Do Not Fold, Spindle or Mutilate the Nurse

An unpleasant, no, ugly and unfortunate situation at Victoria General Hospital is preventing a woman from seeing her son. From the National Post article:

A 73-year-old woman who travelled to Victoria from South Africa to care for her seriously ill son has been banned from Victoria General Hospital after she says she tapped a nurse on the head to get her attention.
Shirley Spence, originally from England, has been sitting in her rented apartment in Victoria since mid-May, barred from seeing her son, Gary Abbott, 52, who was found to have a brain bleed after falling ill.
Instead, every day her longtime partner, Andrew Regan, visits Abbott.
The couple say the situation is surreal and that they keep waiting for common sense and grace to prevail — but it never does. Abbott’s brothers and sisters in South Africa are incensed.
“I can’t believe I’m being treated like a criminal,” Spence said. She wrote an apologetic letter following the alleged incident, saying she was unaware of the no-touching policy, that no harm or aggression was intended, and that she will never touch staff in future. She ended the letter with a plea to see her son. But she was told it was not heartfelt.
[SNIP]
Despite what may seem like a disproportionate reprimand to the average observer, VIHA said it must support its staff on its own zero-tolerance policy concerning violence or abusive behaviour.
“Whether she tapped her or whacked her on the head, it’s unacceptable behaviour,” said VIHA spokeswoman Shannon Marshall. “The nurse’s story doesn’t vary from Mrs. Spence’s as I understand it.”

A couple of thoughts. First, at first glance, unyielding enforcement of a zero tolerance policy against abuse in these circumstances strikes one as not only defying common sense, but deliberately cruel. But then, there is this statement on the incident  from the Vancouver Island Health Authority (VIHA):

The Vancouver Island Health Authority (VIHA) has a zero tolerance policy toward violence of any kind – whether emotional, verbal, or physical – involving any member of our staff, physicians, patients, or visitors.
VIHA recognizes the current situation involving visits to a patient at Victoria General Hospital is complex and challenging – both for staff and the family involved.
Over the past week as this situation has unfolded, VIHA has been committed to the required risk assessment processes around violence in the workplace. In this specific case, a full and complete risk assessment was carried out. This process involved representation from BCNU, HSA, HEU, unit staff, VIHA (Unit Manager, Social Work, Occupational Health, Protection Services and VGH safety advisor). The risk assessment considered what occurred around the incident itself, relevant documents and facts involving family interactions prior to the incident, and the potential risk for future violence. The decision following the risk assessment was unanimous.
VIHA is very aware and concerned about the impact this incident has had on the staff member involved and other staff on the unit.
VIHA also recognizes the stress and concern the current situation is having on the family. Decisions to restrict visitation are not made lightly as we know the importance of family support and visitation in facilitating the recovery process for our patients.
VIHA is exploring ways to support the mother to visit with her son while he remains in hospital. In the short term, this visitation is unlikely to occur on the unit itself, but – as the patient’s condition allows – we are looking at ways to arrange visits in other areas of the hospital. VIHA will be working with the family very shortly to develop visitation arrangements. [Emphasis mine.]

The fact VIHA is doubling down in the face of hostile news reports suggests to me that there is more to the story than is superficially apparent. Note the decision to restrict visitation was unanimous among the risk assessment committee assembled to consider the matter. Perhaps the “head tap” was more than the gentle remonstrance of an elderly woman suggested in the newspaper article — try tapping your skull hard with your fingertips, and you’ll see what I mean — and I wonder too if there was a pattern of escalation.

At any rate it’s a tough balancing act. On one hand, hospitals have a clear legal and ethical duty to provide a safe work place for their employees and to protect them from violent and abusive behaviour. Zero tolerance policies are reflective of this duty. But throwing out family is not a great choice in any situation. Family members are generally considered integral to the health care team surrounding the patient. Note also VIHA is trying to find accommodation for the patients mother. I myself will not hesitate to have family removed if they interfering with patient care or if they are violent or threatening violence. My own rule-of-thumb is what I call the “Bank Teller Rule.” If the behaviour is inappropriate in a bank — and clearly, head-tapping your teller would be — out you go.

