NIWI: Nurse In Washington Internship

I just got back from Capital Hill last week, where I got to attend this amazing program called NIWI or Nurse In Washington Internship. The primary focus of the internship was to help nurses better understand the legislative process, and how nurses can use this process to invoke policy change on both a state and national level. It was a fascinating program from which I learned a great deal. But I think what I enjoyed the most, was meeting so many amazing nurses from all around the country. Nurses who had enough initials behind their name to form a small sentence. Nurses on the boards of some huge nursing organizations, and passionately represented their respective specialties. Nurses who had ventured outside the realm of traditional nursing and gone into politics, business, law, etc. It was the most professionally inspiring experience I have had in a long time! I thoroughly enjoyed every second of it, and I left the program having a clearer idea of what I needed to do to achieve my future goals.

Working as a bedside nurse has put me in the trenches of our healthcare system. Every time I go to work, I see things that make me think our system can be run better. I see a patient's dissatisfaction with their, often times, fragmented care and the rising cost of healthcare. I see physicians- frustrated, overworked, and often disillusioned by a bureaucratic system that doesn't allow them to treat the way they intended to. I see unhappy nurses struggling to provide safe and effective care with limited resources. I see, what I believe to be, fiscally poor decisions being made all the time ranging from the astronomical costs associated with end of life care to our hospital systems increasingly being run based on a consumer model . After years of being a passive observant, I am finally ready to take action. After all, people always say, you have a choice: Either you are part of the problem, or you are part of the solution. And I sure as hell want to be part of the latter!

So I have started to outline a game plan. It is definitely a work in progress, and I am sure it will evolve as my knowledge base grows, but I hope this framework can help me start my journey to creating meaningful change in our healthcare system. 

My first step: Defining what I believe are some key issues. What is the change I wish to see? 

1. Encouraging a shift in American Health culture from reactive care to preventative care. We need to do a better job of maintaining health and vitality, and this includes better access to primary care, creating more affordable food options, addressing health disparities, etc

2. 30% of our nation's health care costs involve end of life care. Something has got to change. We are not doing justice do our dying population, and we are running our national bank account dry. Dr. Atul Gawande's book "Being Mortal" did a great job addressing and expounding on many of the issues surrounding this topic.

3. The practice of defensive medicine that permeates almost every tier of healthcare. This cover your ass mentality has driven up costs (extra consults, more tests ordered, etc), and moreover created a culture of dissatisfied  and paranoid clinicians. 

4. Healthcare systems run on a consumer model. Patients are NOT customers. Hospitals should not be spending precious dollars making sure their lobbies are pretty and their cafeterias serve a variety of food so that patients and their families choose their facility in a time of need. Instead, they should be spending money making sure they can provide the highest levels of safe and effective care. Patient satisfaction scores can play some role in determining hospital funding, but more importantly is the hospital's performance on national patient safety measures. 

Those are probably my top four things I would like to see change in our healthcare system. Of course, there are many more issues that need to be tackled to create a better system, but the ones listed above are the ones I am most passionate about. 

Step 2: Research

I am thinking about interviewing members from all aspects of our healthcare system from patients to doctors to social workers to insurers...I want to better understand the challenges each population faces. What are the changes they wish to see? How do they believe the system can be improved so that they may be happier. I need to have a better understanding of the global needs of each group, so that hopefully I can one day translate it into a better solution. 

I also am thinking about looking into master's programs that will provide me with the background I need to achieve my goals. Currently, thinking about a MPP/MBA. 

Finally, as a member of The American Association of Critical Care Nurses, I need to get more involved in the organization. Hopefully, working in the organization (and others like it) will help me develop the skills needed to invoke grassroot change, and hopefully, eventually more nationally focused change in my later career. 

Step 3: Implementation!

To be determined! Maybe a job in CMS for starters? Who knows!

Overall, I am super excited to get this ball rolling, and be more proactive. The future seems limitless in opportunities :))