All that is the backstory of why I was spending so much time observing an intensive care unit. I noticed something very interesting there. This unit had a nursing to patient ratio of 1 to 2; 1 to 3 very rarely during rush times. The nurses are highly trained, and mostly very experienced. They were extremely attentive. The first few days I felt weird asking people with years of education, training, and experience to get more ice. But one day it suddenly hit me. In the intensive care unit, everything is important. From family involvement to fluid intake, everything contributes to marginal improvement or marginal decline.
And because people in intensive care are, almost by definition, not out of the woods, each of these pieces of information contribute to the whole picture that can literally mean life or death to the patient.
So, in this hospital there are no nurses aides in intensive care. I didn't ask about this, but here is my theory. I don't think it is that there aren't lots of things that nurses aides are perfectly qualified to help with in the ICU. I think that the hospital has determined that it is too risky to rely on information exchange with these critical patients. That having one person watching, recording, and ministering to each patient improves their changes of survival.
Now on to my insight about what this means for the work we do in partnership to design and promote more effective policies. For the most part, we operate in an environment in which the stakes are high - because we seek to improve health in our communities and sometimes that need is high - but the activities are longterm - so burn out is a serious risk if we don't pace ourselves. And almost all of us are working on other things. So here are a few things to think about.
1) Sometimes a few individuals (ideally 2 or 3) will have to take on the roles of the ICU nurse, meaning they will have to be the ones carefully watching, recording, communicating, and making decisions. These times usually are short-term and revolve around change activities like public actions, negotiations, and political campaigns. In partnership, careful attention needs to be paid to who those people are, and how they are chosen.
If the intense period drags on, or is expected to be sustained (as during ballot initiative campaigns), then a mechanism must be put in place to replenish the members of this group with reinforcements. This is part of the reason why good recording is so important. It allows new people to understand what is happening. If possible rotate out one individual at a time.
If face-to-face negotiation is the method, it is pretty important to keep the negotiating team consistent. This helps both with rapport, and with continuity of understanding. So much of face-to-face negotiating is non-verbal, picked up as feelings. Those intangibles can be difficult to express adequately to people who were not present.
2) Our work is long-term. The analogy to the ICU patient continues here as well. Once out of ICU recovery continues. Once a victory, whether negotiated or electoral, is secured, the partnership moves on to an examination of the implementation. For both the patient and the partnership this can be a surprisingly frustrating time. Not always, but often, recovery and policy implementation share the traits of being slower and less complete than we would like. It helps to be emotionally prepared for this.
Wishing all a personally and politically healthy new year.
