What are you worth?

Now here’s an interesting question – what are you worth?

The first issue to clear up is what do we mean by worth? Is it how much money you have, or what other people think of you, or is it what you think of yourself? Let’s look at each of these options …

  1. Material possessions as a measure of worth. Some people would describe their worth, or the worth of others, in terms of their financial resources. The amount of money in the bank or in investments, the size of their house or the fancy-ness of their car, the school that their children attend, and so on. An obvious question then arises as to whether Jeff Bezos, Elon Musk, or Bill Gates is worth more than you are, because they are pretty likely to have more money than you. I personally think a person’s worth is more intrinsic than their possessions, more related to who they are than what they have. This is because I see that many people who have more possessions or higher income than I do are less happy than I am. Maybe I have a warped perception but I think that being satisfied with what you have is ‘worth’ quite a lot.
  2. The opinions of others as a measure of worth. If what other people think of you is related to your character and actions, this might be a reasonable indicator of your worth. Unfortunately, you only have to spend a few minutes interacting on social media to realise that many people have strong opinions based on nothing more than smoke and mirrors, and their opinion of you is essentially meaningless, because they don’t know you. In my admittedly strange upbringing, I came to realise that most people’s opinion of other people is deeply flawed, by which I mean that other people’s opinion of me was the antithesis of who I saw myself to be. This led me to reject other people’s opinions as mere noise in my search for self-worth and purpose in life. That may not apply to a lot of other people out there who value social interaction more than I do and derive a lot of their sense of self from that. However, I can’t help but wonder how safe it is to entrust your worth to others.
  3. Your opinion of yourself as a measure of worth. On the surface, this appears to be the pinnacle of worth-telling. You reflect on your behaviour and actions in various condiitons and compare them with what you believe about yourself. If they match, you’re worth a lot. If they don’t, you are a waste of space. The obvious danger with this is that if you can’t see yourself clearly and objectively, you will possibly spiral out of control. Either you become arrogant and narcissistic, or you get depressed and give up on yourself. Neither are helpful.

In answering the original question, I propose that a combined approach is needed to avoid the pitfalls. You need to meet the basic needs for food, water and shelter (and mobile access) for yourself and those you are responsible for, and material resources do help you to achieve that. Providing for yourself and your loved ones is quite good for your feeling of self-worth. The honest opinions of others who are qualified to have an opinion of you are valuable indicators of how much you are worth in their eyes. In my life, when someone who doesn’t know me flames me on social media, that has minimal impact compared to my best friend telling me that he thinks I handled a situation poorly. If you use the opinions of others as a measure of your worth, at least make sure they are people that you trust. Finally, it doesn’t matter what your bank balance says or what others think of you if you don’t see yourself as being worthwhile. So you must include an element of self-worth in your accounting of what you are worth. This can be a challenge at times, especially when you’re not doing too well and your loved ones think you are worth more than you think you are.

To finish up this ramble, I’d like to make two points:

  1. Using my life as an example, not because it’s worth more than others but because it’s the only one I can speak about with any authority, I can say that the only real measure of worth for me is my own evaluation of it. I realise that this potentially puts me at high risk for depression and feelings of disconnection from others if it all goes pear-shaped. However, so far so good. I can and do listen to the opinions of others, and often take on board useful feedback even when it’s painful. I appreciate my income and career, and feel proud of what I have achieved with my work and my family. But none of this matters much to me if I don’t feel in myself that I am worth it. Empty praise galls me, and I’d rather honest criticism any day. My self-worth is built mostly on continually striving to improve myself as a husband, father, community member, volunteer, employee, manager, leader, mentor, friend and so on.
  2. Why did I go down this particular rabbit hole today, given the millions of topics I could have rambled and ranted about? It comes down to my internal curiosity about how I feel at work. I am currently in a management job I did not want, doing work I thought I wouldn’t enjoy, because my employer asked for my help in an area of need. To my surprise, I find myself actually enjoying it, even though I am more tired than I have ever been, and feel under immense pressure to care for my team. A very strong thread in my sense of self, and therefore my feeling of self-worth, has always been a determination to do any job to the best of my ability. My very first job at 16 was picking up rocks by hand in a paddock using a tractor and trailer to move them to the edges. It looked like an awful job that no-one else wanted, but I loved it and gained a lot of satisfaction in making the paddock clean and safe for cropping. That same thread is now woven through my current job, except now the stakes are a lot higher as I am responsible for a whole team of people. I can’t afford to over-value my worth, but I owe it to my team not to under-value it either. At the end of all this, I come to the realisation that I need to use the opinions of others to ensure that I have the balance right. For a person like me who is entirely comfortable being an intrrovert, that is a significant challenge. Hence the ramble, and thanks for reading it.

