Burned and scarred

WARNING: This post contains sensitive content which some people may find offensive or disturbing.

Many of us assume that pay and other rewards are all that we can expect to receive from our work. There is less emphasis on less-tangible but equally important benefits like trust, respect, civility, and the opportunity to make a positive change. This view of our work encourages behavior and attitude that lead to employees’ burn out. Thus, contributing to a workplace culture that harms people’s well-being and sense of self.

Over the past years, I’ve struggled with the unprecedented consequences of psychological harassment (also known as bullying). Truth be told, I may not be the only one experiencing this. There are many who might have been blinded to see this kind of harassment as simply ‘part of the job’ or an act of ’keeping the organization intact’. Many of whom would not even know that they, too, are victims.

Our culture and system both cultivated a workplace environment that is punitive, antagonistic, cynical, and perhaps self-serving. Some of you might agree that culture, much like a system, is one that is hard to break or change. It takes considerable effort and political will to accomplish this. However, it is my fervent prayer to see the day that workers get to enjoy working in a workplace that emphasizes the importance of openness, trust, transparency, respect, integrity, and accountability.

It has been months since I began thinking about my next big step. And, the recent burn accident that happened to me while on duty showered (figuratively) me with enough motivation to seek some enlightenment. For now, nothing is definite. But I am only sure of one thing: my conscience is clear. Nothing that I ever did or said intended harm to anyone. My views, opinions, and actions are all in accordance with my personal principles, the ethics of nursing, and the vision and mission of the organizations I am affiliated with.

It saddens me that my pure intention to help, no matter how it is expressed, is often dismissed with prejudice. These preconceived opinions, which I believe are not based on reason, have led to several instances of misunderstanding, manipulation, and most especially misinterpretation. The constant desire to prove one’s worth and sincere intentions has surprisingly taken a toll on me.

Today, I begin to seek ways on how to regain myself. I might be better off seeking fertile soil elsewhere to cultivate my skills and share the fruits I long to offer our society, rather than trying to build a garden in a barren desert. I wish to end the nights of loneliness and self-doubt. I pray that one day I will be able to regain or improve my confidence, well-being, self-worth, and sense of self. Tomorrow, we start the process by going back to the bedside and care for people who currently need us most.

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Disclaimer: Views and opinions in this post are my own. They do not reflect the official positions of the organizations I am currently affiliated with. If the shoe fits, wear it.

WE SHOULDN’T BE SILENCED. WE MUST BE HEARD.

WE SHOULDN’T BE SILENCED. WE MUST BE HEARD.

It is almost always difficult to make a decision. Probably, it is harder during a pandemic when you battle against time and limited resources. Not all administrators will make the right decisions. Not all employees will have the same opinion. What’s common, I suppose, is the collective vision of ending the pandemic at the soonest time possible.

Everyone is afraid, anxious, or worried about dealing with many uncertainties. As a result, everybody is doing all things they can to be saved. Obviously, some *subordinates*, as they call them, would want to be heard. Some people talk in small groups. Some in bigger groups. During a pandemic, it is natural for these people to begin to raise their concerns about how things are being handled. It is common for people to criticize decisions they think are doing more harm than good. It is common for people to propose solutions to problems that directly (or indirectly) affect them.

On the one hand, it should NOT be common and natural for people to blatantly silence critics who are airing valid concerns. Issues, concerns and criticisms are all part of leadership. Rather than thinking of them as bullets attacking or undermining the administration, it is more important for administrators to consider them as challenges. Rather than play the victim, administrators can own criticisms and convert them into opportunities.

Too many administrators get too defensive and choose to focus more on their reputation. They tend to impulsively react and dismiss legitimate issues and concerns, rather than objectively assessing or reevaluating the situation at hand. There have been times when administrators turn the criticism around the person speaking up. They end up chasing the ‘mastermind’ who can easily be blamed, rather than seeing it as an opportunity to learn from someone else. Yes, even from someone among the “subordinates”.

Criticisms are sometimes a clear reflection of poor judgment, but never of character or personality. TAKING CRITICISM IS A DIFFICULT THING. But criticism can always be considered a form of communication – an honest feedback on what transpired after a decision was made. Such feedback can make us stronger by allowing us to listen to honest views that tell us what can be done better. Moreover, TAKING CRITICISM IS UNCOMFORTABLE but it forces us to think about how we work and how we decide. Constructive criticism can guide us away from making poor judgment and subscribing to bad practices.

I believe one of the most important qualities of an administrator is being a good listener. And that applies more when one is being criticized. Don’t always shut them down. Turn up the volume, lend your ears, and listen to what is being said. Be the change agent people want you to be. Turn the negativity into an avenue that enables growth, maturity, and innovation. Turn words into action. Show that you can listen to feedback and at the same time get the job done. Together, let us change the workplace culture of blame. Let us heed the call to become more honest, transparent, and consistent.

