Paul's Passing Thoughts

By Paul Dohse, TANC Publishing author and healthcare worker.

It’s Time to Remember What a Healthcare Worker Is 

Let’s talk about nurses dressed up in scrubs protesting against those who are protesting the lockdown. As healthcare workers we receive a lot of training on professional boundaries, but like all rules, they usually don’t include commonsense rules, which should be assumed.

This article is about how these protesting nurses have plowed over commonsense boundaries, particularly commonsense rules about hypocrisy.

Let’s first examine the specific argument and how the argument is communicated, which is surprisingly consistent, as if from one playbook. I initially ignored this nonsense in the beginning because the first protests of this type were obviously staged by political shills.  Real nurses have followed suit, and are using the same talking points. It goes like this:

“Today I stood on the Rhode Island State House steps, with just a few of my coworkers and other front line workers, to take a stand for health care, against those protesting to have the “stay-at-home” order lifted in Rhode Island.

I stood up today for my patients, my coworkers, my parents, my grandparents, my relatives, my friends and other loved ones.

I can proudly say we stood in silence, standing 6 feet apart, and we let our blue scrubs and face masks speak for us.”

Condescending much? News flash: scrubs, if they symbolize anything, symbolize care and treatment focus, not caste knowledge that ends an argument. But unfortunately, a smug, arrogant attitude, under the guise of love, is just the beginning of what makes this whole deal fraught with ignorance, self-aggrandizing, and over-the-top hypocrisy. As an STNA/MA-C that has invested heavily in advanced education and training to be the best I can be for serving nurses, I was first ashamed, now I am offended and ready to call them out.

The narrative being proffered suggests that hundreds of ICUs are a COVID apocalypse and the national lock-down is the only hope of ending the apocalypse. Granted, I don’t believe this is the flu, and I don’t believe it only kills people with underlying conditions. I agree, notions that downplay COVID annoy me; however, not commonsense discernment. Though the percentage is small, it kills people who should not be at risk at all. That’s what makes this virus scary. Couple that with the fact that it is highly contagious. I was told by one nurse, “Oh yes, by all means practice good standard precautions, but if it’s in this facility, you are going to get it.” I believe it is Russian roulette. Yes, you would have to imagine a very large revolver, but would you play if the cylinder held 1000 rounds instead of six? And, some ICUs are, in fact, a medical apocalypse because of this virus.

With that said, these protesting nurses are basing their protests on the idea that a COVID apocalypse is in full swing everywhere. Here in Ohio, where I live, two days ago, there were thirteen COVID deaths in the whole state, if they were COVID deaths. State and federal protocols for classifying a broad spectrum of deaths as COVID cases have been widely publicized. Yet, in Rhode Island, where these protesting nurses live, there have been 200 deaths out of roughly 7000 cases, and the deaths are almost entirely confined to nursing homes.

That makes this protest very cringeworthy, and pretty much indicative of the rest of the like-protests as well. ICU medical apocalypse, primarily the reality in New Jersey and New York, and certainly a horrible reality, is hardly the case in Rhode Island. Their protest, like many others around the country, suggest that they are driven by experiencing a New York like ICU experience. In their case, practically all cases are taking place in long term care facilities where our low-wage brothers and sisters have fled. That is, nurse aides (STNAs) making 12 dollars an hour. I speak personally to what kind of PPE you get in those places, and no in-house service on special precautions for this virus. All in all, this makes the nurses on the Rhode Island courthouse steps a “Paul and the hat moment.”

When I was a young boy, during the holidays, our family stopped by a friend’s house on the way to a large family gathering. I observed a candy dish in the foyer, and while no one was looking removed all of the contents and placed them under my hat (those goofy looking hats parents used to buy for their children in the 60s). We arrived at my grandparents’ house in Oakwood, Ohio and the family all gathered around in the foyer to meet us. At that moment, a phone call was received from the friend who complained that all of the candy was taken by someone. I was accused before the whole family standing there in the foyer, while I denied the charge profusely. The family looked at each other and shrugged their shoulders, and I was vindicated. My grandmother then asked for coats and hats to hang up, and without thinking, took my hat off resulting in the candy crashing to the floor. You could have heard a pin drop. Have you ever seen those “Want to get away?” Southwest Airlines commercials? Well, you have never seen one that good. I remember my embarrassment that night like it was yesterday, and regarding my embarrassment for protesting nurses, you can multiply it by ten. They have egregiously misrepresented what a healthcare worker is.

