Anti-intellectual & hyper-sensitive. WHY?

[mclennan, BSN, RN]

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!"

*sigh*

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?

[Tait, MSN, RN]

Yikes I don't even know what to tell you. I am sorry you were trying to show her the correct way to chart her information and she took it way off into left field.

Not much else I can add :/

Tait

[llg, PhD, RN]

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.

[netglow, ASN, RN]

Wow. Maybe you should have oriented her this way. Chocolate works very well for nursing too!

[psu_213, BSN, RN]

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.

At some point in our culture, "self esteem" became more important than honesty.

I agree with both statements. Unfortunately you (the OP) are not going to change the attitude of this nurse and you are not going to make her more receptive to constructive criticism. If she wants to play hardball about it, and go running to the boss so should you. Yes, give another few chances--i.e. see if her notes improve; see if her attitude improves toward your corrections--if she does not improve, speak with your boss and include her initial (unrevised) notes to you boss to show her how she (the orientee) is not progressing.

Some people are going to say "don't just go running off to the boss about this, deal with it the correct way." Well, further training first and the going to the boss is the correct way. If this person is "released" from orientation and then continues to write sloppy notes, it will come back on you. And you better believe this orientee is the type who will blame it all on you (the OP)--"but my preceptor never tried to correct my notes even though I had been doing it like this all along." If you alert your boss now, she will be alert that this is happening.

[netglow, ASN, RN]

The fact that she is touting being bilingual ...might that be one HUGE reason she was hired in order to increase cashflow from a certain patient population in your service area? Her nursing skills are not really an important factor to administration. Catering to patient populations is. If this is the deal, they'll want to keep her only for that reason.

[mclennan, BSN, RN]

Nope. She comes from a small, seldom-heard-of country. We have plenty of nurses who speak the languages our patients speak.

I think llg said it best. Somewhere along the line, self esteem became more important than honesty. It's true, that is beautifully stated.

I've just had it up to here with nurses who cannot stand one single tiny bit of criticism or hearing they are not perfect. Being offended/defensive is the Great American Pastime.

[wanderlust99]

I can't believe she called you a ***** nurse. Just for that I would report her and get her fired.

[meanmaryjean, DNP, RN]

Nope. She comes from a small, seldom-heard-of country. We have plenty of nurses who speak the languages our patients speak.

I think llg said it best. Somewhere along the line, self esteem became more important than honesty. It's true, that is beautifully stated.

I've just had it up to here with nurses who cannot stand one single tiny bit of criticism or hearing they are not perfect. Being offended/defensive is the Great American Pastime.

BBM: Amen

[llg, PhD, RN]

Being offended/defensive is the Great American Pastime.

Great line. I'll probably us it myself someday. I hope you don't mind.

[HouTx, BSN, MSN, EdD]

I wonder - what was the age of the nurse in question? I'm only asking because my own 2 sprouts can't spell at all - and they both have graduate degrees. They have always had to have a lot of mom-help to translate their written thoughts (gaaahhhh) into grammatically correct, properly punctuated sentences. I blame the changed educational processes - and over-reliance on computers/technology. Seriously, they are absolutely lost unless they have spell-check and grammar check on hand, and OP said that their application does not have these features.

My suggestion is probably a bit lame, but I think that the organization needs to raise the bar - assess basic English competencies as part of the application process. My organization does this for a lot of positions that have heavy clerical responsibilities. It does add t the hiring cost, but if it cuts down on the number of bad hires & overall training time, it would be justified.

[netglow, ASN, RN]

But there is the fact that she's been working and charting for over a decade and this seems to not have been an issue for her. This would then make the OP seem rather ridiculous to her.