Thursday, October 20, 2011

Follow the red tape to New Beginning!

I work for one of the largest bureaucracies in the world and have for 18 years. So, when confronted by red tape, I am not surprised and usually find a way to cut through it rather than work around it. It drives my dad crazy. As a retiree from a large corporation, he knows red tape and tries to redirect my efforts to working within the system, rather than fighting it. I figure it is a little bit of the rebel in me that wants to set things “right,” to have things “make sense,” that drives me in moments like this.

My nursing license was due for renewal at the end of October. Normally, it’s not a big deal. I log onto my computer, answer some questions about whether I’ve been arrested or had action taken against my license—I responded “no” to both, in case you’re wondering—and enter my credit card information. Before long, I’m notified that my status has been updated and am informed of my next license expiration date, two years hence. My chosen state of licensure doesn’t issue a special practitioner license, but I do declare myself as an advanced practice nurse on the renewal form. The Air Force then logs onto the online verification system and—surprise—I am current for another two years.

Not so this year! It seems the Air Force has issued new guidelines (obviously written by someone not familiar with all state licensing requirements) that require APNs to have a nursing license that identifies them, in some way, as an APN. (If memory of my first year of graduate school is correct, I don’t always need a license as an APN, just a registered nurse license and APN certification.) When I pointed this out at the local level, I was told, “But that isn’t what the regulation says.” At the consultant level, I was told: “Don’t worry about it. Have your local level call other bases. It’s fine!”

So, in an effort to do this “the easy way,” I called my state of licensure (it’s a large midwestern state spelled with more than four letters) to request a letter that simply states they are aware of my APN status but do not issue an additional license for this higher level of practice. They agreed this is true, but said: “We are a state; the federal government can’t require us to do anything. If we write you a letter, everyone will want one!” Really? How many APNs, do you think, carry a license in your state? And, if you keep that letter on file, just change the names!

I finally got though to an assistant director, who agreed to discuss my situation with the director of the board, who has never e-mailed me back or returned phone messages. So, I guess this is the way this state wants to “support the troops,” which is what frustrates me more than anything. They request my military stories to share for Nurses Week or 9-11 anniversaries, but when I need something, it boils down to red tape and closed doors.

So, where does this leave me, besides disappointed, frustrated and out the money I paid to renew my license in the state where I have been an active RN for almost 20 years?

I will now have to research the law for the state in which I currently reside and pay the several hundred dollars required to get a license here. (It is the state where APNs started, and where we are so respected, we can open a private practice.) I will need a license here eventually, anyway, as I plan to stay in the area once I retire. (That’s also my dad’s rationale; just get one here rather than argue the issue.)

So, I will spend a vacation day this week doing the research and finding all the necessary paperwork. And, I will cease my relationship with that old state and, here in our new home state, call it a New Beginning!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Sunday, October 9, 2011

Juggling glass balls

Have you heard the story of the many balls we juggle? Some balls are made of rubber and bounce, while others are made of glass and will shatter, if dropped. Each of us determines the balls we juggle and some of them change, depending on a day’s priorities. Often, when I walk in the door of my clinic, my “family” ball changes from glass to rubber, because my kids are well cared for and safe for the day at school, but my “work” ball suddenly becomes glass. Some days, that glass ball stays in the air with what seems like little effort. Other days, I feel as though I should be wearing protective gear as I dive repeatedly to the floor in an attempt to catch my ball before it shatters.

There are many ways the Air Force is ahead of the times (or at least keeping pace). We utilize “mid-levels” to the fullest extent of their education; we embraced the electronic medical record long before our civilian peers; and we are constantly evolving in practice theory with a mindset of patients first.

Where do we fail? In managing our people and, often, the day-to-day running of our clinics. We put nurses or providers into mid-level management roles, and the position of “Group Practice Manager” is handed off like a hot potato to the most junior administrative lieutenant. The result? Often a poorly managed clinic, with constant errors in schedule templates and lots of scrambling to keep up to date on performance reports and award packages.

Have I seen it work? Yes, there are nurses or providers out there who are excellent managers, whose calling is more toward leading people, who display great juggling talent as they keep those glass balls in the air with apparent ease (or they just work 60-hour work weeks to make it all “look easy”). And I have seen group practice managers, with prior experience in running large civilian clinics, calm the chaos and facilitate better provider efficiency.

Why this discussion today? I spent the last week filling in for the nurse who normally performs our middle-management role, while I continued to see a clinic full of patients every day. I have said all along that both are full-time jobs and, when trying to do both, neither is done well. This week proved it. (As glass shattered all around me, I definitely needed protective gear!) 

I was consistently a few patients behind and frequently had a line of people out my door who wanted to update me on personnel issues or get paperwork signed. I missed my usual lunch catch-up time, spending it instead in meetings where my attendance was required but my input not needed. The saving grace? I was not on call, so I didn’t have that added stress.

The lesson I learned? I am a provider, and pretty good at it, but middle management is not where I want to spend my time! I am so thankful for those who do enjoy that role. It allows me to stay where I thrive, immersed in patient care and, most days, easily keeping the balls in the air and not surrounded by shattered glass!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.