Archive for category Battered Nurse Syndrome
Posted by torontoemerg in Battered Nurse Syndrome, Good Nursing Practice is Practising with the Heart and Mind, Health Care Policy That Matters to Nursing, If You Gonna Have a Circus, You Gotta Have Elephants, Nursing Naval Gazing, Public Images of Nurses and Nursing, The Stupid is Strong with This One on Saturday 05 October 2013
So there’s this thing in Quebec which I’m sure my Canadian readers have heard of and maybe also a few of my American readers, which involves the Quebec government devising some legislation called the Charter of Quebec Values. I have to say “charters” and “values” are nice happy positive words, and Quebec is filled with deliciously cheesy poutine, hockey, maple syrup, and those devilishly sexy Québécois men, so what’s there not to like (except for les Habs, boo, hiss!)?
The thing is, this Charter of Quebec Values wants to ban wearing obvious religious symbols for all public employees, including nurses and other health care professionals. This, I have to say, has ABSOLUTELY NOTHING TO DO with some nice Ladies of Muslim persuasion cheekily wearing hijab in broad daylight in Montreal and everything.
(Just so you know, American readers, I must also officially tell you is NOT racist, and the fact the proposed legislation targets Quebecers with brown skin is merely, um, an unfortunate coincidence. We say this because the Quebec government is acting from the purest, noblest of intentions. This is a Fact, because the Quebec government has told us so. (You can Google translate it or something.) It is well-known that the separatist, ruling Parti Québécois has long been offended by clerical collars, Jewish kippahs, wimples and garish Roman Catholic crucifixes. This is also a Fact, which you can also Google.)
The proposed charter will affect health care professionals, including nurses. My question, then, does the wearing of religious symbols or associated clothing have any place in the provision of health care? Should nurses don hijab on the hjob?
Before you run off to start raving, maybe you should consider a few things. First, banning headscarves (or whatever) has a distinct element of authoritarian nastiness about it. Should the nursing profession be that coercive? There’s probably no getting around the fact that if the legislation is passed, it will be nurses enforcing the ban against other nurses.* (The irony of having the Quebec government telling Muslim women how to dress, partly, it is argued, to ensure gender equality, is beyond these guys.)
Another thing: nurses have a long history of wearing weird things on their heads. It’s safe to say that if you look over the course of the history of nursing, no crazy headgear has been the exception, not the rule.
Which reminds me: some of you might say, oh it completely different! it’s a religious thing! Muslims shouldn’t be pushing their faith in our faces!
Well, there’s this:
But not this? (Love this ad, by the way. It was created in response to the proposed Quebec law..)
So if you’re offended by women in hijab but not by Catholic nursing sisters, what’s the difference? Do you really believe the hijab (or any other piece of religious accoutrement) sucks out the nursing from the nurse?
So dear readers, hijab for nurses and other health care professionals, yes or no?
*The Quebec nurses union, FIQ, has courageously taken the position of taking no position at all. In other words, the union won’t defend members running afoul of this law. I’m pro-union, but holy Sam Gompers, sometimes their leadership are dumb as stumps.
…or the negativity they can spew….
“You wouldn’t know what to look for in that type of patient assessment anyways…”
How do you know I don’t know what to assess for? Are you the textbook I read from? The online periodicals I continue to educate myself with? Are you every patient I have assessed in the last 8 years? Did you teach me? Were you my preceptor in some nightmare? Well since you are none of the previous and you’re not a bound textbook (despite how wound up you are all the time) please do not assume that since I have less experience than you, I won’t know how to assess a patient with XYZ diagnosis. Perhaps just ask if I know what the presenting signs and symptoms may be and any associated complications to monitor for, what the normal would be, etc… and take a supportive and educative approach if you are concerned about my assessment skills without any condescending tone or implied disregard for my apparent limited knowledge.
I recently had a patient with a skull fracture, (the head injury happened a day earlier), and the senior nurse asked if the patient had battle’s sign, (bruising behind the ears), which they did not, I informed her, to which she rudely replied with, “you wouldn’t know what battle’s sign looks like anyways…”. Between being 0645 in the morning after a long night shift and the only words coming out of my mouth would have been immature and highly offensive, I felt it right to walk away from the conversation.
As per this blog post, I’m clearly still stewing.
