The Customer is NEVER Right - A Nurse Practitioner's Perspective
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STOP Hurting Us!

In a recent, 28 April 2016, published article, “Workplace violence against health care workers in the United States [of America]”, J. P. Phillips, M.D. points out, “Health care workplace violence is an underreported, ubiquitous, and persistent problem that has been tolerated and largely ignored.” I have been saying the same without the research for decades. How am I able to reach such conclusion? It truly is that obvious!

Yet, when Dr. Phillips research is retold in HealthExec that version’s opening sentence begins, “A study published by the New England Journal of Medicine found surprisingly high rates of workplace violence against healthcare workers, especially those in emergency department and psychiatric wards.”

Really? I just mentioned how obvious it is to those of us who work where the ax meets the rock. Yet, once again and another example, healthcare executives are obviously disconnected from those of us on the frontlines and why they, unlike the rest of us, find the research’s findings “SURPRISING”.
The HealthExec article adding to its surprise,“[t]he study offered a number of surprising statistics, including:

•   46 percent of nurses reported some type of workplace violence in their five most recent shifts; one-third of these nurses were physically assaulted;
•   Emergency department nurses reported the highest rates of assault, with 100 percent reporting verbal incidents and 82.1 percent reporting physical abuse in the last year;
•   78 percent of emergency department physicians reported being the target of workplace violence in the past year;
•   40 percent of psychiatrists reported physical assault;
•   The rate of workplace violence among psychiatric aides is 69 times higher than the national rate;
•   61 percent of home healthcare workers reported violence annually;
Emergency departments and psychiatric wards consistently showed the highest levels of violence, and nursing aids are at highest risk, especially those in psychiatric wards.”
I of course did not know the exact numbers but I did not find them to be surprising. However, I must of thought of them to be high for the perception of such to be so palpable.
Healthcare, an industry genuinely dedicated to helping others, has been forced into an industry of customer-driven service and by any means necessary, where satisfaction scores are the driving force and healthcare workers must follow. Yet, that destructive IDIOTOLOGY [sic] has nothing to show for all the money, time and effort wasted but a trail of overwhelming collateral damage and our great nation’s most silent crisis.
Collateral damage that includes healthcare directed violence, a violence that has become more frequent, more brazen and more violent despite studied extensively by professional and government organizations. Not surprisingly, organizations that have nothing to show either as their recommended conflict resolution and aggression management policies are IMPOTENT and purposely fall short as to not offend patient or families. And despite those organizations’ claims and policies reports from victims continue to be greatly underreported as healthcare workers fear losing their jobs for reporting those incidents due to a lack of support from healthcare’s submissive, altruistic and accommodating culture.
Now, healthcare pundits, of course, want us to believe that healthcare directed violence is at the hands of the demented, psychotic or those under the influence of drugs or alcohol. However, I disagree and Dr. Phillips’ finding points out similar, “Studies that have been performed in emergency departments have suggested…” as my experiences, that healthcare directed violence is more common than not. And more common than not it is NOT at the hands of the demented, psychotic or those under the influence. Instead, it is at the hands of those who did not get what they wanted, tired of waiting, thought it was too noisy at the nurses’ station or whatever flavor of the week it is.
For the longest, as well, I have pointed to “customer experience scores” as a significant contributor and barrier to healthcare directed violence, as we must bow to those who tread on us in order to deflect a poor score. Dr. Phillip indirectly mentioning those same “customer experience scores” as barriers to reporting those who tread on us. Dr. Phillip proclaiming, “Nurses have cited fear of retribution from supervisors, the complexity of the legal system, and disapproval of administrators as barriers to reporting of workplace violence. Specifically, [nurses] cite a lack of management accountability toward such reporting and contend that the current intense focus on customer service in health care serves as a deterrent to reporting workplace violence, since the concept of customer service results in the mentality that ‘the customer is always right.’” Those are not my words but they sure do sound familiar.
It is sad that an industry on the forefront of fighting domestic violence finds itself in an abusive relationship that is tolerated and ignored. A relationship that includes justifying the violence against us by making excuses for that violence and siding with those who are abusive towards us.
With that said, one approach to eradicating healthcare directed violence is to deflate customer service to being just a byproduct rather the driving force of healthcare. However, in order to achieve such seismic paradigm shift healthcare needs convincing and committed change agents willing to go in a new direction. A direction that means going at it alone as few are willing to risk the disapproval of fellows, the censure of colleagues or the wrath of society. A direction that sides with clinical outcome, the safety of healthcare workers and patients, promotes healthcare workers as valuable and trustworthy, supports our collaboration and professionalism, and recognized us as the good-doers we are over petulant, unreasonable, angry, and demanding patients or outsiders looking out for their own interest or those who may take their business elsewhere.
At the same time I would dismiss the rude, the entitled, the abusive and the demanding who tread on us. Because dismissing those who tread on us frees us to focus on those who value, trust and appreciate us for the care we give. On this we MUST stand in solidarity and NOT waiver otherwise those who tread on us will not change their behavior as long as they can find tolerance elsewhere.
Unfortunately, when I cite the above critics claim I am uncaring and lack compassion. However, it seems Dr. Phillip has similar suggestions with regard to reporting and redress pointing out, “[t]he importance of recognizing verbal assault as a form of workplace violence cannot be overlooked, since verbal assault has been shown to be a risk factor to battery. The ‘broken windows’ principle, a criminal-justice theory that apathy toward low-level crimes creates a neighborhood conducive to more serious crime, also applies to workplace violence. When verbal abuse and low-level battery are tolerated, more serious forms of violence are invited.” Again, it all sounds very familiar.

That said, this advocated new paradigm of mine means siding with loyal employees and coworkers over the petulant, unreasonable, angry and demanding who tread on us if we do not submit to their EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS. This is not about us versus patients or their families but about convincing them we are looking out for their best interest and if they desire our help they must stand with us. If they decline they must leave. Because asking to be catered to until they get what they want is manipulative and divides healthcare workers.
With all that said, this is NOT a task for one but of companions standing in solidarity across healthcare and geographic borders.

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