I got in trouble at my job yesterday. I was training in a new case manager. After some time observing me make calls and document, she tried it on her own. She's smart, a great nurse and did a good job on her first call. But her documentation was atrocious. She charted the narrative with absolutely no punctuation, tons of mostly lower-case abbreviations (most of which are disallowed at our company per policy), all in one long block of run-on text, riddled with misspellings (our EMR doesn't have spell-check).
I know our doctors and auditors well, and KNOW they would raise a huge fuss over a note like that. Our bosses' boss will bring up notes that are poorly written and make examples of them at staff meetings. They don't demand perfection - but documentation has to be readable and reasonably error-free. I was a tactful and gentle as I could possibly be, with a smile, praising her call and complete content of the note, but said, "can I show you how the bosses want it to look?"
She said sure, and I cleaned it up & corrected the grammar & punctuation. I kept saying "I know it seems picky they've outlawed abbreviations like this, but it's policy," and "these charts are read by insurance company auditors, doctors and accreditation agencies and I'd rather you not have to deal with them asking you to clarify your notes, it can be a real pain!" I tried to be as lighthearted and kind as I could, because I could FEEL how defensive & stiff she'd gotten. I made sure to praise and praise and praise everything else she did, and assure her it didn't have to be perfect, just within policy.
Sure enough, she ran crying to the supervisor, who said she accused me of "criticizing" her writing and that I "demanded" "perfect" punctuation and grammar & that I was "condescending" to her and "belittled" her "abilities." OF COURSE she pulled the "English is my 2nd language" card - never mind she's been in the States 27 years and speaks crystal clear, articulate and accent-free English. She's been a nurse for 12 years. She has already complained that she's "not good with computers" and came from a small SNF where it was all paper charting. I tried to be mindful of this. I was as tactful and gentle as I could POSSIBLY be. I was all smiles and praise, and tiptoed around her obviously awful writing skills and visible discomfort with the EMR.
Luckily, there was a co-worker in the same office during all this, who jumped to my defense. He had my back, and explained I'd gone out of my way to make this nurse comfortable and that my criticism was kind & constructive. Thank god. Once my boss heard our side of the story she surmised this new nurse was probably nervous and hyper-sensitive, and took things the wrong way.
Just to put the icing on the cake, I overheard her talking on her phone as she walked down a hallway (I was in the hallway above in the atrium & could hear every word). "This ***** nurse who trained me in was a grammar nazi who tried to force me to write like a professor!"
I see so much of this brand of hyper-sensitive, anti-intellectual whining in nursing. I see it here on AN (see: LPN/ADNs bashing people with more education, etc. etc.), I see it out in the field and on the floor, at SNFs.....everywhere. WHY? Whatever happened to being okay with crawling before walking? Whatever happened to pride?
Feb 26, '13
by llg, BSN, MSN, PhD Guide
I wish I had an answer for you -- but I have seen it a lot, myself. You are lucky your co-worker backed you up. Be sure to give him a big "thanks."
I think that attitude derives from a couple of sources:
1. Some people are insecure about their skills and lash out at anyone who points out their learning needs.
2. Some people are in denial about their learning needs. They have such a high opinion of the themselves that any skills/knowledge they do not already have -- well -- it must not be valuable. I think belief this is quite common.
Actually, the more I think about it, the more I think #2 above is the main culprit. People have been praised too much and not given feedback that indicates that they need to improve. They don't know how to handle negative feedback (even when it's constructive and nicely delivered). Their view of reality is that they are perfect -- and anything input that doesn't support that vote must be wrong and/or coming from someone who is not fair.
At some point in our culture, "self esteem" became more important than honesty. That was a big mistake and we are reaping the consequences of that mistake. We are dealing with people who must be told they are wonderful all the time and can't handle feedback that says they are not perfect. I'm not saying that children (and adults) shouldn't be helped to developed a positive self-image -- but that those positive self-images should be based on reality, not fantasy.
Last edit by llg on Feb 28, '13