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The cost of crises

Ontario’s rape crisis centres are struggling to respond to the 50,000 calls they receive from assault victims each year. With increased demand for services, people who support and advocate for these centres are concerned that the $14.8 million dollars they receive annually from the provincial government, plus a recent $1 million dollar boost, isn’t enough. My…

Ontario’s rape crisis centres are struggling to respond to the 50,000 calls they receive from assault victims each year. With increased demand for services, people who support and advocate for these centres are concerned that the $14.8 million dollars they receive annually from the provincial government, plus a recent $1 million dollar boost, isn’t enough.

My question is, why are we prioritizing crisis response?

I think it’s safe to assume the majority of people who support rape crisis centres do the natural thing and say “Rape crisis centres need to help survivors cope with their traumatic experiences”. 

But I wonder, where are the people saying, “Let’s be more like rape prevention centres. Let’s prioritize giving youth and adults the tools and knowledge they need to protect their safety, develop healthy relationships and avoid becoming victims of sexual assault”?

Is anybody saying, “Crisis response costs more than crisis prevention. Let’s build a culture that’s intolerant of sexual violence. Let’s do something different, reach more people and avoid all the running around we’re doing”?

For sure, it’s important to help people who are suffering. But if we focus too much of our attention, time and resources on responding to emergencies and crises, there’s nothing left for us to work on the strategies and tactics we need to avoid unnecessary suffering and the demands that come with it.

Because people who established rape crisis centres in the 1970s decided “what we do is prioritize helping victims” and because people who support these centres today prioritize the same, it’s not surprising we’re stuck in the sad reality of seeing thousands more #MeToo victims every year.

Knowing what we do is important, but it’s not nearly as important as understanding our real problems and why our organizations exist in the first place.

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Are you going down the wrong path?

The only reason I can speak about this is because I understand what it’s like. In fact, I know it so well that I’ll never forget the excruciating pain of it. If you love your work and can’t imagine doing anything else or being anywhere else, that’s wonderful. You’re probably working on something you’re meant…

The only reason I can speak about this is because I understand what it’s like. In fact, I know it so well that I’ll never forget the excruciating pain of it.

If you love your work and can’t imagine doing anything else or being anywhere else, that’s wonderful. You’re probably working on something you’re meant to be doing.

But if you’re feeling stuck, unhappy and uncertain about what to do about your work (or someone you know is), it might be helpful to see the signs you’re going down the wrong path. Because it can be happening without even realizing it.

Most of us like to think that it’s best to wait for things to get better, because sometimes things do get better. On the other hand, we all know that our time is limited. Once it’s gone, we don’t get it back. What many of us don’t know is that chronic stress and unused potential aren’t benign. There are seriously harmful consequences of living a life that isn’t for us.

While success and struggle aren’t mutually exclusive, there are certain kinds of struggles that are red flags for burning out. Here’s a list of some of the signs you might be going down the wrong path:

You’ve lost interest in your work and struggle to get out of bed in the morning. 

Your work doesn’t bring you satisfaction. 

You look forward to weekends, holidays, snow days and retirement (basically any day you don’t have to do your work).

You take sick days when you’re not sick. 

You continuously question what you should be doing. 

You’re always thinking about work. 

You compare yourself to your colleagues and believe that something’s wrong with you because you don’t feel the same about your work as they do. 

You’re looking for other options. 

You’re stressed most of the time.

You’re miserable, irritable and unhappy. 

You feel drained after working.

You feel the need to unwind with drugs, alcohol or over-eating. 

You’re not sleeping well. 

You’ve put in a lot of time and effort and things aren’t getting any better. 

You feel like a failure for not liking your work the way you thought you would. 

You’re worried that you’ve spent too much time and money to get to where you are that it seems impossible and irresponsible to do something else. 

You feel like you’ve lost your identity and a part of who you are. 

You feel the need to sacrifice your values and beliefs to fit in with your colleagues. 

You’re afraid of being judged, criticized, rejected or ignored by your colleagues for quitting. 

You believe you have to work your whole life doing work you don’t like, just to make a living. 

You’re afraid of upsetting your family if you quit. 

You’re afraid you’re too old or too young to do something different. 

I could go on, but I’ll stop here.

There’s an infinite list of signs we’re heading down the wrong path. It feels scary to admit to ourselves when it’s happening, scary to admit to other people and even scarier to do something about it. But these things aren’t as scary as getting to the end of your life and having regrets about how you spent your time.

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“This is what we do”

This is a good time to tell you that I’ve spent most of my life working in health care. As the daughter of a medical receptionist, my career started as soon as I could manage to file charts alphabetically. Somewhere around the age of eight. Over the years, I’ve developed an awareness and a set of…

This is a good time to tell you that I’ve spent most of my life working in health care. As the daughter of a medical receptionist, my career started as soon as I could manage to file charts alphabetically. Somewhere around the age of eight.

