Thursday, November 17, 2011

The history of Canadian healthcare in this era

I am woman, hear me roar. When the men went off to war in 1945, the women worked in the factories: it was the War Effort. Some women did their part in their homes; some women provided childcare for their sister's children. Other women took their place in the work world. The men returned from the war, and the women were sent home. Women built war ammunition, and flew planes from factories to airfields, yet they were denied work in the industry after the war. They were sent back to their homes, competent people they proved themselves to be, still, gender bias prevailed. But they found a toe-hold.
 I come into contact with many of these women in my hospice work. They are amazing.
Michele, paraplegic in LTC, a nurse on BCs west coast for 41 years. Kay, nurse for 40 years. They paved the road.

My daughter, M. Sc., is a hard-working woman and the result of the encouragement my generation gave, as we fought the glass ceiling, the rights of women to remain in the workforce, despite the power-that-be believing we ought to remain barefoot and pregnant, or streaming us into teaching and/or nursing.

Being a physician isn't for all of us. Many women, parents, wives, contributing members of society, thanks to feminist principles, have entered the work force. Women are police officers, volunteer and full-time firefighters, contractors, veterinarians.

Some of us were meant to be teachers (as I was) or nurses, traditionally accepted work, but my generation learned that you must do what you love, not what society thought you should do.

I remember midwives (mostly women) as they fought 30 years ago with OB/GYN physicians for the right to serve health non-risky pregnant women. They won. My daughter gave birth, at home, to our second grandchild in dignity, calm, and the peace of her own bedroom, in her own bed. Attended by two midwives, who immediately taught her how to care for her wee newborn, what to remember, gave her a refresher on how to breastfeed, and visited her, at home, every day for a week.

I can see how nurses have fought physicians for the right to a better education, respect, and to serve patients, especially those without a GP. Nurse Practitioners have won recognition, independence and serve remote rural populations where doctors won't go. Still... some physicians bully nurses, and treat them disrespectfully. Doctors have invented Physician Assistants, a higher rate of pay than nurses, with less education. This saddens me. (Read more about Respect.)

Now, nurse managers in power (and the government) are trying to control the work and the practice of PSWs, as they strive to improve their practice, learning and working conditions, as they serve their clients. Agencies are treating their PSW staff the way they have been treated, domineering attitudes, negativity and disrespect. This must change.
Physicians bullying nurses still exists. (Framing the Discussion Around What’s Best for the Patient) Now, nurse managers are perpetuating this attitude and supervisory practice. 

We know what works in healthcare: communication, collaborative practices, advocacy, respect, a flattened hierarchy that recognizes experiential learning, and the wisdom of years of experience on the front lines. Great male doctors are not be threatened by female nurses. The good ones recognize nurses' important contributions to healthcare in an integrated, collaborative team where Patient Outcomes are the priority. 

I can see how PSWs are being treated as members of the healthcare team. WCBA Season Debut: Personal Support Workers and SeniorsIn long-term care, and other institutional settings, PSWs recognize the intent of Ministry of Health and LTC standards. They recognize that while the law states that a resident must not be roused out of bed before 6:00 a.m., and yet will respond, in their busy morning routine, when an insomniac senior asks for help getting dressed. The nurse manage will reprimand them, with the dire warning that they violate the law. Managers, in their fear in this litigious society, fail to realize that there is a difference between a LTC and a prison, and that a resident must have their requests met if possible with time and energy constrictions. They understand that the intent of the law is to prevent for-profit LTC from acting like a prison, and denying a senior a simple request.

Change is slow. Organised groups, like OPSWA (with whom I volunteer), are fighting for internal accountability, independence and respect. The Ontario government, as it responds to the call for greater accountability, is still treating PSWs (primarily women) as a group they must take care of. This is no longer true. PSWs are learning, faster than some in the nursing profession, to become good managers. They intervene and respond to PSW/patient conflict as the mediators that our poor union brothers and sisters cease to be.

 I will fight for you, with you, and the principles you stand for: better education, better training, respect, accountability, as you work with the most frail, needly, at-risk, vulnerable patients: our loved ones.

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