The Customer is NEVER Right - A Nurse Practitioner's Perspective
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A letter to a VALIANT and BIG heart!

On 13 May 2017, a healthcare worker suffered a savage and violent ordeal NO one should ever go through, much less while at work helping others. Healthcare directed violence in NOT new. If anything, healthcare directed violence is our great nation’s silent national crisis that has gone unchecked by healthcare administrators and pundits despite the violence has become more frequent, more brazen and more violent in the last ten to twenty years. And our professional and government organizations have NOTHING to offer except “feel-good” policies that are IMPOTENT as they purposely fall short as to NOT offend patients or families. Granted this was an extreme case, however, it was NOT the first or will it be the last.
I have been commenting about this unchecked violence directed at healthcare workers for more than fifteen years now and it has fallen on DEATH [sic] ears! Because of this most recent savage crime the healthcare community has begun to buzz, once again, with petitioning politicians for new laws that will prevent such from happening again. My position on laws to protect healthcare workers is that those laws are NO more than “feel good” gestures without teeth. Not to mention, there are laws already that will curtail the same. The missing link is healthcare MUST change its submissive, altruistic and accommodating culture, and push back against those who tread on us, EXCLAMATION POINT!
Unfortunately, that seismic paradigm shift requires surrounding ourselves with those who are bold and on the same mission as us of taking healthcare back from those who have led us down the wrong path. On that note, I tried, but was unable, to watch a video reply to the recent savage crime committed against a peer. The person in the video was someone whose work I came to know most recently during the NursesTakeDC rally. From watching [Deeds NOT Words] her and the work she has done I can tell she is a valiant human with a huge heart that is in the right place. In the video, despite only able to watch snippets, I was able witness and feel her pain as if it were my own pain and RAGE. Because of that sentiment I shared with her the following:
I stand with you. I share the same pain as you. I share the same RAGE as you. Because of that I could only listen to parts of your posted video about the savage crime against a nurse in Illinois. Your heart is in the right place and you are a valiant human being to who I would like to reply. Since viewing your video, days ago, I have come here to compose a reply to you only to set it aside each time as my thoughts crack and my eyes welled up with tears from my RAGE that such savage act of violence would happen to anyone! Those cracked thoughts and welled up eyes even when I find myself alone trying to focus on what I want to share with you.
Unfortunately, violence against healthcare workers is NOT new and will NOT be solved with emotion, regardless rage, depression or helplessness. The reason, healthcare workers are taken for granted by everyone, to include ourselves, some even accepting these dysfunctions of healthcare as par for the course and part of our jobs.
This most recent savage act of violence cannot be dismissed by anyone. But what about the trillions dismissed by so many, to include ourselves, as insignificant. Like, patients or family calling us anything but our names. Telling us to get them this or that. Rolling their eyes. Pushing our hands away during our assessment. Talking to someone else, on the phone or present, when we are speaking to them. Winking or blowing kisses at us. Raising their hand at us or grabbing an object and pointing at us with it. Ignoring us when we speak with them. Touching or feeling us. Throwing things at us or elsewhere. Raising their voices at us. Doing other than what we asked. Telling us how to do our jobs. Reminding us how expendable we are. Snatching things from our hands. Telling us to get out of their rooms or to get someone else but us. And the list goes on and on. All petty!
Yes, ALL petty! [That said, in no manner was I comparing the savage crime towards innocence to a laundry list of petty.] However, the culture of any organization is what is tolerated. And why we say nothing. Or do we? Of course, we tell ourselves, in tears, but in the locked staff bathroom or on our drive home that we will NOT tolerate this any longer, saying, “Next time Mr. Smith pushes my hands away when I am trying to help him I will…I will... Only to bow. We tell coworkers the same stories too and participate in roleplaying to build the confidence of telling Ms. Ricks the next time she does the same. Some might even find the valor of sharing their story during staff meeting in hopes of finding the camaraderie in numbers. But who we DO NOT tell are those who we need to have the conversation with. Nelson Mandela told us, “[paraphrasing] We cannot make peace by talking to our friends.” Meaning, to resolve conflicts, we must talk with those who tread on us.
I am NOT surprised the hospital is not being sued for this dreadful crime despite I blame the hospital for the allowing it to happen. Yes, allowing it to happen. Not knowing the story, I can easily find fought in healthcare’s lackadaisical culture for this to happen. Not only on that floor but throughout healthcare where these stories repeat themselves over and over and over.
