Academic Pet Peeve: What’s yours?

Pet peeve of the day: careerism.

My career has been a great pleasure. I loved being a U.S. Public Health Service (USPHS) officer and I now love being an academic. The worlds have commonalities that drew me to them. They are filled with people that are dedicated to service and to making the world more beautiful. At their worst, there are too many careerists that never consider how their secrecy robs the public of knowledge.

I became a USPHS officer because I wanted to work with the poor and the underserved, but was too fearful of being poor to be a missionary or join the Peace Corps. I became an academic because I wanted to create new knowledge and share it to improve health care and quality of life.

Throughout my career, I have grown increasingly intolerant of those that take a taxpayer-paid salary or taxpayer-funded research grants and then refuse to openly share their work. Over and over I have seen people recreate the wheel because others didn’t know it existed or didn’t respect the person that created it and thus felt it necessary to recreate the work and again at taxpayer expense.

Today I heard an expert on nuclear preparedness communication hold forth on the need to, “make research accessible”. He went on to say that research cannot just be in the peer-reviewed literature. This would have had more integrity if he and most of his panelist had not prefaced their presentations by insisting that there be no photography or recording of their presentations as some of their work is copyrighted.

Hypocrisy: the practice of claiming to have moral standards or beliefs to which one’s own behavior does not conform; pretense.

Castle_Romeo_Atmospheric_Testing_Cropped

Nuclear preparedness research on how to best communicate with the public is critical to preparedness, but for it to be truly effective it must be put into practice not just at the higher levels of government, but it must get down to the workers, to the mom at home with children, or to the average nurse. As the speakers stated the average teacher or clinician doesn’t read the peer-reviewed literature. How will research get down to the bedside if researchers don’t freely and openly share their work? How will we be prepared for a nuclear event if those doing the research and government officials will not share?

If you really care about improving healthcare, making us more prepared, or creating new knowledge consider the impact on lives when careerism rules public good. We can’t let advancing a career trump the public good.

End of rant.

 


Good Nursing is Prudence

The intellect and not our will must guide our decisions. Yet, it is often our will that gets in the way of sound reasoning. Don’t we all want what we want? Would we not prefer to get our way? I know I would and at times my own will has gotten in the way of hearing what others had to say.

When I joined the U.S. Public Health Service (USPHS) I wanted to work with the poor and underserved. I had a mental image of what that meant. Simply, it was those in poverty or homeless. It had never occurred to me to consider those in prison or detained by immigration as poor or underserved. Nor did I ever consider the disproportionate impact that disasters have on those that are poor or homeless.

Late in my career, I accepted a job with the Administration for Children and Families (ACF) working for Daniel Schneider, who is now the Executive Director of the American Conservative Union and CPAC. I was fascinated by what he described to me. He wanted an office that would address the human services needs of people impacted by disaster and especially those that were poor or marginalized. He wanted the office and programs to be built on the principles of self-determination, self-sufficiency, federalism, flexibility and speed, and support to states. Of equal importance, he wanted a close working relationship with faith-based organizations. I was free to develop it as I saw fit so long as I understood that I was fully responsible for any success or failure. It was an opportunity to combine my work in disaster management and at the same time return to working with the poor and the underserved. I was all in and then I had my first meeting with faith-based groups that worked in disasters – ouch!

The first meeting was eye-opening. It was clear that people were angry and especially the person from the United Methodist Committee on Relief. There was bad blood and before I would ever be able to make progress fences needed to be mended. Fortunately, I didn’t have to do it alone. Two amazing organizations stepped forward and offered to help. The first was Catholic Charities, USA that filled me in on what had transpired following Hurricane Katrina. While I had worked in the Office of the Assistant Secretary for Preparedness and Response since 2001 I had no interaction with the human services programs. The second organization was the American Red Cross who suggested I let them host meetings on neutral grounds. I was grateful and realized that I needed to do a lot of listening.

While I listened I also knew that good policy had to be evidence-based or adapted from a policy that has historically been effective. It could not be based on emotion or lack intellectual reasoning. I understood that there had been hurt feelings and a lack of listening in the past, but I would not ignore that there were successful programs that could serve as models. While the population served was different the goals and objectives were the same. We needed to get to mutually agreeable principles and we needed to use evidence-based policy.

