The Quixotic Nurse

As a nurse writer and blogger, I often use metaphor as a way to express deeper ideas about nursing and healthcare. In the past, I've explored the myths of Sisyphus and Hercules as they relate to nurses and the nursing profession, and my nature continues to point me towards metaphor as a tool for understanding.

I've recently been considering the figure of Don Quixote as another metaphor related to our often beleaguered profession; although much has been written about Quixote and the author Miguel Cervantes, I don't believe anything has been written about the potentially quixotic nature of nurses. So, my friends, I give you the notion of "The Quixotic Nurse".

(Note: this post is much longer than my usual 500-600 words. Please bear with me and consider this long-form post as a necessary means to my desired literary end.)

APRNs and 21st-Century American Healthcare

Advanced Practice Registered Nurses (APRNs) are an increasingly important fixture within the 21^st-century American healthcare system and nursing profession. Full practice authority is a central key to APRNs’ ability to fulfill the needs of the American public, and it’s time for such authority to be granted nationwide.

Nurse Change Agents Can Mix It Up

Nurses, when you're at work, do you feel like there are things that need to change? Are there processes, policies, or nursing procedures that everyone follows but seem woefully inefficient or old school? Are people at work stuck doing things the same old way just because no one has taken the initiative to pivot and alter the pattern? That can be frustrating, especially if you're a natural born nurse change agent.

Nurses Rising

Nurses are legion. We populate almost every corner of the healthcare industry, and we are the largest segment of the global healthcare workforce. In terms of hands-on care, we're at the bedside, in the home, caring for residents of long-term care facilities, taking care of schoolchildren, ministering to the dying, and tending the wounded on the battlefield. Like I said, we are legion, and our importance to society cannot be underestimated.

Congresswoman Eddie Bernice Johnson Introduces the National Nurse Act of 2013

Since the issue first came to my attention several years ago, I have strongly supported the passage of the National Nurse Act and the establishment of a National Nurse for Public Health. The following is a press release distributed on February 4th by the National Nursing Network Organization Board of Directors. It is reproduced with their kind permission.

The Consequences of Nurse Burnout

So, my friends, the votes are in and the verdict is clear. Nurse burnout has real consequences and a ripple effect that is far-reaching and pervasive. Now that we clearly know that the impact is real, just what will we do about it?

The ANA Speaks Out

Perusing the internet today, I noticed an article that described how a recent American Nurses Association House of Delegates meeting ended with several notable resolutions being passed. Let's take a look at those resolutions and their potential impact.

The Burden of Medical Bills

A recent study released by the CDC (and reported on Medscape and other sites) states the blunt fact that 20% of American households have difficulty paying their medical bills. And the National Center for Health Statistics states that 1 in 5 Americans has lived in a family that could not pay its medical bills in the last 12 months.

Hate and Healthcare

With physical intimidation, racial epithets and other threats being aimed at lawmakers who voted for health care reform, a newly appalling era of American politics seems to have dawned.

As members of The Tea Party call Representative Barney Frank a "faggot" and scream the "N-word" at Representative John Lewis, a true Civil Rights-era hero, the level of debate in the country has certainly taken a decidedly downward turn.

The controversial vote on health care reform has indeed made many enemies, and it is widely agreed that there is no way that this legislation will please everyone. While some on the left feel that the "reform" is nothing but a capitalist grab at health care dollars, many on the right opine equally strongly that "socialism" is now simply lapping at the shores of the country against the will of the majority of voters.

Never having purported to be terribly politically astute, I have admittedly had a difficult time sorting through the fact and fiction about the legislation in question, and my personal jury is currently out. While I am glad that Congress took bold action, I have concerns about provisions that may line the pockets of some insurance companies, other provisions that could hurt small businesses, and the glaring lack of a single-payer option similar to that of other industrialized nations.

Misgivings about the legislation aside, there is no room in such a debate for hateful speech, legislators being spit on, bricks being thrown through windows, physical intimidation, and other tactics which underscore the divisiveness of the issue with a complete lack of intellectual prowess or forethought. As we learned during the Civil Rights era, change is painful, and those who resist change can sometimes resort to actions and words that are hurtful, divisive and sorely regrettable.