Interesting times continue …

Back on December 24th last year, I wrote about how life sometimes doesn’t follow what we planned. You set out a step by step guide to how you think things will go, or how you would like them to go. Then you find that life gets in the way of your plan.

A few weeks ago, I was moved from my dream job as an educator to help out with a management crisis in my workplace. One colleague called it a ‘battlefield promotion’ and while I was initially repulsed by the military connotations applied to a health care environment, I had to admit that was an apt description. After all, plenty of people tell me I’m a good educator but no-one has ever said I’m a good leader or manager, not to me anyway. So why did I get moved from education to management to help deal with a crisis? This might sound like I’m fishing for compliments, but bear with me as I’m not that type of person.

One possibility is that I was the only suitable candidate for the job that didn’t say “No” so the appointment was done out of desperation rather than merit. Another is that my skills and experience are transferable to a senior management role, and I was the most suitable candidate from a pool of qualified people. The final option I can think of is that my employer had to choose between several bad options, and I was the least bad. Let’s look at each option and see what we can learn from them, if anything.

  1. The only one who didn’t run away. This was very likely a real situation, as I’ve been at my workplace long enough to know all the players, so it may well have been a move of desperation. It may not have been despite a lack of merit though, but then again who am I to say that?
  2. I am adaptable and can transfer skills wherever needed. Ego would naturally pick this option, but that doesn’t mean it’s true. After all, I was ‘managed out’ of a management position in the past due to conflict with my senior manager, so maybe I have some serious issues with communication in difficult situations. These days I have a good reputation for being calm under pressure, so maybe that episode is in the past.
  3. I was the least bad option from a selection of bad options. There is probably a good thread of truth in this viewpoint. After all, I was acknowledged by my colleagues and managers for doing valuable work as an educator, and now I’m not doing that, and neither is anyone else at present. That suggests that my employer was “between a rock and a hard place” and had little choice but to call on me to help.

For what it’s worth, my opinion is that it was a combination of all 3 perspectives, as they are all kind of true, but no one perspective seems to fit properly. I was the only suitable candidate who didn’t decline the opportunity, I do have the skills, experience, education and confidence to tackle the job, and I don’t think my boss was any happier than I was for me to leave the education role unfilled behind me.

A few years ago, I deliberately turned my back on a career pathway into senior management and instead focussed on my dream job as a clinical educator and part time academic. That was the plan. However, life has suddenly thrust me back into management and I’m not sure I like it much. That doesn’t mean I won’t do it well, and give 100% to support the team I am responsible for. Even though I didn’t think to become a manager again, I can’t stop trying to be a leader. I would grade myself as an adequate manager but a good leader, and I truly believe that this is a worthwhile combination. After all, if I had to choose to be strong in either management or leadership, I’d pick leadership every time. This is because good leaders care about people while good managers care about results. It’s not that I don’t care about results, it’s just that I believe that you can’t get sustainable good results unless you care for the people who will deliver them.

The end result of all this for me is that I’m stuck with this “battlefield promotion” until we get our workplace back to some semblance of normal, and I can hand over to someone who is passionate about management. Then I’ll happily go back to being an educator, but hopefully I’ll never stop being a leader. Maybe my skills really are transferable after all?

To test or not to test …

You would think that being able to test for a disease or a condition is always a good thing, and we should do whatever tests we can to be certain we are making the right decisions or giving the best care. You would be right, sort of. It is pretty much always better to be able to test than not to have that option. For example, there is no test for multiple sclerosis (MS) and it would be rather useful if there was. Or maybe sepsis is a better example. Sure there are things we can test to help us diagnose MS or sepsis, but there is no definitive test that indicates either of these conditions. In the case of sepsis, not getting to the diagnosis quickly can have very bad consequences.

What about where we do have a test? Is it always beneficial to do it? Look at a tension pneumothorax as an example. It is certainly possible and definitive to do a chest X-ray to confirm that the trauma victim has a tension pneumothorax, but most trauma professionals would agree that if you haven’t treated it before you got as far as doing a chest X-ray, your knowledge and skills need serious attention.