The stakeholder meetings revealed that health care was largely excluded from the services offered by Voluntary Organizations Active in Disasters (VOADS) and case managers rarely had health care experience. I wanted the case managers to be nurses, but the VOADS and my contracted faith-based organization wanted them to be lay people. We compromised and had a combination of case managers we trained and nurse case managers. When all the research was completed and the program pilot tested it turned out that what was primarily needed was the lay case manager with nurse case managers to be available for people with complicated medical needs and for consultation. Because I first listened and because we were all willing to follow the evidence we ended up with a program that we could all support. You can learn more about the ACF Disaster Case Management program at: https://www.acf.hhs.gov/ohsepr/response-recovery/disaster-case-management .

I considered the development of the Disaster Case Management program a great professional accomplishment. I had an amazing team, exceptional partners, and political appointees that trusted us to do our jobs and have the best interest of the country in mind. There was mutual respect. However, the sense of professional accomplishment paled in comparison to the change in my spiritual life.

When I was in Baton Rogue with Catholic Charities, USA I was asked to stay with them at the retreat center. They gave me free access to the grounds and the chapel and said I could use it anytime. I hadn’t been to a church of any kind since my twenties and so I was amused. Then I listened as CCUSA had to remind the Catholic sisters that they couldn’t give away all of the food. I watched as CCUSA personnel and volunteers worked with compassion and patience and with their dedication exemplified what it means to serve. I, on the other hand, could only see a mission to be accomplished and my cadre of young officers as tools to accomplish it. While CCUSA saw the humanity in everyone I wasn’t even seeing it in my own people. By the time I left something had changed. I was no longer listening with my ears, but with my heart. The VOADS and the faith-based organizations had a different perspective than the government. It wasn’t about sitreps, or numbers proving the success, but rather compassionate care provided to people that were suffering.  I woke up one day shortly after our time in Baton Rogue and announced I intended to retire. Not long after the project was completed I was working for a small Catholic university where I found what I sought and though I left the university after three years what I found and what they nurtured has never left me.

Following the evidence resulted in a policy that ensured better services to the poor and underserved impacted by a disaster. Letting the spirit transform the knowledge into an accomplishment for good put the program in hands that are filled with compassion. By being open to what was good and just rather than tactically efficient government and faith-based organizations were able to bring the best of what each has to offer to serve those in need.

I am forever grateful to Dan for the opportunity, to the administration at the time for prioritizing the poor, and to Brent whose faith I am sure crafted the principles on which the program was built and through which I found my faith. The experience showed me what I lacked as a human being, what I no longer wanted to be, and a path to a more compassionate existence.

Prudence is the birth mother of all virtue.

compassion


Civil Unrest and the Role of Nursing

The health care system must be aware of the impact civil unrest can have on the mission of providing care. We have watched, some with alarm and others with a sense of civic involvement, the incidents of civil unrest that have occurred in communities across the United States since 2014. As health care providers and administrators, we must be prepared to keep our doors open and we must know how to keep our facilities safe.

Please take the time to read

Nurse Leaders’ Response to Civil Unrest in the Urban Core

Inequalities in society, culture, and finance have resulted in civil unrest, rioting, and intentional violence throughout our history. Nowhere is this currently more apparent than in the cities of Ferguson and Baltimore. It is not the civil unrest itself, but the resulting rioting and intentional violence that can create a disaster situation. This increases the care burden of health care providers during times when the governmental structure may be overwhelmed or functioning in a less than optimal manner. Beginning with the death of Michael Brown, civil unrest over the last 2 years has necessitated a closer examination of the role nurse leaders play in preparing their staff and facilities for potential results of this civil unrest. The similarities between the results of rioting and violence and natural disaster are obvious, but the differences are significant. Without adequate preparation, providers may not offer the appropriate response. Attention to the 10 “musts” for preparedness for civil unrest will facilitate a planning process and provide for a better response and recovery when communities face these issues.