Racial slurs and homophobic language have no place in this debate, nor do threats of death and injury. Heckling is one thing, but the foul language and violent actions of those protesting health care reform have no place in our society.

No one knows how the health care debate will unfold, and neither can we predict how the political fortunes of its authors and supporters will be changed. What is crystal clear to me at this time in history is that there are still elements within the United States who are willing to use intimidation and hateful speech to make their discontent known. Such angry action and speech is a waste of breath and energy, and will most likely only backfire on those who use it. Shame on those who stoop so low, and shame on those who sit back quietly without protest as such ugliness spills into our streets.

The National Health Service

As Congress argues about whether national health care can ever be a reality here in the United States (with fears of socialism abounding), the British National Health Service (NHS) is often brought up as an example of socialized medicine gone awry.

Just a few days ago, I received an email from a contact who wanted me to share with my readers some real facts about the NHS in order to counter many of the falsehoods bandied about. The NHS was established in 1948 for the benefit of the residents of England, Wales, Scotland and Northern Ireland, and contrary to popular opinion here in the US, residents of those countries can indeed purchase private health insurance, go to private hospitals and otherwise pursue high-quality care.

An article on Health Express extolls many of the positive aspects of the NHS, readers can click here to peruse the article in its entirety.

A few highlights of this review of the NHS include:

• The first successful "test-tube baby" was born under the auspices of the NHS in 1978
• Nurses make up 30% of the NHS workforce
• Almost 1 out of every 23 residents of Wales and England are employed by the NHS
• The NHS pays for and supports 16,000 home births per year
• Life expectancy for both men and women has increased by 10 years since the NHS was founded

While I have no illusions that the NHS is perfect, and I have no doubt that there are plenty of British citizens ready to complain about their healthcare (or lack thereof), it's interesting to hear of the successes of the NHS, and have additional information from which to form an opinion.

Meanwhile, millions of American children and adults still live without any health insurance whatsoever, and a considerable percentage of home foreclosures in the US are due to health care bills which homeowners simply cannot pay.

Health care in the US is frequently a sad state of affairs, and perhaps some day we'll look back on the millions of uninsured as a sad stain on our health care history. Til then, the debate rages on........

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?"

Obama Administration and Congress Invest in Nurses

Several major American nursing organizations are applauding the support demonstrated by Congress and the Obama administration for the nursing profession, with newly allocated funding that should have a profound impact on every aspect of nursing, including the central focuses of education, practice, retention and recruitment.

As part of the American Recovery and Reinvestment Act (H.R. 1), $300 million were awarded to the National Health Service Corps and $200 million will be divided between the Nursing Workforce Development Programs (Title VIII of the Public Health Service Act) and the Health Professions Training Programs (Title VII). $10 billion will also be allocated for the National Institutes of Health, with $7.4 billion distributed to various Institutes, including the National Institute of Nursing Research, further demonstrating that nursing's contributions to both the clinical and research worlds is indeed taken seriously.

The provisions in H.R. 1 allow for money to be distributed directly to nursing students and schools of nursing, with allocations for Title VII programs like Scholarships for Disadvantaged Students and the Faculty Loan Repayment Program.

Additionally, the monies allocated for the National Health Service Corps will fund scholarships and loans to nurse practitioners, certified nurse-midwives, primary care physicians, dentists, mental and behavioral health professionals, physician assistants and dental hygienists.

In blog posts leading up to President Obama's inauguration, I voiced cautious optimism (and some considerable doubt) that an Obama administration would pay close enough attention to the nursing shortage, addressing not only the need for increased scholarships and education funding for nursing students, but also funding to address the lack of qualified nursing professors available to educate new nurses. Seemingly, multiple levels of the nursing profession have been addressed under the auspices of these new programs, and the money allocated will not only provide scholarships for nursing students, but will also offer loan repayment programs for those nurses who might wish to teach but would likely be dissuaded by the relatively low salaries offered to nursing professors.

I am heartened by this news, and foresee a blossoming of the nursing profession at a time when a universal nursing shortage (and an economy in apparent free fall) inform the overarching zeitgeist that currently casts a pall over the entire health care industry. Yes, most nursing schools are filled to capacity, yet that capacity is generally hobbled by a profound shortage of professors, a reality which very well may be addressed as these funds become available.