Another example of testing perhaps being less useful than we might think was when my wife was pregnant with our third child. She declined an amniocentesis test because when she asked why it should be done, the health practiitoner told her that is was so she could choose to terminate the pregancy if there were defects noted. Since she was not prepared to consider that possibility unless her life was endangered, she declined the test, and copped quite a bit of pressure from well-meaning people for it. To add weight to her decision, the test was not without its own risk of causing miscarriage, so why do it when there’s no benefit?

The question I always ask is, “What will we gain by doing this test/procedure/intervention?” When I was learning to be a Nurse Practitioner, and working in a busy Emergency Department on night shift, I adopted the approach that tests are only useful if the result will change my management of the patient. This was particularly relevant on night shift, because we had to call in the hospital scientist to do pathology tests after hours, or the on-call radiographer to do X-rays. Where the results were unlikely to to make any difference to the management of the patient before morning, the decision was to leave the tests until then. Of course you had to have confidence in your clinical decision making to know when it was OK to wait, and when tests really did need to be done immediately. One of the useful techniques I used was to make a note of these decisions and review them the next day to see if I missed anything. Of course I made mistakes, but over time, I became less reliant on testing for everything just because I could.

Let’s move on the topic of the times – COVID testing using the PCR (polymerase chain reaction) method in a pathology laboratory. It is a triumph of science that we have a safe and reliable test for COVID-19 infection, even in people who are completely well. In the 1918 influenza pandemic, there was no test other than people getting sick and dying, and no-one knew who the asymptomatic carriers of infection were. So it would appear that we have a fantastic tool to help beat the COVID-19 pandemic that our forbears did not have. Therefore it would appear obvious that getting everyone tested would be a good thing. But is it?

I think the answer is multi-threaded. On one thread, it is absolutely beneficial to know the COVID-19 infection status for as many people as possible during an outbreak, so blanket testing is necessary. On another thread, testing takes time and resources, so we need to weigh up whether the benefits are enough to justify the costs, and they usually are. A third thread is the dissemination of results, where a timely result will make a significant difference to such activity as contact tracing and quarantining or isolation of positive cases. This is where we run into problems. Let’s look at a case study:

Day 1: Wastewater testing in our community finds virus fragments specific to the virus which causes COVID-19. This test tells us that someone in the wastewater catchment area has COVID-19, or that someone with COVID-19 was in the area recently. It does not tell us who that person was. So we begin testing everyone in the community who has any symptoms that might be due to COVID-19.

Day 2-5: Testing continues and results of these tests are received within 2-3 days. Some postive cases are found. Contact tracing commences and testing is ramped up to include all residents of the community. Results begin to slow, and some even go missing.

Day 6-14: Testing of the entire community is undertaken, with some people such as frontline health staff and police being tested repeatedly. Results begin to take over a week to arrive, and some never arrive. This is where the incredible value of testing as a pandemic control tool begins to lose ground. Unless the results are available quickly enough to make a difference, then people begin to ask what’s the point. And they are right. Here we have one of the best tools we have being blunted by lack of timely output.

Travellers wishing to leave the area initially needed to have a PCR test no more than 72 hours before entering some other jurisdictions, but it took over a week to get the result by which time it was invalid. It was and is currently not possible to get a result within 72 hours as the pathology laboratories are overwhelmed with the volume of testing. We absolutely do not want to abandon testing, so how can we fix the problem?

One solution is to formalise Rapid Antigen Testing (RAT) for travellers and asymptomatic people who are not close contacts. It takes 15 minutes rather than over a week to get the result, and is safe and reliable. Some jurisdictions will not accept a negative RAT for entry but still require the negative laboratory test within the 72 hours prior to entry. This in effect means that no-one can enter that jurisdiction as they have to obtain a test result that is unobtainable in that time frame. Part of the issue may be that the RAT is self-administered and human nature being what it is, some COVID positive people may game the system to get across borders. If border control could somehow include supervision of RATs for travellers, or clever technicians work out an electronic means of doing this, it would reduce the risk of misuse. Using the RAT for widespread community testing of well people would give much more timely results, with only the unwell or those with a positive RAT needing the laboratory test. This would help ease the enormous pressure on pathology laboratories, allowing them to focus on testing close contacts, people in quarantine and isolation, and people who have a positive RAT. That will resharpen our tools for bringing the pandemic under control.

Going back to my opening points about testing, COVID-19 testing is only useful if we know the results of the test in a timely manner. Where results are so delayed that they are meaningless, resources are being spent needlessly. Rapid Antigen Testing may give us a way forward to get back timely test results, which will make the whole COVID-19 testing regime less frustrating for clinicians, community members, and travellers. PCR testing via a pathology laboratory is still vital but I think it should be reserved for where it is most needed, and the RAT used as the first line of testing in the community for most people.