Over the years, I’ve developed an awareness and a set of beliefs about how health care should be, and about what works and what doesn’t.

The other day when I called a local hospital and spoke to a radiologist on the phone about a client I saw who needed urgent diagnostic imaging, but who didn’t need to be assessed in the emergency department, I wasn’t happy or surprised when the response was, “Just send them to the emergency department. It’s the easiest way to get urgent imaging”. 

Nor was I thrilled or shocked when, on the same day, I received an email with a 25-page journal article attached. It was an important article and relevant to my practice, but as soon as I started to read it, I knew it would be difficult for me to remember and apply in practice.  

I don’t believe the majority of health care providers consciously misuse health care services, waste money and subject people to unnecessary care. I also don’t believe that researchers and authors want to write impractical and inconvenient articles for us.

So why is the emergency department the fastest way to get urgent diagnostic imaging? And why do researchers write articles that are hard to apply to real life?

One of the reasons, I think, is that we fall into the trap of believing that “the things we do” are the ultimate goals of our work. As a result, we get stuck with systems, processes and solutions that are based on what we knew and what was possible a century ago, rather than what we know today about the world and what people really need.

Instead of sticking with the lists of things we do and don’t do in our organizations, we ought to intentionally and regularly ask ourselves why we do what we do and if what we’re doing should be done the way we do it.

Knowing what we do is important, but it rarely leads to transformation and growth. Real change happens when we’re clear about our purpose and reasons for our work.

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This is health sick care

Living in a rural area, I’m fortunate to have a primary care provider and access to several hospitals. It’s comforting to know that if and when I need help, it’s there. One thing I’ve noticed is that we have long wait-times for appointments and over-crowding in our emergency departments and hospital floors. Why is this?…

Living in a rural area, I’m fortunate to have a primary care provider and access to several hospitals. It’s comforting to know that if and when I need help, it’s there.

One thing I’ve noticed is that we have long wait-times for appointments and over-crowding in our emergency departments and hospital floors.

Why is this?

The answer is simple: Because when health care providers aren’t busy caring for people who are sick, injured and suffering, we’re waiting for them to walk through our doors.

Does this sound similar to where you work?

Instead of going into the community and teaching health knowledge and skills, building resiliency and tackling the social determinants of health, we stay put and deal with problems as they happen.

Most of us working in emergency departments don’t re-direct people to use alternative, more appropriate locations of care in the moment. Instead, we make people wait and treat whoever comes in.

Most of us working on in-patient units and in long-term care facilities are so busy looking after sick people that we don’t have a chance to help them stay well and avoid needing us in the first place.

Most of us working in mental health are too overwhelmed by the number of people presenting with crises, traumas and mental illness that we don’t have time to teach resiliency so that people can cope with adversity.

And most of us working in primary health care don’t get outside our buildings and prevent problems before they happen. Instead, we wait for the next person with influenza, cancer, diabetes and hypertension to see us.

Our health care systems prioritize urgent problems, completing tasks and putting out fires. It’s hard to measure and reward insight, prevention, empathy and thinking differently. As a result, we’re busy and stuck.

The causes of many of the problems our patients experience are not inside our health care institutions and neither are the solutions. Yet we certainly act like they are.

I can only hope that more of us learn to see that a lot of what we do as health care providers is far removed from the kind of help people actually want and need.

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Do you have the authority?

Are you allowed? Who said you could do this? Has someone granted you permission?  These are the wrong questions to ask. The question is, do you need to have the authority to do the work you want to do? When I started NursEd a few years ago, a lawyer asked me if I had the authority to start my…

Are you allowed? Who said you could do this? Has someone granted you permission? 

These are the wrong questions to ask.

The question is, do you need to have the authority to do the work you want to do?

When I started NursEd a few years ago, a lawyer asked me if I had the authority to start my business. As if I needed someone’s stamp of approval to work on improving nursing and education. “No I don’t have authority, and I don’t need to”, I politely replied.

For sure, we need permission to diagnose, prescribe, administer medications and perform procedures. But no, we don’t need authority to look at systems and processes that aren’t working and try to make things better.

The problem is, from kindergarten all the way through nursing school we’ve been trained to believe we need to wait for someone to say we’re allowed do anything that falls outside the norm.

The people who are thriving in the world today are the ones who are creating new systems and ways of doing things right next to the systems that everyone else is too afraid to change.

Achievements of a lifetime rarely come to people who stick to the rules, keep their head down and wait for someone else’s permission. Once we realize that no one is going to give us the authority to do the work we care about, we’ve got to choose ourselves.

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