The bottom line: a THANK YOU to all the people at HMC East who helped me over the years.
Here in Honolulu two hospitals closed recently. It made the national news. For years the organization than ran these two places teetered under a large debt load. Finally the bank said they couldn’t help any more and the place went bankrupt. About a thousand people added to the unemployment line, including maybe three hundred Registered Nurses.
Paradox of Organizational Bankruptcy
Yes, the place went bankrupt and closed. But here is a paradox: the front-line employees were doing a good job, and were very dedicated. Makes me think back to 1984 when due to the implementation of DRGs and the Reagan Budget, there was a “Reduction-in-Force” at the community hospital in Maine where I was a department head. That was the first time I ever dealt with this from a management point of view. Our little hospital laid off about forty people as I recall. People cried and it was about more than just the loss of a paycheck. in 1984, an excellent employee who was among the survivors also got emotional as she said “what was I doing wrong to cause this?”
The answer was: nothing. The front-line worker did not cause the problem back then. That’s still true here, today.
A daily witness of dedication to small things
Back to Honolulu. Part of the reason I loved using that hospital for clinical was that the nurse’s aides worked so hard and took such pride in their work. I was teaching beginner nursing students and the focus was to acquire basic skills – making sure the patients were clean and comfortable, happy and safe. This is a challenge sometimes when major incurable health problems exist; to meet these goals on a day-in-day-out basis requires hard work and dedication and backbreaking labor. It requires teamwork and communication. When the patient lives in a chronic care situation, the room at the institution becomes their home. If they were with their family they would thrive on love and a sense of belonging. At the hospital, the staff worked hard to provide that element. That is what kept things going – love and a sense of family that complemented excellent care.
Watch what I do….
All of these attributes were modeled to my students every day we were there over the past six years. The nursing students who signed up for clinical there could see it immediately and learn. I think I had nearly two hundred and fifty students cycle through that Skilled Nursing Facility over that time. These young University students started their professional careers on Skilled Nursing and then these took the lessons of how to work hard, make assessments, use a “nurse’s brain” and other intangibles, to all their subsequent clinical experiences. Many of these former students now work in specialty areas such as ICU. Starting at SNF gave them confidence in the basics.
One of the ironies is that to a large extent, it was the Nurse’s Aides who modeled these things. Oh, the RNs and LPNs were excellent, but many of the basic skills I was teaching were ones an aide carries out in real life. It’s not just the tasks, but such things as how to remain upbeat when you are helping the tenth helpless patient of the day to regain dignity after fecal incontinence. How to stay motivated when this happens day after day, for weeks. A long list of such things, but you get the idea.
Even Sisyphus could learn to take pride in his work
Most of the Nurses Aides at this place spoke Ilokano, the language of Ilokos Norte in the P.I. The crew was also old enough to be the mother of a University student. Here was another thing the staff and students shared, since the student group was mostly “local.” There is a long tradition of caring among this cultural group and nursing has always occupied a place of honor for persons from the Philippine Islands. I think the positive attitude also has to do with being Catholic, and this was formerly a Catholic hospital.
But I digress. Today I am thinking of this group of people, and also about any person who does a task that others might think of as menial. They brought a professionalism and sense of spirit to their work which I admired. Even the most humbling job can be carried out with dignity and pride in the outcome. A task which may seem unpleasant to an outsider can be carried out in such a way that it validates the humanity of both the recipient and the caregiver. And the willingness to start every day with a smile and a good attitude, is infectious in even the most somber surroundings. The team is being dismantled, but I hope that each is able to know, down deep, that they did nothing wrong.
These are wonderful people and I am sorry to see them on the unemployment line.