Disclaimer: This post is entirley my own thoughts and ideas and does not represent the position of my employer or the government of the jusrisdiction I live and work in. I am not an epidemiologist or a pathology scientist, so welcome any comment if I have misunderstood the issues.

Plans vs life

The past 13 days have been interesting. I read somewhere about an ancient curse that goes like this, “May you live in interesting times”. The past two weeks have been cursed if you accept that definition. After nearly two years of remaining free of the COVID-19 virus, our remote town has seen an outbreak, and one thing has become very clear. All of our planning and preparation, while good and worthwhile in itself, was overcome by the reality of the pandemic steamroller. I know lots of other areas have experienced this and dealt with it, and we were lucky to learn from their experience. However, what caught us by surprise was the speed and scope of the public health action required. It’s one thing to practice scenarios, and do lots of training in using PPE and doing swabs and contact tracing. It’s something altogether different when you suddenly have to do it for real after 22 months of waiting and being lulled into a false sense of security.

Ready to start leading the team

Sorry if I’m rambling, but I’ll use the excuse that I have worked 72 hours in the past week and had one day off. Balancing the needs of work in doing my part for the pandemic response with my disabled wife’s needs has been a challenge. To add to the fun, a family member who is usually at home to assist with my wife’s care had to go away on a work trip just before the COVID-19 outbreak began. Everything was planned, and transport arranged weeks in advance, then our plans got derailed. My car needed some major work a couple of weeks previously, and I had to wait an awfully long time for the parts to arrive, so when I was left alone with my wife to care for and a sudden COVID-19 outbreak, I had no vehicle. No problem, I’ll use my bicycle. That was the plan anyway, until the temperature headed into the mid-40s, then the bicycle blew a tyre. The subsequent walk to work was reasonably pleasant in the morning, but returning home in the evening was very uncomfortable. OK that’s fine, I’ll just have a cool shower to freshen up. Sounds good, until you realise that a cold shower is not feasible when the shower water is hot from the cold tap. In fact, in hot weather we turn the hot water heater off as we don’t need it. So here I am with a disabled wife on a weekend, me working 12-15 hours to help with the local pandemic response, no transport, and no help at home. That definitely was not part of our planning! The interesting thing is that we did have a contingency plan for when my wife needed care and I was unavailable, but that involved admission to the local hospital, which is the last place she needed to be during an outbreak. My wife had a backup plan, which was to phone me when she needed my help. Pretty good plan except when I was in full PPE and couldn’t answer my phone for up to 30 minutes.

Despite the plans that didn’t stand up to the crisis, we have managed so far. My wife now has care when I am unavailable due to other family coming home to help. I have transport sometimes, so don’t have to walk everywhere, the hot weather has abated a little, and indications are that we are getting the outbreak under control. That reminds me of a saying we used to have in the volunteer fire brigade I belonged to in South Australia, “If you think the situation is under control, you obviously don’t understand the situation!” Here’s hoping that this time we have got it right.

The lesson from all this I think is that plans are good to have, and while practicing for the unexpected or even the inevitable is better than not, you will never be fully ready. This is not a new idea for me. When I was a team leader in a busy regional Emergency Department, I was known for ALWAYS having a plan B and usually a plan C. This meant that I very rarely lost the big picture and mostly kept my cool. Realising that you cannot prepare 100% for life is pretty useful, as it means you will build in some uncertainty in your planning and resource allocation, including time. For example, if you can “afford” a $1.2m mortgage at current interest rates but not if they go up 1 or 2%, then you can’t afford it.

Our pandemic response planning has helped us at work as a team to get to grips with what we needed to do, and I think the built-in resilience of knowing that we don’t have it all covered has been protective. One comment I received recently was that my get-it-done attitude was appreciated. That comes from my ability to implement plans, to take ideas and make them work. I’m terrible at coming up with ideas but if you feed them to me I will process them and use what’s usable to get things done. That’s why I often end up as the team leader, which is not a role I seek but which nearly always seeks me. I do have plans, and sometimes even follow them, but often find that flexibility and adaptability are also necessary to succeed.

In summary, I think planning is important, as long as we remember that we cannot plan for everything and sometimes our plans turn out to be unusable. To really thrive in this uncertain world, we need to accept the uncertainty as inevitable and work out how to deal with it. Planning, including contingency or backup planning, is just one part of it. If we focus all our efforts on making plans, we are very likely to not get around to living life, especially when things go wrong, which I think you will agree is often.

