Archive for category Nurses Behaving Badly
…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?
… and other examples of nurses eating their young…
A few statements I’ve heard in the last few years that I shall share periodically.
“It is more important that I get all of my breaks than you young folk because I’m older and need to rest more often”
I fail to understand how one person’s break is more valuable than anyone else. I realize that to-the-death cage matches can occur for which nurse goes first when it’s crazy busy, but seriously, just because you are senior staff does not make you superior and priority when it comes to a moment to stop, eat, go to the bathroom, etc. I like to think we are all the same as department staff members (obviously not including experience or department responsibilities for example…) but everyone is entitled to their break. Years of service to the hospital should not, in my mind, make you first up for every break. I often see the charge nurses getting fewer breaks than the rest of the staff (which is unfortunate) because they are trying to see that everyone else is getting a chance to eat. And for the most part, the charge nurses are all very senior staff. If you cannot keep up with the pace and demands of a busy emergency department or other job area and feel you cannot miss any breaks because of your age then perhaps you need to work in a different environment. Or retire. Missing breaks sucks no matter what way you look at it, but we have to work together to ensure we’re all taken care of.
- I do make the exception however for those with medical conditions, such as diabetes or a pregnant staff member (which is not a condition albeit) who is carrying/growing another human being inside of them. I have never personally grown a human, but from what I have observed, it’s tiring and your body needs extra food and having your lower legs elevated for a period of time in the day (that may have become the size of my thighs) is important too. So I personally would not have any issue with offering them the first available break.
- please also note that this does not in any way encompass all senior staff. Just the few that can be particularly nasty.
Posted by torontoemerg in Before I Start Throwing Things, I'd Better Write This Down, Good Nursing Practice is Practising with the Heart and Mind, Nurses Behaving Badly on Tuesday 17 April 2012
Why does any discussion of breastfeeding makes people a little insane? I don’t exclude myself: even I get a little agitated. Here are some examples of what I mean:
Exhibit A: a recent post on breastfeeding at KevinMD.com sparked a small flame war in the comments. Barbara Bronson, an RN wrote there:
And guess what? Our kids — now in their twentie [sic] – turned out just fine. They have no allergies. They are smart. They’re not fat. They’re healthy. They are kind, and funny and athletic, and you couldn’t pick them out in a crowd. But if you read some of the research and most of the women’s magazines, you’d think we’d be hauled in for heresy for disclosing this seldom-talking-about fact: in the end, whether you breast-feed or you bottle-feed, no one — not even a physician, a nurse, a teacher or a psychologist – will ever be able to tell the difference.
So that’s why I was pleased to see the World Health Organization announce that although they recommend breastfeeding for the first six months of life, they say it may not be a realistic option for many. The report was published online March 14, 2012 in the BMJ Open.
The curious thing about this particular post is that it almost completely misrepresents the British Medical Journal article cited above. The BMJ article suggests an idealistic public policy approach to breastfeeding may be counterproductive — and only dealt with new mothers in a developed country. Bronson’s post managed to turn this important study into a disavowal of the World Health Organization’s breastfeeding guidelines. Of course, it said no such thing. (A far more accurate take on the BMJ article can be found on the Breastfeeding Medicine blog. Or just read the damn thing.) Not that is matters much: the debate degenerates into bomb-throwing between pro-formula-you-lactivists-are-Nazis and breast-is-best types. Who cares about the science, anyway — it just gets in the way of anecdotes and feelings.
(Yes, I am annoyed.)
Exhibit B: a city ordinance in Seattle protecting the rights of neonates to breastfeed publicly causes distress for those who prefer breastfeeding mothers to be unseen and unheard:
“We need to get to the point where breastfeeding is accepted by everybody,” said Schwartz of the Breastfeeding Coalition. Although businesses that break the law can face fines, she said the main goal was to educate people and change attitudes.
“It’s feeding your baby for heaven’s sake,” she said.
But advocates will have to overcome an ingrained hostility, as seen oozing in the comments on a KING/5’s story on the breastfeeding bill.
“Wanna feed your kid, great feed your kid, just don’t put up a bill board (sic) pointing to your saggy udders trying to get some attention,” wrote “freedomfrank” on the site.
“As far as I’m concerned, women with babies can get the (hell) out of any restaurant I’m in if they want to breast feed,” another commenter wrote. “You’re not special and we don’t give a rip that you have a baby.”
One woman wrote that she supported breastfeeding – had nursed her own kids – but just didn’t like it in public.
“I do not want to watch you when I am trying to eat or walking in the mall with my teen son,” she said.
