Annual Dog & Pony Show

[Davey Do]

Yes. It's once again time for the ever-dreaded mandatory all-day dog & pony show inservice that I would prefer second only to marathon tag-team gum surgery.

Four hours involve a boring four hour presentation by a droll self-important hypocritical short man syndrome certified CPI administrator ask-kisser. He reads from the booklet we all have a copy of things like "only an LIP or RN can terminate a restraint", yet does not follow the guidelines.

For the whole story, you may want to read this thread:

Thank you. Just putting together this thread has helped me to feel better.

[JKL33]

Ask for the official word from TBTP.

It's either this or it's that. Clark is probably wrong because why would there be a scenario where, in theory (which Clark is apparently fond of), someone could restrain your patient without you knowing? Or could decide that they don't agree with your assessment and they are restraining the patient when you know it is not appropriate and then just walk away and let you be responsible for what they have done? And why would the policy enable them to endanger the patient and everyone else by discontinuing a restraint when it isn't appropriate to do so? Why would someone be given any of these responsibilities without also having the responsibility for the clinical assessment of the patient?

Re the profanity. Convey on the evaluation form that this does not enhance the presentation and something along the lines @RNNPICU wrote. I would leave out the 18 part, myself. Counting is simply the manner in which you occupied yourself while listening to...[Clark]; don't give anyone the chance to accuse you of pettiness so that they can avoid addressing the question at hand, which is: How exactly does this work that anyone can restrain patients and remove restraints but not be responsible for the care and assessment of the patient.

JM.02 ??‍♀️

[RNNPICU, BSN, RN]

JKL33:

Good point about th "18" it could be perceived as petty and could come accross as not paying attention to the presentation.

6 minutes ago, JKL33 said:

. I would leave out the 18 part, myself. Counting is simply the manner in which you occupied yourself while listening to..

JM.02 ??‍♀️

[amoLucia]

RNNPICU & JKL comment about your concern/approach to address the 18 epitaphs (50 cent word). It doesn't sound like you.

Just talk to the presenter. You will have made your point. To comment even on a course eval leaves a paper trail for TPTB.

You are correct that so many F-bombs weren't nec. So maybe the presenter used bad judgment for self-aggrandizement (another 50 cent word). I'd bet many of us have done so also. The 18 times was a bit overkill - but not everybody might have been as offended as you.

Just let it go .

[TriciaJ, RN]

Just reading the original post made me want to put pins in my eyes.

Yesterday I was feeling crappy from a shingles shot and high-fiving myself that I'm retired and didn't have to agonize over calling in sick. Then I stumbled on the post about legally mandated staffing and some poster thought staffing committees were the answer. Committees! Just seeing that word makes me want to give myself a paper cut and put some lemon juice on it. Never mind! I'm retired!

Now I'm reminded of the Annual Dog and Pony Show. That's not even a good name for it because if it involved an actual dog and pony, it would be fun. Pet therapy! It's more like the Annual Emperor Who Is Not Only Naked But Has Crucial Bits Missing.

I will be spending much of today dealing with elderly father-in-law with dementia issues. I wasn't looking forward to it. Now I just have to think about Fire Safety and Diversity and my afternoon will be comparatively fun.

[Hoosier_RN, MSN]

7 hours ago, Davey Do said:

Well, this Dog & Pony Show was anything but boring, primarily due to a disagreement between me and the CPI instructor, Clark. The next three paragraphs are excerpts from my own personal documentation:

As we were discussing page 15 which states, "the RN is responsible for patient care" and "RNs have the authority to initiate and stop the restraint" Clark said, "Anybody can initiate or stop a restraint".

I spoke up and said, "I disagree". I stated that only an RN can terminate a restraint, that there is a process, and the RN makes the final decision, for which I received argument. Clark brought up theoretical cases, stating "What if...what if...?" and "some nurses will leave a patient in restraints even after they've calmed down". I replied that I was "not speaking of opinions, perspectives, generalities or other nurses". I stated, "When I'm the RN on the unit, and I am in charge, no patient will be released from restraints until I deem so".

...For years at past CPI trainings, a question has always been asked, "Who can initiate a restraint?" with the answer being "Anybody." The question that has always followed was "But who terminates the restraint?" The answer has always been "Only the RN."

