Today I did something I love. I spent 2 hours giving a presentation to public health nurses, 30 of them from one local health department. The goal is to increase their understanding of being a professional, a public health professional, a nursing professional, whose job includes addressing health problems of populations, not only of individuals.They would say it is stretching their minds.
I value the time I spend "in the field", out of the "ivory tower". It's when I get a reality check on what is the current state of affairs. A reality check on how far away I am from where they are. A reality check on my own passions and commitments. More than once I acknowledged that my small diatribes were my soap boxes. But, soap boxes are closer to our hearts and passion than almost anything else. Why not claim, "This is my soap box, this is my passion, this is what I am willing to work hard to change." And, the really weird thing about soap boxes; we rarely know they are there until we step up on it and let the passion flow.
Most successful people who are admired, people who are famous say that they are successful because they are doing what they love. Me, working with public health nurses, to give them a sense of pride and confidence, and a sense of being able to make the next baby step of advancement. This is my passion. I don't expect a raise for doing this work. I don't expect a prize for doing this work. I do expect to have made a tiny improvement in people who themselves contribute to a better world.
20 May 2010
Days Gone By
Tuesday and Wednesday were uneventful, with one exception. I got the last of the speakers for the AHRQ conference. Relief! Now I can turn to doing KRISP work on Friday and maybe manuscript writing on Saturday.
And, that little email I sent to the listseve yesterday did indeed generate lots of discussion and posts. I found it fascinating how differently individuals read the original email and chose differnt foci. The emotions were present in all of the emails. Public health nurses feeling slighted, ignored by the nursing profession, expressing profound uncertainties aobut their collective futures, and more than a hint of anger.
I came to realize some time ago that anger is a peculiar emotion. It often serves to energize in the face of overwhelming odds. And, that's what I saw as thread in the posts. Angry public health nurses, struggling to find validation for who they are professionally and for what they do. Unfortunately, although anger can energize, that energy does not allows get manifesed in ways that are benficial, that are PC or that challenge rationales.
Nonetheless, I'm glad that I stirred the pot and urged the group to take unifed action. We need the leaders to step up and be leaders. We need leaders to be visible, like generals before a war. We, public health nurses need this. The urgency and the timing is now. If we miss this moment in history, we only have ourselves to blame.
And, that little email I sent to the listseve yesterday did indeed generate lots of discussion and posts. I found it fascinating how differently individuals read the original email and chose differnt foci. The emotions were present in all of the emails. Public health nurses feeling slighted, ignored by the nursing profession, expressing profound uncertainties aobut their collective futures, and more than a hint of anger.
I came to realize some time ago that anger is a peculiar emotion. It often serves to energize in the face of overwhelming odds. And, that's what I saw as thread in the posts. Angry public health nurses, struggling to find validation for who they are professionally and for what they do. Unfortunately, although anger can energize, that energy does not allows get manifesed in ways that are benficial, that are PC or that challenge rationales.
Nonetheless, I'm glad that I stirred the pot and urged the group to take unifed action. We need the leaders to step up and be leaders. We need leaders to be visible, like generals before a war. We, public health nurses need this. The urgency and the timing is now. If we miss this moment in history, we only have ourselves to blame.
18 May 2010
Monday Morning
As I was walking toward the elevators to get the week started, a colleauge was coming in to work. I started the ususal chit chat for such circumstances; "So, how was your weekend?" "I'm glad it's over." Huh? She was not forthcoming with an explanation, but we chuckled nonetheless on the irony of her response. That pretty much set the tone for the day, a bit whacky but good.
The day consisted of faculty meeting, a teleconfernece for the AHRQ grant, meeting with project staff, meeting with student to map out a publication, responding to emails (including another Doodle), and working on the promotion papers. Here's the grumble ~ data are collected by the Office of Reseach but not in a format nor with the same information required for the promotion forms. Looks to me like a pretty big communication gap at the university level which results in at least 6 hours of silly work for me. I don't mind working, but this copy and pasting and retyping and having to track down information is such a waste. And, inefficiencies really push my buttons.
I had a breif, pleasant conversation with one of the directors of nursing at a local health department. She had received an email from NACCHO regarding their recommendations for allocation of health reform funds. Fine. Except that public health nurses were not included in a brief list of needed health professionals. YIKES! What were they thinking? At a point in time when health deparrtments are really strapped for funding and looking to cut expenses, nurses are easy targets because they cost so much. Never mind the high rate of return for thier work. I immediately though how can I mobilize the public health nursing associations to take some action? I sent out a email to a listserve and will keep the pressure up. This could get interesting....
