The Poor Fit: 6 Signs That Your Job is Absolutely the Wrong One

Dangerously close, anybody ?!?!?
Live and learn…. Monitor, analyze, and if not the RIGHT fit -> get out! it’s allowed, it’s ok, it will be the right move in the end. I promise. Your career is CALLING YOU 🙂

Marla Gottschalk

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Many of us have experienced this — the wrong job. It’s really no one’s fault, but it’s dawned on you that your work life may be dangerously out of alignment.

Nothing is worse than throwing yourself into work, yet things just seem to go very, very wrong. The trick here? Identifying the problem for what it is (in very short shrift) and acting to make changes. Poor matches do happen. So, let yourself off the hook and avoid a long-term “soul sucking” experience. Remember that “withering on the vine” is not a viable career strategy.

Here are 6 signs that you should be paying attention to:

  • You feel lost. Have you had the classic nightmare that you arrive at class, only to find that you’ve not read a single page of the textbook and it is final exam day? This should not be your experience with work during waking hours…

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When Settling Cross-Functional Concerns — Lay the Cards on the Table

How revolutionary, I love it!!!
It goes completely against our self-diminishing, ingrained and drilled-in office “etiquette of a sheep” with expected customs of “keeping the calm”, not making any waves, keeping the peace, playing nice, being a team player, not be pegged as a troublemaker or thought of as “the problematic one”. Yes, I LOVE IT!

Marla Gottschalk

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When different functions within our own organizations aren’t seeing “eye to eye”, we tend to shy away from bringing them together. We don’t intend to prolong the conflict — but, in reality, that is what occurs. Our instincts are often to act as an intermediary and settle the issue calmly and quickly. But, that is likely not in the best interest of the organization.

Digging into the concerns is often the best route, especially if the conflict directly affects your clients or customers. Often it’s time for things to change — yet we’ve ignored the signs or haven’t had the opportunity to address the issues.

It’s best to lay the cards on the table and expose the root of the problems, even when this is an extreme challenge, as quickly as possible. Hopefully, exploring the developing issues wards off delivery problems related to products and services.

When I’m called in…

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Should the Paramedics take on the role of Rural Home Health Nurse?

What do you think?
Earlier this week I attended a 3-hr of public hearing in Sacramento where a variety of speakers were debating a pilot program proposal for an increased role of PARAMEDICS in managing chronic care diseases when attending to home care needs of patients (in rural on inner city areas they say).

While I fully support the notion that something must be done with the dreadful state of CA public health, access to medical care and adherence to home care / discharge plans, with all due respect and deference to paramedics, to manage a chronic condition in a home setting takes fine tuning and years of studies and practice. Just because nobody is bleeding does NOT mean it is not critical, problematic or very complexed issue to deal with.
There is a reason new grad RNs are NOT hired for home health because you MUST have experience in dealing with the disease management before you will be even considered to be sent out there making decisions on location!

It is usually the patients who are not bleeding or vomiting or collapsing that are the biggest problem in a home health setting, those who sit quietly, those who if you don’t know what and how to ask OR if you don’t know what signs to look for – usually, they are the ones who don’t even tell you! They don’t wanna be a ‘bother’ – I’ve heard that SO MANY times from grandmas and grandpas
(Again, I am talking about chronic disease management in home care, not discharge home from tonsillectomy, for example)

To manage chronic care diseases, you must know and understand the disease process, the disease signs & symptoms, to know how it was managed in a hospital, what can be the side effects of any of the above, what to look for, how probable complications look like even before they become major problems…. And finally, you must understand how to fine-tune the care!
Again, paramedic are GREAT and FANTASTIC at what they do, which is the FIRST phase of giving emergency care, I worked with them for many years on 2 continents (and in Czech I worked in the department!), so my hats off to you, but to manage the last part so-to-speak of care such as COPD or CHF or HTN or DM – that takes years of training, learning and practice!