There's a lot more to this documentation, but I wanted to give you the gist of it. During the discourse with Clark, I also made a request. These next two paragraphs are excerpts from more documentation:

I had to request that the CPI instructor Clark refrain from "flagrant profanity". Clark used obscene words like "p****d, a**, b*******', f***" a total of about 18 times before I finally voiced my request.

Clark's argument was that he was merely repeating what a patient had said. This was untrue, in that his presentation was sprinkled with profanities, as I kept track on the pages of handouts. Also, Clark was not entering verbatim words used by a patient on legal documentation, he was merely repeating profanities as an example of patient behaviors. Clark could have been more appropriate by using euphemisms, or the first letter of the profanity. We all know what "F this! F that! F! F!" means without having to hear the actual obscenity.

I'm considering using the documentation as communication to administration. I may just keep it for my own records. Any input from allnurses members will be appreciated.

To end on a positive note, my supervisor, RoofElmo, during the inservice gave me recognition for my recent interventions and subsequent documentation. RoofElmo was referring to an adult male psych patient who medically decompensated last Friday. She also mentioned that the CNO praised me.

I told my medical nurse wife Belinda that the situation would be one with which she routinely deals. But when a psych nurse medically makes a good call, they're a Rock Star Nurse!

Or, in this case, a burned out 70's DJ Nurse!

In the case of restraints, I've always heard that anyone could initiate for safety, only the RN could discontinue.

For Clark's unnecessary cussing...I would have stopped him dead in his tracks by stating that "while I'm impressed with your creative use of the English language, there are others here who I can tell are offended by it. Be professional, and drop the garbage and move on!" I don't know why, all of a sudden, everyone thinks that it's ok to cuss in professional situations, even if demonstrating a situation. Even when I document, I have used enough letters and asterisks to get the point across.

***I wish I had your artistic talent! I'd draw my fave burned out 70's DJ nurse ?

[TriciaJ, RN]

8 hours ago, Davey Do said:

Well, this Dog & Pony Show was anything but boring, primarily due to a disagreement between me and the CPI instructor, Clark. The next three paragraphs are excerpts from my own personal documentation:

As we were discussing page 15 which states, "the RN is responsible for patient care" and "RNs have the authority to initiate and stop the restraint" Clark said, "Anybody can initiate or stop a restraint".

I spoke up and said, "I disagree". I stated that only an RN can terminate a restraint, that there is a process, and the RN makes the final decision, for which I received argument. Clark brought up theoretical cases, stating "What if...what if...?" and "some nurses will leave a patient in restraints even after they've calmed down". I replied that I was "not speaking of opinions, perspectives, generalities or other nurses". I stated, "When I'm the RN on the unit, and I am in charge, no patient will be released from restraints until I deem so".

...For years at past CPI trainings, a question has always been asked, "Who can initiate a restraint?" with the answer being "Anybody." The question that has always followed was "But who terminates the restraint?" The answer has always been "Only the RN."

There's a lot more to this documentation, but I wanted to give you the gist of it. During the discourse with Clark, I also made a request. These next two paragraphs are excerpts from more documentation:

I had to request that the CPI instructor Clark refrain from "flagrant profanity". Clark used obscene words like "p****d, a**, b*******', f***" a total of about 18 times before I finally voiced my request.

Clark's argument was that he was merely repeating what a patient had said. This was untrue, in that his presentation was sprinkled with profanities, as I kept track on the pages of handouts. Also, Clark was not entering verbatim words used by a patient on legal documentation, he was merely repeating profanities as an example of patient behaviors. Clark could have been more appropriate by using euphemisms, or the first letter of the profanity. We all know what "F this! F that! F! F!" means without having to hear the actual obscenity.

My initial take on this situation is that Clark has no other credential than "CPI Instructor". He now gets to instruct a room full of professional people so he is going to impress everyone with how cool he is (salty language during a presentation) and he is going to unilaterally rewrite the policy manual, because he's, like, cool.

Your facility really needs an iron-clad policy dictating who can initiate restraints and who can terminate them. It doesn't usually work when everyone has authority but only a few have professional responsibility.