Transferring knowledge and skills

I have almost completed my updated Certificate IV in Training and Assessment (TAE40116) and it’s been an interesting experience. In my professional life I teach adults all the time, in clinical education and in the SES (emergency services). What fascinated me was the common ground between a) workplace education and training, b) higher education via the tertiary sector, and c) training in the VET sector. It was ostensibly for the latter that I undertook the Cert IV TAE. Every one of the three streams used the principles of adult learning, but in a different way, and it appears that teachers at each level regard their approach as ‘the correct way’. Being involved in all of them, I can see that the principles are always the principles, and learning occurs pretty much the same way any time adults are involved.

The Australian Qualifications Framework gives tertiary qualifications a higher number than VET qualifications, which could be interpreted as giving them greater value or worth. They can certainly cost more! The funny thing is that my Graduate Certificate in Clinical Education (AQF level 8) cost significantly more but was a lot easier to gain than my Cert IV in Training and Assessment (AQF level 4). Maybe this was due to my high level of familiarity with tertiary study, as the GCCE was my fifth tertiary qualification. I would have thought that my level 8 skills and knowledge would be easily transferred to a level 4 course, and was unpleasantly surprised to find it difficult. This started me thinking about why this would be.

I think it comes down to transfer of skills and knowledge from one domain or ‘life jurisdiction’ to another. A cooking analogy is one I use a lot, so let’s try it here. Say a person was an excellent pastry cook, and could turn out the most amazing cakes and slices seemingly without effort. Then they are asked to bake some bread rolls while the usual baker is away, and the result is significantly less appealing. After a few attempts, they get better at it, but everyone breathes a sigh of relief when the regular baker returns. In working towards my Cert IV qualification, I found myself trying to use cake baking principles to make bread, and being frustrated with the results. For example, I often had to resubmit assignments when my responses completely missed the point. I consistently over-thought the questions and answered them as it they were Masters degree questions (level 9). Sometimes I was frustrated by the way questions were worded, when I could see a lot of nuance and room for differing interpretations, meaning I was unsure how to answer them.

Does this mean that tertiary education skills and knowledge are not useful in or even a barrier to pursuing vocational education and qualifications? I certainly hope not! That would tend to invalidate one of my core beliefs that no education is wasted. In my case, the required step was to contextualise what I already knew from tertiary study and professional experience so it could be applied to vocational learning. It’s not that easy for a student comfortable with studying in a level 9 course to apply themselves to study effectively in a level 4 course. The trick for me was to remember that I was in a level 4 course, and to adjust my thinking and learning approach to suit. Once I did this, I was able to relax and enjoy what turned out to be a fun and useful course. I suspect my teachers found it less stressful too once I put aside the Masters thesis level thinking and stopped over-analysing everything.

One final question. Do we need to do thinking at all at the level of a Master’s degree or a PhD? Refer back to my core belief – no education is wasted. No, we don’t need to, nor should we, always think at levels 9 and 10. However, there are times when that is just what is required to solve a vexing problem or change the course of history. The rest of the time, we just need to apply the right amount of thinking for the circumstances. How much is the right amount, you ask? I have no idea, but one thing I can tell you is that going back to the recipe (training plan, learning outcomes) will help keep you on track.

In the end, I was able to transfer enough skills and knowledge from my Bachelor degree, two Graduate Certificates, two Master’s degrees, and professional experience as an adult educator towards my Cert IV studies. Even better, what I have learned in my Cert IV studies has already begun to impact on my work as an adult educator in the area of clinical learning. The disciplined structure and focus of training and assessment in the VET sector contains many lessons for those who also play in tertiary education and workplace learning. Even if you don’t work for an RTO (registered training organisation), undertaking the Cert IV TAE40116 will make you a better adult educator. That alone is worth the frustration and high cognitive load of trying to repurpose your thinking from what it is now to what it could be.

The “Sunk Cost” Fallacy

Some time ago, in a land far away (Victoria to be exact), I purchased a really sweet vehicle. It was a wheelchair capable people mover, and it was at that time the most well-appointed vehicle I had ever owned. It seemed to be a good price, and being a little short on time and money, I flew down to Melbourne and checked it out myself. No shonky mechanics for me! Turns out I didn’t really know what I was looking at, because the vehicle didn’t make it home. It lost its coolant and I was still 1800km short of home when the engine seized up. Not to worry, I’m a pretty good bush mechanic. Or so I thought …

I asked my brother to rescue me and being the cool bro that he is, he came out with the car trailer and towed my new yard ornament to his farm about 500km away. I got busy and purchased a new head gasket, piston rings and all the extras needed to get the engine going again. Then I got into it and pulled the engine out of the vehicle and stripped it down. I should have stopped there! It was the most complicated machine I had ever worked on, by far. Anyway, to cut a long story short, the rebuild failed and I had to leave the vehicle on the farm and catch the bus home. By this time I was a week late getting back to work and had used up my remaining leave. So I left the vehicle to rust away on the farm and cut my losses, right? … right? … of course not, I wasn’t that smart.