These are difficult economic times for many Americans, and as President Obama's economic recovery plan is actualized, we will begin to see the ways in which the plan may succeed and fail. Over all, I feel optimistic that, in terms of the nursing profession and the profound shortage therein,we will sense a discernible sea change if the allocated funds are targeted and distributed as proposed. While I have not seen the fine print (and we all know that the large print can giveth and the small print taketh away), my hope is that the fine print will in no way diminish the potential impact of such an historically and economically significant investment in the future of nursing.

Despite the dire warnings and the hand wringing occuring nationwide as the unemployment roles grow, perhaps some optimism, positive movement and job growth within the nursing profession will have a ripple effect throughout the health care industry. And for this we can only hope.

Chronic Disease and Optimism for the Future

A recent press conference sponsored by the Partnership to Fight Chronic Disease (PFCD) revealed a startling statistic: chronic disease costs the American taxpayer more than two Wall Street bailouts per year. (To listen to the press conference or download a transcript, click here.)

According to PFCD, 45% of Americans live with a chronic illness; poorly controlled asthma sends 5,000 people to the ER every day; and obesity rates of American teenagers has tripled in the last 20 years.

Perusing the PFCD website, it's obvious that there is a great deal of optimism being verbalized vis-a-vis the opportunity that Barack Obama and his administration have in terms of addressing chronic illness and health care reform. Improvement in the management of chronic illness is seen as a clearly bipartisan issue by many in the know, and a number of members of Congress are apparently already preparing policies vis-a-vis these issues in advance of Mr. Obama's inauguration and first 100 days of governance.

In terms of technological advances, there are many policy-makers and consumers who are calling for a national Electronic Medical Record (EMR) that will streamline information, track prescription drug use and medical visits, as well as allow more continuity of care. This type of system would also allow for easy access to immunization records, would simplify facility-to-facility patient transfers, and facilitate care of patients who have moved or who need health care while traveling. Furthermore, chronic disease care could also be greatly enhanced by such centralized record-keeping, providing crucial financial and medical data about the overall state of American health---and its medical management. While pundits (justifiably) worry that a government-run EMR could raise Orwellian privacy concerns, perhaps some type of third-party oversight could assuage such fears as the project moves ahead.

Obviously, something needs to be done to address the state of disarray in which we find health care in America. We are less healthy, more obese, taking more chronic medications, and experiencing greater levels of stress than ever before. Sadly, 40 million of us are still uninsured (a pathetic statistic which I am apt to belabor ad nauseum here on Digital Doorway), and the percentage of us suffering from chronic conditions such as diabetes and heart disease is currently rising.

As 2009 beckons, the Obama-Biden transition team is revving its engines and preparing for an all-out attack on the American economy, including the economics of health care. In my virtual peregrinations, I am seeing that a great deal of optimism is being expressed vis-a-vis the future of health care and chronic illness management in the United States. As the economy inevitably rises from the ashes and financial stability returns to the markets, many feel that the health care
infrastructure will also revive itself with government-funded resources aimed at curbing chronic illness and improving public health. As a newly-minted Public Health Nurse, I am quietly joining that chorus of optimism, and will do my best (from my lowly municipal position) to support those valuable and forward-thinking efforts.

The Obama-Biden Health Care Agenda

The Obama-Biden Transition Team is requesting that all interested citizens pay a visit to the transition's website, Change.gov, and voice ideas and concerns regarding American health care and health care reform. By clicking here, you can go directly to the web page dedicated to the health care agenda and submit your opinions and views.

The Obama-Biden web page discusses health care in this manner:

"On health care reform, the American people are too often offered two extremes -- government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.

"The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

"Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options."

Allegedly, the plan would:

• Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
• Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
• Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
• Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
• Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees' health care.
• Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
• Ensure everyone who needs it will receive a tax credit for their premiums.
• Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.
• Require hospitals to collect and report health care cost and quality data.
• Reduce the costs of catastrophic illnesses for employers and their employees.
• Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.

I am personally dubious that insurance company practices can be sufficiently reformed to prevent abuses. I am also dubious that such a ponderous system administered by both the federal government and employers will not prove incredibly complex and difficult to manage for employers, government officials, insurers, providers, and consumers alike.