I think the problem started in psychiatry around the 1970s with the "everyone is equal" movement. That's when we switched to street clothes and what used to be nurses' aides got fancy job titles like "mental health specialist" or "psychiatric technician". The problem with these titles is that they imply a credential that doesn't exist. Someone with a master's degree in macaroni art isn't a specialist in anything. And will not be held ultimately accountable if someone gets injured due to an inappropriate restraint practice. (Not that anyone cares, but I think anyone working in psychiatry who doesn't have their own credential should be required to hold a CNA or CMA certificate and that should be their job title. And no, they shouldn't be "team leaders" or any other such nonsense.)

I'm all for a flattened hierarchy but there are some caveats. The current system has spawned a lot of Clarks who huff and puff and give themselves airs and suck people into believing that they are actually authorities on anything. Now you've had to listen to a lot of profanity in what should have been a profanity-free zone and a serious policy has been muddied.

Your management now needs to do some damage control. They need to clarify the restraint policy and it needs to be JCAHO compliant. And they need to retire Clark from the dog and pony circuit.

[Daisy4RN]

11 hours ago, Davey Do said:

Well, this Dog & Pony Show was anything but boring, primarily due to a disagreement between me and the CPI instructor, Clark. The next three paragraphs are excerpts from my own personal documentation:

As we were discussing page 15 which states, "the RN is responsible for patient care" and "RNs have the authority to initiate and stop the restraint" Clark said, "Anybody can initiate or stop a restraint".

I spoke up and said, "I disagree". I stated that only an RN can terminate a restraint, that there is a process, and the RN makes the final decision, for which I received argument. Clark brought up theoretical cases, stating "What if...what if...?" and "some nurses will leave a patient in restraints even after they've calmed down". I replied that I was "not speaking of opinions, perspectives, generalities or other nurses". I stated, "When I'm the RN on the unit, and I am in charge, no patient will be released from restraints until I deem so".

...For years at past CPI trainings, a question has always been asked, "Who can initiate a restraint?" with the answer being "Anybody." The question that has always followed was "But who terminates the restraint?" The answer has always been "Only the RN."

There's a lot more to this documentation, but I wanted to give you the gist of it. During the discourse with Clark, I also made a request. These next two paragraphs are excerpts from more documentation:

I had to request that the CPI instructor Clark refrain from "flagrant profanity". Clark used obscene words like "p****d, a**, b*******', f***" a total of about 18 times before I finally voiced my request.

Clark's argument was that he was merely repeating what a patient had said. This was untrue, in that his presentation was sprinkled with profanities, as I kept track on the pages of handouts. Also, Clark was not entering verbatim words used by a patient on legal documentation, he was merely repeating profanities as an example of patient behaviors. Clark could have been more appropriate by using euphemisms, or the first letter of the profanity. We all know what "F this! F that! F! F!" means without having to hear the actual obscenity.

I'm considering using the documentation as communication to administration. I may just keep it for my own records. Any input from allnurses members will be appreciated.

To end on a positive note, my supervisor, RoofElmo, during the inservice gave me recognition for my recent interventions and subsequent documentation. RoofElmo was referring to an adult male psych patient who medically decompensated last Friday. She also mentioned that the CNO praised me.

I told my medical nurse wife Belinda that the situation would be one with which she routinely deals. But when a psych nurse medically makes a good call, they're a Rock Star Nurse!

Or, in this case, a burned out 70's DJ Nurse!

I would not say anything to admin. While i agree that this was very unprofessional (and I really am shocked Clark would speak like that, and not much shocks me anymore) i think you would do more harm to yourself than good. It has been my experience that admin knows what is going on but likes to stick their head...shall we say...in the sand. Unless of course you are getting ready to leave that job at Wrongway (i am picturing your cartoon of your self driving to work day 1 saying Ugh and then home on day 3 saying that wasnt so bad (something like that). The way i looked at it towards the end of my career is are you really going to be able to change the situation and/or is it worth the headache.

Yep, burned out 70s nurse!

[Davey Do]

I sincerely want to thank each and every one of you for your posts. I value your opinions. RNNPICU post made me stop and consider.

15 hours ago, RNNPICU said:

"For everyone's benefit it would be helpful to have other words used besides profanity laced descriptions. While a patient may actually use the words, as medical professionals in professional settings such as an inservice we are educated enough to only use an abbreviated version to illustrate the point. In a recent inservice, a speaker used full profanity 18 times when this could have been greatly reduced and even eliminated. Although I understand we are all co-workers, in professional setting we should be handling ourselves as the medical professionals we are."

