us with some computer skills, the software was poorly designed and did not take into account the needs of the clinician.  This was before Informatics Nurses and why informatics became a specialty.   About 5 years ago, the organization I work for  changed over to a new computer software package.  The leader in charge of educating all the staff in using the program had a saying “You have to make the same mistake six times before you can master it”.   At the time, I found that prediction to be very annoying, but unfortunately, she was right.   I would keep making the same mistakes until finally, I figured it out and it became second nature.  

So here I am, making the same mistakes over and over again.  This time, that prediction of making  mistakes  before mastery is more amusing to me.  It has helped me to be more patient with myself as I try to master the skill of blogging.  Just using the blog program is a struggle for me. The writing is easy and fun, but creating the page is a whole new skill set.  Blogging has opened up a whole new world for me of what is going on in nursing.  And for that I again thank The View.  If they had not started the firestorm over Kelley Johnson's monologue, who knows how long it would have taken me to discover all those great bloggers and try it for myself.

Practicing my new blogging skill, adding hyperlinks

  I love this site, Better after 50 has great relationship, fashion and health tips. Besides being very funny, it is geared to those of us who are of a certain age.





My favorite nursing blog is The Nerdy Nurse, this is where I did my research on blogging, I still have many more to view.