TAKE good care 2025
Clearing out some mental space in the new year. Thank you for being here <3
Is it possible for me to wrap up what I’ve spent… years… trying to say about:
Care
Healthcare
Nursing
Navigation
Loneliness?
Let me try.
Care: What I mean is, “care of and for each other”. It is nuanced, there are gaps, those gaps can be filled, and it will require effort and resources: Time, Money, Sustained Attention, People, Knowledge, Compassion.
Healthcare: What I mean is, “Modern American Healthcare” – whose purpose is: to resolve discrepancies that occur within someone’s human body/health: Disease, Disability, Drugs, Dying. The cost of which must be covered (entirely) by society (insurance), without exception, for every human with a body.
The diseases of despair: hypertension, diabetes, depression, substance use, etc. are societal and must be dealt with at the community and federal level.
Nursing: What I mean is, “_____” — the definition of “nurse” is nuanced. The role varies by state, level of care, license, certification, experience, schooling, as well as human variables of motivation, skill, desire, intention, ability, and so on. To “nurse” is a verb. A “nurse” is a noun. To nurse includes the actual care of a human condition – mental, physical, spiritual, disease-driven, informational, motivational, time-sensitive, age-related… the box has no walls, the lines are blurred, but the caring and compassion are there, wholeheartedly, and without exception. To nurse is to show up. To nurse is to try. To nurse is to witness suffering… to suffer… to aid recovery… to recover… and to show up again. To nurse is to try. To nurse is to know when to stop trying. To nurse is to know when to consult an expert, add an intervention, remove one… To nurse is to understand the whole picture: The person, the problem, the path, and the plan.
To nurse is to see that all journeys end with a transition – to another person, place, or plane of existence. And to walk this part of the journey with another.
To nurse is to partner – with a team – in the service of another. Call them patients, or colleagues, or providers, or care partners. Nurses are partners in care.
Nurses are wayfinders.
Navigation: What I mean is, everyone’s figuring out what to do, as efficiently as possible, and at the lowest cost (of all resources, not just money) – but we all seem to keep doing it the hard way. Navigation means bringing in those who know or who have experience, leveraging that experience to help others learn and grow, and using that wisdom to create maps, develop guides, and point the way so that those coming on the path next will have an easier time.
If there’s a:
Roadblock: mark it
Fork in the road: label it
Difficult journey: warn them
Safety event: report it, share it, learn from it, do different next time
Wrong way: make the consequences known, clearly, consistency, compassionately
Choice: support it with information and resources — help people make informed decisions
Dead end: say so — NO WAY FORWARD, KEEP OUT
Mystery: SAY SO! We can’t know everything, it’s okay to not know. Try to figure it out, or find someone who can
People don’t know what they don’t know – in particular when it comes to navigating their health, disease, abilities, or the path toward dying. They just don’t know.
But we do. We – in Healthcare – and we, who’ve walked a Healthcare Journey. We know.
The COVID-19 Pandemic Ripples On…
Recovery… it’s been a hard few years. The pandemic and its ripple didn’t end when disease numbers went down. The impact of the pandemic is still affecting healthcare and healthcare workers at all levels of care. All Disciplines. The COVID-19 pandemic RIPPLES ON. How do we learn and grow?
How do we take what we’ve learned and know — nurture ourselves to recover — and grow from this?
How do we use what we know to either:
Compost it: It served its purpose, it’s just the peel now, and it’s ready to be discarded. Compost means it’s not going to waste. Compost means it will be repurposed. Broken down, turned to mush, and then put to good use. Not a cesspool — not a stinking, gooky, poop pile. Compost is an amendment. It nurtures the soil, provides the richness, the sustenance, so that new things may grow. Compost is essential.
Reuse it: If a process works, or a path is good, it should be written, spoken, standardized, and disseminated so that others can access it (easily, clearly, simply, and without barriers) and be able to do so again, and again.
Rework it: if a process doesn’t work, but could, it should be reimagined. Quality Improvement models help guide this process, and give rigor to the questions “what’s working? What isn’t? What needs to change? How? By who, when, where? Why?”. Quality Improvement and Control are nuanced, and it requires a team. Rework requires collaboration (consider documentation, Artificial Intelligence, and the time/energy of healthcare workers… where do you want people spending themselves? Charting? no…). Consistency. And, again, compassion.