I thought about it, from time to time, all day long. And I told myself, "Yes- that would be the very best way to handle it- it's clear, direct, and respectful".

But it's not what I'm going to do.

If I were dealing with individuals who this golden piece of prose would make any impression upon, I would send it, nearly word for word. But it will be read as Gary Larson's dog understands:"Blah blah blah blah blah, Ginger!"

I sense they would read it and say to themselves, "Yeah. Right. 'Handle ourselves as professionals'... Yawn!"

I'm dealing with coworkers and management who have to be instructed on appropriate behavior. I'm talking Basic Courtesies 101 here.

Emerson said, "There is guidance for each of us and by lowly listening, we shall hear the right word". I lowly listen through my art. And my art said this:

Clark is trying to tell me how to do my job? No way. He, and management, need to be punched in the face. My report through the chain of command will be direct, objective reporting with no sugar coating.

Moves I make in any process I play like a game of chess, thinking several ahead. I am prepared for just about any retort, and if I get a surprise kick, I know how to aikido that kick.

Once gain, I truly appreciate all of your input, as it has allowed me to visualize other perspectives submitted by my virtual compatriots with whom I respect and feel a certain kindredship.

Thank you.

[Davey Do]

This caused me to laugh out loud:

10 hours ago, TriciaJ said:

Just reading the original post made me want to put pins in my eyes.

And I am truly sorry for your discomforts, @TriciaJ.

When I read this, I thought , "She hit the nail on the head!"

7 hours ago, TriciaJ said:

My initial take on this situation is that Clark has no other credential than "CPI Instructor". He now gets to instruct a room full of professional people so he is going to impress everyone with how cool he is (salty language during a presentation) and he is going to unilaterally rewrite the policy manual, because he's, like, cool.

I'm going to be pouring over these posts for some time to come, but I wanted to say something about TriciaJ's before I took a break.

[Davey Do]

13 hours ago, JKL33 said:

I would leave out the 18 part, myself. Counting is simply the manner in which you occupied yourself while listening to...[Clark]; don't give anyone the chance to accuse you of pettiness

Thank you for your submission, JKL. It was a worthy read.

I've taken a portion of your post to utilize as an example of playing chess, thinking several moves ahead. I had considered this counting thing as a possible retort administration might use and have devised a couple of comebacks:

First, the concern is not about me being petty- it's about inappropriate behavior on the part of Clark which fits the definition of, among other discourtesies, harassment. My so-called "pettiness" is a red herring.

Next, the whole CPI training, like many other inservices, are mere formalities. They are not actual educational processes by which we are given information and tested to assure our knowledge of that information. We are given the answers to the tests at the time they are taken. Actual listening and assimilation of the information is not a necessity when the accepted process is a worn and well known method.

I have more ammunition to argue similar points, but suffice it to say I feel prepared for just about any opposing premise.

[Davey Do]

9 hours ago, Hoosier_RN said:

In the case of restraints, I've always heard that anyone could initiate for safety, only the RN could discontinue.

Exactly, Hoosir_RN.

9 hours ago, Hoosier_RN said:

I don't know why, all of a sudden, everyone thinks that it's ok to cuss in professional situations, even if demonstrating a situation.

My belief is that the perpetrator has boundary issues and has never been been herded into the pen of appropriate behavior. They are allowed to roam free and unencumbered. Clark is a good example of this.

[Davey Do]

6 hours ago, Daisy4RN said:

i think you would do more harm to yourself than good. It has been my experience that admin knows what is going on but likes to stick their head...shall we say...in the sand.

One of the great things about being an old, arrogant, crabby nurse with a reputation for quality patient care is that I can say just about anything to anybody since I possess pretty good communication skills, Daisy. I often say to peers and coworkers, "You can tell administration, 'Dave said...' and I will stand behind you and my words".

I was joking with Jason Hiney RN once about me getting fired and Jason said, "Dave, you'd have to kill somebody in order to get fired from here!"

Ranger Rodd RN said to me, after an inservice, "I'd say what you say in inservices if I knew I was going to leave this job!"

"LIve to never be ashamed if anything you do or say is published around the world- even if what is published is not true" -Richard Bach