The day consisted of faculty meeting, a teleconfernece for the AHRQ grant, meeting with project staff, meeting with student to map out a publication, responding to emails (including another Doodle), and working on the promotion papers. Here's the grumble ~ data are collected by the Office of Reseach but not in a format nor with the same information required for the promotion forms. Looks to me like a pretty big communication gap at the university level which results in at least 6 hours of silly work for me. I don't mind working, but this copy and pasting and retyping and having to track down information is such a waste. And, inefficiencies really push my buttons.
I had a breif, pleasant conversation with one of the directors of nursing at a local health department. She had received an email from NACCHO regarding their recommendations for allocation of health reform funds. Fine. Except that public health nurses were not included in a brief list of needed health professionals. YIKES! What were they thinking? At a point in time when health deparrtments are really strapped for funding and looking to cut expenses, nurses are easy targets because they cost so much. Never mind the high rate of return for thier work. I immediately though how can I mobilize the public health nursing associations to take some action? I sent out a email to a listserve and will keep the pressure up. This could get interesting....
15 May 2010
TGIF, not
Two days of long hours and not one item crossed off my list. I'm wondering if I ought to make a list of the tiny things I did accomplish, just so that I can put a line through something....teleconference with KRISP grant co-investigators, met with Proj Coordinator to keep the KRISP project coordinated, responded to student emails asking for appointments and help with practicum objectives, attended a meeting to explain the procedure for seeking promotion, worked on power point presentations, wrote up notes from meetings, responded to emails asking me to respond to a Doodle (an online free meeting scheduling program, LOVE it), and made final edits to a manuscript which I can not yet submit because the editor hasn't changed the status in the online system.
As yo can see, the stumbling block (to feeling productive) was not lack of working. I just could not find someone who would be good for filling in the last slot at the AHRQconference. So, I spent hours online doing lit searches and then reading bios. This exercise gave me a renewed and deeper appreciation of how few scholars can be counted as public health nurse scholars ~ reinforcing the need for the conference and creating a catch-22.
As yo can see, the stumbling block (to feeling productive) was not lack of working. I just could not find someone who would be good for filling in the last slot at the AHRQconference. So, I spent hours online doing lit searches and then reading bios. This exercise gave me a renewed and deeper appreciation of how few scholars can be counted as public health nurse scholars ~ reinforcing the need for the conference and creating a catch-22.
13 May 2010
Travel Agent
You'd never guess that facutly also are travel agents.
We go to conferences to present scientific papers or, rarely, to gain some professional training (the two rarely overlap). Each trip entails selecting flights, booking hotel room and registering for the conference. That's straightforward. But, the decisions include whether to attend for more than the session at which you are presenting and how that matches with flight costs and availability, the cost of the conference hotel versus one a long walk away, and the deadline for early registration. Then, there's the issue of whether to travel with a colleague who is also presenting and whether to share a hotel room. We are friends and the budget is tight, or so the argument goes. Then, those decisions need to be communicated to the staff with access to the grant funds to pay in advance for the expenses that the university permits to be paid in advance. In this way, I don't have to pay for the flight but I do pay for hotel and later get reimbursed. Oh, yeah, there's the reimbursement process and forms and signatures and receipts once back from the trip.
Arg. I want a personal secretary!
PS I added a photo of me hooding my doctoral student. The photo speaks for itself.
We go to conferences to present scientific papers or, rarely, to gain some professional training (the two rarely overlap). Each trip entails selecting flights, booking hotel room and registering for the conference. That's straightforward. But, the decisions include whether to attend for more than the session at which you are presenting and how that matches with flight costs and availability, the cost of the conference hotel versus one a long walk away, and the deadline for early registration. Then, there's the issue of whether to travel with a colleague who is also presenting and whether to share a hotel room. We are friends and the budget is tight, or so the argument goes. Then, those decisions need to be communicated to the staff with access to the grant funds to pay in advance for the expenses that the university permits to be paid in advance. In this way, I don't have to pay for the flight but I do pay for hotel and later get reimbursed. Oh, yeah, there's the reimbursement process and forms and signatures and receipts once back from the trip.
Arg. I want a personal secretary!
PS I added a photo of me hooding my doctoral student. The photo speaks for itself.
12 May 2010
Federal Funding
Let me quasi-quote myself (from a forthcoming editorial) ~
Within the U.S. Department of Health and Human Services (DHHS), five agencies are likely to address health care management: the Agency for Health Care Research and Quality (AHRQ), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration’s (HRSA), and the Centers for Medicare and Medicaid Services (CMS). These five, I’ll call them the Big 5, receive considerable federal funding for research, health care reimbursement, and training. The NIH budget of $30.6 billion (FY 2009 Budget) is nearly four times CDC’s $8.8 billion and HRSA’s $7.5 billion budgets for Fiscal Year 2010, and dwarfs AHRQ’s $372 million budget request for fiscal year 2010. The CMS 2010 Fiscal Year budget was $818 billion, of which $811 billion was earmarked for health insurance and long term care.
