So we recently admitted a male patient who identifies himself as female. We don't get many patients like her. A nurse in particular let's his political views get in the way of work and has been calling this patient "it".
Now, let's fast forward to the dilemma. During medication pass, he addressed the patient as "it" out loud and other staff and patients started laughing; next thing you know, we had a behavioral emergency on our hands.
I filled out an incident report because several other nurses and I have spoken to this nurse prior to the event happening. One nurse even brought it up the chain of command. Not only is it unprofessional but it's endangering the safety of others - clearly, it's one of her triggers. Has anyone ever dealt with this type of conduct?
Bingo! Admitting alleged wrongdoing by another person is, at the very least, bad form. Beyond that, while apologizing for the alleged action of another may feel good, it can potentially put the person who apologizes in the third person in a bad legal position.
Libby1987, is correct... leaving this to management to handle is likely the best course of action.
The OP spoke of actual, witnessed wrongdoing, that resulted in a psychological crisis for the patient, not "alleged" wrongdoing. We are not talking about unsubstantiated wrongdoing.
Woudn't acknowledgement and validation of abuse by another employee have an impact on liability? "Even your own staff said I was abused," would be admitting abuse?
Not that I disagree, I don't know why that nurse and those that laughed along are still employed, but I would consider my job at risk for admitting wrong doing to the patient. We don't typically do that at work, admit to a patient that they received bad care (insert correct adjective) and leave it to our managers, right?
This is from a hospital's risk managment team:
"Studies show that disclosing medical errors with an apology and assurances that steps will be taken to prevent the error from happening again minimize the chance that a lawsuit will be filed. If a lawsuit is filed, it increases the likelihood of settling the case for a lesser amount than if no explanation or apology had been given.
A number of states have passed laws that make an apology inadmissable in a court of law to show fault."
Not only is an apology the right thing to do, but it is the financially smart thing to do.
Bingo! Admitting alleged wrongdoing by another person is, at the very least, bad form. Beyond that, while apologizing for the alleged action of another may feel good, it can potentially put the person who apologizes in the third person in a bad legal position.
Libby1987, is correct... leaving this to management to handle is likely the best course of action.
It's been fairly commonly accepted knowledge, at least among risk managers, for about 15 years that there is actually far less monetary liability in proactively disclosing fault and admitting to fault. You might make a patient aware of something they can now sue for that they weren't aware of before, but that doesn't add nearly as much to the monetary costs of lawsuits as when a patient finds out we weren't honest with them.
But beyond that, my allegiance is to my patient, not the facility's administrators.
... My partner and I get up to move to the back of the bus, and when I turn around to see if you're following, your face contorts as your throat makes a deep hacking sound. I watch, seemingly in slow motion, as you rise from your seat to spit at us. I watch your phlegm splat onto the bus floor, inches away from my heels.
I want to yell obscenities at you. I want to tell you to rot in hell. I want to scream until I fracture your ear drums.
But I say nothing. I say nothing at all, because being transgender means never knowing if a small altercation could lead to violence. And because getting the last word between us runs the risk of those being the last words I ever speak. And it's a risk I won't let myself take.
The driver says nothing, and the other passengers on the bus say nothing, and you, satisfied with yourself, take your seat again.
I shroud myself in the silence, and I try to steady my shaking hands. I spend the next fifteen minutes – which feel like a lifetime – pretending to stare out the window, while I feel your eyes on me, your mouth forming a gleeful, delighted smirk.
You've put me in my place, haven't you? Seeing me so powerless makes you feel something, something you enjoy, something that makes you straighten your spine a little and bare your teeth.
... I can't ride the bus for a week after the incident. I skip all my classes. I order takeout instead of going to the grocery store, and I call in sick to work. Not because this is the first time it's ever happened and I'm shocked, but because it happens all too often and I am afraid that the next time will be the last time.
And everywhere I turn, I wonder which ones are like you, the ones who have forgotten my humanity. The ones that see me a wild animal to be put into submission.
