The Customer is NEVER Right - A Nurse Practitioner's Perspective
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More edentulous policy/legislation CRAP!

More edentulous policy/legislation CRAP from professional organizations who claim to represent healthcare workers, the latter being even bigger CRAP! First and foremost, any attempt to quell healthcare directed violence, be it physical, psychological or incivility, must begin by separating that inappropriate behavior which is instigated by patients and/or family from similar behavior by coworkers, as the latter is no more than junior high school immaturity behavior. Adding to that, healthcare is not the only industry were coworkers behave as if still in junior high school thus not necessarily a unique issue to healthcare. That, despite the all too common phrase, “Nurses eat their young”, which is the same as a right of passage in other industries. Having said that, in no way am I in agreement with that idiotology [sic] but instead simply pointing out that it is not a healthcare only malignancy. With that said, and to be absolutely clear, the only violent behavior addressed here will be that of patients and/or family and not the childish behavior of coworkers.

On that note, as for patients and/or family who are uncivil or become violent while receiving healthcare, for those who do NOT get it allow me to enlighten you, healthcare workers are NOT punching bags for anyone! Not for patients! Not for families! And most definitely not for administrators!

If any profession is in the business of dealing with violence as part of their daily job it is police officers and not healthcare workers. Yet, it is healthcare workers who are more often the victims of assault while at work than any other profession.

The numbers: “Violence and other injuries by persons or animals accounted for 4 percent of the cases in the private sector in 2013, with a rate of 4.2 cases per 10,000 full-time workers. In the health care and social assistance sector, 13 percent of the injuries and illnesses were the result of violence and the rate increased for the second year in a row to 16.2 cases per 10,000 full-time workers, up from 15.1 in 2012. (See table 1.)”

Is anyone paying attention? Of course not, because if they were paying attention they would notice healthcare directed violence is not only on the rise as I have pointed out over and over. But, as I have also pointed out, over and over as well, those acts of violence against us have become more brazen, more frequent and more violent.
Making matters worse, pundits, like the American Nurses Association (ANA) mentioned in this article, want us to believe that healthcare directed violence is mostly at the hands of those who are demented, psychotic or under the influence of drugs or alcohol.

Yet, although not found in Pub Med searches or peer-review supported, that has not been my experience, which instead includes violence at the hands of people from all walks of life, the well off and not so well off, men and women, young and old who are neither demented, psychotic or under the influence but instead for no reason what so ever and from whom later claim they were “extremely stressed-out” or “just tired of waiting” as to why they became violent.

Because, unfortunately, many in healthcare’s submissive and accommodating culture believe being a punching bag is part of the job and they will, more common than not, blame themselves as to why patients become violent. At the other end of that credence, sadly, there are many more who have succumbed to the culture, against their own convictions I must add, to being punching bags just to keep their jobs. Then, there are the worst of the worst, those who believe they would have done better in the same situation, like deescalate the violence. And those individuals rather stand with their colleagues they instead stand with the perpetrator and blame colleagues as the cause for the patient’s violence.

Lastly, as if not enough, but to add insult to injury, and a major reason as to why the violence continues, and healthcare’s most hushed reality, the fact that healthcare administrators, “police and prosecutors ‘don’t necessarily feel that [healthcare directed violence] is a big issue unless someone is hurt very severely, even though there are felony laws against it.’” So rather stand with healthcare workers those designated to look after us ALL look away!

I get it. Most who seek medical attention do so during some of the worse moments of their lives, during inconvenient times, for choices that are uncertain, unpredictable and even volatile, in places that are unknown, unpleasant and unforgiving. I get it. But we are there to help. Many before and many more after them have been and will be in the same difficulties experiencing the worse moments of their lives yet they trusted and will trust us to do them well. To that, our record of helping others has been consistent and of all the professions it healthcare workers who the public trust the most. So, why do some thread on us when we have and will do them well?

It would help if healthcare administrators and pundits promoted healthcare workers as valuable and trustworthy, supported our collaboration and professionalism and recognized us as the good-doers we are for our genuine desire to help others over petulant, unreasonable, angry and demanding patients. But instead they put forth these edentulous gestures that make them feel good and to save face with their constituents who might accuse them of standing on the sidelines looking away.