Exhibit C: suffer not the little children unto me. Rachel Stone writes:
When he was one year old and decidedly cherubic—with chubby pink cheeks and golden curls—my family visited Rome, and, of course, Vatican City. I was prepared with skirts and modest tops for visiting St. Peter’s, but I hadn’t considered for a moment that breastfeeding might break the rules of modesty. So when my little cherub was hungry, I settled cross-legged in a corner, in sight of Michelangelo’s Pieta—that haunting sculpture where Mary cradles the broken body of her Son—and began to nurse, identifying, maybe for the first time, with Jesus’ mom as I cradled by own boy.
Seconds later, a uniformed guard came along, slapping his chest and saying, emphatically, “Latte, latte!? Latte? Uh, downstair! Uh, da batroom!” Of course: he wanted me to go breastfeed in the bathroom. Because nursing my son in that space was equivalent to a plunging neckline or a miniskirt.
All of this makes me a little crazy for the sheer stupidity. However, I get there is some deep cultural
resistance antipathy to breastfeeding in the West and particularly in North America. I happen to think this ambiguity — where Facebook bans pictures of breastfeeding but permits hypersexualized pictures of busty women — is utterly idiotic and tied up in some bizarre societal notions about breasts and sexuality, but I understand that others’ mileage may vary.
I get that nurses, midwives and other healthcare providers haven’t been the best at times supporting and encouraging new mothers to breastfeed. We nag, hector and finger-wag when we should be providing support and empathy.
But still, for all of that, breastfeeding is undoubtedly the best choice for most women and neonates. Yes, there are exceptions: neonates who can’t or won’t nurse, or physical, health or social/economic problems preventing the mother from nursing. But really, are theses exceptions so numerous to recommend formula as the equivalent choice for all neonates? To use an analogy, gold standard treatment for pneumonia is the prescription of antibiotics. Does the standard change because a few might not tolerate the drugs? It bothers me more than a little the nurse mentioned above would suggest bottle and breast are equivalent, whatever her own personal experience.
Something else which makes me unhappy: how the debate around breastfeeding is almost always framed from the perspective of middle-class women from developed countries like the U.S, Canada or Britain who have the resources to consider formula as a viable option. For most of the world’s women, the sheer logistics of bottle feeding are not feasible or realistic. These include consistent access clean water, soap, a stove, fuel, education, and nurse/midwife support, the formula itself and other supplies, or the money to buy it. According to the World Health Organization:
When infant formula is not properly prepared, there are some risks arising from the use of unsafe water and unsterilized equipment or the potential presence of bacteria in powdered formula. Malnutrition can result from over-diluting formula to “stretch” supplies. Further, frequent feedings maintain the breast milk supply. If formula is used but becomes unavailable, a return to breastfeeding may not be an option due to diminished breast milk production.
For many, if not the majority of women in the world, and especially the poorest, there is no option but breastfeeding. We should probably bear this in mind when discussing how “realistic” the WHO guidelines are.
Posted by torontoemerg in Good Nursing Practice is Practising with the Heart and Mind, Life in the Emergency Department, Nurses Behaving Badly, Nursing Naval Gazing on Sunday 25 March 2012
This might be a new low in nursing management. Instead of actually providing caring, empathy and compassion, some hospitals would like nurses to provide a simulacrum of caring, empathy and compassion, believing patients are stupid enough not to tell the difference:
Nurses unions say an increasing number of hospitals nationwide are asking nurses to adhere to standard scripts when talking to patients, down to how often they use a patient’s name (at least three times per shift)
At several Massachusetts hospitals, nurses have been given laminated cards to hang around their necks with the words they should utter at the end of every visit: “Is there anything else I can do for you before I leave? I have the time while I am here in your room.’’
These particular words, consultants say, are important because of research showing that patients are more satisfied with their care when they believe nurses made time for them. [Emphasis mine.]
This is called “scripting.” It’s the newest shiny object for nurse managers. The underlying philosophy is that it doesn’t really matter if the nurse in reality establishes a therapeutic relationship, administers a medication properly and safely, completes a thorough and accurate assessment, or does all the myriad (and out-of-sight) procedures and processes necessary to ensure a successful and healing visit. All of that falls by the wayside: what’s most important and valuable is that the patient believes they got good care.