... For too many of us, when you are transgender, there is no such thing as feeling safe. And in a society in which we're never safe, I often wonder why so many are surprised by the staggering rates of suicide – something I'm no stranger to – unemployment, incarceration; why anyone would wonder, for a moment, why we struggle the way that we do, when they remember to think of us at all.
(Bolded sections are in the original)
For a longer, more in-depth picture of the journey, try Stone Butch Blues by Leslie Feinberg.
So theoretically speaking, whenever a coworker makes an error, you go to the patient and apologize for the incompetent care? You don't allow mgmt to handle it? You do it?
In the case of mgmt not doing the right thing ie not coming down in hateful contemptuous staff, I would speak up one way or another.
In the case of mgmt that I either trust and/or witness doing what I would deem the right thing, at least definitely in the ball park, I would not take it upon myself to verbalize wrong doing to the patient. I would definitely demonstrate respect of the patient and my stance by how I publicly treated the patient.
However personally speaking, I'd be all over that coworker and the sheep that laughed in a **** way as well as reporting to mgmt. If it occurred in front of the patient (as it seemed it did) I would be more professional about it but I don't stand idly by. I'd do it right then. I wouldn't have not been able not to, not if the patient was being abused.
AGAIN, I was only answering the question as to what the fallout could be. Please stop quoting my post out of context.
So theoretically speaking, whenever a coworker makes an error, you go to the patient and apologize for the incompetent care? You don't allow mgmt to handle it? You do it?
In the case of mgmt not doing the right thing ie not coming down in hateful contemptuous staff, I would speak up one way or another.
In the case of mgmt that I either trust and/or witness doing what I would deem the right thing, at least definitely in the ball park, I would not take it upon myself to verbalize wrong doing to the patient. I would definitely demonstrate respect of the patient and my stance by how I publicly treated the patient.
However personally speaking, I'd be all over that coworker and the sheep that laughed in a **** way as well as reporting to mgmt. If it occurred in front of the patient (as it seemed it did) I would be more professional about it but I don't stand idly by. I'd do it right then. I wouldn't have not been able not to, not if the patient was being abused.
AGAIN, I was only answering the question as to what the fallout could be. Please stop quoting my post out of context.
No ... it's not incumbent on staff to personally apologize for all incompetent care, but it probably increases the damage in this case to pretend that it never happened. It seems to me that it would also make it much harder for staff to earn back the trust of the patient who was abused. In my opinion, risk management and "good form" are secondary considerations.
I'm not sure if you realize what question I was responding to but I in no way support wrong doing or avoiding doing the decent thing.
I understood what question you were responding to. I reread my response to you. I never said that I believe that you support wrongdoing. This part of your post made me think that you don't:
Not that I disagree, I don't know why that nurse and those that laughed along are still employed
What I was commenting on was the sad state of affairs in society in general, if fear of litigation means that healthcare professionals will be afraid to admit to wrongdoing. In all fairness, you did say this:
Woudn't acknowledgement and validation of abuse by another employee have an impact on liability? "Even your own staff said I was abused," would be admitting abuse?
We don't typically do that at work, admit to a patient that they received bad care (insert correct adjective) and leave it to our managers, right?
I interpreted that as meaning that despite your personal belief that the patient was treated badly, you personally usually wouldn't admit to the patient that they'd received bad care because it might impact liability. Am I missing something here?
So theoretically speaking, whenever a coworker makes an error, you go to the patient and apologize for the incompetent care? You don't allow mgmt to handle it? You do it?
Personally, I'm in the habit of apologizing only for my own mistakes. I go to the patient and explain and apologize. I don't run it by my nurse manager first, but I will inform her/him at a suitable point in time so that they are kept in the loop.
I usually leave it up to my co-workers to apologize for the mistakes that they make.
In the specific situation that the OP has described, I don't sense that an apology from the "it"-nurse is forthcoming. In that situation I believe that an apology from the other nurses on the gender-challenged nurse's behalf might have therapeutic value.