First, the details are truly irrelevant. This was a patient, end of story. Being a prisoner is truly irrelevant. It only takes away from the hospital’s responsibility to which they will wash their hands after wiping their forehead in response to dodging that responsibility. Second, healthcare workers should NEVER be expected to diffuse any situation. Regardless, the agitator has a weapon or rolled their eyes. Our role is helping others NOT managing drama. The fact a patient did not like what was served for lunch is NOT a healthcare issue. It is an administrative issue and that is who needs to manage such. Third, we are NOT angels, even if it is my middle name. We are instead members of a time-honored profession. When we answer to metaphors we are blindly being steered down a path those in control of the reins want us to conform to for their gains and NOT in our best interest. The examples, the badge of honor syndrome healthcare workers are so gullible to. Like, not eating or taking bathroom breaks, that you’re “strong”, “competent”, “reliable”, “team player”, etc. all in the patient’s best interest before yourself. My favorite, NOT, that “it’s a calling”, and the list of martyrdoms, which I labeled “Florence Nightingalish elitist”, goes on and on and on.
Compartmentalizing, which is so commonly used by healthcare workers to cope, is NOT a skill it is a defense mechanism and a bad one at that. Group thinking, although a separate issue is all too common in healthcare as well and why I describe healthcare as junior-high school. Healthcare needs to break away from those prehistoric idiot-ologies.
My points are many, but why am I sharing them with you? Healthcare directed violence is not new. This savage attack is one of many over the past 30+ years that have become more common, more brazen and more violent in the last decade. However, not new. And although this savagery stayed in the news cycle almost two weeks, longer than others before it, it too has vanished as if nothing happened, with the last mention being five days ago with a different focus.
When I gave my presentation at a nursing conference in Fort Lauderdale, FL Feb 2016 I made the following comment which I removed, with good reason, from the presentation in Alexandria, VA,
“The literature is inundated with articles that suggest, why rating your doctor is bad for your health yet no one is interested. But don’t let someone suggest I borrowed my stethoscope without the world coming to a screeching halt. Who cares whose stethoscope it is? Instead, what the ladies from The View proved was that the public is inattentive and has no idea what we do. Yet, we are asking them, the public, to rate us.”
I wrote and repeated that statement unaware of the great work you had started and continue to do with ShowMeYourStethscope (SMYS). That said, bear with me, are we barking up the wrong tree? I understand nurse:patient ratios is a major problem in healthcare and I stand with you and with SMYS in pursuing that cause. However, again, bear with me, as I say in my presentations, who cares whose stethoscope it is. Ronald Reagan said, “[paraphrasing] We can accomplish a lot more if we didn’t care who took the credit.” On that note, we MUST put healthcare workers FIRST and everything else will fall into place, EVERYTHING! To include nurse:patient ratios.
Since viewing your video I have been invited to join a Facebook page aimed at pursuing laws to fix healthcare’s problems (i.e. a la nurse:patient ratio legislation). I DO NOT believe laws are the solution to healthcare’s problems. Healthcare’s problems are NOT laws but its culture. I am a thinker (thus this dissertation) and a simple person who relies on commonsense to get through the day. I am NOT a political person. That disclaimer for the following, during the 2016 Presidential campaign Hillary Clinton told members of Black Lives Matter, "I don’t believe you change hearts. I believe you change laws, you change allocation of resources, you change the way systems operate.” A la Bernie Sanders, “I disagree.” First, we already have those laws (see attached article). We need to enforce them. New laws are only “feel-good” attempts to quell the natives into thinking something was accomplished before the natives realize the new law got them NOWHERE. Previous nurse:patient ratio legislation a great example of such bait and switch tactics by politicians. If anything, the new laws create new industries without fixing the problem. Second, healthcare is junior-high school all over again and that is what needs to change, the culture (the hearts and minds). Having said that, I DO agree with Mrs. Clinton regarding (1) changing the allocation of resources (healthcare workers, nurses specifically) will cripple any healthcare organization, regardless the size. But that can only be accomplished with a takeover attitude where healthcare workers come before patients, end of story, EXCLAMMATION POINT! And NOT the same old same old union-like participation attitude. The “what is best for the patient” mantra is a double edge sword healthcare workers keep losing to. I say, lose the sword and put healthcare workers first, others to follow. (2) Change in healthcare will ONLY come after changing the way healthcare operates, see previous sentence.
This seismic paradigm shift I envision will be extremely difficult to obtain but can be the only approach to the long overdue change healthcare so desperately needs. Of course, this seismic paradigm shift will require money to be spent on more staff and beefing up security, the latter taking responsibility to dismiss those who annoy us, but in the end only healthcare, healthcare workers, and patients will benefit. Yes, leaving out the outsiders, who, for too long have taken healthcare in the wrong direction.
Again, I stand with you. You are a force multiplier, meaning, you get others to do what needs to be done by providing them purpose, motivation and direction. Keep at it! Thank you!

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