Five Tips to Success

It's not the first time I've been asked what have been the influences on my life that have allowed me to flourish in my personal and public life. Contemplating "success" (as I stand with my feet in the chilly Spring Atlantic ocean), I am happy. The sensation of the ocean breeze, the smell of the salt air, the cool sand and the sharp tingle as the water breaks over my feet... I am alive, and I am happy.

Success is being open to your own potential and not being afraid of it:

1. Listen: to others, without your own inner monologue getting in the way. Really pay attention to what people have to say. 

2. Respect: yourself first: don't sell yourself short. And then, respect others: avoid the inherent noise based on what people look like, sound like, dress like..

3. Trust: your instincts. If what someone says sounds wrong to your inner self, it probably is. Do the research. Check things out. But trust your gut.

4. Focus: keep your eye on the ball. Set up your plan (short term, mid-term, long-term) for your goals for yourself. Review regularly.  When you need to be flexible, do it.

5. Leap: and don't be afraid. All that stuff about doors closing and windows opening-- it's true. Don't be afraid to take a chance: "I wonder what would happen if..."

6. Enjoy (I know, I said Five things, but...): don't take yourself too seriously. A sense of humour and a smile always helps.

Optimistic healthcare

I seem to think about this blog like the box of cookies I found in the living room cabinet, where I had stored it for 'later'... and then forgot it was there. Fortunately, they were still edible... not sure what the shelf-life for chocolate cookies is, really. Who cares. Chocolate is chocolate.

Okay, but I think perhaps if I keep writing my thoughts, eventually my hard thinking will permeate someone else's brain and there will be a groundswell of surprisingly intelligent actions re: healthcare-- sort of like how suddenly everyone decided to really like coffee or cupcakes. Maybe really liking healthcare reform will be next...

I live in hope.

I am not a young person. In fact, most of my friends are tipping into being what I would have considered old-- when I was younger. Sixty seemed like ancient; now it's behind me, and I have to admit, most of the time, I don't think of myself as 'old'. But I know, deep down, that eventually I will be not so flexible or full of energy.

I was walking the dog (or he was walking me) this evening & I passed an elderly couple-- the man walking in front of his wife by a few paces... we said hello & something about the weather... and his wife, walking behind, a smile on her face, just kept walking. I have seen them around the neighbourhood before & I know the woman has some form of dementia-- lives at home with her husband, who obviously takes good care of her. And I think, "So, what will happen when there are so many more of us... in that age group, with these needs?".

We have Community Care Access Centres that are supposed to be system navigators here in Ontario. But they don't work. They REALLY don't work. Everyone I speak with (who doesn't work at a CCAC) feels this way. There are components of these centres that are good, and people that want to do the right thing-- I don't disagree with that... but there are so many "wrong" things about this set-up-- and I have seen them across the province, acting the same way.

To be politically correct is to remain silent in this case. We have a new Minister of Health, but he's said he doesn't have plans to change the current structure of the LHINs and CCACs. I hope that once he has the opportunity to really look at their mandate and how they function, he will realize that there are far more effective ways of providing these services.

I certainly don't have answers. But I have questions. For example, how is it that the CCACs say the patients/clients in the community "belong" to them-- and that the agencies have no right to engage clients in (for example) studies (that have been through Ethics & have approval) without the express approval of the CCAC? Why is there a layer of bureaucracy at the CCAC that demands nurses fill in paperwork and have to ask permission to change visit schedules, dressings, etc.? (and often from non-nurses at the CCAC)? Why was there an enormous amount of time, money and energy spent on introducing "Outcome Based Pathways" (which were mandated by the OACCAC across the province-- and this has now been shelved???

Answer me these questions-- along with why the OACCAC office is on the "Mink Mile" on Bloor Street in Toronto-- (look it up on Google maps if you don't believe me: 130 Bloor Street West, Toronto, Ontario M5S 1N5) tucked in with Cartier, Louis Vuitton, Gucci, etc.... where the bathroom in the OACCAC has marble tiles that would each pay for someone's compression stockings for a couple of years...

So how is the Ontario government putting a stop to the profligate spending and arrogance demonstrated time and time again in this bureaucratic nightmare (for anyone who is NOT part of the CCAC...). ? So far, doing nothing.

