Tuesday, May 27, 2008

Gracious snakes.

I post, I go to bed. I wake up earlier than God, and bang! Six comments in six hours.

Strike a nerve, much?

Some study I Googled last night said that 430,000 nurses report that they're victims of violence or intimidation on the job every year, and that that number is likely low due to under-reporting. Seems that a lot of nurses think that getting clocked or yelled at is just part of the business of being a nurse, and that some managers think it's whiny if you report being a victim of violence.


You know, what pisses me off most about last night, is this: (well, two things, actually)

First, that the first-line person, my manager, did not automatically go to bat for me. Instead of laying out ground rules, he attempted to perform some weird magical act of conflict resolution that would somehow make it all okay. 

That has two results. The first is that the person who swang/swung/swinged at me has no incentive to change that behavior. "Act badly, get coddled" is the message.

The second result is that I know, now, that if I attempt to set firm boundaries with a person, like "Do not try to hit me. That behavior is unacceptable" I have absolutely nothing with which to back that up. I am really and truly on my own as a caregiver. If the person then complains, or tries to rough somebody up, we're back to Conflict Resolution and Good Customer Service.

And this makes me sit back and scratch my head and slurp my coffee thoughtfully.

The majority of comments left after yesterday's post talked about lawsuits and criminal charges, which tells me this: That I am not alone in working for a facility that has no plan in place for dealing with patient-on-caregiver or family-on-caregiver violence. I'll bet doghair to donuts that all of you guys have codes for civil disturbances or codes for when some nut comes onto the floor waving a gun, but that there's no code to call when a patient tries to cold-cock you.

So. Sunnydale has no plan. Sunnydale's Corporate Manglement has no plan. It's nursing, Three-Stooges style, except the pratfalls are real. So what will I do the next time this happens?

That's a hell of a question. If I'm feeling tough, I might well file charges and insist upon a root-cause analysis of the problem. (RCA's are when all the mucketies get together and go, seriously and with intent, over the entire history of something that has gone Very Wrong.) I might make noises about lawsuits and editorials for nursing magazines. I might even be serious.

Because, as I said before, the only way to get the folks on the carpet to listen is to threaten either their bottom line or their good public image. 

Now: one thing to get straight this second is that I would not, unless Manglement or the hospital were way, way in the wrong, sue anybody for money. I'm not really interested in that sort of drawn-out, pain-in-the-ass process, and it wouldn't end up solving a damned thing, as the facility (if somebody *were* to get hurt) would settle in return for a non-disclosure agreement.

What I *would* do is insist on new standards of behavior for patients, family members, and visitors. What I want is a policy in place that says, If you do X, then Y will happen. What would make me happy about working where I work is a recognition on the part of all the managers that The Customer Is Not Always Right, and that there are some things that are beyond the pale. 

Right now, all of us, whether we're in the ER or on the floor, are subject to threats that would never fly in any other business. If you holler abuse in a bar or try to start a fight, you get thrown out. If you throw a temper tantrum in a restaurant, you'll get thrown out. If you try to injure somebody in public, you're gonna have to talk to the police. But swing at or holler at a nurse? It's all part of the game.

Why are we less safe at work than we are in a bar? Why are the standards of behavior so much lower for the consumers of our product? Because, quite frankly, if the patient is going to be treated as a consumer of healthcare, they need to be subject to the same standards of behavior that consumers of alcohol, groceries, or cut flowers take for granted.

The answer to the problem of violence against nurses is simple: People who are violent or threatening need to be refused care. The way to get that policy implemented is much, much more difficult.

I think I'm going to lean back, furrow my brow, and slurp some more coffee while I think about it.


Vanda said...

At our hospital, here in England there are signs posted all over that abusiveness will not be tolerated and police will be called. This goes for visitors and patients.

At my local hospital we even have a sub police station and when it's closed one is around and about the hospital.

Man alive, that stinks that your hospital doesn't give a damn about the staff. Until someone gets really hurt or worse then it would be damage control only.

Anne said...

Do it! Be proactive (sorry for the management-speak, but it really is the right word). A disoriented or demented patient is one thing; someone who knows exactly what they're doing is another. Your management has a duty to put protocols in place to protect you from both: sedation or behavioral techniques in the first instance, kicking someone's ass to the curb in the second.

Carin Diaz said...

I feel for you. That patient's abuse towards you should not be tolerated by anyone!

Vanda said...

Greetings from across the pond. Just in case you check your stats, I'm the one who has been logged on to here for hours! I have been reading your archives. Back tomorrow to continue reading.

Beth Young said...

You're right on. When confused patients get combative, we routinely use chemical or physical restraints. It makes no sense to tolerate worse behavior from the mentally intact than we do from the confused. Standard healthcare policies requiring us to provide care for everyone should have an obvious clause excepting those who are not compliant.

Ian Furst said...

I read the post yesterday and was split between laughing my ass off at the sting of profanities (loved it) and being amazed at what a bunch of tools you seem to work for. The joy of private practice is that when someone gets that out of control violent to one of our staff (or even says they will) is that it's one easy call to get them removed with a note that they can't return. It is the difference between the people that get spit on in emerg/ward in the middle of the night and those that read the reports. Your bosses should absolutely be backing you if not for financial/legal reasons then for leadership ones. I mean what the hell -- if someone takes a poke at one of the nurses they should be layed out patient or not. Since my college would pull my licence for that then just call the cops. Good blog though Jo -- you may not have meant it as funny but your vent put a smile on my face. Ian.

heartnurse said...

we have lots of signs for "violence will not be tolerated", but the violent don't read these signs.
I work in Canada and we have what is called a code whitte which is meant for a violent patient. I have never had to call it for a violent patient but called it 3 times for a specialist who recently immigrated from Pakistan via the UK. He has been relieved of his position now.

heartnurse said...

we have lots of signs for "violence will not be tolerated", but the violent don't read these signs.
I work in Canada and we have what is called a code whitte which is meant for a violent patient. I have never had to call it for a violent patient but called it 3 times for a specialist who recently immigrated from Pakistan via the UK. He has been relieved of his position now.

Penny Mitchell said...

See, this is why I'm interested in surgery.


You deserve SO much better.

Anonymous said...

I miss the good old days LOOK

woolywoman said...

If he's in his right mind, call the cops. Cops will come, in uniforms. Cops will be seen by patients, families, managers. Cops are the nurse's friends. Cops will, even if they can't file charges, talk sternly to mean patient. W, B, and N? Tell them you called because you feared for the safety of the patients- thought Mr Badass had gang connections, was going out of control, was going to rampage. Just remember to dial 9 for an outside line.

Put another way,I think of it like this: If I stopped at a 7-11 on the way home from work, and someone acted like this to me or anyone else, would I call the cops? If yes, than feel free to bypass hospital security. The life you save may be your own.