Who benefits?

When we give people with urinary tract infections, sore throats and ear infections no other choice but to come to the emergency department, who benefits?

When we make people with minor illnesses wait weeks to be seen by their primary care provider, who benefits?

When we institutionalize people instead of finding ways to keep them at home, who benefits?

When we spend our time managing crises and problems instead of preventing them, who benefits?

When we’re asked to prioritize volume and efficiency over quality, who benefits?

When we’re forced to make certain decisions and choose ‘this or that’, a question we need to ask ourselves is who benefits when we force people how to act?

When we apply the who benefits question to the dilemma about whether we should make people with acute, non-life threatening health problems come to emergency departments instead of using alternative models of care, the answer is clear. The people who benefit the most are the ones who believe emergency departments are the best way to provide acute care.

When we apply the who benefits question to the dilemma about how many clients a nurse should care for in a day, the answer is obvious. The people who benefit the most are the ones who decide it’s best to prioritize quantity over quality and efficiency over empathy and science over art.

When we apply the who benefits question to the dilemma about whether we should teach nurses about illness instead of helping them learn more about upstream approaches to health care, the answer is also clear. The people who benefit are the ones who decide it’s our job to care for the sick and injured.

These dilemmas are personal to me. I became a nurse because I wanted to help people stay healthy and at home. If you’re anything like me, you probably don’t want to be sick or institutionalized or have to go to the emergency department if you don’t have to. Most people don’t.

When I started nursing school in 2010, nursing was primarily focused on illness. We learned about diseases and were trained how manage them at the expense of learning how to prevent them. A single textbook and a six-week course covered community health. Our professors trained us to work in hospitals, not in homes. It was clear that publishers, textbook authors, teachers, administrators, nurses and experts who believed in downstream approaches to health benefited the most.

And yet, ironically, non-nursing research consistently shows that the way to improve a population’s health is to invest in social services and upstream approaches to health care. That in fact, investing more into traditional health care doesn’t make us healthier.

It takes empathy to seek the truth and guts to stand up against the tradition of this is the way it’s always been done. If you’re protecting yourself from asking tough questions about your work, who benefits?

When we feel tension between the work we’re actually doing and the work we hope to do, it’s a sign that other people are benefiting from forcing us to choose.