Wednesday, September 30, 2009

Facing the Unknown

The health care debate seems to be full of unknowns these days. As the arguments over health care reform heat up to the boiling point, the notion of a government-run program raises the hackles of so many people across the spectrum, and cries of socialism are heard across the land. Will our care be rationed? Will grandma be left to die when a bureaucrat decides that she has reached her life expectancy and her surgery is not cost effective based on her age? Misrepresentation and misinformation abounds.

Meanwhile, H1N1 challenges the public health infrastructure, and the availability and distribution of the vaccine poses questions that still cannot be fully answered. And as the manufacturing of that new vaccine is ramped up, seasonal flu vaccine distribution has been slowed to a veritable trickle, confounding the plans of even the most earnest local health department.

Speaking of H1N1, studies now show that many pregnant women and others eligible for the H1N1 vaccine will refuse to receive it, leaving public health officials wondering just who will want it, anyway? In our local circles, many of us are asking the following question: "If we throw an H1N1 party, will anyone come?"

Wednesday, September 23, 2009

A Replacement Cometh

Today was the day when we interviewed the four top candidates to replace me in my position as Public Health Nurse. Without disclosing anything specific about the interviews or the interviewees themselves, it was a relief to realize that, yes, there are a number of qualified candidates who are interested in taking my place and assuming all of my responsibilities. Even more encouraging, our #1 choice is available to start on October 1st, which would afford a two-week overlap before I gracefully exit, stage left.

In prior blog posts (see "Stirrings of Nursely Guilt"), I have discussed the feeling of being indispensable as a nurse, carrying my nursing positions like crosses that I alone can bear. That's complete hogwash, of course, and I continue to process the emotions that lay beneath the nursely guilt complex.

Leaving my current position---at a time when the public health infrastructure is facing its greatest challenge in a generation---is truly a test of my personal resolve, and the guilt underscores for me the fact that I truly want to leave my position in qualified and well-prepared hands.

Today, it seems that the capable and qualified hands for which I have been waiting may well be ready to relieve me of my occupational burden (and guilt!), and I am only now beginning to see glimmers of light at the end of the tunnel.

Personally, these are exciting times as my wife and I ready ourselves for the cross-country trip of a lifetime. Wresting ourselves from our occupational shackles is one of the final acts that we must mindfully commit prior to stepping off of the precipice into the Great Unknown. And knowing that we may very well have found the person to whom I can pass the public health torch is a feeling of relief beyond measure. Now, as I wait to hear that the offer of employment has been accepted, I dare not to hold my breath........

Monday, September 21, 2009

Most Famous Nurses in History

Dear Readers,

Here is a link to a very interesting and informative post on the 25 most famous nurses in history, including a separate section on famous fictional nurses. Of course, they have not yet included Bob the Nurse on such lists, but I intend to make sure that Bob does indeed go down in nursing history!

Sunday, September 20, 2009

Finding a Successor

This week, we will interview four potential successors, intrepid nurses who are willing (and hopefully able) to pick up where I leave off on October 15th. The one who is chosen to take my place will inherit my office, my files, my newly written Public Health Nurse training manual, my many responsibilities, and the certainty that this flu season will be a doozy.

In preparation for my departure, I will continue to write the training manual, purge and organize files, order supplies, and administer as many flu shots as I can before my successor takes over. Now, the problem is that production and distribution of the seasonal flu vaccine is now slowing to a trickle as manufacturers try to cope with the ramped up need for H1N1 vaccine. So, plan as we may, how can we hold successful and far-reaching flu clinics if the flu vaccine is in short supply? Woe to the public health nurse who wants to be ahead of the 8-ball for a change.

So, we prepare, we strategize, and we hope---with multiple fingers crossed---that one of the interviewees is indeed intrepid, ready, willing, and able to pick up the torch and run with it into the crashing waves of flu season.

Friday, September 18, 2009

Change of Shift at Medic 999

The newest edition of Change of Shift, the famous nursing blog carnival, is up and ready for visiting at Medic 999. Pay a visit!

Monday, September 14, 2009

H1N1: Many Questions and Stormy Days Ahead

The questions about H1N1 are coming fast and furious now, and I often don't know what to say.

Seniors feel slighted because they're lowest on the priority list for the new H1N1 vaccine. Middle-aged people who are otherwise healthy who would like the vaccine notice that they do not meet the criteria for being in the first wave of recipients, if at all. There are the many health care workers who usually don't receive a flu vaccine and are reluctant to get the H1N1 vaccine, even if it means protecting their patients from illness. Meanwhile, pregnant women are afraid to receive this newly formulated vaccine, even though they are top priority for receiving it in order to protect their gestating children, and parents of school age children are also afraid. And then there's the conspiracy theorists who feel it's all a government ploy to poison, sicken, and subjugate us.

What's an earnest Public Health Nurse to do, anyway?

The concerns, the worries, the misgivings, the fears, the suspicions---they are all rising to the surface as the flu season kicks into gear. There is certainly confusing information out there, and some of it even seems contradictory. We can rest assured that many media outlets will undoubtedly get it wrong along the way, further adding to the confusion that so many people feel.

So I answer calls, assuage fears, refer people to the most reliable websites about H1N1, and I cross my fingers that we find a qualified replacement for me before I leave my position on October 15th. It's a wild influenza world out there, and something tells me the weather's about to get rougher.

