June 28, 2012--A Day in History

June 28, 2012…..will this become a landmark date within the history of our country?  Perhaps not, but as I pause to collect a few thoughts for Unum Vox, it is hard to take one’s eyes off of CNN, or the explosion within the blogosphere, over today’s Supreme Court ruling relative to the PPACA (Patient Protection and Affordable Care Act).  Without a doubt this is a critical moment in our country’s lurching, ponderous journey towards universally accessible, affordable, safe and reliable health care.  Rest assured, the political debate will only escalate, pundits will continue to pontificate, but a stake has now been placed firmly in the ground, and any effort to diminish, augment, or change our approach to health care reform will have to travel through this historic piece of health care legislation, or at least be measured by/compared to it.

Regardless of an individual’s political or philosophical persuasion, the PPACA pushes this country in several positive ways.  In fact, many laudable accomplishments can already be attributed to it.  The misfortune of severe illness no longer renders an individual uninsurable.  “Pre-existing illness” will disappear from the insurance industry’s lexicon.  Young adults will continue to be able to access the benefits of family coverage rates until age 26.  Through exchanges, employer based plans, and expanded Medicaid coverage we should be able to approach fully accessible health care for 95% of all citizens, and simultaneously remove a long standing embarrassment for this country amidst the roll call of nations within the developed world (even many countries considered to be “third world”).

Admittedly, this piece of legislation was/is far from perfect.  Much of the “tough medicine” true reform requires was side-stepped by our political leaders.  Sustainability is only possible within the context of affordability, and most will agree that the measures taken within the PPACA fall far short of dealing with the difficult decisions needed to take control of the inexorable climb of health care costs.  Until we hard-wire care that is fully cost conscious, and high value, this effort will collapse under its own weight.

However, I take great solace and daily inspiration from two critical observations by Dr. Donald Berwick, past director of CMS, and founder of IHI.  First, he likened the journey towards high quality, safe and reliable health care to a car trip, and he stated that the health care community (i.e. not Congress) drives that car.  Secondly, he opined the following:  “the key to improvement is coverage, and the key to coverage is improvement.”  In other words, we will never produce high value, high quality care for our country until everyone has access to that care.  Likewise, unless we produce care that is of the highest quality, universal coverage will be unsustainable.

As for me, I choose to be greatly encouraged today.  The keys are in OUR hands. 

--Tom Braithwaite, M.D., FACP is Chief Quality Officer at Sanford Health in Sioux Falls

The Art and Science of Nursing

      My desire to be a nurse came about eight years ago when I was hospitalized on a pediatric floor for three weeks. I was the crazy kid who wanted to go back to the hospital when I came home because I missed “my nurses.” I remember the nurses who comforted me and listened when I was scared, and the nurse who told me “honey, crying isn’t going to help anything.”  After my experience as a patient, I knew I wanted to be a nurse who made a difference. I strive to be a genuine nurse of integrity and compassion, a life-long learner dedicated to collaboration and teamwork so that I can provide the best quality care possible.

      Jesus has called me to love the people around me—“Love one another. As I have loved you, so you must love one another (John 13:34).” He has also blessed me with a love for science and a longing to understand how the body functions so complexly. Being a nurse is one of the most tangible ways I can think of to love others using the characteristics and talents God has given me. Nursing is both an art and a science. To be a nurse is to care for the whole person—physically, emotionally, and spiritually. A nurse cannot adequately care for a patient unless he or she considers all aspects of care; being a nurse is not merely the ability to start an IV, remove sutures, or administer a medication.

      I firmly believe I can be the “smartest” nurse, but if I do not have compassion and know how to care for the whole person, my patients will suffer. Knowledge is important. Keeping up with research and being able to explain the complexity of a patient’s health status to the family is essential to nursing care. However, nursing is also about comforting the family of a dying patient, celebrating the little milestones of a stroke victim, and holding the hand of a crying child.

      I remember my first day of nursing clinicals, just two years ago. I was terrified to give a bed bath. Looking back I think, “Wow! Look how far we’ve come.” I remember my first patient; her name and diagnosis but little else. When I first started nursing school, I was so focused on disease and trying to make things perfect. Now I look back to more recent experiences, and I remember something different.

      I remember an older gentleman who was scared out of his mind for a complex surgical procedure he would be undergoing the next day. I remember seeing fear in his eyes, and seeing that fear eased when I simply asked if he wanted to go for a walk. With a smile on his face he said, “If I get to go on a date with you, then ABSOLUTELY!” I remember his wife, and how all three of us joked around about me “stealing” her husband to go on “walking dates.” We talked about his fears, and he told me about his faith in God and how it was the only thing that was going to sustain him. Yes, I learned a lot about his disease process, but I remember more than his diagnosis. I remember his family and his stories and his faith, and I remember praying for him every time I entered his room.

      Ultimately, nurses see patients at the best and worst moments of their lives, yet accept them the way they are. Nurses acknowledge the uniqueness of each patient by individualizing care, and through this they integrate knowledge and research with compassion and love. A nurse of integrity is a lifelong learner, someone who recognizes he or she is not all knowing, and one who is willing to ask questions of others in the clinical environment. A nurse realizes that he or she is just one part of a patient’s plan of care, and strives to interact with the entire healthcare team in order to provide patients with the best quality care.

      After graduation I will be starting a new career as a pediatric intensive care nurse. Nervous? Yes. Excited? Absolutely. I know I am starting out in one of the most challenging places in nursing. I am going to have days when I feel like I do not know anything. I am going to be placed in situations where I do not have the perfect words to say. But this is what I do know: GOD IS GOOD. He has given me this opportunity to love children and their families, and to grow as a leader. Ultimately, nursing combines the science of the human body and research with the art of communication, compassion and love, and I am blessed to be part of it.

           - Caitlin Leimbach is a recent graduate of South Dakota State University, and currently working as a nurse in the Sanford Pediatric Intensive Care Unit in Sioux Falls. Caitlin is also a graduate section leader for our SD IHI Open School chapter.