On July 4th we celebrate the 248th anniversary of the signing of the Declaration of Independence. The document put forward that “all men (sic) are created equal” and endowed with the right to “life, liberty and the pursuit of happiness.”
Things were different then: the Founders did not consider that women, Native Americans, Africans, European indentured servants, and non-land owners should have any rights. We’ve changed as a nation in many ways.
But principles haven’t changed. Consider: what are the conditions that make it possible to live, enjoy freedom and pursue happiness? Certainly, quality healthcare is a necessary pre-requisite. That’s why we say, “Healthcare is a Right.”
This is defined as the mental process of actively conceptualizing, applying, analyzing, synthesizing and evaluating information to reach a conclusion. There’s a great deal of hype around this. Nurses are often told to use “critical thinking” when evaluating patients and developing care plans.
How often can we spend enough quality time with patients to engage in such thinking? What indication do we get from Employers that they care about what we think or need? When was the last staff meeting focused on what front-line nurses require to do our jobs better? What forms of professional development are offered free of charge to nurses on work time anymore?
The myth of shared governance
This misnomer, being promoted in a number of facilities, is little more than a forum to put forth management’s agenda with obligatory input from hands-on caregivers – a condition for getting magnet status. The critical element in true shared governance is budgetary control. That is clearly not up for discussion with direct care providers like us. While a few cosmetic changes might be made to appease unrest, fundamental practices are not altered as a result of such interaction.
Staffing, support, education and resources are the key elements in allowing for meaningful nurse-patient relationships – staffing being the most essential one. Unfortunately, few of our needs are met as nurses on a daily basis. EMR systems are not focused on care; their primary purpose is to provide optimum reimbursement to the facility. When nurses offer solutions to problems, it is often only through concerted activity, under the union umbrella, that we see real changes implemented.
Time for a new paradigm
The predominantly Assembly Line Care that we are forced to deliver – in spite of rhetoric to the contrary – will continue as long as we allow it to. When will nurses stop saying, “Oh, that will never happen,” or “The hospital says it can’t afford it,” or “Single Payer is a pipe dream. You’ll never get rid of these insurance companies?”
The famous Brazilian educator, Paolo Freire, developed the concept of “critical pedagogy.” He postulated that in most societies people are educated to be “objects” in our world, to be fed information which they then regurgitate in the form of exams or expected behaviors. Freire saw that liberated people are instead “subjects” of our world, with the capability of understanding and changing it.
As we celebrate Independence Day let’s examine this concept of liberty. We can choose to be victimized and powerless, with the illusion of influence. Or we can choose to think critically, become agents of change and exercise the freedoms that we value. That would require investigation, open and honest communication and collective action.