These numbers are profoundly staggering. Except for CMS, which is essentially federal health insurance for the elderly and the poor, the agencies focus on improving health care services. I don't quibble with the amounts, but only wish that more of the funds would be for prevention of disease rather than for treatment. I also wish that more of the money would go toward services and programs that are population-focused. One could argue that is the case with Medicaid, but it boils down to reimbursement for individual care.
These issues are on my mind as I struggle with the local health departments to figure out how to aligng funding with prevention and population-focused practice. When I look at the budget numbers, I see possibilities but not motivation. I can only wonder what the future will hold and how much of the future I might be able to shape.
Within the U.S. Department of Health and Human Services (DHHS), five agencies are likely to address health care management: the Agency for Health Care Research and Quality (AHRQ), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration’s (HRSA), and the Centers for Medicare and Medicaid Services (CMS). These five, I’ll call them the Big 5, receive considerable federal funding for research, health care reimbursement, and training. The NIH budget of $30.6 billion (FY 2009 Budget) is nearly four times CDC’s $8.8 billion and HRSA’s $7.5 billion budgets for Fiscal Year 2010, and dwarfs AHRQ’s $372 million budget request for fiscal year 2010. The CMS 2010 Fiscal Year budget was $818 billion, of which $811 billion was earmarked for health insurance and long term care.
These numbers are profoundly staggering. Except for CMS, which is essentially federal health insurance for the elderly and the poor, the agencies focus on improving health care services. I don't quibble with the amounts, but only wish that more of the funds would be for prevention of disease rather than for treatment. I also wish that more of the money would go toward services and programs that are population-focused. One could argue that is the case with Medicaid, but it boils down to reimbursement for individual care.
These issues are on my mind as I struggle with the local health departments to figure out how to aligng funding with prevention and population-focused practice. When I look at the budget numbers, I see possibilities but not motivation. I can only wonder what the future will hold and how much of the future I might be able to shape.
11 May 2010
Monday Blues
Monday began with a faculty meeting. More faculty were in attendance than usual, probably thinking it was the last meeting of the academic year. Not. None of the agenda items were particularly stimulating, with the exception of voting rights.
At our institution, tenure tack faculty have "statutory" voting rights which means they can vote on elections held at all levels ~university, school, department. The statutory faculty have the authority to give non-statutory faculty voting rights so that they too might participate in elections at different levels. The the list of faculty in our department to be given voting privileges by the statutory faculty contained some faculty individuals of questionable commitment to our department and the school. So, there was discussion of what to do. One option acknowledged to be that the involved faculty run for offices, making it less likely that one of the uninvolved would be voted into an office. In the end, the list was voted on as a whole, giving them all voting privileges I was on the list to be given voting privileges, so I just listened.
Yes, this sounds a bit crazy. Faculty governance is a quite an anomaly in today's world of bureaucratic organizations. Faculty make decisions that are directly related to the work of being a faculty: curriculum development and revision, hiring and promotion of peers, admission of students, and academic remediation. Doing this work of self-governance is both very empowering and time consuming. Still, I'd rather have this high degree of control over my work than be punching a clock and following instructions. Faculty tend to be highly independent and self-directed, which can make for lively debates. I'm in the right job for me.
At our institution, tenure tack faculty have "statutory" voting rights which means they can vote on elections held at all levels ~university, school, department. The statutory faculty have the authority to give non-statutory faculty voting rights so that they too might participate in elections at different levels. The the list of faculty in our department to be given voting privileges by the statutory faculty contained some faculty individuals of questionable commitment to our department and the school. So, there was discussion of what to do. One option acknowledged to be that the involved faculty run for offices, making it less likely that one of the uninvolved would be voted into an office. In the end, the list was voted on as a whole, giving them all voting privileges I was on the list to be given voting privileges, so I just listened.
Yes, this sounds a bit crazy. Faculty governance is a quite an anomaly in today's world of bureaucratic organizations. Faculty make decisions that are directly related to the work of being a faculty: curriculum development and revision, hiring and promotion of peers, admission of students, and academic remediation. Doing this work of self-governance is both very empowering and time consuming. Still, I'd rather have this high degree of control over my work than be punching a clock and following instructions. Faculty tend to be highly independent and self-directed, which can make for lively debates. I'm in the right job for me.