As I said, I know there are good people within the CCACs. But I also know that there are enormous flaws in this system that require a complete re-working of the Empire. Because that's what it's become. And frankly, before I and my cohort really need the healthcare services, as our lives unravel like old sweaters, or like the elderly couple out walking in my neighbourhood-- I worry-- how long will they be able to manage? And how will the bureaucratic fortress of the CCACs be in any position to help?

You know, this is not right. We need to have intelligent decisions made-- and the people making the decisions need to be, not policy analysts & accountants & business-people, but nurses and doctors and allied healthcare workers along with patients and their families. We need a strong Ministry of Health to help do this-- and a solid electronic healthcare information/data system too-- one that can keep track of data and ensure we are doing the right thing, and spending our money wisely.

Because it is OUR money. I don't want to pay for rent in the Mink Mile when I'm told a patient can't have a service or a dressing because it costs too much.

Healthcare that would work

There always seems to be great attention paid to how to improve the healthcare system in this country. First, I think we have a pretty darn good system--thanks to Tommy Douglas and the legacy of our system of universal healthcare. But that being the pat on the back, we need to now take a long look at how this system needs updating. and I'm not just talking about a new hair-do, or repainting the front door to something more trendy... we need a big time overhaul.

To start with, the pyramid of care, with the physician at the peak, has got to go. From what I've seen from my MD friends and colleagues, they don't wanna be at the top--they want some quality of life, some down-time and the opportunity to really do the best they can without feeling like they are dancing on the head of a pin all the time.

I had to have eye surgery--nothing major, just a little laser weld-job on a retinal tear ("just" I say...), and it happened at the Ivey Eye Institute in London about a month ago-- my optometrist found the tear and sent me over to the Institute right away--she called them & they said, "C'mon over...we're waiting for you!!" In 3 hours, I'd seen a Clinical Clerk, a Year 2 Resident, a Year 4 Resident, and finally the surgeon, who was refreshingly knowledgeable, professional and quick: fixed me up in a matter of minutes.

But when I went back for the check-up, before heading up to the cottage, I arrived for my 9:30 appointment and he finally saw me for the requisite 10 minutes (if it was even that long) at 11:00am. In the intervening time, I'd seen the poor man dashing around, trying not to look superhuman or like a clone of himself, seeing a vast array of patients for a variety of things. All by himself. I asked him where his minions were, and he said, "Oh, they're all off learning things elsewhere"...and I thought, this is really the place for a Nurse Practitioner. or two. You could easily have 2 NPs seeing these patients and confirming "yup, that tear is healing" or "nope... there's a problem... now you need to see the surgeon". Then, the surgeon is used for his/her skills and the NP can see the garden variety patients. Believe it or not, the NP can be taught these skills--and best, know how to provide education, follow-up info and recognize when there is a problem when the surgeon really does need to be consulted.

Wow, if we had a system like that, imagine how many patients could be seen? Imagine how useful the surgeon's time would be--and how many actual surgeries he/she could perform? and, bonus, what about putting the surgeon on a salary, instead of fee-for-service? That way, he/she would have benefits, a pension, sick days...all the things "normal" professionals have.

I would bet that the majority of MDs would love a system where they could actually do what they have been highly trained to do--if they had colleagues (e.g., NPs) whom they could trust to do the other, less complex stuff. And, bonus, they could be paid a salary that would give them a reasonable wage. Gee, we could get rid of the bureaucracy of OHIP (does anyone actually know how much OHIP costs us??). Old doctors could retire, young doctors could have kids and families and time off, and other healthcare providers (like NPs) could work to their scope of practice and provide the excellent care, based on knowledge, research and (that over-used term) best practice. Patients would get the very best, and it would be faster, more appropriate and less expensive.

What's wrong with that picture, then? Why isn't this the way we are doing things? Well, old habits die hard, and those people who are entrenched in power can't understand how this "new way" could possibly be better, safer, more effective and efficient. If the MD is no longer top of the healthcare foodchain, how could that possibly work?

