Why nurses don't want to talk to a ward psychologist?

[manjar]

Hello,

Since I often seek and get good information at this forum I had an idea I can ask you for help with my current issue.

I am a psychologist working in a pediatric ICU. I am there mostly for parents and older children. But I am also supposed to be available for supporting staff with their professional or personal issues.

Head nurse asked me to prepare a talk about the importance of talking to someone and receiving help after a mistake while giving medications to a patient. This I can handle. I can talk about the importance of talk support or therapy. But I am having troubles with the other part which is the fact that nurses rarely seek psychological help or advice. Head nurse encouraged me to talk about reasons for that. I do have my explanations but I would be really happy to hear what you think about that.

So, to summarize: if you had an option to speak to a psychologist, working at your ward about your work or personal issues - would you do it? Why yes and why no?

Regards,

Manja

[Daisy Joyce]

Fear of being ratted out to the higher ups.

Fear of looking inept or weak to a co-worker (that means you).

There is a stigma attached to needing help.

You might be perfectly lovely and compassionate and have great ideas, but you are still a co-worker, and your paycheck is signed by the bosses, and not the nurse-client.

[Medic/Nurse, BSN, RN]

.... Although our EMR is protected health information, it's really not. I have a coworker that takes every opportunity to scour other employee's EMR's (including providers) when she is given the chance to do so, and she can't keep a secret even if her life depended on it.

^^^^ This is why HIPAA Prisons were built & are staffed like a freaking Supermax (or should be)! Actually, those fines can be meaningful too. As can exclusion from CMS facilities (so most everywhere) and professional license discipline. And once someone gets fired, well shift that paradigm.

Next time this Nosey-Ass Co-Worker did this, I'd make certain I had the meddler dead to rights here - being clear on date/time/terminal ID & the activity well documented. I'd make sure corporate compliance was made aware. I might even report to the Feds (HHS) if this person is "special" to management. Cause damn.

I'd shut that $#!% down in a heartbeat. Actually, half a heartbeat. Like R on T half heartbeat - but, I'm not very tolerant of these type of shenanigans.

All EMRs leave electronic "breadcrumbs" - meaning IT can positively identify via logon/terminal ID who accessed the record, how long, what they looked at, any change or entry, if anything was printed or emailed.

This is a big deal. If this was my employer and my med info was "breached" in this manner & I found out, I'd bring action against the person & facility just to ensure that this never happened again.

Folks --- also LESSON cause there are folks like this --- always LOG OUT when you step away from a terminal or access point. Wow.

:angel:

[3ringnursing, BSN]

^^^^ This is why HIPAA Prisons were built & are staffed like a freaking Supermax (or should be)! Actually, those fines can be meaningful too. As can exclusion from CMS facilities (so most everywhere) and professional license discipline. And once someone gets fired, well shift that paradigm.

Next time this Nosey-Ass Co-Worker did this, I'd make certain I had the meddler dead to rights here - being clear on date/time/terminal ID & the activity well documented. I'd make sure corporate compliance was made aware. I might even report to the Feds (HHS) if this person is "special" to management. Cause damn.

I'd shut that $#!% down in a heartbeat. Actually, half a heartbeat. Like R on T half heartbeat - but, I'm not very tolerant of these type of shenanigans.

All EMRs leave electronic "breadcrumbs" - meaning IT can positively identify via logon/terminal ID who accessed the record, how long, what they looked at, any change or entry, if anything was printed or emailed.

This is a big deal. If this was my employer and my med info was "breached" in this manner & I found out, I'd bring action against the person & facility just to ensure that this never happened again.

Folks --- also LESSON cause there are folks like this --- always LOG OUT when you step away from a terminal or access point. Wow.

:angel:

Sadly, many of us work from home. I never witness it, but I've heard about it after the fact. Hearsay. My word against a special, special snowflake.

I fiercely guard my pt's (and at times coworker's, or their family) EMR's like I would my own. That s!∆* is private!

[3ringnursing, BSN]

Regarding the original topic, I echo J. Seizure.

Maybe you should seek to simply develop trusted and friendly relationships with staff on the ward and offer care over time? Just sort of "become" someone, over time, whom they will approach casually with issues that crop up. I think your position (at least as far as the staff is concerned) would be better utilized as simply a resource present on the ward whom anyone can casually and informally interact with - - not as someone with whom staff makes an appointment and goes to for "therapy."

Now that I'm thinking about it that might be a very helpful thing.

We had a priest at a VA I worked at years ago. He carefully established relationships over a period of time, came around and spoke to those whom wanted to speak to him (almost everyone) and was a good, nonjudgmental source of comfort for many. He didn't pry, ask about your mother, or do anything remotely threatening.

When 9/11 blew up in the world's face he was there. Many (including me) leaned on him as a source of comfort - I'm not even Catholic. But he was a trustable, likable guy that exuded bonhomie, and good will.

I had no reservations discussing many things with him in my very limited time.

This was a very special type of relationship with a very unique person. The VA was his "church" and we were all his charges. This isn't something easily replicated - he had it down to an art form.

[JinnSchlajfertig]

I say this as a nurse and someone who will soon be starting my first psych ARNP job who also has a degree in Occupational Health Nursing who us very into employee mental health issues.

Ditto what others have said. We have CISM which is a peer-run program, that responds to critical incidents. It is geared towards the correctional officers who are accustomed to accessing that service. But I don't think nurses use it that much, but it's confidential, so who knows. Maybe if a nurse was on the CISM team...

