Walking in Uncertainty: The future of American healthcare

Existential angst has been our constant companion over the last two years as the SARS-CoV-2 pandemic has shaken our healthcare system — and our very lives, economies, and societies — to the very core. Nurses have selflessly borne an enormous Sisyphean burden throughout these fraught times, and uncertainty has become a ubiquitous lens through which we view this period in history. And perhaps some creative solutions exist that could potentially change the course of American healthcare for the better. But first, this universal uncertainty must be openly acknowledged.

The Currency of Uncertainty

What have we been able to hold as certain during these many months? That this wily virus will continue to confound and confuse even as we begin to foolishly wonder if we now understand it? That our children’s education will continue to be sporadically and maddeningly interrupted, and their academic prowess and socialization stunted? That the bidding wars for the services of travel nurses has created a schism in pay between loyal long-term staff nurses and those who elect to leave their families and homes for the adventure, stress, and mystery of 13-week assignments in far-flung facilities? And that nurses and their multidisciplinary colleagues everywhere have been pushed to their limit over and over again?

Uncertainty is the currency with which we move in this world of early 2022, and although the Omicron variant appears to be in retreat around the majority of the United States, there is no crystal ball that prognosticates a complete end to the dangerous and irritating nature of life during the worst pandemic in over a century.

Our politics, our schools, and even our knowledge of what’s most important in life have been thrown into a vat of confusion, and there’s no way of truly knowing how the history books will eventually tie a bow on this epoch of viral chaos.

Public Health? The Unsexy Stepchild of Healthcare

When it comes to uncertainty and the tenuous future related to the state of healthcare in the United States, public health comes to mind as the famously unsexy stepchild of the healthcare system. When preparing for graduation from nursing school, few students will, when asked, admit to plans of pursuing a public health career; rather, the emergency department, trauma, and the ICU are the perceived sexy nursing specialties where adrenaline junkies are seemingly magnetically drawn.

Population-based health, education, and the paramount issue of surveillance and public health infrastructure have shown themselves to be of the utmost importance during this time of the coronavirus pandemic, however, the long-standing underfunding of American public health has come home to roost during this time of epic need. Institutions like the Public Health Foundation have been at the forefront of pushing for needed funds and the recognition of the importance of public health, yet the struggle has remained for decades as the money flows elsewhere.

With many nurses currently having their minds attuned to the paramount importance of public health, perhaps more will pursue careers and education in this crucial area in order to escape the stressors and deprivations of acute care. We need smart, thoughtful people in this sector, and there are some great nurses whose talents are desperately needed.

Learning Lessons and Thinking Critically

The “hero” moniker bestowed upon nurses and frontline workers can at times be perceived as a pandemic-inspired cliché after two years of such diligent and life-saving labor on behalf of the citizens of this beleaguered country. We’ve clearly learned that nurses are as fallible as anyone and can suffer from moral distress, compassion fatigue, depersonalization, traumatic stress, and burnout. And let us not forget those aforementioned nurses who are raising children, caring for elderly parents, and looking after their own families during these turbulent times.

Walking into uncertainty means that we can carefully watch the road upon which we find ourselves, use our keen powers of critical thinking as tools of discovery, uncover landmines and pitfalls, and develop novel ideas and creative solutions.

Whether it’s a nurse-developed contact tracing app, a unique model of school-based population-based healthcare delivery, or the recruitment of more young, talented nurses into research or public health, the future of American healthcare must be wrested from the hands of those who seek only profit, and instead placed in the hands of those who truly wish to find the righteous road forward.

Yes, these uncertain times are troubling, yet great opportunity exists if we can summon the individual and collective will to bring about overdue changes to a behemoth of a system that spends a great deal of money for what we might classify as wholly lukewarm outcomes.

The future of American health can be written — and perhaps rewritten yet again — by those who know it best. With nurses being the veritable mitochondria of the healthcare system, the opportunity is there for those who hear the call. Having been shaken to our core while under siege by COVID-19, perhaps the time has come when those who have energy, ideas, and expertise to share will be welcomed to the table and given a platform to participate. Nurses deserve a seat at that table — after all, being on the menu is no longer a viable option.

— Keith Carlson, BSN, RN, NC-BC is a holistic career coach for nurses, award-winning nurse blogger, writer, podcaster, speaker, and author.

(This story originally appeared in American Nurse.)