08 May 2010
Pomp without much pomp
For those who have not been at a college or school convocation (as contrasted to a University commencement ceremony), the pattern is as follows: (1) faculty gather in one room where they pull thin, wrinkled gowns out of cardboard boxes, while students gather in a separate room and chatter excitedly, (2) each group eventually get led to the auditorium where we form a procession, lead by the University Provost, Dean, Distinguished Speaker, and others who go and sit on the platform (aka stage) while the rest of the faculty sit off the side and basically not seen again until we leave, (3) everyone on the platform has their 5 minutes of welcome, (4) the speaker has 10 minutes for a speech, (5) the students finally get to proceed one by one across the platform to be hooded and hugged, and some family and friends make the process more interesting with outbursts of cheers, (6) the Provost pronounces that they are now officially awarded the degree, (7) brief good-byes, and (8) we have the exit procession. The whole thing takes 2 hours, give or take.
This year I was hooding a graduating doctoral student and so was in the front row of faculty. The advantage turned out to be that I got a clear view of the students as they lined up to go on the platform, and sat next to a very talkative faculty. We giggled and studied the footwear of the students lined in front of us. And, in the spirit of good science, came up with some hypotheses on the inverse correlation of heal height and intelligence, and selected the best heeled division in the school. That we did all this intermingled with clapping and walking to the platform to hood our doctoral students is testimony to the lack of seriousness and the lack of pomp that we were experiencing.
For me this really means that in 31/2 months, we will be starting all over with a new batch of students. An endless cycle, not an ending nor a beginning. Just a point along the spiral.
07 May 2010
Collegial Work
For 24 hours, I had in-person time for working with my colleague from Seattle. Our focus was on the KRISP grant, which is clearly at at developmental milestone. And, as milestones go, this one requires careful coordination of activities to make it successfully to the next milestone. Working via distance with only hour long monthly meetings was clearly not getting to the level of detailed planning that we now need.
I need to mention that as we sat in the restaurant, I toasted to our productivity and having fun. So, there was a fair amount of deeper getting to know each other, as happens when the intellectual task ahead requires an unshakable friendship foundation.
We spent time focused on planning what to do about our research assistants, the interested doctoral student, the budget and future manuscript preparation. But mostly, we came to the realization that the health departments were in need of training and support. I had envisioned that the health departments would, by now, be deeply engaged in quality improvement efforts. But, they are are struggling with how to transition the public health nurses from individual and family care to population-focused practice. Not an easy transition by any reckoning. This was not the intent of the grant, but must be addressed in the spirit of the grant in order to maintain the trust and cooperation of the health departments. We both become reluctantly resigned to what the next year would likely be like; travel to the local health departments and trainings.
Oh, new blazing new trails is such hard work on so many levels. I just pray I can make a path that is passable to those behind me and of use to those who have not yet ventured out.
I need to mention that as we sat in the restaurant, I toasted to our productivity and having fun. So, there was a fair amount of deeper getting to know each other, as happens when the intellectual task ahead requires an unshakable friendship foundation.
We spent time focused on planning what to do about our research assistants, the interested doctoral student, the budget and future manuscript preparation. But mostly, we came to the realization that the health departments were in need of training and support. I had envisioned that the health departments would, by now, be deeply engaged in quality improvement efforts. But, they are are struggling with how to transition the public health nurses from individual and family care to population-focused practice. Not an easy transition by any reckoning. This was not the intent of the grant, but must be addressed in the spirit of the grant in order to maintain the trust and cooperation of the health departments. We both become reluctantly resigned to what the next year would likely be like; travel to the local health departments and trainings.
Oh, new blazing new trails is such hard work on so many levels. I just pray I can make a path that is passable to those behind me and of use to those who have not yet ventured out.
06 May 2010
Technology woes
For the past few days, I've been loosing the battle against an protecting aging computer against malware and crashes. Naturally, this has cut deep into my productivity. More interestingly, it has brought to the forefront of my awareness my own reliance on the comfort of one's own compute and desk and chair and lighting. There's a settling in factor which can not be ignored. It's like wearing comfortable walking shoes rather than new, rigid shoes.
I sure hope the tech support people can work some magic in short order.
I sure hope the tech support people can work some magic in short order.