Which brings me to the OP comment about nurses getting support from psych after a med error.

I would never go to psych for support after a med error. I had a med error, was mortified, and other nurses stepped up to help me frame the experience in a healthy way. Just knowing that other nurses (who I looked up to for being highly competent) had similar experiences helped me to get through it. A psychologist doesn't pass hundreds of meds every day and can't know the pressure that brings and the visceral, gut-churning horror that a med error evokes. So unless the OPs med error recovery program has nursing input, I doubt people will access it. Maybe a better route would be to set up a peer support program. Or training for managers to help staff nurses through common issues like that.

[mariahlily]

Has anyone said they trust their employer yet?

I like my current job. My coworkers and charge nurses are all kind. The nurse managers are supportive

However, my first real nursing job was a train wreck. That particular institution did a whole song and dance number about how they wanted to lift us up and support us when we made mistakes--they didn't want to punish us.

That's what they told us during orientation and staff meetings. But the culture was very much one of thinning the herds. Even minor mistakes on my part (like accidentally putting my initials on the wrong space on a form) were framed as a "lack of critical thinking skills." When one of my nicer, most helpful coworkers was such suddenly fired, and no one else showed any emotion about her departure, I knew to watch my back. Actions speak louder than words

If your institution is trying to verbally reassure the nurses that they can talk to you with impunity, they need to show their trustworthiness first. Managers and charge nurses have opportunities every single day to show the nurses that they're on their side. They need to do it, and keep doing it to gain their staff's trust

Btw why is it that you trust this place? I have to wonder why they specifically want nurses to talk about "mistakes"

There are a 101 ways to get stressed out at work: bullying, patient deaths, exhaustion, anxiety, grief.

but if management is only expressing interest in getting nurses to open up about medical errors, it's a sign that this is out of interest for the institution, not the employees

[JKL33]

Btw why is it that you trust this place? I have to wonder why they specifically want nurses to talk about "mistakes"

There are a 101 ways to get stressed out at work: bullying, patient deaths, exhaustion, anxiety, grief.

but if management is only expressing interest in getting nurses to open up about medical errors, it's a sign that this is out of interest for the institution, not the employees

I thought the same thing. "Gee, that's kind of an odd stressor to hone in on when there are things like angry/stressed/demanding parents...." - - which is a far more frequent stressor (by orders of magnitude) than medication errors for any given nurse individually.

[Green Tea, RN]

When I was working on med-surg for my first nursing job, a nurse educator came to see me after my shift frequently as part of my residency program. She was not a psychologist, but I can kind of relate her to you.

I honestly didn't like that she came in after my 12 hour shift. Every time, I was exhausted mentally and physically and just wanted to go home and rest. Because of that, I tried to finish every session with her as short as possible. I tried not to bring up any issues or concerns from my side. I acted like everything was fine in front of her.

At one time I was very tired during a session with her and without thinking much I blurted out that having seven patients was too much. She then quickly change the subject. Since that time, I became not to want to see her much more.

I think, in general, nurses are aware why nursing is mentally and physically exhausting. The reason is obvious. And often times, the solution is not a therapy.

[elijahvegas, ASN, RN, EMT-P]

nope. the basic idea comes from something i learned from dealing with women--family and romantic relationships.

when people complain, they dont want advice, 99% they just need someone to listen to them vent.

so if i need to vent, i dont really need to do it to someone who will understand every aspect of what im complaining about. i just need someone to hear me and tell me things will be okay. and thats what a support system is for. friends, family, some random at a bar even.

id rather not have someone from my place of employment know that im bad at my job haha

[PANYNP]

Our hospital's team of psych clinical liaison (psych CL) nurses, whose primary role is to tend to hospitalized inpatients related to emotional and spiritual concerns, also is available to groups of staff for critical incident stress debriefing, such as following a "bad" code, or issues with abusive patients or families.

I don't believe I've heard about individual counseling, though, for all the reasons listed by everyone else.

[akulahawkRN, ADN, RN, EMT-P]

Aside from mandated CISM debriefings, I won't typically talk to a staff psychiatrist or psychologist while at work regarding issues of a personal nature. As others here have stated, we just usually do not have time to do it and I'm no exception to this. For that matter, I won't ask our medical providers about a personal medical issue for the same reason. If there's something that's immediately pressing, I may ask a provider for a recommendation about who to go to for a given issue but that's as far as that goes. For mental health stuff, I'm also like pretty much everyone here. I would choose a mental health professional that's not work-connected because too often word gets around and jobs change. I would normally want a provider (medical or mental health) to be separate (and take several different insurance programs) so that if I had to change jobs, I could generally continue seeing the provider for my health. It makes for better personal privacy and better continuity of care.

Now if I got sick or injured in some way and I had to go to my hospital's ED, I wouldn't mind as they're really good people and they genuinely care about their co-workers. I would, however, just simply prefer that my work not be my source of primary medical or mental health care.

[Orion81RN]

I don't mean to be disrespectful, but how would you know that people are not seeking psychological help? Perhaps these employees are not seeking it from you but elsewhere if it is needed. Additionally, if you are talking to the head nurse about employees seeking/not seeking advice on the unit, I would be spooked, personally.

EXACTLY!! He/She ALREADY gave up too much info even discussing this with the "head nurse." NOT OK