If I was called "it" once by some fool, I'd likely get angry but it wouldn't cause any lasting damage. I'm not regularly harrassed and I am emotionally in a good/stable place. However, if you do this to an emotionally vulnerable person who might have been subjected to other people's idiocy for a long time, it could actually be the straw that breaks the camel's back. Patients seek healthcare to get help, not to be abused.
I think that the staff on this floor needs to try to gain back this patient's trust and by clearly stating that what their co-worker said is unacceptable, they could be taking the first step of that process.
I understood what question you were responding to. I reread my response to you. I never said that I believe that you support wrongdoing. This part of your post made me think that you don't:
What I was commenting on was the sad state of affairs in society in general, if fear of litigation means that Healthcare professionals will be afraid to admit to wrongdoing. In all fairness, you did say this:
I interpreted that as meaning that despite your personal belief that the patient was treated badly, you personally usually wouldn't admit to the patient that they'd received bad care because it might impact liability. Am I missing something here?
My answer had nothing to do with what I would do personally, I was only suggesting what the possible fallout could be, primarily to the facility.
But with my post being quoted repeatedly, it seems the acknowledgment of that possible outcome correlates with me doing nothing to advocate for the patient.
The bigger issue is not whether we would apologize to the patient but the culture of hateful bigotry at this facility. The other staff LAUGHED in the presence of this patient. An apology to the patient would be pretty empty as she remained vulnerable in this hateful environment.
@ Libby1987: I honestly don't get where you're coming from. I may be misreading your tone, but it seems to me that you feel that you're being attacked.
Evidence has been presented that fears of litigation are overblown and that an apology might actually help prevent a lawsuit.
Evidence was also presented that failure to acknowledge the abuse is likely to intensify the damage and impede the rebuilding of trust.
Some posters also expressed the opinion that an aplology is in order out of basic human decency.
In other words, a number of posters explained why they disagreed with the suggestion that an apology would be wrong because of risk management concerns.
How do you think staff should go about re-building trust in this case? How would you address the institutional culture that let multiple staff members find the abuse funny?
The OP seems to have seagulled (IOW, dropped a load and flown away). I would love to hear how the incident was actually handled, both therapeutically and institutionally.
@ Libby1987: I honestly don't get where you're coming from. I may be misreading your tone, but it seems to me that you feel that you're being attacked.
Evidence has been presented that fears of litigation are overblown and that an apology might actually help prevent a lawsuit.
Evidence was also presented that failure to acknowledge the abuse is likely to intensify the damage and impede the rebuilding of trust.
Some posters also expressed the opinion that an aplology is in order out of basic human decency.
In other words, a number of posters explained why they disagreed with the suggestion that an apology would be wrong because of risk management concerns.
How do you think staff should go about re-building trust in this case? How would you address the institutional culture that let multiple staff members find the abuse funny?
The OP seems to have seagulled (IOW, dropped a load and flown away). I would love to hear how the incident was actually handled, both therapeutically and institutionally.
I haven't flown away. A few posts back, I updated everyone on what followed. I'm not sure if the nurse was disciplined or received counseling. Such matters are confidential. I do know that he was seen by our manager and is still working on the unit. The patient was transferred to a different unit due to administrative reasons. Normally, if an investigation was carried out, I would have been asked to write a formal statement aside from the incident report I filled out. I wasn't asked to make a statement so I'm sure the corrective action here was to simply transfer the patient to prevent that nurse from working with her.
I do believe a formal apology on behalf of the staff could make things better. I'm not sure if this patient has sought or will seek legal action for abuse; I do know that her family is very involved. If legal action was sought, I don't think management will divulge that to the staff at this point in time. However, an apology just may prevent things from taking that nasty turn.
Susie2310
2,121 Posts
The OP spoke of actual, witnessed wrongdoing, that resulted in a psychological crisis for the patient, not "alleged" wrongdoing. We are not talking about unsubstantiated wrongdoing.