Re-honing the cylinder bores on cooked engine

Two months later I hooked up a borrowed car trailer and towed this now very expensive piece of equipment back home, which was a 2200km trip from my brother’s farm. Why? Because I’d spent so much money on the vehicle and thought if I just did a bit more work on it, I could get it going properly again. So I rebuilt the engine a second time, having discovered that the cylinder head was cracked. Got the new cylinder head and all the necessary bits, and thought, “Great! I’ve found the problem and once this is fixed it’ll be good for years”. All went well until I stripped the nut that holds the pulley on the front of the crankshaft. On to eBay and sourced a new crankshaft from Slovenia, which arrived in good order in about a month. Then of course the old crankshaft bearings and connecting rod bearings wouldn’t fit so I had to buy new ones. Wow, I’m going to have a brand new engine by the time I’ve finished this rebuild. Sweet! Might as well put new fuel injectors in it while I have it apart, they’re only $740 for the set.

Finally got my new vehicle on the road over 8 months after I bought it, and headed off on a road trip. Made it about 100km down the road before it boiled off the coolant all over again. Back home and stripped down for the third time, to find that the cylinder block was cracked. Not good. I went to my daughter and asked for a loan to buy a new cylinder block and she called me out on my stupidity. NO, she was not going to enable me to be an idiot. However, she would lend me the money to do what I should have done at the beginning, which is to buy another vehicle. Feeling sick at how much money I had literally just thrown away on this project, I agreed and did as she demanded. One of the conditions was that I get an independent assessment done on the new vehicle before I bought it.

Why did I spend several thousand dollars on trying to save a vehicle that was only worth about $8,000? One possible reason is the “sunk cost” fallacy. This is a cognitive bias where you convince yourself that because you have invested so much into a project, it has to work, and if it doesn’t, you just need to invest a little more and it will work out OK. Looking back now, I shake my head and ask what was I thinking?

This lesson was about buying a lemon of a vehicle, but it is applicable to any endeavour in which we invest money, time or ourselves.I’m not suggesting we give up as soon as we hit any hurdle, but that we really need to have some way to step back from time to time and ask ourselves, “Is this project/vehicle/job/relationship still worth the investment”. You will need to deal with the pain of giving up everything you’ve sunk into it if you walk away, but in the long run your losses could be significantly less if you accept them sooner. It took me several years to pay back all the people I borrowed from to try to keep my project going, and I don’t think my daughter will ever let me live it down!

Learning Games

Last week I had the pleasure and privilege of playing a game with a group of students. They were 1st Year nursing students on a very remote health experience. My job was to entertain them one evening, and here’s how it went:

  1. We did a round of “why did you choose nursing?” Each participant shared what led them to studying for their nursing degree. The range was amazing, and for a really simple-sounding question, we learned a lot about each other. I took my turn, but that’s the subject for another post.
  2. We played a game called Social Determinants of Health in which each player takes a card with a profile on it. To avoid causing anyone distress by over-identifying with the profile, I asked the students to see the profile as that of a patient they were caring for. They rolled dice to move around a playing board. Some squares were for protective factors, such as a public library opening in the local area, while others were risk factors such as the local greengrocer going out of business. There were also clinic squares on which you could get stuck if you had a negative experience of health care. The profiles dictated how some risk factors played out, for example if you didn’t have dental health insurance, you suffered more from dental disease, or if you were gay, you fared poorly when the gay-friendly local health provider retired.

The SDOH game started a lot of discussion, and this was helped by each participant reading the explanatory notes on each protective factor or risk factor card as they were picked up. The aim of the game is to teach students that health is many-faceted, and often people with poor health have limited control over the risks.

I have become interested in the topic of gamification, and want to explore more opportunities to teach complex concepts using gaming. It’s not only children who enjoy a good session of play!

A disclaimer: I did not invent the SDOH game, I’m not that clever! I found it while looking for something else, and it immediately captured my attention. The original concept was devised in the USA for teaching about urban underprivileged people and was then adopted by several rural areas. I just took the concept and localised it to the Australian rural and remote context.