In terms of the plan, I would also like to see the following:

• details regarding a more robust national plan of preventive health care initiatives
• sufficient funding for public health initiatives
• sufficient funding for emergency preparedness and the national Medical Reserve Corps
• a comprehensive plan to decrease the nursing shortage, including grants and loan forgiveness
• a plan to assuage the nationwide shortage of primary care physicians
• a plan to create an Office of the National Nurse

Despite my reservations, doubts, and dubiousness, it is indeed exciting to see a new administration apparently dedicated to transparency, as well as the active participation of all Americans in the process of change that is underway.

Meanwhile, I am willing to suspend my disbelief, listen to the conversation, join in on the conversation when I have something useful to say, and watch as the story unfolds. These are exciting and nerve-wracking times, and I do indeed hope that the change that has been promised will indeed be delivered. Until that time, patience is one virtue we will all need to put into practice.

The Office of the National Nurse and the Obama Administration

Now that Barack Obama has been elected and some changes in the trajectory of American healthcare are on the way, those of us who support the creation of an Office of the National Nurse are asking that citizens supportive of our cause please communicate that support to the Obama team. For a review of the importance of such an office, please see my previous blog post on the subject. To communicate your opinion to the Obama-Biden team, please click here.

While the current Chief Nurse Officer (CNO) of the United States serves as Assistant Surgeon General, many of us feel strongly that it is time for nurses to be taken seriously as key players in the development of far-reaching preventive measures to improve the health and well-being of the American people. Rather than have the CNO remain in a subservient role to the Surgeon General, giving the National Nurse a prominent, autonomous and equal part in the government's efforts vis-a-vis preventive healthcare would send a clear message that the nursing profession has finally received the recognition it deserves.

Nursing has a great deal to offer to the American healthcare system and to policy discussions vis-a-vis the changes that are needed to improve the health and well-being of all Americans. The establishment of the Office of the National Nurse would be a major step towards recognizing the profession of nursing for its contributions to medicine and health (separate and autonomous from the medical profession), and for moving the United States and its citizens towards improved self-care, improved health outcomes, and renewed standing as a country that views the health of its citizens as a true measure of "national security".

To send the Obama-Biden administration a message regarding this issue---or any issue close to your heart---simply click here to visit a special page for communicating your vision of America to the incoming administration. Your support for the establishment of an Office of the National Nurse would be greatly appreciated.

Obama, Daschle and Healthcare

It is now confirmed that Barack Obama has asked former South Dakota Senator Tom Daschle to serve as the administration's Secretary of Health and Human Services. While the nominee has already undergone a rigorous vetting process by the Obama transition team, he will of course face a Senate confirmation hearing after the President-Elect is inaugurated on January 20th. I will venture a guess that Daschle will be handily confirmed by the Senate, and I imagine that he is already setting his sights on a broad plan of action. Whether that plan leads to successful change in the healthcare trenches remains to be seen.

Meanwhile, a powerful bipartisan group of senators met in the offices of Edward Kennedy (D-MA) today, at the behest of Senator Max Baucus (D-MT), to begin shaping potential Democratic legislation vis-a-vis broad healthcare reform.

With 15% of the country's GDP going to healthcare and the number of American uninsured (estimated at 40 to 47 million) expected to rise as layoffs and unemployment increase in response to the economy, the stakes are high for meaningful healthcare reform.

We all know we can do better. In terms of healthcare access, funding and quality of care, the World Health Organization has ranked the United States as 37th in the world. Concurrently, our ranking in terms of infant mortality and life expectancy also continue to plummet when compared with other nations. These statistics bear out the widely accepted notion that the enormous per capita expenditures on healthcare by the United States government have fallen far short of their potential, and many other countries have somehow managed to produce far better results utilizing a percentage of what we spend here.

The battle regarding the potential benefits and pitfalls of universal healthcare is on. Yesterday on Digital Doorway, I pointed readers towards an excellent website where the arguments for and against universal government-sponsored healthcare is being argued quite cogently. This nationwide conversation will only intensify, and it remains to be seen how the Obama administration will rise to this Herculean challenge.