One way is to start looking at using the right people for the right job. Value engineering (a theory I particularly like) seems to fit this--choose the person who is the best fit for the job--get out of the old assumptions that only one "type" can do a job. So, why not have a clinic where the surgeon sees the complex patients, and the NPs (or RNs working to their full scope of practice) who are trained by the surgeon, see those patients who are likely to be "normal" or "routine".

why not? We need to start changing the way we do the "business" of healthcare.

Spring! Time to re-create!

Ah! This Spring has jumped the ice and snow (what ice? what snow?) and we have lolled in sunshine, warmth and daffodils, rather than snow shovels, winter parkas, layers of mittens, scarves, hats and boots...it feels as if we have escaped something. SSHHH... a couple of days ago, there was snow--for a brief few minutes anyway, and I thought "good, the winter stuff is still hanging in the front hall!". But before I could reach for the boots, it had stopped.
Today was sunny; I ate my lunch outside by the pond and considered the garden, the fountain that needs replacing, what plants might need to be moved... All the while, the cardinals, and other less flashy birds hung out by the bird feeder, swatting away the squirrels who seem inordinately fat this year (squirrels: a topic for another more rant-like post!!).
Today is full of potential. I'm always travel-hungry in the Spring, but this year I am feeling the rush of hopefulness, despite the gloom/belt tightening around us (another topic for another day). I see potential in this world: opening up the box to look outside--there is Spring.

So much has happened!!

It has been a long time since I've written anything here--life gets in the way, with changing jobs, more renovations, thinking about how and what I want to do... Right now I am enjoying working in an environment where I can actually feel change happening--where there are opportunities to be creative in ways that will improve patient care, by sharing knowledge.

I like this concept. It seems that we spend a lot of time spinning our wheels or reinventing the wheel-- looking for solutions to what are actually fairly simple things. For example, in my world, how to heal a wound is sometimes not the important question, but exploring the reasons behind why a wound won't heal would be the place(s) to look.

If you take away someone's specialty bed because the "system" will only cover the cost for 2 months, and the person has a wound that is likely not going to heal because the individual is unable to walk...then economically, what is the purpose of continuing to throw nursing care, dressings, etc at someone who really won't heal without that bed surface or some way to off-load the pressure and manage the drainage?

so in my "new" world, can I make change happen? Maybe not quick enough for this patient, but perhaps help to put in place some mechanisms so we pay more attention to the underlying (ha ha) issues rather than the "put a bandaid on it and walk away" approach. I hope so. For now, I'm an optimist.

September: the new year!

I always consider September as the new year. Having been a student for such a long time, I guess that's only normal...and the Fall signals the turning of the seasons to something more introspective than the perfusion of blossoms and warmth of summer, when basking in the sun, enjoying the long days and silken evenings is coming to a close. Although this year, the summer is still in full swing (hot, humid days; flowers rioting in the garden and pond).

The first day of school used to be the moment to step into those plaid, slightly scratchy wool jumpers, long socks, brushed hair pulled back with barrettes... but now, the first day of school will be shorts and tee-shirts, flip-flop sandals. Can't imagine anyone wearing wool in this heat!

And for me, I'm starting a new job next week, so that will be exciting and different... no shorts & tees, but I'll pass on the wool jumper too.

summertime

Mid-summer. All the activities of paring down (the yard sale earlier this month) and relaxing (the Home County Folk Festival, visiting some wineries in the Niagara region) are just the thing for our short time with summer.

When I consider complaining about the heat (it was 33 degrees C. today), I just have to look back at some of the photos of the winter--and this winter was particularly "challenging" in terms of the amount/frequency of snow!! I like winter for a couple of weeks, when the snow is white and crispy. But longer than that, and I'm ready to consider moving to some climate where winter and snow don't drag on.

So the summer heat is refreshing and delightful as I watch my garden unfold in various blooms. The dog lies down beside the pond, cooling his belly on the flagstones. I make sure the bird feeders are topped up, the fountains continuing to burble...and relax in the fragrant warmth of summertime. Too short...

Enrichment

Thinking of a word that somehow brings to light the feeling of more than being happy, of being “enriched” in the way one feels waking up from the best night’s sleep, in a beautiful room, with the light just so—and no bills to pay, no pressing engagements of the day. Waking up to the aroma of coffee.

