Practice Matters

Knowing you can make it

They were the darkest days of World War II. Ships—even those sailing far to the north, above the Arctic Circle—were being sunk with disastrous regularity by German U-boats. Most of the sailors on those ships drowned, but a few survived. What fascinated investigators was that the older men—and often those who were less physically fit—survived while younger, and presumably more fit, colleagues died.

The question was “Why?” The answer, after months of study and hundreds of interviews, seemed extraordinarily simple: The older men survived because they knew they could. They had lived long enough and suffered through enough to know that if they could just hang in there, they could (or at least might) survive this, too. For the younger men, the disaster came too early—before they’d learned they could survive adversity, even disaster, if they could just hang on. Although young people tend to be more optimistic than older people, untested optimism can be utterly crushed by unanticipated adversity.

Disarray in the system

Of course, there’s a point to this philosophizing. The U.S. healthcare system is in disarray. The problems attendant to the disarray have been chronicled many times over the last 15 years—from the Institute of Medicine’s 2000 report “To Err Is Human: Building a Safer Health System” to a 2013 JAMA study that found surgical complications in one health system cost up to $14 million a year, to a 2013 Time Magazine article exposing crazy differences in hospital costs—and, of course, to the problems plaguing implementation of the Affordable Care Act.

Much of the disarray stems from rapid changes and what seems to be anticipatory fear over budget cuts. However, both common sense and good business practice demand that everyone, including nurses, be treated well in the workplace. Every management principle promulgated since Theory X supports a work environment that encourages and rewards workers for excellence. And nearly every one of those management principles has been ignored in the past few years.

It’s going to take time and concerted effort to heal the healthcare system. But it can be healed. Survival and success are as much about mindset as anything else. We “old folks” know that, but we need the optimism and energy of youth to pull it off. Together, not only can we heal our healthcare system; we can make it better. For now we know. We have the proof:
Only clinical excellence is cost effective. And only clinical excellence can save our healthcare system.

Leah Curtin, RN, ScD(h), FAAN
Executive Editor, Professional Outreach
American Nurse Today


Selected references

Brill S. Bitter pill: Why medical bills are killing us. Time. February 20, 2013. http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/print/[2/26/2013 7:31:26 AM. Accessed December 3, 2014.

Eappen S, Lane BH, Rosenberg B, et al. Relationship between occurrence of surgical complications and hospital finances. JAMA. 2013;309(15):1599-606.

Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000. www.nap.edu/catalog/9728/to-err-is-human-building-a-safer-health-system. Accessed December 3, 2014.

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