In case you are wondering, violence and abusive behaviour directed towards nurses is widespread. One study showed exactly how common violence is — and why, incidentally, I enthusiastically support zero tolerance policies:

Emergency Nurses
39.9 percent were threatened with assault
21.9 percent were physically assaulted
Medical Surgical Nurses
22.6 percent were threatened with assault
24.2 percent were physically assaulted
Psychiatry Nurses
20.3 percent were threatened with assault
43.3 percent were physically assaulted
(Source: Hesketh, K., S. M. Duncan, C. A. Estabroks, et al. 2003. Workplace violence in Alberta and British Columbia hospitals. Health Policy 63: 311–321.)

I think the study actually under-reports. Personally, I have been slapped countless times by demented and not-so-demented patients, I have been bitten to the point of bleeding, and once I was punched in the side of the head and knocked to the ground. This last was witnessed by police, and of course, no charges were laid. Again I repeat: why is there an expectation that nurses should tolerate behaviour from patients and families that is not tolerated anywhere else?

Did I sign up for any of this? Did any nurse?

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  1. #1 by jeanhill on Friday 01 June 2012 - 1303

    When it comes to abuse issues such as these I think hospital policy needs to be zero tolerance. Very black and white, despite what this may unfortunately mean for a patient or family member and it’s impact. If exceptions are made, rules bended and the whole policy becomes grey, what would be the point of enforcing it in the first place? Everyone could get around it somehow. Actions have consequences despite the (apparent or not apparent) implied intent.

  2. #2 by ArtDoctor II on Friday 01 June 2012 - 1355

    Ya, I agree with your statement at the bottom of your post. People don’t tap each other on the head at home to get attention, or at work. Why should it happen anywhere else? That woman has psychiatric issues.Too bad that “blame the nurse” kicked in. There is likely a lack of awareness of the policy at that hospital. At my doc’s office, there are signs stating, “any abuse, verbal, physical, or emotional directed at our staff will not be tolerated.” It’s on signs with photos of some staff from the hospital at the check in area, and waiting room, and I think it’s very effective.

  3. #3 by Janice on Friday 01 June 2012 - 1718

    Attitudes towards nurses have changed so much in what is only a few decades. When I was growing up in the sixties and seventies, nurses were venerated figures, almost secular saints, but also glamorous. I remember reading the Cherry Ames series of stories about this glamorous nurse and her many adventures, also nurses were well represented in romantic novels. Perhaps a little corny by today’s standards, but these stories certainly reflected society’s attitude towards nurses and also shaped them. So what happened?

  4. #4 by Aurelia on Saturday 02 June 2012 - 1130

    No nurse/doctor should ever be assaulted on the job, period. Neither should patients or family–yes, I’ve seen that happen to.

    But, something does sound odd about this story. I clicked through the original story, and now I am thinking cultural differences between South Africa and Canada may be another issue.

    I know younger women who are from SA and they don’t do this–but older generations have phrases, actions, ways of speaking that are, umm, old-fashioned in SA, and would likely considered unbelievably rude, and ignorant here.

    Now I wonder if it’s verbal as well as “tapping” and if this is just a huge huge misunderstanding. This elderly woman may have no clue that what she said is offensive. And the hospital may not realize that.

  5. #5 by rhachis on Monday 04 June 2012 - 1644

    Why not just take her son to a different hospital?

  6. #6 by lisa on Monday 04 June 2012 - 2223

    I’m so tired of getting clawed, kicked, bitten and spit upon by patients that it isn’t funny. We routinely slap spit socks on patients, put mitts over the hands of patients in 4-pts, and are blessed with helpful security….

    Trauma unit and I’m sick of drunks.

  7. #7 by Norman Kaden on Thursday 10 October 2013 - 0329

    You have to wonder why they felt the need to tap the nurse. Sometimes it’s out of frustration. Everyone assumes it’s the visitors fault. But let’s be honest sometimes the nurses are that arrogant that they need to learn that they are no better than the rest of us.

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