Holiday planning 2022 style

Ten years after I wrote about the difficulties in planning a holiday with a disabled spouse, I find myself still doing it.  Now that’s a surprise!

Over the past 10 years, Anita has gradually become more restricted in her movements, and now cannot move her hands, right arm, or legs at all, and only weak movement of her left arm.  This has required fitment of a head array to her wheelchair so she can control it with movements of her head.  What does this have to do with holidays, you may be asking by now …

Well, we can’t leave Anita alone for more than a couple of hours, and she certainly can’t come hiking with us in January across the south of Tasmania.  So what to do?  There are a few options:

  • Respite care in a residential facility, but NOT in Tennant Creek!  The facility here is, shall we say, suboptimal. Alice Springs may be an option.
  • Take her with us to Adelaide to stay with relatives.
  • Take her with us to Tasmania and find a respite facility there.
  • Hire a live-in carer to stay in our home while we are away.
  • Cancel the hike and do something else because it’s all too hard.

We ruled out taking her outside the NT as the logistics are a nightmare, so that left hiring a carer or cancelling the hike.  Anita didn’t want us to cancel the hike, so it was time to hunt for a carer prepared to stay with Anita for the 14 days we will be away.  Fortunately, one was found and signed up, so that’s one hurdle out of the way.

The only other thing to get done for Anita’s safety is for modifications to be made to the front door of the house so she can exit and enter without assistance.  This requires widening of the door, and fitment of an automatic system triggered by a proximity key.  Then when Anita drives her wheelchair to within 2m of the door, it opens for her.  Everyone else has to use a normal key.  Sounds like a cool plan, right?  Sadly, it’s just a plan. I have been waiting for over a year for ARRCS to do what we paid them to do and coordinate the modifications.  Looks like I’m going to have to arrange the job myself, so another dollop of taxpayers’ money has just disappeared.  Of course I’ll have to get new quotes, and now the builder is super busy so it’ll probably be another 12 months before the work can be done.

What this debacle means is that we’ll have to hire the carer to provide 24 hour care for Anita for safety.

For those of you wondering how a disabled person can travel out of Tennant Creek to go on holiday, here’s a fun fact for you.  They can’t catch a plane or a bus unless they can get on and off by themselves.  So they have to travel in a private vehicle. And of course NDIS doesn’t fund travel by private vehicle.  Naturally.

Anyway that’s it for this rant or ramble or whatever it is.

Inspiration and Encouragement – ACN National Nursing Forum 2018

I attended the Australian College of Nursing’s (ACN) National Nursing Forum (NNF2018) at the end of August 2018.  My reason for attending was that I needed a boost of inspiration and enthusiasm for my chosen profession.  Getting to the Gold Coast from Tennant Creek was expensive and time-consuming, the hire car and accommodation added to the cost, and taking 5 days off work left a mountain of catch-up when I returned.  So was it worth it?  Absolutely!
There were many things about NNF2018 that met my goal of being inspired.  Perhaps the most significant was the contribution of a group of ENLs (Emerging Nurse Leaders) who are sponsored by ACN to develop their leadership capabilities.  One session was a discussion about the new Next-Gen Nurses Community of Interest (COI).  The young nurses involved in this session were articulate, passionate, fearless, and focussed.  They tackled issues head-on, and responded very well to any problems raised by dinosaurs like myself and other older colleagues.  It was incredibly inspiring to see this group of nurses take control of their future and their profession, and left me feeling that nursing will be in good hands when we retire.
A key focus of NNF2018 was “Diversity and Difference” and one speaker talked about gender imbalance in nursing.  She noted that the proportion of men in nursing has been about 10% for several decades, and these men have often had to deal with negative stereotypes.  Some might say, “Serve them right, welcome to what women have had to put up with for millennia.”  This attitude demeans the caring nature of nursing, and justifies one bad situation by referencing another.  One young man in the audience commented that is is time that society in general and the nursing profession in particular recognises that it is “OK for men to care.”  The point is that being caring is still often seen as a weak and undesirable trait.  
Another speaker (who was not a nurse) shared his personal insights into nursing based on family connections and personal experience of healthcare.  He graphically described the work of nurses who staff our Emergency Departments, dealing with people who are often not on their best behaviour.  And a former emergency nurse, his stories resonated with me as he shared his experience of seeing ED nurses being screamed at, spat on, abused and assaulted.  He noted that nurses did not give up and run away, but “held the line and kept on caring” because all people need good quality compassionate health care.  I had never been so proud to be a nurse!  We do need to care for each other and ourselves through, because it takes a toll when you “hold the line”.
My other goal in attending NNF2018 was to be encouraged in my further career development.  One very useful session involved a kind of speed-dating with leaders.  Participants were given a block of 5 minutes to connect with a leader and hear their advice and encouragement regarding an aspect of leadership.  It was a challenge to encapsulate a lifetime of leadership advice into 5 minutes, but the leaders did an excellent job.  I focussed on my looming choice between further development as a nurse educator or as a senior manager, as I have come to a point of divergence where a choice must be made.  The outcome of these short sharp discussions with recognised leaders was that I realised that while I really enjoy both education and management, I am passionate about education.
I was very pleased and proud to have my eldest daughter Laura with me at NNF2018.  She is now an RN working in a small remote Emergency Department, and we were able to have great conversations about our experiences at the forum.  It was encouraging to see her networking with colleagues and speaking confidently and articulately with established leaders in the nursing profession.  Laura is hoping to be accepted into ACN’s Emerging Nurse Leader program in 2019.  She epitomises the next-gen nurse.