Rather than flashing your palm at someone, open up your arms and say…
“I have thought about what you said and this is what I’m planning to do. What more do you think can we do?”

Nurses’ professional and moral duty

Nurses have 5 fundamental responsibilities:
-to promote health
-to prevent illness
-to restore health
-to alleviate suffering
-to assist towards a peaceful death

Inherent in nursing is our duty to perform these responsibilities especially in the context of a pandemic. It is hard for many of us to turn our backs on our patients simply because we have pledged our whole lives in the service of the people.

However, times like this also beg the following questions:
Do nurses, and other health care workers, have a duty to care for patients when doing so exposes the nurses themselves to significant risks of harm and even death? More importantly, in the face of serious infectious disease, is there a duty to treat?

Our health system does not have the capacity to handle a pandemic. And this was made apparent in the previous weeks. Let me cite some experiences from the frontline (these ones I got from personal communications with nurses on the ground from various locations).
-Because of their duty to treat, some nurses were forced to perform CPR without adequate personal protective equipment or PPE on a patient with unknown COVID status.
-Some nurses left their sick family members because they were asked to report to duty.
-A nurse did not leave the patient room because her patient was unstable, unresponsive and drowning in his own urine and feces. Without any help, the nurse stayed with the patient and changed his diaper 3 times.
-Some nurses chose to stay inside patient rooms so they can properly monitor their patients because the hospital lacks proper surveillance equipment and has inadequate nursing staff. This despite hospital protocol saying that nurses should only stay in patient rooms for a maximum of two hours in an eight-hour shift.

These are some of many instances where nurses felt responsible to perform their duties despite knowing risks of harm and death. Truth be told, nurses will continue to perform their duties despite the risk of dying or acquiring the disease because many of us feel that it is our professional and moral duty to do so.

Pen Point 46

Clearly, we now see the need to invest more in our health system to improve its capacity to address the growing needs of the Filipino people. After this pandemic, let us urge our lawmakers to push for more funding, innovation, and research.

Recommendations to Address the Potential Local Nursing Shortage Amid the COVID-19 Pandemic

The role of nurses has been considered crucial in managing this pandemic, most especially in implementing strategies to #flattenthecurve. While this is the case, shortage in the nursing workforce will not make the management of the pandemic any easier. We recommend an integrated approach comprised of some or all the recommendations mentioned in this policy brief. However, these recommendations are interim solutions to a possibly chronic nursing workforce shortage in the Philippines. A national investment in the nursing profession is needed to address this shortage. Such investment will require significant political will, support, and financial investment.

Thank you Neil Roy Rosales for writing this with me. Please feel free to share with your colleagues.

Link to full policy brief: Recommendations

Foster collaborative relationships

Immediately after the news broke that three doctors died due to COVID-19, people took their frustration to Twitter and were quick to blame patients for their failure to divulge accurate health and travel history. For many, this alleged ’lie’ caused the life of an unsung hero who was at the frontline battling the pandemic.

A patient withholding facts and misleading health workers is no laughing matter. Physicians cannot appropriately diagnose and treat patients unless the latter share information freely. Thus, the feelings of anger, hatred, and frustration felt by many doctors last week were all valid. These feelings make them human after all. But, this is more than a simple case of dishonesty. To directly equate a person’s death to a lie, whether intentional or not, is a bit overstretched. Alternatively, our frustration directs us to question what could have possibly gone wrong between the patient-physician relationship.

Patients also fear for their lives, much like the rest of us in the field of health care. Some patients are intimidated, only to share their whole health history after their first conversation with a health worker.  Truth be told, it is sometimes difficult to share private information to our friends and families. What more to people you barely know? Unfortunately, this is not an excuse for patients to deliberately lie about their health status.

Although motivations for withholding the truth vary from patient to patient, options to address this problem are rooted in one concept: a collaborative patient-health worker relationship. It is important, I suppose, for our patients to feel that we trust them and that they, too, can trust us. Let us allow our patients to freely verbalize their thoughts and feelings. Let us take time to listen to them so that they can put their trust in us.

Conversations with patients are almost always difficult. But given the gravity of what’s at stake, we are encouraged to find ways to expand and make better the existing lines of communication. We are encouraged to find ways to make patients more comfortable to admit embarrassing behaviors, and facts about themselves. Finally, we are encouraged to create a trusting environment embedded in the system to allow and support collaborative relationships between patients and health workers.

The frontline

As a nurse, waking up each day is a struggle knowing that there is a high risk for us to acquire the disease. However, we are constantly reminded of our duty to the people. That it is our duty and responsibility to help those in need, especially the poor, weak, and vulnerable.

Times like this make us realize that effective communication is key. Sadly, the field of health has failed to do it well in many instances. Today, more than ever, I fervently ask our leaders to first show TRANSPARENCY. Make things clear for us. Make us understand how things will be managed, coordinated, and disseminated. Make us feel that you are on top of this and that processes are as clear as they can be.