This is not about us versus them. This is about convincing patients that we are looking out for their best interest and if they desire we help them they must stand with us as there is NEVER a reason to harm those helping others. NEVER! And patients who decline must leave because asking to see others until they get what they want is manipulative and not what we are there for. Not to mention, that manipulative behavior only divides healthcare workers trying to help others.

Again, healthcare workers are there to help others! Period! We are NOT there to accommodate the EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS of a few.

To pundits who believe otherwise or who believe that healthcare workers ignore or tolerate incivility and violence because we lack knowledge, as this article states, that thought is even BIGGER CRAP! For those who do NOT get it, allow me to enlighten you, again, healthcare workers ignore or tolerate inappropriate behavior ONLY to keep our JOBS and NOT because we lack knowledge! Have none of these pundits read “The Customer is NEVER Right: A Nurse Practitioner’s Perspective”? They need to before this silent national crisis, healthcare directed violence, mushrooms and many more are hurt.

On that note, I would say, the only thing healthcare workers DO lack is support from their employers! As those disturbing experiences of violence directed at healthcare workers ONLY leads to negative effects, such as those listed in the article: decreased job satisfaction, reduced organizational commitment (although I would say it is MORE likely than not the organization is who is uncommitted to their employees rather than visa-a-versa), decreased personal health, and the added direct and indirect costs to employers and healthcare workers (of course, the ANA listing employers FIRST over their constituents!).

On that note, it is those disturbing experiences that are the reason so many leave the ONLY industry genuinely dedicated to helping others and NOT the made up claim of compassion fatigue as pundits want us to believe. No one fatigues from helping others. NO ONE! What we fatigue about and are frustrated with is the CRAP we must put up to keep our jobs and the lack of support from those designated to look after us, like healthcare administrators and organizations, police, prosecutors and judges.

On top of that, those disturbing experiences impair clinical judgment to the extent that the healthcare worker’s performance is affected. Not to mention, it sets the tone for the remaining shift and even longer as these incidents are hard to shake off. As if not enough, then there is the thought of what will be the consequences, like, am I going to loose my job over this, as the first thing administrators ask us after these incidents is, “What did you do to piss-off that patient/family?” Been there! Done that! Wrote a book about it!

It does not help that healthcare, as the article mentions, labels those of us who push back as complainers who need to learn how to be more assertive, tolerant and less a victim. Seriously? Again, pundits with their heads so far up their ass their eyes and ears are full of CRAP and why they cannot see or hear what is in front of them. I want to point out, that, at its best, that is healthcare’s altruistic, submissive and accommodating culture of bending over. YES, bending over rather side with their own. Because boohoo me for being a victim, intolerant and not assertive enough. Are you freaking kidding me?
To the ANA I say, don’t be a doormat. Because when you become a doormat not only will people walk all over you they will wipe their feet on you as well.
Not to mention, as if throwing healthcare workers under the bus were not enough, healthcare administrators and pundits dare to call out healthcare workers as if the inappropriate behavior from others were our fault. Again, like the all to common first thing administrators always ask us after a patient complaints, “What did you say/do to piss that patient/family off?”
Adding insult to injury, now these professional organizations, that so-called represent us, want to suggest the following list as the BEST healthcare pundits could come up with.
·    (1) commit to "promoting healthy interpersonal relationships" and become "cognizant of their own interactions, including actions taken and not taken".

·    (2) participate in training on effective communication, diversity and inclusiveness, and conflict negotiation and resolution training.

·    (3) establish an agreed-upon code word or signal to let others know they feel threatened. "This outreach may involve the targeted individual or a bystander using a predetermined phrase that signals all available nurses to move toward the target both to provide nonverbal support and to witness the harmful actions taking place".

·    (4) after an incident of incivility or bullying, report the incident through appropriate channels, according to their institution's policies.

·    (5) after an incident of incivility or bullying, keep a detailed written record of what happened, relevant names, dates, and any witnesses.