That’s the thing with Navigation – it doesn’t stop. The conditions are continually changing. The earth shifts, the tides ebb and flow, the seasons… change… the climate… responds. If there’s a flood, a wayfinder knows the water comes from upstream.
Get upstream. Find the Source.
When you get upstream – wait and listen. Observe. Stand witness. Consider, what is this situation/problem/condition like, without intervention, without assistance, without you. A QI tool called a “Gemba Walk” is used to observe a process, team, department, workflow, etc. without changing anything. Taking notes, interacting, but not “solving” anything… yet.
Because – wayfinders who get upstream — by observing and learning what’s happening — usually find a Source. The source of the Resource, or of the Problem.
And the Resource may be abundant… or lacking.
The Problem may be simple… or wicked.
An abundant resource must be available to all. A lacking resource must be dealt with as a scarcity, a precious gift, and it must be protected. Our planet is a resource, and our clean water, healthy soil, breathable air… are precious. Nursing is a resource. Healthcare workers are a resource. And, the problem is nuanced. A wicked problem.
A wicked problem (thanks Dr. Michelle Kramer) – doesn’t have an easy solution. The cause is sticky, gooey, gets in the cracks, gums up the works, and is NUANCED. Unclear. Gray. Ill-defined. Hard to treat. Unhealthy. Potentially harmful. Difficult.
Wicked Problems are NOT Impossible
Wicked problems feel like they’re attacking us. They seem to be working against us.
Wicked problems aren’t just in the way, they are resisting.
Wicked Problems look impossible… but they are not impossible.
Wicked problems are just solutions that haven’t happened yet… Because we haven’t found them, can’t afford them, or don’t know how to implement them.
Wicked problems require a team with a plan (a vision), a map, a guide (a navigator), tools, resources, and the ability to try.
A wicked problem could be resolved. But not all wicked problems can be “fixed”.
Some wicked problems must be stopped. Buried. Laid to rest. Retired. Put to a funeral out to sea…
…Before they can cause more harm. To help avoid future suffering. To prevent the spread of further sticky, wicked problems. A wicked problem, if it cannot be solved, must die.
And if it must die/retire/end, we should consider (and honor) its impact:
What did we learn?
How did we grow?
Where did it come from?
How did it happen?
What, upstream, permitted this situation, event, unfolding, to occur.
And how do we prevent it from happening again?
…Until it can be buried, how do we protect others from stumbling into it? Hurting themselves or others due to ignorance?
An Altar of Hope
Protect People From Wicked Problems Until They Can Be Dealt With
We post signs, warning others of the sticky, wicked, sometimes awful effects of touching, breathing, consuming this wicked thing. We tell our communities “stay away” – livewire, do not touch. We warn people the best we can.
And then, people will be people-y. Some will ignore the signs, and approach the wicked problem. They’ll get hurt, some will die, and we will learn some more.
Learn from their mistakes, and grow from them.
Others… people who are… maybe not human at all… will read the signs, fully understand the problem, and knowingly enter at their own risk. Or worse… will know the risks, avoid them for themselves, and send others to do the dirty work. These people are villains. They are not helpers, they are not ignorant. They are intentionally and maliciously out to cause harm, chaos, and destruction. These people, hurt people, will continue to hurt people indefinitely. Because they, themselves, are a wicked problem.
Dastardly.
Their wickedness didn’t come from nowhere. Further upstream, the cause of their hurt lingers deeper.
Hurt people hurt people.
Their hurt will continue to seep, leak, gum up the works. Their hurt will fester. Like an infection — becoming sepsis — it will kill us as it spreads…
…or…
Unless…
We see it, warn people, protect ourselves, and keep our communities safe.
Until we can cordon off the wicked people/problems, and treat that which is causing the wickedness itself.
Protect and Treat.
With compassion.
With medicine.
With time, energy, attention.
Hurt people are lonely people. Lonely people are hurting. Themselves, each other, our environment.
And nurses understand that pain is a vital sign – an indicator – a warning – that something is wrong. And if it’s broken, we fix it. If we can’t fix it, we ask for help (seek expert consultation). If we ask for help and don’t get an answer, we ask again, or we ask someone else. We keep trying, showing up, putting in the effort, taking good care of our patients, populations, people, and planet…
Taking good care of our selves.
So we can rise up and shine another day. To thrive.
Take good care in this bright year of opportunity.
Love,
Jessie