I spend my life walking around this word, this concept.

perfection is in the eye of the beholder

Walking the dog this morning (a cool Sunday, nice change from the heat/humidity last week) and I, of course, am snooping other people's gardens--at least those gardens that are visible from the sidewalk. Several gardens on my usual route are wonderful: peonies and irises in full bloom with candy-pink and royal purple flowers, along with other pretty plants (although somewhat less spectacularly sized). These gardens are immaculate, with neatly mowed lawns, swept and clean patios, flower beds with tidy borders.

The first emotion, after the bliss of such beauty, is anxiety. I consider my own chaotic gardens and worry that the lack of order somehow reflects badly on me as a gardener. However it doesn't take long to realize that my gardens are fine the way they are; the untidiness is really just an expression of joy at the ability of flowers to bloom, birds to come and fish to dash around in the pond that manages to remain the best part of the garden despite the maple keys that shower into it and a fountain that sometimes sputters to a stop, clogged with debris. The lawn is lumpy, the grass is a bit long, the borders of my flower beds uneven and there are weeds.

But when I'm in my backyard,  I'm happy. No comparisons with those gorgeous gardens on my walk. It's the perfect place to be.

listen to the little voice in your head

I went to the Southwest Local Health Integration Network (LHIN) first Quality Symposium on Thursday (torrential rains, high winds to drive through on the way to Stratford) & was impressed by the themes presented by a number of the speakers--including the provincial Minister of Health, the Honourable Deb Matthews, PhD (her background is demographics, how appropriate!). The "end-note" speaker was Steven Lewis (not to be confused with Stephen Lewis, who would have been equally at home there). But the messages of how to maintain universal healthcare in the face of the increasingly elderly demographic with multiple chronic health issues were reminders of that little voice in my head.

I am the Participaction generation, with medals to prove my ability, as a 10 year old, to be supremely (well, okay, reasonably) fit. But it got me into running, cycling and other activities that have remained part of my life--even if sometimes taking second or third place to other things, like having children and working/going to school.

As a wound care specialist, I have seen the effects of sedentary lifestyle, eating junk food,  high salt consumption, diet pop instead of water or milk, and cigarette smoking. I have patients with diabetes, high blood pressure, lousy circulation, sore joints (ankles, knees, hips) and sometimes joint replacements or other "corrective" surgeries. The majority of these individuals are overweight. And not by just 10 pounds or so, but what we politely call, "morbidly obese". Obesity is an epidemic, we all know, and it's not getting any better.

I look around and think, it's not that hard. When that little voice in your head says, "You don't really need to eat that" or " How about parking the car a block further so you can get some exercise" or " Yeah, that cough IS from smoking. You do need to quit before it kills you". It's time to say "YES, you're right!"

Last year, I listened to the little voice. I lost about 40 pounds, started to exercise (aquafit, yoga, cycling--things I enjoy) and WOW!! How much better do I feel? A million times better. I don't plan to be in that chronic illness demographic as I get older.

Do you?

Having A Space of One's Own

I remember reading Virginia Woolf's "A Room of One's Own" when I was about twenty & considering how important it was to make sure I had my own space. At the time, it seemed easy to do: the extra bedroom would be my "workroom", with the long table, the sewing machine, art, fabric, photos, drawings. The window looking out over the garden...

Years went by and the space somehow disappeared. Children needed bedrooms, toys and books, musical instruments, their art, their imaginative jumble, took over everywhere, and my "space" became smaller and smaller.

There was always an office (and at home, a desk carved out in a corner), but the idea of "space", where creativity was more the focus, was elusive.

Now I find that I am once again in a position to claim "space" for myself. It feels a bit strange, like an almost forgotten memory of something I once did... this won't be the same space as anything I had before, and I feel much more tentative about the creative part of it. But I suspect I will begin to enjoy this place.

A new space. Arms outstretched, I feel the fluttering of ideas.

Do as I say, not as I do.

