Friday, September 17, 2010

Another excellent question from the comments section:

Nurse Philosopher sent this one in (which I tried to find after I'd hit "publish comment", but now cannot; thank heavens I saved the message):

What can you tell me about prejudice and lack of compassion among staff members? At Little Ol' County General we have staffers renowned for their competence, steadiness under fire, and breadth of knowledge. They'll call you sweetie and God Bless you all day long.

Yet these same members have been observed expressing a good deal of judgmentality about patients who are 1)LGBT, 2)of an unusual faith (i.e., not mainline Christian), who have 3)lifestyle-related diagnoses (alcoholism, HIV,) anyone with 4)a psych history, 5) are non-native speakers of English, OR 6)whose family members are assertive in their advocacy for the patient.

Speaking for myself, I enjoy the "different" patients & families. I find a little compassion and support goes a long way in many cases. I do spend more time listening to patient stories than most of my colleagues, because I enjoy them. I also find that informing & encouraging the strongest family member helps the patient and the family in general. It lowers their anxiety levels, which is all to the good.

So, why do so many of my fellow nurses accept a negative attitude? Why does it seem ok to them to denigrate and dismiss patients' genuine concerns because the pt has one or more of the Big Bad Five elements above? Is there anything I can do to encourage a more positive attitude toward disliked classes of patients?


I've seen these atittudes too, and toward the same groups of patients. I've also *had* these attitudes on bad days.

Sometimes we have good reasons for dreading an encounter with a particular patient, especially if that person's been a Hospital Hobbyist for years and we know them. Most of the time, though, our prejudices against certain patients or people with particular diagnoses are just that: prejudices. They're unfounded and unfair.

*scratches head*

Seems to me that we're dealing with two different issues here: one is bigotry and the other is an unwillingness to deal with "difficult" patients or families.

Bigotry you can't do jack about unless you're willing to say, over and over, "It's not always like that, you know." If someone says something offensive and you feel comfortable calling them out, then do so. You can do that in a way that's not rude or combative; just saying, "I find that remark really offensive" is enough in most cases. The best you can hope for is to shut people up while they're around you. I guess if you're really feeling tough one day, you could ask (in response to a bigoted statement), "Why do you say that?" or "Why do you feel that way?" and keep probing until the other person gets uncomfortable.

Difficult patients/family members is a different story. Most of the time, people are hard to work with or demanding because they're frightened, or they're trying to keep some sort of control over a situation that's spun totally out of hand. Nurses tend to dread them because they're control freaks (and so are we), or because they question everything (just like we do).

Those are folks I actually really enjoy working with. It's sort of a challenge, but you can build a respectful relationship in three ways: by being open and accessible, by setting boundaries, and by answering questions. *Not* giving the family short shrift over their concerns is the place to start. It's also one of the easier ways to model better behavior and foster better attitudes among coworkers.

Honestly, I don't know that you're going to be able to change deep-seated attitudes. I don't know that you'll be able to stop venting that's bigoted or otherwise short-sighted. Acting the way you'd like your coworkers to act and refusing to participate in the gay- or non-English-speaking- or Zoroastrian-bashing might be all you can do.

Suggestions, anybody? Nurse Philosopher has knocked upon the noggin something we all have to handle, every day.


Anonymous said...

I once(literally) made a ward clerk cry for making a vaguely racist remark about a Jamaican-Canadian RN. She didn't speak to me months afterwards, which I was actually OK with.

I'm doubtful I changed her behaviour much. But at least I changed it so she says nothing about no-one when I'm in earshot. This makes me happy, because I don't have to listen to whatever crap she's talking about.

Now imagine if everyone made the racists, homophobes etc. cry. . .

Anonymous said...

One of the things I found interesting in the past few months as a resident on the wards: once or twice, I've made some chummy comment about a patient to the nurses along the lines of, "Oh, you know she/he was a nurse for __ (usually long) years." The response is almost always one of slight trepidation, "Oh, no, really?" One seasoned ICU nurse told me that they simply expect nurses to be either really demanding or really really sick, because "that's just how we would be - we'd either be too sick to be worried or too worried to just let someone take care of us."

Needless to say, I don't bring it up anymore. I doubt doctors would be any different (I certainly wouldn't), but it was still interesting.

Bonnie said...

Huh. The kids in my class (I'm 46) certainly already have their share of those attitudes. At the beginning of the schizophrenia lecture, the teacher said "Let's go over causes of schiz" and someone actualy replied "Because they are cr-ayZEE" and laughed.
Yet they'd all tell you how open and compassionate they are. I think they really don't see their own behavior, and I know a lot of it is just plain being so damn young they don't realize how narrow their life experience really is.
Still, interesting question.

woolywoman said...

Well, if it's really a racist remark, and the first time I've heard it, I go with "wow- that must not have come out right, because it sounds racist." I escalate to the flat toned "that's racist" and turning away. Finally, like the idiots you mentioned a while back, " I activate the management
response system, telling the manager that it is hostile, unacceptable, ect and they have always been supportive.

For the demanding flipped out types, My response is, "well, she really loves her momma/brother/husband/kid I can't imagine how I would act if it was my kid and I didn't know what was happening." For the mentally ill folks, I say to my fellows, " well, this is someone's baby and they are a tortured soul."

These are just my stock answers, because if I scream "you are a bigoted JERK!!!!" then it is less professional. The main thing is to never laugh with the bigots, never agree by being silent and take lots of deep breaths.

Also- Resident Physician who was outing nurses? please don't. Nurses go to great pains to conceal that they are a nurse when they are ill. Don't blow it for us. It does not improve the care we get.

Alpine, R.N. said...

I actually VOLUNTEERED on my OB rotation to take care of the VERY worried Oncology Attending/ laboring mother, because I felt like what she really needed was someone to sit down with her and EXPLAIN all the machines. She was snapping at the nurses because she was in the ONE area of the hospital where she knew VERY little, and was TERRIFIED that her labor wasn't going as she planned. She turned out to be SO nice, just...prickly.