Alene Nitzky is an oncology nurse, author of Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care, Blue Bayou Press, 2018. She is a cancer exercise trainer and health coach, and is CEO/Founder of Cancer Harbors®.
Nurses can apply the principles of beneficience and nonmaleficience to heal healthcare.
As we were choosing our leaders for the next few years, the topics not being discussed were as important as the topics that were. One of the issues that didn’t get much attention during this recent, volatile election cycle was infrastructure.
Fixing infrastructure means rebuilding what’s broken or breaking down an underlying structure, which is, essentially, healing. It requires an ongoing process of careful assessment, diagnosis, planning, intervention, and evaluation. This needs to be discussed, especially as it relates to healthcare, and our work with patients.
It is the infrastructure of healthcare that is broken; not just our structures and processes, but ourselves. We need leadership to fix these issues, but leadership does not have to come from above.
Fixing healthcare infrastructure on a national level requires consideration of everyone who has a stake in it. We are putting resources (money, labor, time, energy, investment) into something that not all of us will necessarily need, benefit from, or use equally. As a society, we understand that the resources going into infrastructure will help people with needs that are different from our own, and we accept that.This approach requires empathy, and an understanding that just because you don’t need it now doesn’t mean you never will need it.
Some of the most strained infrastructure involves workplaces in healthcare. When there is not a collaborative model,when business interests at the top conflict with professional and practical needs among the care providers, we are all pulling in different directions. Administrators, nurses, and physicians have learned their respective skills, but none of it is built in a way to work together. We are always scrambling to retrofit after big changes, and no one ever seems to know what is coming at them.
We’ve spent billions of dollars on EHRs and new mandates that might have less to do with patient care than they do with executive compensation. Measurement for the sake of itself seems to be more important than what is being done as a whole.
Patients want to feel better without getting destroyed financially, nurses want to use their knowledge and skills and be allowed to give their patients the attention they need in a respectful, safe environment. Instead, we barely have time to do anything but documentation in our busy, automated days. Hands-on care gets minimized and delayed, creating additional sickness and suffering.
Executives, out of touch with the training of providers to heal rather than record and measure, push us into a factory production model, so essential services are understaffed and neglected, and the disintegration continues. It truly is sick care that we provide. We have put our resources in the wrong places for too long, and it’s time for a radical change.
When we look at the ideological division among people in this country, and how profoundly we have been affected by it, we realize that we cannot rely on leaders to fix our infrastructure. We are the infrastructure.
I am not saying this to be contentious. I am saying it because nurses cannot afford any more inertia or apathy, not in our daily lives, not in our work, not for our own health, and not for our families or communities. Most of us working in these systems are not healthy, physically, mentally, or holistically.
If we believe in the principles of beneficience and nonmaleficience, we need to take a close look at how we have conducted our professional lives and where we have abandoned our principles, to ourselves and to all who rely on us, by acquiescing to a system that is broken. By remaining silent, apathetic, divided and fearful, we are doing our patients, our families, and our communities no favors.
It starts with us. The public trusts our profession, but we don’t deserve that trust if we enable an abusive system that is crumbling before our eyes and taking our public health with it. Just like any elected leader who claims to represent us but only serves the highest bidder, we are at fault.
In a country of 320 million people, it cannot be every person for themselves. We are truly in this together, and it is long past time we stopped relying on others to do it for us. Nurses have skills to heal people, but we must heal the infrastructure, first through critical and honest assessment of ourselves. That starts with acknowledging we have power, and using it for the greater good.