I am personally and professionally invested in the developments vis-a-vis healthcare reform in the United States, and I assume it will be years before we know the true successes or failures of President Obama's efforts, with support from Tom Daschle and other key players (not to mention the input of the American people, if it is heeded amidst the noise).

These next months and years will be an interesting affair, and great grist for writers, bloggers, healthcare policy professionals, pundits, and ordinary citizens alike. Meanwhile, as the conversation and debate rages, the statistics related to the uninsured and underinsured will certainly worsen. We can only hope and pray that a truly remarkable (and successful) solution is indeed within reach.

Obama, Healthcare and A Trio of Mythic Figures

(Note: This is my second post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

Barack Obama, the presumed Democratic nominee for President, faces a tough crowd when talking about healthcare in America. As a nurse, I myself am a tough crowd, and my cynicism towards politicians of any stripe runs relatively deep. In my (potentially naive) hopes for a universal, single-payer health plan for all Americans, I see potential for such a future in some of Senator Obama's positions, but when it comes to his chances (and true motivation) to deliver the goods, my jury is still definitively out.

When perusing the Senator's website, we begin with a quote by Mr. Obama from a speech in Iowa City on May 29, 2007:

“We now face an opportunity — and an obligation — to turn the page on the failed politics of yesterday's health care debates. My plan begins by covering every American. If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the 45 million Americans who don't have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness.”

At face value, this sounds like a wonderful idea and I'm interested to know the details. I heard similar rhetoric from the Clinton Administration in the early 90's (and we all know how that panned out). Still, the sentiment---of universal coverage regardless of pre-existing conditions and no change to current premiums---makes some salient points.

Further on, the data is there for all to see: an estimated 47 million uninsured Americans, including 9 million children. Health insurance premiums have risen four times as fast as wages over the last six years, and less than 4 cents of every healthcare dollar is spent on prevention and public health.

Mr. Obama's plan promises many things:

*Coverage for all Americans that is similar to the coverage now provided to members of Congress

*Guaranteed eligibility

*Comprehensive benefits, including mental health, maternity, and preventive care

*Affordable premiums, co-pays and deductibles

*Subsidies for those who do not qualify for Medicaid or SCHIP but cannot afford premiums

*Simplified paper work and decreased costs

*Easy enrollment

*A National Health Insurance Exchange which provides portability from state to state and job to job without loss of coverage

*Employer contributions with exemptions for small businesses

*Mandatory coverage for children

*Expansion of Medicaid and SCHIP

*Flexibility for states already implementing their own plans

I agree that all of the points outlined above are like music to this nurse's ears. With portability, 100% eligibility for all Americans, expansion of Medicaid---it all seems too good to be true. The site continues to describe plans for lowering costs by modernizing the healthcare delivery system, disease management programs, team management of chronic illness, patient safety, independent research on effectiveness, a comprehensive effort to redress health disparities, and stronger anti-trust laws with a goal of decreased malpractice insurance premiums and fewer lawsuits.

Obama's plan also addresses the need for electronic medical records, less reliance on paper charts, and increased competition for drug companies and insurers, not to mention increased biomedical research, an expansion of the global fight against AIDS, support for Americans with disabilities, mental health parity, lead and mercury poisoning prevention, and increased research related to Autism.

Reading my downloaded copy of the plan in further detail, I was disappointed by the omission of several key issues that have been very much on my mind in recent months:

1) The nursing shortage: although Senator Obama's plan states that the number of "primary care providers and public health practitioners" are dwindling, the plan makes no mention of nurses, the (global) nursing shortage, and the need for massive investment in training, increased nursing faculty, loan programs, and other incentives to a) keep nurses in the workforce, b) prevent burnout by decreasing nurse-patient ratios, c) provide financial incentives for those who wish to be nursing faculty, and d) expand enrollment in nursing education. Where does he stand on the nursing shortage, and how can he not consider it a cornerstone of any meaningful national healthcare policy?