Making Mistakes

It has been said that “to err is human” yet there are endeavours in which error cannot be accepted. The airline industry is an obvious example, and the nuclear industry is another.  Dose this mean that to be safe we need to remove humans from the equation?  The short answer is ‘Yes’ and that is exactly what has been done in the above examples.  Humans are still involved, but systems have been created that monitor for errors and correct or prevent them.
Now to health care.  In many ways, errors must be avoided because they cause illness or injury, increased length of stay in hospital, or death.  Everyone accepts that errors are bad, but for some reason it is expected, by regulators, managers, the public, and health care practitioners themselves, that health care will be error free. In effect we expect that health care workers are not human! This is patently absurd because it is their humanity that makes them effective.  For all our faults and propensity for making mistakes, humans are still better at caring for other humans than machines are. Granted, there may be some individuals who do feel they have a relationship with ‘Siri’ on their iPhone or iPad, but very few people would actually choose to have nursing or medical care delivered by a machine. The therapeutic relationship is a crucial component of caring.
The expectation of perfection is therefore unrealistic and unreasonable, and in fact is not supported by case law.  The law accepts the concept of ‘reasonableness’ which therefore allows for mistakes.  So why does everyone else, including health care workers themselves, expect perfection? I think it is because mistakes are taboo, and that is dangerous.  Very few health care workers go to work intending to harm someone that day, and if someone is harmed they feel tremendous guilt and self-doubt. We are typically not trained to deal with mistakes, as the unspoken rule is that if you are ‘good enough’ you won’t make any.  So we hide our errors, possibly even from ourselves. If you do report an error and the report is then mishandled by managers who take the easy approach of blaming you for it, you will be far less likely to report any future errors.  What about near misses?  If no harm was caused, forget about anybody reporting it.  This robs the organisation of any chance to prevent future events that might not be near misses.  In many causes, managers only have themselves to blame for this culture of avoidance.  You can’t encourage a person to be honest by beating them every time they tell the truth!
That’s the problem, and it’s a big one.  What can we do about it?  Firstly, we must adopt a no-blame approach to incident reporting.  Mistakes happen all the time in health care, yet very few are reported especially if the patient was not obviously harmed or not aware of the mistake.  Then we must investigate the incident reports to work out what system faults caused the error or allowed it to progress.  In some cases the person is the problem, but that should never be the first or primary conclusion because no-one works in isolation from the systems.  Disciplinary matters have their place, a long way down the priority list.
We need to educate health care workers that mistakes are inevitable and our only hope of preventing them is to work together.  ‘Two minds are better than one’ rings true as cross-checking is a valuable tool to detect and prevent mistakes.  To make this work properly, all participants have to have a voice, and be heard. Part of investigating an incident report should be about how cross-checking failed, and whether the error could have been prevented if someone had spoken up.  If so, what prevented them from doing so? Shifting blame to the person who didn’t speak up is unhelpful, so the focus is on addressing the culture of the workplace so that everyone has the right to speak.
In summary, errors are inevitable in health care, and will remain so because humans are involved in it. Systems need to be created that help fallible humans to detect and prevent them before harm is caused, and these systems cannot be based on blaming the person who made the mistake. System change is driven by incident reporting, and the focus of investigation must be heavily biased towards finding system flaws that facilitated the mistakes. Finally, we all need to stop expecting the impossible s that just perpetuates the problem.