Friday, September 11, 2009

The Nurse as Sisyphus

As I march headlong towards my last day at work as a public health nurse, I am reminded again and again how the work of a nurse often seems Sisyphean in nature. Sisyphus, you may recall, is the poor downtrodden soul who was doomed by Hades to spend the rest of his days pushing a boulder up an impossibly steep hill, only to have it roll back down at the end of the day, making his day's toil utterly useless.

Now, I am not meaning to say that my work as a nurse is thankless, pointless and unrewarding. Far from it. But the Sisyphean aspect of nursing resides in the notion that whatever we do, however we do it, it never seems to be enough. Nursing of all kinds demands attention to detail, amazing amounts of paperwork, vast stores of patience (and some patients, as well, of course), and a willingness to consistently give more than you may have been ready or able to give. In my view, nursing is often the work of the willingly codependent, those of us willing, able and ready to go above and beyond again and again, even when it is against our better judgment, compromises our health, and subjects us to the vicissitudes of stress-induced illness.

As a nurse, I have consistently found myself in positions wherein I felt indispensable, the repository of information or knowledge that is, a) difficult to pass on and, b) incredibly important. Whether it be patient care or public health management, taking my leave of a nursing position is so often fraught with anxiety, hard work, and the knowledge that not everything that I know can be clearly communicated to my successor.

Winding up my work as a public health nurse, I am hard pressed to write down the endless details that constitute my position and my work from day to day. When I took this position, I was given five sheets of paper with cryptic instructions, three hours of rushed training, and an office and files that were in dire need of organization. I inherited a multifaceted position that was poorly explained and passed on in a manner that created the steepest possible learning curve as I dipped my toes in the waters of local public health.

Now, preparing for my successor (who has yet to be identified despite my having given a very generous three months' notice some two months ago), I am writing a training manual, organizing files, streamlining processes, and preparing for what I hope will be two full weeks of training for a position that is simultaneously fascinating and maddening.

As my wife and I prepare to step into the unknown in our personal lives, I am hoping to create as few unknowns as possible for the intrepid soul who picks up where I leave off at the health department. And with H1N1 breathing down our necks, that will not be a small undertaking for myself or the next in line.

So, I struggle to create a seamless transition, knowing full well that some "t" will be left uncrossed, some "i" undotted, and some loose end will inevitable be left untied. Did I say that this undertaking was Sisyphean? It may very well seem that way, but on October 15th when I leave that office behind, my shoulder will no longer bear the burden of the boulder being pushed up that hill, and I, for one, will rejoice at the freedom that the loss of that burden will engender.

Wednesday, September 09, 2009

Can Obama Do It?

Even though I rarely listen to the radio anymore and no longer have TV, we tuned into President Obama's health care speech this evening, and I felt stirrings of hope as his words flowed through the airwaves.

Not having examined the speech closely, my hope is tinged with a hint of cynicism at the ways of Washington, but with the post-humous words of Ted Kennedy spurring us on, I feel that perhaps the reform we have all been waiting for may actually come to pass.

Even as the debate rages on, millions of American children still live without health insurance, the unemployed and underemployed seek primary care in emergency rooms, and the self-employed struggle to find coverage that doesn't break the bank.

Cries of socialism abound, but the President reminds us that Medicare itself was derided as being tantamount to socialism back in the day, and that "sacred trust" is now a promise that no American would ever wish to see broken.

I hold out hope that we will see comprehensive health care reform in this decade, and that my grandchildren will grow up in a country where they will never need to choose between medicine and groceries.

Health care reform? Socialism? If every American can obtain affordable coverage and no one has to go without, then I don't care what we call it. Can Obama do it? Only time will tell.

Monday, September 07, 2009

Stirrings of Nursely Guilt

Well, in a mere 6 weeks I will be saying goodbye to my work as a Public Health Nurse and hitting the open road with my wife and dog (see our new blog for details).

So, what does it mean to eschew the trappings of the workaday world and leave the workforce, at least temporarily? What does it say about someone who works in public health and chooses to step out of that role just as H1N1 begins to rear its wintry head in our very direction? How selfish am I?

As I prepare to quit my job, leave the workaday world, pack up our cares and woes, gear up the RV and launch ourselves onto the highways and byways of America, I feel stirrings of nursely guilt that I am abandoning ship just as my country needs me the most.

Sure, we could have changed our plans. We could have chosen to spend yet another frosty winter in New England, slogging through the snow to save humanity. But my wife and I are making another choice. We are choosing to catapult our lives forward in a radical way, and doing something this radical has its price, and one price that I am currently paying is the feeling that I am breaking ranks when my services are most urgently needed.

Now, I am not one to think that no one else can do my job. There are plenty of capable nurses out there, and two of them are interviewing for my position in a week or so. Still, taking leave of my job at this historical time does indeed put extra stress on our local public health infrastructure, and I am concerned that my replacement will completely miss the frying pan as she or he falls directly into the fire of H1N1 and flu season. (Oh, the guilt.)

Still, I am thankful and appreciative that my boss is so evolved and has given me her (understandably reluctant) blessings to go on my merry way. And perhaps my worries are for nothing. Will H1N1 fall flat on its face? Will the massive vaccination campaign never materialize? Will this public health juggernaut never leave the launchpad? I actually feel that the H1N1 horse has already left the gate and we are rushing headlong into what will be a pretty intense flu season, made infinitely more complicated by twin vaccination campaigns (for seasonal flu and H1N1).

May my successor accept this challenge with grace and equanimity, and may I take leave of my position without guilt or remorse. The helper and healer within me cringes at ever shirking my nursely responsibilities, and leaving this job at this time in history is one of the hardest professional decisions I have ever made.