Also, I am NOT saying we, the nurses, are fine-tuning or managing the treatments, that’s why we have specialists such as fantastic pulmonologists, but we the nurses are fine-tuning the plans of care upon discharge, the follow ups and the adherence to those. At least that’s what the nurses should do – but we don’t have them!
WHY?
Because the State cut the budget in 2011 and DHS and DSS just don’t have the funding! Those positions got cut. …Now we see how much it actually cost us because just because you cut a position or access to care here does NOT mean those patients will not seek the treatment or medical attention elsewhere. Now, all those trips to ERs – they get very expensive for the State! And now with added millions of new patients via Obamacare – don’t get me even started!

While I fully support the need for a change and innovation in our roles and in health care system delivery overall, in fact I have been calling for it for some time now, I do not believe paramedics as chronic care managers or home health caregivers are the long-term solutions to our much bigger problem.
They are trained as ‘ready to go’ as first responders, and I believe they are the BEST in the WORLD, but not as chronic care or home health care giver, and 16-18 hours of added education will not change that.
… At the same time, I absolutely understand what they are trying to do or accomplish and WHY!
I get it, I understand.
But I don’t believe this is the right solution.

Ukraine Today: Political Realism First, Please!

Ukraine Today: Political Realism First, Please!

marketa houskova |Educate Influence Make a Difference

(original post on humanitarian situation written on Feb 20th, 2014 in Sacramento, CA, USA. Updated based on last week’s cease-fire and political agreements on Feb 24th, 2014 in Sacramento, CA, USA)

czech vlajka znak

I was a young Czech nurse when the atrocities were happening in the Balkans, and NOBODY from the EU moved a finger, nobody helped them! I often asked myself what would have I done…?

While I had no influence over it, as after the Velvet Revolution in Czechoslovakia, after 40 years of oppression, and 20 years of Soviet occupation, I finally was allowed to travel abroad and I left home.

I looked after children, cleaned houses and pubs, learned English by myself at nights, held 2-3 jobs in order to follow my dreams of studying and obtaining my Nursing licenses in Canada & USA, only to go further towards my biggest dreams of earning multiple university degrees in global politics…

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Hippocrates, the Original Public Health Care Worker?

Hippocrates, the Original Public Health Care Worker?

Recently, I watched a videotaped lecture by the famed Dr. Carl Taylor, MD DrPH (1916-2010), the founding father of then-new academic discipline called International Health. Dr. Taylor’s lecture, taped few years before he died at the age of 93, was called The Key Studies of Primary Health Care and it was available on the Johns Hopkins open access website. This interesting lecture was actually a part of Dr. Taylor’s teaching curriculum at the Department of International Health that he established at his beloved Johns Hopkins. His love, however, was to travel around all corners of the earth and help communities empower themselves!

Johns Hopkins hospital, Baltimore MD

Currently, I am taking Health for All Through Primary Health Care class through Johns Hopkins, and if we realize that by all accounts the most important Alma Ata Conference was held in 1978, that we are faced with a certain crisis of unfulfilled Millennium Development Goals (MDG) by 2015, and that more people live in abject poverty today than ever before – we begin to truly appreciate the genius of Dr. Carl Taylor’s approach and his vision for not only health care as such, but for PRIMARY HEALTH CARE especially!

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WHY is primary or community health care THE point? Simple: If the government doesn’t do it for you (i.e. the Top-Down model) the people must do it for themselves (Bottom-Up model)… Hopefully with some help and guidance from global health or international organizations, sure, but by leading themselves nonetheless.

As for me, I would have never believed I would be interested in a discipline that does not have all the critical & intensive bells and whistles that only Code Blue, cardiac arrests, Swan-Ganz and ICP or resuscitation in hallways can provide and only critical intensive nursing can deliver. However, as my professional development began to move forward, I very slowly started to move away from all that acute rush in hospitals to seeing ‘Public Health’ from not only an administrator point of view, but also from the level of public health policy.

