Posts Tagged bully

Observations and Assessments

Notions to small for a blog post, all in one place.

Pomodoro is not just Italian for tomato. It’s actually an effective time-management technique. Like (for example) in clearing up unanswered emails. I find it actually keeps me focussed on writing, and helps me avoid the ever-present temptation of the evil Twitter.

The best thing about basic nursing is that it reminds you of why you became a nurse. An elemental truth. Susan Eller explains:

This patient in the hallway, waiting for a bed and needing some pain medications just needed some routine nursing care: comfort measures, information, and compassion.

Yet, the wife took my hand before they left the ED and thanked me for taking the time.  She appreciated that even though he wasn’t my patient, and she could see that I was busy, that I took the time to make sure that he was informed and comfortable.

It startled me that she was so grateful. In my perspective, I was just doing my job the way I always do it.  In the scope of my busy day with critically ill patients who needed so much more, this tiny little thing that I did made an impact on her.

Coal Cares. Really, they do.

And the high and mighty this campaign managed to piss off. Given the thousands that air pollution kills every year by exacerbating various respiratory illnesses, you’d think the coal industry — whose contribution to poor air quality is remarkable — would be a little less, um, shameless.

Parakeet madness in Britain. Hitchcock would have a field day.

A good source of nursing blogs (via @DrDeanBurke). Oh, yeah. There I am. Sweet.

More on bullying. The Nursing Ethics Blog:

The hardest questions I’ve ever been asked by med students and nursing students have to do with bullying, and with the difficulties inherent in being at the bottom of their respective professional hierarchies. Students understandably find it difficult — and a source of moral distress — to be not only subject to bullying, but to sometimes be involved in courses of action that they see as unethical and yet powerless to do anything about it.

In discussions I’ve seen around the Interwebs this past week, the consensus seems to be the risk of bullying decreases with experience and growth of confidence. Which begs the question: why do we subject the most valuable and vulnerable members of our profession to this behaviour?

And still more. From a med student who gets it:

As a medical student, I’ve witnessed and experienced my share of bullying by a handful of doctors (though to be fair, by nurses as well). In one instance, I watched a surgeon mock a new nurse in the operating room, teaching her with absurd faux-patience how to properly hand him his instruments.

And silence still kills. “Research and regulatory bodies have long confirmed that poor communication in healthcare is harmful at best and deadly at worst.”

Dept. of It Was Too Good To be True. Magnet hospitals are just as sucky for nurses as normal hospitals. Except they’re better at self-promotion.

Housekeeping. The spam filter has been acting up again. I gave it a good swift kick, and restored some comments that were placed in the spam file.

Also if you have emailed in past while and I haven’t gotten back to you, I will. A friend of mine declared email bankruptcy and deleted a whack of messages in one fell swoop, on the theory she was never going to asnwerthem, and they were just sitting there, making her worried and a little neurotic. Not quite there, but I can see the premise.

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When Nurses Write About Physician Bullies, Don’t Shoot the Messenger

Theresa Brown has taken some heat for the op-ed she wrote for the New York Times last Sunday. When she wrote about her experiences being bullied by a physician and the detrimental effect bullying has on patient care, the reaction from MDs was angry and defensive. I am beginning to think, after reading though all the posts and comments, that her real sin was being a nurse challenging physician authority. Ford Vox, writing at The Atlantic took particular umbrage at a physician being called out at Brown’s work place. “Drawing and quartering your coworkers in the Sunday New York Times,” he wrote, might be run-of-the-mill for politicians. I’d like to see something better out of doctors and nurses.”  While making a very slight nod to the issue of  bullying behaviour among physicians, Vox’s principal objection to Brown’s article was the ethics of making an example of one particular physician; he went to an exceptional effort at demonstrating the physician could be identified — at least by his co-workers — by a Google search (and in the process outing Brown’s place of work, which at least one commenter construed as an act of bullying itself.)

Kevin Pho was somewhat more even-handed. But still, while acknowledging that bullying is a serious issue — which Vox trivializes as a “workplace spat” —  he accuses Brown acting in bad faith, of pandering to an anti-physician audience and “metaphorically” acting as a bully herself; he also engages in a tu quoque argument that nurses in general are bullies themselves. “Shouldn’t they [i.e. nurses],” he asks rhetorically, “bear some responsibility as well?” (Except that we do. Endlessly. Do physicians in the same way?)

The message, in any case, from our physician colleagues, is that nurses should shut up. We should not be airing our dirty linen in public. Any mention of physician bullying will only serve to exacerbate poor nurse-physician relations. It’s unfair to single out physicians. We aren’t bad actors ourselves, we treat nurses with the utmost respect, ergo, nurses should acknowledge the physician bully is a singular creature, as unique as a butterfly in a Toronto January. Et cetera.

I beg to differ.

I don’t think it’s quite true that physician bullying is rare and out of ordinary, even now, despite assertions to the contrary. When I thought about it, I realized without too much difficulty I could list dozens of examples of physician bullying, that I have been subjected to or witnessed, some dating from the dark ages of the late 1990s. These range from the utterly appalling — like the ED physician who unfairly and angrily blamed the primary RN for the death of a septic neonate, in front of the parents — to the half-humourous, some of which I have documented on this blog. I’m pretty sure nurses reading this could come up with a similar list.

Stating that some physicians bully, and that it is a more widespread problem than physicians themselves suppose, is not to take away from the respectful and collegial relationships I enjoy with the vast majority of the physicians I work with, but rather to address the reality of the complex power relationships in the hospital pecking order. It isn’t physician-bashing to point out the obvious. In any case both Vox and Pho ignore the central point in Brown’s piece: that when physicians bully, patient care suffers. It suffers because nurses are understandably reluctant to deal with a physician who will demean them. Who wants to call with a high blood sugar in the middle of the night, or question an inappropriate medication order, if you’re pretty sure you’re going to get reamed out in the process? It suffers because it’s a large factor in determining quality of nursing work life: poor nursing morale results in poor patient outcomes.

