9/16/2008

Bullying in Nursing

I was reading the Dethmama Chronicles recently and came across her post on a new study by the JCAH on bullying among nurses at hospitals. Perhaps many people don't realize the real soap operas that go on behind the scenes in hospitals but they are much more interesting than even the most dramatic TV shows.

nurse_bullies_crop380w Many years ago when I worked for a major teaching hospital, bullying among nurses and by doctors was quite common. Usually, among nursing staff it took the form of passive-aggressive behavior but among surgeons it could devolve into downright violence at times.

It's one of the reasons I no longer work in the nursing field. While I am considering a return on the administrative side, I'm not sure I would care to return to the strange world of being an actual member of the patient care team.

While I was awaiting transplant I learned that I carried the MRSA bacteria after a routine nose swab. That wasn't too surprising since many medical people carry MRSA because of exposure during patient care. However, I knew exactly where I had picked up this resident bacterium.

As a Surgical Technologist at a teaching hospital, I oversaw students on a daily basis. One morning I was working with a surgeon who had a notoriously "bad temper" to use the preferred euphemism. However, the more appropriate description would be an egomaniac with severe anger control problems and a violent personality. He had, in the past, thrown objects at nurses, including scalpels, threatened other doctors and even shoved nurses and students. Yet, no major disciplinary action had ever been initiated because of his stature and money making ability.

That morning we were doing an AV fistula, a procedure to create an artificial link between an artery and vein in the forearm for the use of dialysis. My student was assisting the doctor under my supervision. However, she was not as quick, of course, as a seasoned pro. The surgeon became irate and decided to let us know his displeasure not by asking she be relieved but by filling a bulb syringe with blood from our patient and spraying it in my face and my student's face. Later that afternoon I learned from the PACU nurse taking care of the patient that he had tested positive for MRSA. I was incensed and approached my head nurse about the incident. I wanted to file a formal disciplinary action and told her I also wanted to file a charge for assault against the surgeon based on the fact that it was body fluid he had used.

I was taken to a quiet area of the OR and told by this nurse that it was up to me what I wanted to do. But, she added, "if you do that you'll be fired." I said she couldn't fire me for that, to which she replied "Maybe not for that, but they'll make me find some reason to fire you. Just let it go."

So, needing my job, I let it go. I was not offered prophylactic antibiotics nor any monitoring to see if I developed MRSA either actively or as a carrier. I was just told to shut up and not make waves.

To me this was double bullying, first by the surgeon and secondly by my head nurse. So, I'm all for JCAH getting involved in this issue.

During my years in the field I saw all sorts of bullying behavior. I saw nurses answer questions incorrectly in order to embarrass a new colleague. I saw nurses use their military status to take personal trips to Europe while insisting that others be fired for having to take a day off for a sick child or husband. I saw nurses hide equipment so that others couldn't use it.

I suppose that much of this comes from the fact that managers in hospitals work their way up from staff positions. In some ways that's very good since they have hands on experience. But, in many cases they are ill equipped to actually be managers. They don't know how to handle complex personnel situations and will either micro manage or wait until a situation has become completely unfixable before trying to step in. Many resort to passive-aggressive behavior to avoid directly confronting a doctor or subordinate about issues and others just become recluses holed up in their offices and unreachable.

Managing is not an easy task. But, when people who have no experience outside of medicine are thrust into that role the results are often disastrous for all.

Sure, there is a nursing shortage and much of the blame for that can be laid at the feet of colleges and legislatures. Older adults who want to enter the field and bring a lifetime of experience with them are squeezed out by high school graduates who jump into "accelerated" programs based on taking LVN classes in high school. Schools cry that they want to expand their programs but the legislatures and licensing boards won't allow them to admit more students. It's a Catch-22 and meantime the profession suffers.

While I was awaiting transplant I had the chance to experience the downside for patients of the "nursing shortage". My favorite pre-op hospital had hired a number of "contract nurses" from foreign countries. Some were excellent but quite a few lacked the bedside manner and experience necessary to deal with severely ill patients and their families.

After my first laparoscopic liver biopsy in 2006, I was more or less swinging between unconscious and disoriented for about a week. I have few recollections of that week. Although, I'm told that I was talkative and sometimes made sense but often seemed regressed to a childlike state.

I do have one clear memory. I can remember waking up in the middle of the night with my nephew (a very large man) wrestling with a foreign male nurse. I remember pain in the side of my head and this nurse leaning over me and hitting me with a handheld pulse oximeter. My nephew pulled him off of me and bodily threw him out the door. All I can recall is pain and that bit of scene.

Later I learned that I had pulled down the nasal oxygen tubing and my oxygen level had dropped. The nurse was angry that I kept taking it off (remember I was almost completely out of it) and had come in screaming at me and hitting me with the device used to measure the level telling me to keep the tubing in place.

My sister filed a complaint against the nurse and he was removed from my care and the hospital promised disciplinary action. I suppose that action wasn't termination or suspension because he was still employed there on my next visit, although he was not assigned to me.

But, this incident shows the problems of lax management and the fear of the "nursing shortage" that cuts out good candidates for the profession while retaining those ill-suited for the job.

In my opinion as both a former staff member and as a patient, I certainly am pleased to see the JCAH tackling this subject. Let's hope some good changes come out of it.

1 comment:

dethmama said...

Aha! Thought you could hide from me, didn't you?

Great post on the subject of "nurse bullying". It has been given recognition today (9/17) on Dethmama Chronicles.

It's going to be a lot harder to hide the problem of abuse in the clinical workplace now that JCAH has addressed it.

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