Of course, there is a fairly large gap between reality and belief. When I worked in the United States, my employer was exceedingly concerned with customer relations (I use the phrase advisedly), and regularly called nurses on the carpet for (allegedly) dissing patients. I personally was the recipient of a patient complaint in this regard: she believed I was missing in action for her entire visit. Fortunately I had charted extensively and nearly hourly because she was also receiving some high doses of narcotics and spent most of her visit sleeping. My care, in fact, and I will blow my own horn here, was exemplary. But you see the point. There is no such thing as the completely satisfied patient. It is a myth. The capacity for patients being satisfied on every aspect of their care is nearly infinite. Unfortunately, our capacity to make patients satisfied in all things is rather constrained. Patient care is complicated. It’s impossible to account for every contingency. Furthermore, patients sometimes equate nursing care to hotel room service. Sadly, we aren’t bellhops or waitresses. Trying to achieve patient satisfaction in each and every case is a ultimately a losing game.
In any case, the value of scripting nurses, at least in the Emergency department setting, might be limited. One study indicates patient satisfaction scores remained constant pre-and-post introduction of scripts in an ED. This suggests to me, anyway, that scripting is just another in a long series of quick fixes for a problem which is actually hides the real elephant in the room: the link between nurse working conditions and job satisfaction, and patient mortality, morbidity and overall satisfaction. Nurse Keith at Digital Doorways excellently discusses this in blog post on the same subject. I won’t rehearse the argument at length, which basically boils down to “happy nurses make for happy patients.
So in the end, do you think treating nurses like idiots would increase or decrease job satisfaction? And how do you think that affects patient care?
[Update: corrections in formatting made. I sometimes forget WYSIWYG blogging isn’t always WYSIWYG.]
Posted by torontoemerg in Good Nursing Practice is Practising with the Heart and Mind, Nurses Behaving Badly on Thursday 22 March 2012
Irony alert! The best way to decrease empathy in nurses, apparently, is to actually practice nursing. A new study of nursing students found that
as students gained more clinical exposure, they demonstrated a much greater decline in empathy scores over the year than did those with limited clinical experience during that year. This finding extended to students with previous work experiences in the clinical setting, who also evidenced declines in empathy of practical importance. . .
The study indicates the usual suspects in this decline of empathy: lack of time to empathetically interact with patients, lack of support, lack of role modelling, focus on the technical aspects of nursing and so on. It concludes: “[U]ntil the art of nursing is recognized as a necessary criterion for successful completion of coursework and as important as passing an exam, students will likely continue to demonstrate behaviors that make them good technicians but not necessarily very good nurses.”
But I’m not very surprised. I was speaking to a friend the other day who is a clinical instructor for a certain university-based nursing program in Toronto. She told me of the open and enormous contempt the academic instructors at this university have for the clinical instructors (the majority of whom are bedside nurses as well) and by extension, for bedside nursing in general. (This isn’t the first time I have heard this, and I have experienced this myself when I was a clinical instructor.) It isn’t a large leap to suggest what we esteem in bedside nursing, i.e. empathy and compassion, are devalued in the same way, and that negative attitudes are passed on to students.
The rot, it seems, begins early. I would be interested to know the experience of other clinical instructors, or new graduates. Or am I just talking through my hat?
A note sent to me from my favourite MRT (Medical Radiation Technologist). A reminder too, that nurses aren’t the centre of the universe, even if we think we are.
Some thoughts from an MRT. . .
If a portable examination is requested it’s because the patient is too ill to come to the department, not because they are in the bed nearest the window and it’s a hassle to get them out of the room. Portable exams give less information than a department film so why chose inferior diagnostics?
So the patient is too sick to leave the floor might there be a need for a nurse to help the MRT with the patient? Just saying, just wondering. Now this help isn’t for the MRT’s benefit – though lifting and maneuvering people one handed is tricky – it’s for the patient.. Even if your patient is sitting bolt upright and square on do you think it’s a kindness to have them pulled forward by one arm as the heavy cassette is placed behind them? Because this is what the MRT has to do if the patient can’t lean forwards.
Oh and please don’t all run the minute the portable machine comes trundling down the corridor. It isn’t radioactive. And if you don’t have time to move 2 chairs, a commode, a walker, and a couple of tables out of the room what makes you think the MRT does??
You know if you help with the exam then I’ll help put everything back in it’s place.
In Emerg, when you call the tech for a stat film then do acknowlede ge them when they arrive, and maybe even stay to help, (see above re too sick to go to the department.) If you don’t hang around then do answer the tech when they ask if the patient can be sat up for the film, or have any other questions about your patient.
Points well taken. Remember it’s about the patients, right? I’m pretty sure too other health care professionals have similar valid gripes about us. Ladies and gents, we need to pull up our socks.