·    (6) support coworkers who experience incivility or bullying, which can include offering emotional support and validation as well as helping the targeted employee document and record the incident.
A list which I see as edentulous, once again, as their impotent suggestions take the responsibility away from patient/family, as the article singles out, “RNs and employers share responsibility for creating a culture of respect and implementing evidence-based prevention strategies…”
I ask, why do our so-called representatives insist it is our responsibility to be respectful? Why don’t they instead put the burden of responsibility on those who are disrespectful to those helping others?
In my opinion, and I know we all have one, but nonetheless, all CRAP! Instead, here is my rebuttal to the ANA’s impotent suggestions above:
(1)   Despite 70-80% patients are satisfy with our interactions healthcare pundit want us to police ourselves by being “cognizant”. I guess, the ANA’s intent, is to reel in the 20-30% who just do not get it that we are here to help others. How about the policy that my personality is who I am and my attitude is about who others are? The latter being something none of us have control over and dismissing those who thread on us does not take away from my caring or compassion.

(2)   Again, why? Why is it we must change? What is wrong with our communication, diversity and inclusiveness when the majority, 70-80%, we interact with are just fine with us just the way we are. Not to mention, the training, and policies for that matter, they speak of are IMPOTENT as they purposely fall short as to not offend patients or families.

(3)   Finally, something I agree with. A code word to get others attention and action. Although mine is not likely what the ANA has in mind. Mine being, “Security”! However, not for security to come talk to the person, as is ALL too common, but instead for them to escort that person off campus. Because nice talk, although nice, it does nothing but reinforce the inappropriate behavior that got them the attention they desired. I instead insist we dismiss those who annoy us. The rude. The entitled. The abusive. The demanding. The manipulative. Dismiss them all. Now, that is ZERO tolerance. Because by dismissing all those who annoy us it frees us to focus on those who value, trust and appreciate us for the care we give. In this we must stand in solidarity and not waiver otherwise those who annoy us will not change their behavior as long as they find tolerance elsewhere. This is why, “The more chances you give someone the less respect they’ll start to have for you. They’ll begin to ignore the standards that you’ve set because they’ll know another chance will always be given. They’re not afraid to lose you because they know no matter what you won’t walk away. They get comfortable with depending on your forgiveness.” Because of that, “NEVER let a person get comfortable disrespecting you.” NEVER!

(4)   Disingenuous, as report after report has been file after a healthcare worker has been violated only to be ignored by those trusted with protecting us thus a futile suggestion. Not to mention, the retaliation after one does submit such reports as the culture labels us as uncaring and lacking compassion. Not to mention, the submissive and accommodating culture of healthcare also supports the idiotology [sic] that being a punching bag comes with the job or that at a minimum these acts of violence would not occur if we did our jobs well. So before another report is submitted administrators must commit to being on our side. The first step towards that being not asking the ALL TOO COMMON, “What did you do to piss off that patient/family?” Otherwise, what is the point, as those reports will continue to be filed as they have for decades, in the trash. Yes, decades, as none of this is new.

(5)   See number 4. Same CRAP!

(6)   Do we really have to mention solidarity and siding with loyal employees and coworkers over petulant, unreasonable, angry and demanding patients? This is not about us versus patients. This is about preserving a time-honored profession, healthcare, that is trusted with saving lives and stomping out disease. A profession that advocates for patients, promotes health, prevents illness and injury, maintains levels of health for others, cultivates the profession and steers it in the right direction while placing patients’ reasonable concerns ahead of personal conveniences, pleasures, profits and safety without bias, stereotype or compromising the contributions of colleagues or peers with who we MUST stand in solidarity.
To be clear, I am not asking for policies with teeth. Instead, I want policies with a chain saw that will cut down those who thread on us. In other words, policies that are upfront and clear and not this wishy-washy stuff the ANA and others keep coming up with. Having said that, not to the extend that of judges who demand, “All raise,” in their courtrooms. But with the same authority that if you as little roll your eyes at a judge you will be escorted from that courtroom or worse escorted to jail. The same in healthcare, if you as little roll your eyes at a healthcare worker you will be escorted off campus. And if you dare to touch one of us you WILL go straight to jail, no and, if, or buts about it, and you DO NOT collect the $200, PERIOD! Instead, tell the story to your cellmate so that the word spreads, DON’T THREAD ON HEALTHCARE!
To the ANA, this edentulous policy is no more than just another feel good attempt at legislation so that you can say your organization made an effort. But healthcare deserves better than whish-washy attempts that make healthcare pundits feel good. "I [for one] prefer people who rock the boat to people who jump out"—Orson Welles. As the ANA, and others, are too easy to bend over when it comes to looking out for healthcare workers.
Again, no peer-reviewed data support but instead experience from thousands of patient encounters! In other words, my two sense [sic]!

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