Dinner last night with an old friend who toils in the mines of Labour and Delivery. She has worked there for four years. She told me of an incident not too long ago working the night shift, faced with a post-partum patient who was bleeding, hypotensive, and tachycardic, in short, showing all the signs of going into hypovolemic shock. She was running around, starting IV lines on flat veins and hanging blood products. Packed red cells. Platelets. Cryoprecipitate. And by-the-by, saline by the bucketful. She called for help from her colleagues. Apart from this patient and another who was walking the halls a few hours from delivery, it was a slow night.
Of course, you know the end to this story, don’t you?
No one came.
No one even popped their head in the doorway to ask, “Is everything okay?”
All of them were at the nursing station, playing Draw Something on their phones, watching the season finale of Grey’s Anatomy, what have you. Too busy to help a drowning colleague with a shocky patient.
My friend went to her educator and her manager. They shrugged it off. No biggie, they said. Clearly my friend had things under control. “The patient lived, didn’t she?” they said. And then: “Maybe you need to improve your organizational skills to handle critically ill patients.”
This last to a 50-something woman who has been nursing 25-plus years, almost all of it in critical care settings.
For my friend, this incident may well be the last straw. She is definitely leaving L & D. Why would she want to stay? The workplace culture on this unit is awful. She feels alone and isolated when going into work. She can’t trust her colleagues. “Why,” she asks, “would anyone want to work there? There is no teamwork. No solidarity. Nurses backstab each other at the first opportunity.”
The only question remaining is whether my friend will leave nursing altogether and take her 25-plus years of experience with her, which included not only the knowledge to provide expert care to patients, but the potential to share that expertise in mentoring and nurturing new nurses. She’s uncertain what she would otherwise do, but leaning towards abandoning the profession which has shaped her adult life. She only needs an out — which she hasn’t found yet. She is that disgusted.
You might tell me that stories like this are unusual and not representative of nursing. Unfortunately, we all know better. So in the end, I don’t blame my friend for wanting to leave. I would do the same.
So what would be your response?
UPDATE: Some comments from Twitter:
The second to last tweet from @NorthernMurse is probably the relevant question, don’t you think?
Posted by torontoemerg in Battered Nurse Syndrome, Before I Start Throwing Things, I'd Better Write This Down, When the Health Care Corporation Speaks on Monday 14 May 2012
More on the Texas hospital, Citizens Medical Center, which banned fat people from being hired. Citizens Medical Center, you might remember, made it policy to exclude new hires with a body mass index >35, and explicitly stated employees appearance should “fit with a representational image or specific mental projection of the job of a healthcare professional . . . free from distraction” for patients. Medscape has a video (sorry, couldn’t figure out how to embed) from a medical ethicist named Art Caplan with another point of view. Partial transcript:
Look, I’m all for trying to set a good example and I think there are plenty of businesses where being thin and being in shape really do matter. I guess if you run a modeling agency it is very important. But I’m not convinced, really, that putting in weight restrictions is the best idea in terms of sending out the right message or a necessary message to patients. Patients, I think, can work with their doctors to try to overcome common problems. Doctors see all kinds of patients with all kinds of habits and all kinds of lifestyles. I think patients can deal with seeing all kinds of healthcare workers with all kinds of habits and all kinds of lifestyles. If they want a thin one, they should be able to pick one, but I don’t think the hospital necessarily should have to say that only the thin ones can work here. [Emphasis mine.]
Really? That last bit sounds needlessly, well, stupid. Does he really think patients should be allowed to choose their health care providers on the basis of their appearance? “Let’s see. . . ” one can imagine patients musing, “that nurse is too fat. Tht nurse is too old. That nurse is too. . . dark. That nurse is too male. That nurse is too Muslim. That nurse is too gay.” And so on. Apart from fostering bigotry and discrimination, and demeaning and devaluing staff, in practical terms, you’d soon run out of nurses. I mean, not every nurse looks is thin, white, young and female.
One more thing. I understand there is a role for hospital policies regulating appearance: hygiene, facial hair, tattoos, uniforms and jewellery are usually targeted. Fair enough. I also understand the need for an ethicist to weigh (so to speak) both sides of the issue, but isn’t there some point where, after all is said and done, you have to say evaluating people of the basis of their body characteristics in general is just wrong? I don’t think that medical ethicist Art Caplan exactly said it was wrong. Making a value judgement, that employers treating nurses and physicians as human beings with inherent dignity and worth, is important. It might even be a good place to start.
[UPDATE] Also, too, these thoughts from a writer named Susan Pape at Policymic.com:
When I am in need of hospital care, I want the staff to be the best, hardest working, most talented, most caring available. I do not care if they are overweight. Employing health care providers on the basis of their competence is a matter of life or death …to me.
