No man can serve two masters: for either he will hate the one, and love the other; or else he will hold to the one, and despise the other. Ye cannot serve God and mammon…And why take ye thought for raiment? Consider the lilies of the field, how they grow; they toil not, neither do they spin: And yet I say unto you, That even Solomon in all his glory was not arrayed like one of these. –Matthew 6:24, 28-29
“Hello, my name is Heather,” I used to say many times a day, “and I’m a nurse with your insurance company. I’m calling to see if you’re doing better following your stay in the hospital.”
My introduction completed, I would eel my way into a conversation about my client’s health and begin to identify problem areas to be addressed. I sat at my desk in my home office and listened, asked targeted questions, and finally provided education and direction.
“That’s something you should call your doctor about immediately,” I would say to one man. “It would be better to take your blood pressure medications after your dialysis treatment,” I explained to another client. For another, I would teach about the importance of gentle, daily exercise and frequent hand washing for chronic lung disease.
The theory underlying this occupation is elegant and, at least on its face, an excellent example of the capitalist concept that financial constraints can drive moral solutions.
First, the problem. Profit margin for health insurance companies is dependent on the health of the insured population. In any population, acute and chronic illnesses will require health care expenditures. However, there is a statistical difference in the amount of money required to pay for a bunch of sick people who are “compliant” with health care directions and a similar bunch of people who don’t understand how or aren’t motivated to care for their health.
The market-driven solution is to provide expert education and support to sick people. Advice and a helping hand cut costs.
The long and short of it is I was a very good nurse to my clients at this, my last job. Also I was a lousy employee. There was a time during the span of my position when the productivity requirements made by my bosses became impossible to meet. Or–perhaps not impossible. It would be more fair for me to say the demands of administration conflicted with my ability to do what I thought was best for my patients.
I experienced a period of despair. I needed this job. It paid well and it allowed me to stay home with my brood of teenagers with their predilection for drama and danger. Following despair came fear and with fear the flight/fight instinct kicked in.
My “solution” was simple. I would continue to provide each of my client-patients with the best I had to offer and ignore productivity expectations for as long as my company would keep paying me. In the recesses of my rebellious mind and in the crevices of my proletarian heart I rejoiced to “stick it to the man.”
In retrospect, I see every lengthy encounter with a client, every time I made six calls to advocate for someone instead of one, every time I raised my middle finger in the direction of “productivity,” I deepened the grubby hole where others could bury my career.
In the proud tradition of Don Quixote and Vladimir Lenin, I chose to joust with the capitalist windmills. My patients loved me. I made a difference in a lot of lives. At least once a day I said something or made a call which facilitated better health for a client. In the meantime I’m sure my supervisors noticed my distinct lack of interest in the finer points of the art of volume.
In March of this year my care management company failed to win a contract renewal with the insurer. By late May the new company had hired most of my coworkers while choosing to decline my services. On the first of July I became officially unemployed.
Over the last few weeks I have discovered that more of my self-image was based on having a job than I thought. I have become depressed. I have concluded my normal self-confidence was just a clever ruse to cover up my basic inability to be a “good worker.”
I cannot argue I was ever a bad nurse to my patients at any of my jobs ever. But I do see a bit of a pattern of defiance against administration when the chips come down.
Currently a few shocks are running through my brain in parallel. I have fully realized there is a stark difference between being a good nurse and being a good employee. Damning evidence has emerged that the Democratic National Committee rigged the primary. And I’m reading Russell Brand’s book “Revolution.” You, dear reader, are smart enough to see where this is going so I’ll stop ranting and end with a question: When did doing the right thing get subsumed under the financial bottom line?