Sunday, May 10, 2009

While it's sometimes tempting to eat the young, here's a better recipe

Welcome to Flo & Bo's continuing series on nursing sensibilities. This week hundreds of colleges in the US are graduating students, celebrations that herald the arrival of a new wave of graduate nurses, pharmacists, PAs, and therapists who will soon join the ranks of seasoned professionals providing healthcare. Welcome! We surely need you.

A month or so ago NPR ran a story in which a woman answered questions from her young son about how she met his father. I hope you'll have time to click on the link and listen to the 3 minute story from NPR's Story Corps.

If you can't, here's the part that spoke to me: This storyteller's mother had died when she was 7, and she was on her own by age 16. As the mother interacts with her son, she doesn't hesitate to answer his probing questions, but takes care at the beginning of their conversation to say, "So, what I did and what you get to do are going to be two different things because ...."

At this point in the dialogue her son abruptly, but confidently, interrupts her and finishes her sentence by saying, "I always have somebody looking out for me. That's you, dad, and pretty much everybody else in our family."

I could have used this story on Mother's Day. But I think the message transcends parenting, and speaks more to what people in the Judeo-Christian tradition call original sin, acting on the urge to subject the next generation to trials and tribulations that caused pain, dysfunction, and disorder in previous ones.

If you're about to orient new graduates, you'll likely use some sort of skills checklist and an evaluation process to document their mastery of core skills and validate emerging competencies. These are important tools, but the mother-son conversation illustrates another, equally important, measure of successful transition. It happens when the next generation can speak confidently of what's to come, without having to walk the same painful path that you did.

Resisting the urge to "eat the young" is the right thing to do. But today I'm also going to make a business case for why you should go out of your way to include novices, facilitating their transition to professional practice, and advocating for their voices to be heard.

Just two months ago, a Business Roundtable Health Care Value Comparability Study commissioned by CEO's of leading companies in the U.S., described a 23 percent “value gap” in the cost and performance of healthcare in the U.S. when compared to five leading economic competitors, all industrial nations. Foremost among the criticisms of the current system offered in the report?

"......basic practices untouched by the productivity revolution that has transformed every other sector of the economy." - Ivan Seidenberg, Chairman and CEO, Verizon Communications
Each and every day, seasoned healthcare professionals bring unmatched clinical expertise to mind-boggling, soul-wrenching problems, expertise that drives innovation, outcomes, and miracles (something I experience first-hand every time I speak to my pre-lingually deaf, cochlear-implant-using daughter by cellphone.) And I thank you.

But, having finessed high-tech miracles using antiquated infrastructure for so many years, seasoned professionals may no longer recognize the gap between what we find acceptable when shopping at the AT&T store and what we find acceptable when we go to work.

The "digital natives" about to join your ranks will see this gap. They're going to ask why a second registered nurse is paid to re-enter data previously entered by another registered nurse. (And, "The ER's system doesn't 'talk' to ours" won't satisfy them.) They'll ask why 17 distinct, but clinically irrelevant, variants of a penicillin allergy can't be purged from admission assessment documents containing over 100 distinct patient queries. They'll understand the inherent safety problems that arise when a pharmacy's computer system doesn't interface with those used to display laboratory results (and they probably won't think "tubing" or "faxing" a hand-written slip to compensate for electronic snafus is an acceptable way to communicate high-consequence data). They'll wonder why a bar-code scanner isn't attached to every anesthesia machine and why checking a price tag at Target is easier than checking a high-alert drug at work.

Digital natives will adapt their social media skills (like facebooking and twittering) and harness modalities (like iPhone apps and blogs) to communicate deficits, network, and help redefine best practices, allowing the productivity revolution that has transformed every other sector of the economy to illuminate the corridors of healthcare.

Welcome, sunshine! We need you more than we know.

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