Obesity is not a choice, and it is not immoral.
A Texas hospital has declared war on the scourge of obese nurses:
A Victoria [Texas] hospital already embroiled in a discrimination lawsuit filed by doctors of Indian descent has instituted a highly unusual hiring policy: It bans job applicants from employment for being too overweight.
The Citizens Medical Center policy, instituted a little more than a year ago, requires potential employees to have a body mass index of less than 35 — which is 210 pounds for someone who is 5-foot-5, and 245 pounds for someone who is 5-foot-10. It states that an employee’s physique “should fit with a representational image or specific mental projection of the job of a healthcare professional,” including an appearance “free from distraction” for hospital patients.
“The majority of our patients are over 65, and they have expectations that cannot be ignored in terms of personal appearance,” hospital chief executive David Brown said in an interview. “We have the ability as an employer to characterize our process and to have a policy that says what’s best for our business and for our patients.”
It all sounds so, well, high-schoolish, and I don’t think the CEO is seventeen, though he’s acting like it. I mean, can you get any more shallow? Since when does physical appearance have anything to do with competence or worth or dignity of any health care professional?
Or maybe David Brown doesn’t really believe nurses actually have skills — we just stand around as decoration, lookin’ pretty.
And fitting the “representational image” of hospital employees to meet patient “expectations?” What the hell does that mean, anyway? If patients expect this (and this is a pretty common “representation”)
then hiring practices should make sure all nurses are boobalicious? What if the patients want all-white nurses? Or all females? Or no Muslims?
The man is a bit of a dink, obviously. I can only imagine how valued overweight nurses employed by this hospital must feel.
The article goes on to note that this David Brown, CEO of Citizens Medical Center, has some issues. In 2007 he wrote memo about some foreign-born physicians in which he stated: “I feel a sense of disgust but am more concerned with what this means to the future of the hospital as more of our Middle-Eastern-born physicians demand leadership roles and demand influence.” He continued, “It will change the entire complexion of the hospital and create a level of fear among our employees.”
Needless to say, there is a discrimination lawsuit over that.
So let’s summarize what the leadership at Citizens Medical Center believes: scary scary fat nurses scaring patients. Scary scary dark-skinned physicians scaring employees and patients.
Clearly a place where I would want to work. Or be treated.
News flash! From Fierce Medical News, here’s the shocking headline:
Docs, nurses miscommunicate on respect, job role
When you guys pick yourselves off the floor from laughing, here’s the money quote:
In particular, the survey found differing views of how doctors treat nurses. According to 42 percent of nurse leaders, physician abuse or disrespect of nurses was common, whereas only 13 percent of physician leaders said it was common. Fifty-eight percent of nurse leaders considered disrespect for nurses uncommon, while 88 percent of physician leaders said it was uncommon at their healthcare organizations.
“I do believe nurses and physicians are on two different pages when it comes to communication,” Pam Kadlick, vice president of patient care and chief nursing officer for Ohio’s Mercy St. Anne Hospital, said in a HealthLeaders Media article. “Nurses have a tendency to give a very detailed report, more than what a physician may want to hear; hence, the physician may interrupt, seem to be abrupt, even rude at times.”
But most physicians don’t consider such behavior to be disrespectful, she noted.
You’re telling me abuse of nurses is all about physicians being insensitive, maybe, and nurses having too many hurt fee-fees? Really? And nurses are supposed to be surprised that physicians “don’t consider such behavior to be disrespectful?”
Why does this sound like a ’80s sitcom?
Why does this sound like this report is trying to validate abusive physician behaviour?
You can only shake your head. And you just know, somewhere, in a darkened office maybe, in an obscure corner of a mega health care corporation, a manager is reading this report and exclaiming, “I knew nurses were to blame!”
I will very happily concede abusive behaviour of all kinds has declined markedly in my own time as a nurse, though I will say I work in an institution that enforces a zero tolerance policy against abusive behaviour. Moreover, the physicians I work with, shoulder to shoulder, are lovely and professional, and there is a true sense of collaboration. This makes for excellent patient care.
However, by no means is this true everywhere. So let’s not pretend the brow-beating, the mocking, the chart-throwing, the patronizing — to be blunt, treating nurses like you wouldn’t treat your mother, daughter, wife, bank clerk, Wal-Mart greeter, housekeeper, or dog — still doesn’t go on. Denial will never fix the problem, either from physicians — or nurses.