The narrative is furthered by a meme that shows a mob of people celebrating a nurse with a number of scissors sticking out of her back. It said something like: “Don’t praise us and then stab us in the back by protesting the lockdown.” This proffers the idea that while a total lockdown is the only hope against the ICU apocalypse, a bunch of fly-over hicks want to end the lockdown so they can go to WWE events which will invariably increase the carnage experienced by healthcare workers already on their way to dealing with post-traumatic stress. While the latter may be true of some healthcare workers in several ICUs, to protest according to that narrative on behalf of all healthcare workers is a perverted fraud.

Beside that, since when have healthcare workers not been sheep led to the slaughter by the healthcare system? Come now, we all know the best of us are totally expendable and always have been. It’s part of the job description. Yes indeed, what a shame that we would be “stabbed in the back” by people who have lost everything they have worked for all of their lives. What a shame that people who have lost their spouses to suicide are angry and frustrated. Future patients are now our enemies because, you know, the government and the healthcare system have always held us in the highest regard! Now, we must take sides for those who do so much right by us. Middle America Trump supporters are our enemies because they won’t swallow everything the government is handing down. You know, the same government that cannot even supply us with enough paper masks for a worldwide pandemic. Because, you know, pandemics are such a novelty.

This is healthcare: it is a singular focus on care needed at any given moment by any given human being. That can be a problem for us, because those in charge of our supply know we will bitch a lot, but ultimately we are going to treat people with whatever we have available because that’s what healthcare workers do.

We treat with whatever we have, and the reason the need is in front of us is completely irrelevant. As an STNA, the invalids I treat who are invalids because of their stupid choices get the same care as those stricken with cancer. We make life as good as it can be for individuals to the best of our ability with whatever we have. That’s what we do; that’s who we are. The end of a lockdown will overwhelm us and we are already overwhelmed? Even if that is true, what of it? That’s nothing new in healthcare. If not a premature lifting of a lockdown, it will be something else.

Those who took advantage of Florida allowing citizens to return to the beaches are now “#morons” on Twitter (FYI, sunlight kills viruses). Meanwhile, nurses out of work because they contracted COVID are getting time off charged against their PTO. Hail to the all-virtuous and all-knowing healthcare system. But the dark turn of events follow: protesting nurses are demanding those protesting the lockdown step-up and decline to be treated if they become infected. Presumably, if you don’t follow lockdown orthodoxy you don’t deserve treatment. Apparently, if you end up in ER with COVID, you better make sure they are aware of your support for the lockdown if you want adequate treatment. Someone has already created, as a meme, a waiver document for lockdown protestors. If you are against the lockdown, you don’t deserve treatment because you have stabbed healthcare workers in the back with scissors. But the fact of the matter is, no real healthcare worker has any room on their backs for an additional pair of scissors to begin with.

How an individual ends up under our care is completely irrelevant. Healthcare workers leave all of those judgments to God. Every one. At work, care is our only religion; care is our only brand of politics. And every care worker should know that only one person has our back: God himself. When the government or a healthcare system does something that shows appreciation for what we do through supply or good management, we are thankful, but since when do we expect it?

Let’s do a summary to this point before we move forward: the basis of the nurse protests misrepresent the reality of the crises, conflates their experience with those who are too busy saving lives to protest, presume to speak for all healthcare workers, and misrepresent what a healthcare worker is. Now we will move on to the hypocrisy of their actions.

Acute Care Versus Long Term Care 

Acute care workers have been the primary focus of accolades for those on the front lines of the COVID pandemic. We have seen the massive display of police and fire department recognitions for nurses and doctors changing shifts at hospitals. Here is where you haven’t seen such accolades involving dozens of police cars and emergency vehicles with lights flashing and the doling out of free food: in front of a nursing home. Yet, as well publicized, hospitals have dumped a lot of their COVID patients into nursing homes to be cared for by LPNs and STNAs. And, undoubtedly, uncertified caregivers who work in nursing home assisted living halls.