Yesterday I was vehemently encouraging patients to eat their lunch. My goal was to promote wound healing; and nutrition plays a huge role in providing the energy the body requires to heal. I always tell people that wounds need three things to heal: get rid of the cause (often pressure related), give the body optimal nutrition and last, consider the dressing.
So I spend a lot of time encouraging people to eat.
Yesterday at about 3 o'clock, I was running around the hospital, feeling tired and headachy. Hmm... did I have lunch? Uh, no. How often do I miss lunch because I'm too busy? Hmm...more than I should.

So, telling other people to do things is easy. Sometimes telling yourself the same thing--and following through--is hard!
I had lunch today, though.

The Black Dog of Happiness

Pets are the best. Patients faces light up when their pet comes in to visit--granted, these have to be arranged in advance, the pet has to be "vetted" (ha ha) and have a better health inspection than most of us. But imagine how nice it feels to have that companion with the warm, moist nose and friendly eyes, lying beside you on the bed.

what it's like to be deaf

Over the past six months or so, I have had to face up to the fact that I need a hearing aid. I'm deaf in my right ear. Nearly 60% deaf. It's strange-- I thought it was "just wax" and when Joan, the Nurse Practitioner at the Family Health Network reamed out my ears, I thought she hadn't done a complete job, since I still couldn't hear well out of my right ear. Noooo.... she said, "go to an audiologist". So off I went to Canada Hears and lo and behold, I really couldn't hear. Hearing aid time.

Hey, only old people have hearing aids. Not so, as my daughter pointed out, some of her best friends have had hearing aids since they were little. I felt very Politically Incorrect. And old. But given the family history of osteoarthritis (in the ear???), it's not that surprising. Unlike my uncle Leopold Kohr, who was stone deaf and most annoying -- and must have been frustrated himself, because his hearing aid, that looked like some sort of big recording device he'd hold up to your face (someone at a cocktail party once leaned into it and said "testing, testing, one, two, three" assuming it was, in fact, going to record him, as Uncle Poldi merely was trying to hear him better). Anyway, I'm not STONE deaf, just on the right side.

So, stand to my left, wouldya?

commemorating my mother

My mother was an amazing woman. She was a pharmacist, with a BSc in Pharmacy from University of Toronto in the 1930s, with only a few other women in her class. She was a business woman, entrepreneur, involved in the Canadian Consumers' Association, drove a Karman Ghia convertible, and was working on a Real Estate License when she became ill with what turned out to be ovarian cancer.

She was 54 when she died, a year after being diagnosed. As a 17 year old, I was not prepared for my mother's demise. In fact, I didn't realize she was dying until a few weeks before she actually died. Up until then, I assumed she was just sick & would recover and come home. Almost a year in the hospital, she wasted away until even as a self-centred teen-ager, I could no longer avoid the inevitable truth. She was going to die.

When I look at the list of famous women who have died of ovarian cancer, the most obvious thing is how young they were when they died; mostly in their forties, fifties and early sixties. What does this do to families, whose main anchor is taken away? I know what happened to our family. It was very, very hard.

If I was in a position to create a foundation, it would be in the memory of my mother and other women like her: hard working, loving, energetic role-models for their children and those around them--and taken away half a century too soon.

Some day, I hope I can do this. Ovarian cancer is still the deadly silent killer, that destroys families by taking away mothers, wives, sisters.
What can we do to win this battle?

Palliative care: on death's doorstep??

There seems to be a mis-understanding that if someone needs Palliative Care (in the hospital), they might as well be heading to the cemetery. I have these discussions with people sometimes, where they look anxious & worried when the word "Palliative" is mentioned. As healthcare providers, we work hard to deal with pain in particular, to try to help patients get what they need. And as it becomes obvious to us that someone is likely not going to recover, and is, in fact, deteriorating... that's when the thought of Palliative Care comes to mind.
I have friends who are part of the Palliative Care team and I suspect they feel mis-understood when people refuse the offer of their services, because they think of Palliative Care as being at the very final end of life. But we have many patients who receive much better pain management, and other symptom management (nausea, constipation,etc) because the Palliative Care team are experts in making those subtle combinations of drugs work well--and keep people as functional and comfortable as possible.
As well, they are the ones whose kind and gentle faces, hands and voices are there to provide solace and support during what can be a long, exhausting process of moving from life to death. A natural thing, but still very hard to accept for many people.

passport photos

I went to have my passport photo taken today. My passport is due to expire, and rather than go through the effort (and detail required) to have a whole new passport, I thought I'd actually be organized enough to get the few things I need for the renewal. One of these was the photo.