And that’s where it really hits you!

Saving people’s lives one by one thus making a difference in my patients and their families lives in ICU or OR or ER or PACU was wonderful and I loved every minute of my 13+ years on 2 continents and 3 countries! But, if you really want to make a difference, difference on a much broader global scale that is, you must look at the discipline of Public Health – and specifically, International or Global Public Health (as is my Masters Degree) through a different set of eyes and through completely different prism.

And this why I LOVE it so much!

In order to be successful and effective here, you must fully understand the intricacies of health care / patient care delivery, from there you must be abreast on how to deliver said services in a department or an organization, which is finally leading you to realization you can have influence through your earned knowledge and understanding over global issues, politics and public policies that are determined by international decisions via foreign policies. Those in turn deeply affect all those other social determinants of health which decide the actual individual health and well being – or not – of your people. … when they come to ICU and I can save them…

The astounding combination of my 3 professional loves and passions:  [Global] Healthcare, Politics & Administration all lead to my overall passion and I believe a certain inner sense of Global Public Health Administration. And that is why I slowly moved, over the span of several years and large sums of money for university education) from all the bells and whistles in intensive and critical care units to a global view of social determinants of health, determinants affected by political decisions.

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From Dr. Taylor’s lecture, we learned that the idea behind ‘community-based primary health care‘ is as ancient and as old as Hippocrates himself, as he began to treat sick people in the open, as in village squares where every person from the village could come and offer advice on treatment and getting better! While I don’t really agree with openly spreading germs to the village, the fact that Hippocrates did not isolate the sick, that he did not put them somewhere ‘away’ from the others, shows his initial foresight of holistic / community approach to healing and showed his outlook to the future foundation for community-based primary health care.

What I also did not know is that it was Hippocrates who first started to separate medicine from public health as he started to recognize that different geographical areas meant different patterns of diseases. That was a major fork in the road for healthcare where medicine has clearly different goals and different strategies from community-based primary health care.

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Dr. Carl Taylor stated that in the early days, U.S. physicians viewed primary care as ‘individual’ care, while following approach originating in South Africa encompassed and recognized all aspects of health care in its Community Oriented Primary Care approach (COPC). Here again, many years after Hippocrates, we see the resurgence of the core idea that community is at the center of “health” and well-being of an individual thus of the collective “health” of the whole community.

In a historic context, I would compare this community centered resurgence of the South African (and later American and Israeli) approach to the recent resurgence of the principles of the Alma Ata Declaration. Lancet article (Walley et all. 2008) clearly states that the community-based or community-centered approach to public health is going through a re-birth of sorts as more and more studies show that Dr. Taylor’s SEED-scale approach, which clearly encompasses Kerrer’s South African COPC model, is an approach that takes all other, not only health and disease, but also other social determinants of health in account when dealing with “health“.

Walley says: “The emphasis must shift from single intervention to creating integrated, long-term sustainable and ethical health systems…” Nobody, not the U.N. or any NGO, can achieve this Alma Ata-centered goal without dealing with a host of other determinants. Sadly, for our global health care objectives, those determinants are decided and implemented (-or not-) by sovereign national governments.

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Herein resides the problem.

Health does not happen in a vacuum! Very rarely do people get sick out of nowhere…

Health” happens as a result of… or a consequence to… certain political actions or social events.
The primary public health care problem we are discussing here, is a problem originating in poverty, lack of potable water, lack of safe environment, lack of developed infrastructure, lack of knowledge and awareness, and lastly, as a lack of political will.

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That is why I applaud the resurgence of the Alma Ata principles taught by Dr. Carl Taylor and the ongoing recognition of the variety of other important aspects that influence, directly or indirectly, the overall status of public health and primary health care in particular.

In fact, it was Hippocrates who preceded Alma Ata Declaration with his vision, when he involved and engaged the whole community in the treatment and planning of healing solutions… And that concept is THE cornerstone of  Alma Ata Declaration!