Full stop: while a real apocalypse is taking place in ICUs to some extent, there is also a much more widespread medical apocalypse taking place in nursing homes across the nation. Nursing homes, or long term care facilities, are being decimated. One LTC in New Jersey had to store deceased residents in a maintenance shed behind the facility.

Rhode Island is an interesting example. While acute care nurses are protesting on the RI statehouse steps, virtually all of the state’s COVID deaths are taking place in LTC facilities. In RI, this resulted in low-wage healthcare workers fleeing the facilities. If the hero acute care workers are taking time off from doing Tic Toc videos and protesting to fill the gaps in LTC facilities, we have no word of it.

In fact, the RI governor is asking for federal funding to increase the pay of LTC facility workers to at least twenty dollars an hour or more, and scheduling hiring events. Of course, the shortcut would be to hire furloughed acute care workers to fill the gap, but frankly, I believe many acute care nurses think they are above working in a LTC facility. If they don’t, news of their willingness to do so in the middle of this crises is certainly obscure. In New York, where NYC was endowed by the federal government with massive hospital overflow support and a gargantuan Navy hospital ship, COVID patients were dumped into nursing homes while the temporary hospitals were left empty.

If you have been vacationing on the moon for the past 20 years, you are unaware that LTC facilities are chronically understaffed to begin with. With all of the hysteria about “bending the curve” to prevent hospitals from being overwhelmed, how often did you hear about a concern for nursing homes being overwhelmed? You didn’t. But yet, dumping COVID patients into nursing homes was the plan all along. In some LTC facilities, residents have been displaced to make room for them. This is a scandal of biblical proportions, and the point follows: the protesting nurses represent facilities that have done exactly what they are protesting against; ie., overwhelming a healthcare system with foolishness.

But, there is further insult to consider: already, LTC facilities are the focus of government investigations and law suits, because, you know, the government and state healthcare systems have our back, and are always our friends. Meanwhile, to bring acute care under such scrutiny is sacrilegious because acute care is the new 911 era heroes.

While ER doctors and nurses bemoan the difficulty of getting a grip on how to save people from this dreaded disease and proclaim the details of the ICU war zone with sackcloth and ashes, nothing at all was said about dumping COVID patients into ill prepared LTC facilities. In contrast, the outcry is against the lowborn protesting in front of the capital and lectures about staying at home.

Meanwhile, at LTC facilities, LPNs and STNAs ask, “We are now expected to deliver care under impossible circumstances, what else is new? And, after expecting the impossible they are coming after our licenses? That’s not new either.

All and all, the LTC facilities are being held together by the nurses and aides who are the real deal. Some are determined to do the work of two or three aides, others are visibly defeated, but know the defeated are better than nothing right now. I am not surprised there is a shortage of aides, I am surprised anyone would do the job period. Keep in mind, when the federal government shut down mental institutions, where do you think all of those people got dumped? Right, LTC facilities while STNAs received no mental healthcare training. Now we have “behavioral” units in LTC facilities. We also have dementia units, and rehab units for people who receive surgery at the hospital. LTC facilities are asked to do more and more with less and less. What’s the latest? COVID isolation units. It’s just the latest thing foisted on long term care.

With all of that said, NO LTC worker in their right mind would deny the paramount need for acute care nursing, I am just uncertain that the respect cuts both ways. It’s beginning to look like, to me, that acute care nurses need to get over themselves a little bit. Before now, I never gave that any consideration for a second until people started dressing up in scrubs to suggest that receiving care is only deserved by those who agree with the government. Please do it in brown uniforms with armbands instead; you don’t speak for those who know what the heart of healthcare is.

Furthermore, there is much irony in nurses lecturing the public about good health choices. There is much irony in nurses lecturing people about anything. I know many, many nurses in LTC and other venues. You are all awesome on the halls, but being a nurse does not qualify you for lecturing people about life in general and politics in particular. A lot of you smoke cigarettes regardless of the physiology classes you took, I really enjoy listening in on all of your boyfriend/girlfreind fails at the nurse station while I am charting, and I don’t mind working harder to bail you out when you are hungover, but let’s be honest, that’s why you need to focus on care.

That’s what you are good at; tyranny does not become you.

Paul Dohse

STNA/MA-C