Second, I ask for CONSISTENCY. We are tired of hearing conflicting statements, especially those from the higher ranks. Such conflicting statements create confusion which in turn causes panic. Let there be a single message from a single source.

Finally, I ask for INTEGRITY. Let us not fool each other. Again, kabaro mo na. Sana hindi ka na isahan pa. Tayo-tayo dapat ang nagtutulungan. Hindi dapat nag-gugulangan. Let us be honest to each other so we can all work well together. After all, we all aim for one goal – the end of this crisis.

The coming weeks will show how resilient and responsive our health care system is. The circumstances will test how our current systems will adapt and change according to the pressing needs of the people. Our experiences during this pandemic will surely change how we will implement the UHC law in a bigger scale in the following years.

Please pray for everyone, especially those in the frontline. It is a scary, scary world and we have nobody to save us but ourselves. Ingat!

DISCLAIMER: There is no way this post pertains to a particular individual, hospital, or organization. Before you try to twist whatever I said in this post and send complaints, please clarify them first with me. Send me a message. It’s free.

Pen Point 45

Why do we keep treating people for illness, only to send them back to the conditions that created the illness in the first place?

It is a bit frustrating to give your all just so they can be wasted in the end. Clearly, the current system is inefficient and cure-centric. How do we cure a sick health system?

Nudging in health care

We saw a dramatic change in people’s behavior brought about by information (and misinformation) regarding the worldwide spread of COVID-19. People began clamoring for more health information and others started wearing surgical face masks to protect themselves. Following advice from the Department of Health, several organizations cancelled their scheduled conferences and conventions this year.

What surprised me, however, is the fact that many food, retail, and service companies started providing hand sanitizers not only to their employees but also to their customers. Schools, hospitals, and shopping malls did the same, and even placed posters at entry and exit points to inform the public on infection control measures that should be observed within their premises. The placement of posters, the availability of and accessibility to alcohol or hand sanitizers created a positive reinforcement that influenced individual and group decision-making leading to a change in behavior. In behavioral science, this is best explained by the “Nudge Theory”.

The reaction of the Filipino community to this actual health threat is a manifestation of how the theory works. Based on observation, some people who saw hand sanitizers and alcohols on counter tops actually rubbed some on their hands. To an extent, the mere presence of these alcohol-containing preparations ‘nudged’ people to make the right decision which is to practice hand hygiene. Studies in other countries such as the UK have been successful in providing empirical evidence to support the use of nudging to influence behavior in health care settings. Such practice, however, has not been extensively explored in the Philippines.

While we focus on containing the local transmission of COVID-19 in Metro Manila for now, health care professionals and policy makers can take this opportunity to review existing policies on hand hygiene, infection control, and even outbreaks. We have been accustomed to using the rational choice model to create policies influencing people’s behavior. Using this model, we assume that humans are rational beings and given adequate information, they will rationally act on their own self-interest. Sadly, this approach does not work well in real life. Fortunately, the nudge theory, introduced by Nobel-prize winner Richard Thaler and law professor Cass Sunstein, provides policy-makers with another approach to influencing behavior. This theory suggests that we cannot stop people from being irrational because much of instant decision-making is influenced by context and environment. We can, however, seek to influence decision-making impulses to produce outcomes that are beneficial both at the individual and societal levels.

At the moment, we are pleased and thankful for the initiatives of private companies to educate their employees and customers on proper hand hygiene, and providing the necessary facilities to practice hand hygiene procedures. In the future, we should hope to see how the government will use nudging techniques to influence people’s behavior. As the theory can be applied even in realms outside health, nudging presents a low-cost and effective policy option that can perhaps complement or replace traditional regulation with nudges to influence people’s everyday choices without restricting their freedom of choice, and imposing penal charges or taxation.

Foreign ownership in the health care market

The proposed measure to allow foreign ownership of transportation and telecommunication services clearly sets a precedent for other public services in the Philippines, such as health care.

Opening the Philippine health care market to foreign ownership, obviously, has potential benefits including employment opportunities, better provision of health services, and health technology exchange. Foreign ownership of health facilities/service providers, however, has the potential to negatively affect the already struggling health care system of the country.

First, foreign investors may be enticed by the government to own hospitals and other health facilities (laboratories, ambulatory clinics, etc) in places where the government has failed or is yet to invest in. In this way, the government is lifting itself from the burden of expanding its public health services by allowing foreign investors to build and own these facilities. While this could be a win-win situation, poor regulation might undermine the primary intention of such set-up which is to improve access to health care services. In places where there is only one (monopoly) or few firms (oligopoly) providing health services, there is a potential for these firms to collude in order to maximize profits.

Second, foreign ownership has the potential to further promote a two-tiered health care system, separating the upper class from the low and middle classes. Having a two-tiered system means enabling price discrimination as an effective price-setting strategy. With price discrimination, some consumers will end up paying higher prices.