So there are some very good reasons to point out this behaviour out. Should have Brown been so specific, even if anonymously so? Both Vox and Pho complain vigorously about Brown’s lack of discretion in her account of the incident. My only thought is that their reaction is a bit over-dramatic, because the only people witnessing the inappropriate behaviour were the care team and the patient — and they don’t have to be told who the bully is. Further, I guess if Brown is as careful as most health care bloggers, she’s disguised the identity of the physician in question by changing details and artful misdirection so that it would be difficult for even employees of her institution to make identification. And I’ll add a small artistic quibble: a direct, concise, personal example is worth a thousand words of exposition. In the event, I’m not clear where the appropriate place would be to deal with it, except publicly and openly.

Bullying is an exceedingly frustrating issue for nurses, mostly because of the sense of powerlessness. When you’re subjected to the bullying, you feel like a target, and helpless to boot — and you can only respond with difficulty because the power relationships within the hospital hierarchy. In short, physician-bullies, like bullies everywhere, get away with it because they can. Nurses have been complaining about bad physician behaviour since Florence Nightingale disembarked at Scutari. You would think, that after 150-odd years of politely asking physicians to pull up their socks, they might take the issue to heart and engage in some real collective self-reflection on the issue.

It was encouraging to see this in a few of the comments to all the posts, amid all the palpable anger toward Brown. But she only put to words what every nurse knows. The physician reaction to complaints of inappropriate behaviour has always been to minimize, to scorn, to condescend, to trivialize, to redirect, or to deny. Kevin Pho points out, correctly, that hospitals are beginning to address the issue through workplace respect programs. But in all seriousness, how many physicians have actually been called to account in any meaningful way by these programs? Pho writes, in another post on the subject that, “My issue is Brown’s methods, by pitting a wronged nurse against arrogant doctors. It’s a narrative that physicians will lose 100% of the time, no matter how they respond.” True enough. But despite this, it’s also true that nearly 100% of the time bullying physician behaviour will go by without serious consequences. The question I would like to pose to both Vox and Pho — and all the angry physicians out there — is this: have you ever witnessed a physician bullying a nurse, and what did you do about it?

Their answer, I would guess, would be, “Yes, and nothing.” I would be gratified to hear otherwise.

So physicians, stop complaining. We’re merely pointing out bad behaviour. It’s up to you to fix it.

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Do Nurses Have the Courage to Stop Bullies?

Hands up, nurse colleagues, if you recognize this story: bright young new grad lands dream job in sophisticated critical care unit by dint of hard work, persistence and perseverance, finds said unit is actually populated by orcs, trolls and toads. NurseXY provides the unpleasant details:

It was nice while it lasted, but the honeymoon is over. The true colors of my coworkers are starting to show through.

[SNIP --- but NurseXY's post continues with a heart-warming tale of nurses acting their very best. Go read the whole thing.]

I’m so very tired of hearing, [he goes on] “You have to be careful how you approach so and so about that.”

Why can’t I openly and clearly communicate my patient’s needs to those responsible for assisting me in caring for them? I am so tired of having to slink up to various people from docs to support staff like a helpless, hapless junior high damsel in distress to get what my patient needs. Too many egos to stroke. I demand respectfully request you grow the #@$) up.

And it’s only been 3 1/2 months!!!

I’ve written about the phenomenon of nurses behaving badly to their colleagues so often it’s tiresome. And sadly, I think, we’re all complicit in permitting bullying behaviour amongst ourselves, whether we are experienced nurses “breaking in” new staff, managers who avoid the issue, or tacitly permit it as a management technique (and this is far commoner than you might think), or educators who think abuse is the best way to train new nurses. It’s so ugly and so pervasive I sometimes despair for my profession.

RNnnnrGrl, after reading NurseXY’s post, vents on her blog at some length about the special hell of working with “seasoned nurses.” She’s on the mark, but maybe not in the way she thinks. While I don’t believe for a minute that bullying nurses make up more than a tiny fragment of our profession, how many times have we older nurses stood by silent while we let a bully tear into a nurse? When we passively let them stand unchallenged, it’s effectively the same as being bullies ourselves. So what to do? An excellent article at Medscape provides some practical responses to bullying:

Murray suggests that nurses should take a collaborative approach to bullying; nurses should “look out for each other,” and support victims of bullying during and following an episode, including reporting the incident. Victims are encouraged to document incidents of bullying, including date, time, site of occurrence, and witnesses.

Dellasega has this advice for nurses who witness an episode of bullying: “Intervene quickly to prevent minor conflicts from escalating.” Often, she continues, “a misperception or false assumption triggers behavior that spins out of control.” Because bystanders usually outnumber bullies and victims, they can act together to alter the situation’s dynamic and avert a bullying incident. “You can intervene on behalf of a coworker who is being bullied by asking her to help you with a task in another location, speaking up on her behalf, or simply standing beside her.” Dellasega also cautions nurses about participating in gossiping, which is also a form of bullying. [Emphasis mine]

I’ve highlighted the last bit because I think it speaks to something vitally important to the nursing profession, but often lacking: a sense of solidarity with your colleagues. Let’s say this plainly: either you stand with your colleagues, or you stand with the bullies. Afraid of retaliation or intimidation? You already have courage. You’re a nurse, right?

[Also, Sean Dent on the same.]

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