2) Schools and student health: although the Senator's plan addresses the need for expanded physical fitness in schools, improved use of lunch programs, and "more healthful environments" in the nation's schools, the plan fails to mention that although the federal government mandates that there be one school nurse for every 750 children, the national average is more than 1,110 children per nurse, with some states far exceeding even that number. Nurses are essential to the health of our school-age children, and Senator Obama seems to have overlooked this very important point. However, we can rest assured that there is a full-time nurse on staff in any private school attended by Mr. Obama's privileged children.

3) Dental coverage: it is widely understood that dental health is one of the most important forms of preventive healthcare, but the Obama health plan fails to mention dental care in the large or the fine print. Millions of Americans who indeed have health coverage through their employers or a private insurance plan still lack dental coverage for even the most routine care. When it comes to the prevention of infection, improved immune function and proper nutrition, dental care is paramount. Unnecessary tooth and bone loss, oral cancers, and preventable complications from dental diseases are truly public health disasters. If the plan for American universal coverage does not include universal coverage for preventive and corrective dentistry, a serious source of chronic health problems will not have been addressed or alleviated.

4) Stem-cell research: one must take note that the Senator's plan makes no mention of advancing and expanding stem-cell research, a controversial issue stymied by the unscientific and "values-based" prognostications of the Bush Administration, although he does call for increased biomedical research (a euphemism, perhaps, in order to not alienate a certain type of moderate voter?)

I am in no way a policy-oriented person, and when it comes to politics, I tend to sit on the sidelines and watch the wheels turn (with the occasional blog post for good measure). Mr. Obama's healthcare plan is impressive in both depth and breadth, and if he can actualize his plan in the real world, we will certainly be considerably more better off as a nation than we are now. As far as the blind eye that the Senator has turned to the nursing shortage (at least as far as his healthcare plan is concerned), he would do well to realize the importance of nursing to the success of any national healthcare agenda and address the very realistic concerns which nurses have raised again and again.

As I said earlier in this article, my jury is still out vis-a-vis Obama's ability to actually manifest his vision when the campaign is over and the ticker-tape has been swept from the streets. History has illustrated again and again that "politics-as-usual" can rear its ugly head quite quickly when the mad dash of the campaign season is over.

Obama's hardest fight will not even begin until he sits in that famous Oval Office and attempts to wrestle with the troubles of the day. Will his ambitious healthcare plan survive the deluge of responsibilities and decisions (and special interests) which will make themselves painfully known after January 20th? Will he see that nurses really matter, and then succeed in bringing their needs to the table? This (somewhat cynical) nurse isn't so sure, but I am willing to give the Senator the benefit of the doubt as long as his efforts remain focused on the needs of ordinary Americans, and not on the desires of lobbyists, insurance company executives, Big Pharma, hospital CEOs, and others who feel that their agenda should supercede that of the American citizenry.

It is the uninsured, the disabled and the working poor (and their children) who truly carry the burden of our dysfunctional and top-heavy healthcare system. With more money spent per capita on healthcare than any other industrialized country in the world, the United States ranks embarrassingly low in terms of poverty, infant mortality, obesity rates, and many other statistical markers of overall public health. This is a travesty.

Transforming American healthcare is at best a Herculean task of enormous proportions, and any president who shoulders the burden could also be compared to yet another long-suffering mythic figure, Atlas. We can only hope that a President Obama would not instead become a figure more akin to Sisyphus, the mythical man doomed for eternity to roll a boulder up a hill every day, only to have it roll to the bottom before he begins the struggle once more. Mythically speaking, I believe that Sisyphus most accurately (and sadly) represents the life history of healthcare reform in America, with Bill and Hillary playing the parts of the last unlucky Sisyphean figures to traverse that cursed hill.

Obama will struggle against many forces united to defeat a movement towards healthcare parity for all Americans, and the interests with the financial wherewithal to thwart such a struggle are more powerful than most of us know. While my cynicism often gets the best of me, I do indeed hold out hope for a healthcare system that can function smoothly and efficiently, keep costs under control, improve public health, advance research, reverse the nursing shortage, and address the myriad concerns mentioned in this and thousands of other diatribes about the current state of healthcare in these United States.

I wish Mr. Obama Godspeed in attempting what has been up until now an impossible task, and I will continually strive to keep my cynicism at bay as we move closer to the day when a new administration assumes its (Sisyphean?) place in the Oval Office.