05 May 2010
The universe answered my plea for help with Spring Fever. The answer was meetings. The first meeting was with a graduating doctoral student who now faces career choices and corresponding angst about which choice to make. The best I could do was listen and confirm that all points had been considered. There really isn't much in life that prepares us for making such life course altering decisions. Another student needed guidance on the structure of the MPH essay and support in standing ground so as to not be abused by other faculty. (Sometimes I can't believe my colleagues, nor non-colleagues.) Then I met with and hired a doctoral student to be my new RA for the AHRQ grant. In mix was also meetings being canceled and rescheduled, and meetings in the process of being scheduled. The last meeting was the most interesting. And, in between I did a little of this and that. The hallways were very quiet now that classes are over.
The last telephone meeting was with one of the local health departments. We talked about public health nursing and the very real and very big changes that are facing public health nursing. The shift from an individual and family focused public health care delivery system to a population focused mindset requires new skills of everyone. This shift is a welcomed change on one hand, but dreaded on the other. It's dreaded by the managers because their funding is still program specific and the programs are individual level care programs. This creates a fiscal bind for the health departments; neither the states nor the feds seem to shifting their requirements for funding or reimbursing health promotion or protection programs. While the conversation was good, it left me feeling a bit like Atlas ~ carrying the weight of how to make all this happen on behalf of public health nurses.
The last telephone meeting was with one of the local health departments. We talked about public health nursing and the very real and very big changes that are facing public health nursing. The shift from an individual and family focused public health care delivery system to a population focused mindset requires new skills of everyone. This shift is a welcomed change on one hand, but dreaded on the other. It's dreaded by the managers because their funding is still program specific and the programs are individual level care programs. This creates a fiscal bind for the health departments; neither the states nor the feds seem to shifting their requirements for funding or reimbursing health promotion or protection programs. While the conversation was good, it left me feeling a bit like Atlas ~ carrying the weight of how to make all this happen on behalf of public health nurses.
03 May 2010
Spring Fever
I have a serious case of spring fever which has dramatically reduced my productivity. The signs and symptoms are long periods of sitting still to smell the lilac fragrance, restlessness in front of a computer, choosing long evening walks over manuscript revisions, and a nearly irresistible urge to take a road trip. Possible remedies include getting the first sunburn of the season (definitely not a healthy option), implementing a strong behavior modification strategy linking products with reward (which unfortunately also requires self-discipline), simply waiting for unwelcoming weather, or scheduling lots more meetings that will make it impossible to not be at-task.
Without clear evidence of which of these approaches to use, I need to do a lit search and find an evidence-based intervention with a high probably of successfully treating spring fever. And, I need the intervention applied ASAP.
Without clear evidence of which of these approaches to use, I need to do a lit search and find an evidence-based intervention with a high probably of successfully treating spring fever. And, I need the intervention applied ASAP.
01 May 2010
Last Class
Every semester ends. Some have easier, simpler, more gratifying ends than others. This semester ends on a high note: one doctoral student finished and who will be hooded next week, one master's student overcame a huge hump toward completion of her essay, and a class with students who praised the course as meeting their needs. A faculty member can't ask for much more.
The final assignment of the course was for the student to give a brief book report on the biography or autobiography of a scientist . I saw two themes across the lives: following passion and intuition is linked to success, and personalities can affect the level of recognition received. Both lessons relevant to yesterday...
The rest of the day was taken up with telephone meetings, in-person planning, and email. As I was packing up my briefcase with work for the weekend, I looked over the to-do list. And, felt disappointed in myself. I could not cross one item. Yet, I has spent the full 8 hours at task. Things come up. I've learned that it's easier to get it done just then. Once it's on the to-do list, it could be weeks.
And were was the public health part today? One of the calls was with one of the local health departments participating in my intervention project. We talked about the workforce needs and how we might best address them. Quality improvement is the new focus and requires that everyone in the health departments learn new skills and change attitudes about change. It was the type of conversation that helps me stay connected to the real, the daily, the practice. And, challenges me to find ways to make useful, little-by-little changes.
The final assignment of the course was for the student to give a brief book report on the biography or autobiography of a scientist . I saw two themes across the lives: following passion and intuition is linked to success, and personalities can affect the level of recognition received. Both lessons relevant to yesterday...
The rest of the day was taken up with telephone meetings, in-person planning, and email. As I was packing up my briefcase with work for the weekend, I looked over the to-do list. And, felt disappointed in myself. I could not cross one item. Yet, I has spent the full 8 hours at task. Things come up. I've learned that it's easier to get it done just then. Once it's on the to-do list, it could be weeks.
And were was the public health part today? One of the calls was with one of the local health departments participating in my intervention project. We talked about the workforce needs and how we might best address them. Quality improvement is the new focus and requires that everyone in the health departments learn new skills and change attitudes about change. It was the type of conversation that helps me stay connected to the real, the daily, the practice. And, challenges me to find ways to make useful, little-by-little changes.
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