Risk - The real Butterfly Effect

I posted this to the NURSE-PHILOSOPHY@JISCMAIL.AC.UK listserver in the middle (well I hope it is not still going on) of the Japanese nuclear facility catastrophe in 2011.

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I have resisted the impulse to comment on Japan. But there are only a few "Teachable moments" as profound as this one.

45+ years ago somebody thought it would be a great idea to build a nuclear reactor along the pacific ocean coastline in a country with high seismic activity and high risks of tsunamis.

That day, a butterfly emerged from its chrysalis and flapped its wings. The gentle flapping of its wings reverberated over the years and the cumulative effect became stronger and stronger each and every day.

Nobody really noticed the effect of the butterfly's wings. Life went on as usual. In fact, the people who decided to build one reactor took heart from the fact that things were going very well, there were no gale force winds, so they built a second, third, fourth, fifth and sixth reactor at the same site.

And the long term effect of the butterfly just kept growing stronger and stronger. But the people felt only the subtlest of breezes.

Since things were going so well the plant's owners, the government of Japan and
the people just went about life. Repairs to the reactors were deferred, employees who balked at such practices were malcontents, and anyone who questioned these practices was maligned.

And the cumulative effect of the butterfly's wings just kept growing. The people felt only the gentlest of breezes. In the summer they felt cooler and in the winter, only the slightest nip in the air.

More and more problems developed. They too were ignored. The gentlest breezes
turned into strong winds. In the summer it blew sand into people's eyes and in the winter it felt like ice against their faces. They closed their eyes and covered their faces. It worked out just fine.

And the cumulative effect of the butterfly's wings grew stronger.

Then one day, the entire universe shifted and all those years of ignoring risks
came together.

Why would nurses care about such things? Because the butterfly's wings for our health care (finance) systems, the decision to transfer insurance risks to health care providers, have been developing for the same last 4 decades and we are seeing and will see more in the future of the full force and effect of those decisions and their cumulative effects.

Ignored risk doesn't just go away, it builds and builds until one day, like a hurricane, earthquake, tsunami, the collapse of your economy, or of more concern in this email, the collapse of your health care (finance) system, just overwhelms you.

We nurses ought not "...just go gentle into that good night" of our demise, of the loss of all we trained for, struggle to protect, and say we want.

The consequences of compelling health care providers to accept insurance risks, the fact that nurses, doctors, hospitals, nursing homes, and home health agencies are all asked to meet the needs of their patients while inefficiently and ineptly managing insurance portfolios are coming to their full fruition: health care providers leaving their practices, shuttering their facilities, reducing patient services, and abandoning patients.

The loss of health care facilities, health care workers, equipment and supplies in affected areas in Japan has been horrific. But all those facilities, their staff, their equipment and their supplies were barely adequate to meet the needs of people before they were lost. Now the entire health care system in Japan is reeling. The remaining hospitals, physicians, nurses, equipment and supplies are clearly proving inadequate for the new demands being put on them.

Just as the risks of operating nuclear plants on a wing and a prayer, and being relatively unprepared for a health care crisis have come home to roost in Japan, so is there days of reckoning ahead for all of us.

The plight here (the USA) and elsewhere is as clearly in focus at this moment in history as the problems at the nuclear plants and the health care system in Japan should have been a year ago. The question for those plants, that health care system and for our health care (finance) systems was/is WHEN, not IF.

And yet nursing and we nurses close our eyes and cover our faces. We ignore the risks that abound all around us and it only hurts a little bit...

We just keep cutting back on Medicaid, Medicare, VA facilities in the
USA. We "Transform" the NHS by foisting insurance risks on local trusts. We are systematically ignoring the consequences for public health services, eviscerating safety net programs, sacrificing emergency preparedness, ordering equipment and
supplies only when they have failed to work or as they are running out. And the distance between health care workers and those replenished pieces of equipment and supplies are growing, relying more and more on remote supply lines.

We in the US continue to staff health facilities by compelling health care workers to work mandatory overtime on what are regular "emergency" bases as our only solution to maintaining staffing on a regular basis.

It only hurts a little bit more every day...

But, in those dark hours of the night, when the monsters and ogres keep
pushing open the closet door, don't you have to ask:

"Is that a butterfly, a breeze, a wind, or a tornado I am feeling?"

bear