My friend Christine told me that the little post office around the corner does passport photos for about $10., which was half what Black's charges. So I went there. Had my picture taken by an elderly man who had set up the photo area like a Karsh studio. The lights, the bounce-foil umbrella, the white board to hold on my lap to deal with the shadows under my chin (fleetingly worried that this might be just my chin(s)).

And the result: I look less like a terrorist/escaped convict and more like a disgruntled housewife. Sad, but true. The photographer said, "Try to put more softness in your eyes", since I clearly was forbidden to smile--now that we are all suspect if we look pleasant & happy.

Unfortunately, I don't think, unless you're a trained model, that looking pleasant while forcing a solemn expression somewhere between grim and unhappy, can do the trick. Oh well, at least it's done and I can get on with the next step in the process...

Now I just need to find my birth certificate. Where did I put that thing???

Learned Helplessness

There seems to be a culture of letting the experts make the decisions in healthcare... and it's to the detriment of the critical thinking skills nurses have learned and developed in their educational and experiential programs. I recall Seligman's idea of "Learned Helplessness" as a theory that explained how people seem to give up/allow others to make decisions. Although a good portion of this is in relation to depression, it also applies to how people learn from others who model the behaviour.

Nurses generally work in groups and my observation is that the "new" nurses to the unit want to fit in, and want to develop a style that is congruent with the overall style of the unit (often not an official style, but the way the natural leaders of the unit behave). If it's the norm to defer to the expertise of others, then that's the way it works. While this is fine if the nursing knowledge might actually be limited, I find it puzzling that for chronic wound care, nurses will wait for the MD to write orders before even looking at the wound.

This strikes me as odd, since nurses need to assess the whole patient in order to identify nursing-relevant plans of care & to wait for the doctor to open/assess the wound implies that the nurse can't do this him/herself. Last time I checked, this was within the realm of practice of nurses (in Ontario, anyway). So, why not do it?

I think it's that sense of not really knowing what to do...that someone else has more expertise--even when they actually don't, or when the nurse does have enough knowledge to figure out what might be an appropriate treatment (unless it's a particularly complex situation). But I've had nurses say to me that they "need" an order for a chronic wound dressing, as if they are unable to make observations and suggestions themselves.

Not that I'm trying to work my way out of a job (although that would be gratifying, if every nurse knew what needed to be done, and felt comfortable/confident to do it, for those garden-variety chronic wounds). And I guess, if we could get over the feeling that somehow we just aren't quite capable...

certificates and certification

It's interesting that every  workshop I attend-- whether it's a couple of hours or a couple of days in length-- has a "Certificate of Attendance" (often pretty fancy, with my name in caligraphic font) that I could hang on my wall.

I also provide these for my Wound Care Made Simple workshops, because people can keep these as reminders for their College of Nurses self-assessment, or for their institution's performance review. But I always tell people it's a Certificate of ATTENDANCE, not for any kind of certification. Just means you've been there, warming a seat (hopefully learning something too, but since there's no test, who really knows!). I have heard people say that they have been "certified" by attending some workshop or conference, and that's a bit scary.

Certification means something else: an approved (by an academic/regulatory body, like a College or University) program with a standardized method of evaluation.

So, much as those "Certificates of Attendance" can be quite beautiful to display on the wall, they merely indicate you've been to something. And maybe learned something... : )

I had to change my title...

I was going to write something fairly long about how I had to make sure my academic credentials wouldn't possibly lead to confusion. But I worry that these sorts of things get out of hand, and just cause more anxiety. So, suffice to say, I now have "Tertiary Care Nurse Practitioner Certificate (UWO, 1998)" after my other academic credentials.

I used to joke that I wanted more letters AFTER my name than my name. Hmm. I've succeeded now, for sure. But the point for me is that I earned those credentials & I don't want someone to think because I now have to spell out the whole thing, I'll just give up and go away. Definitely not my style.