Complacency in Healthcare

How do you know when you as a nurse need to take a step back, breathe and even reevaluate? It's those moments where you can't pick yourself up off the floor, there is a tightness about your approach to care, the moment, where you can't stand yourself as a caregiver...

Complacency in Healthcare

Webster's Dictionary defines complacency in a way that we, as a people, can all understand. As nurses and caregivers, we know deep down that complacency is taken to an entirely different level within our scope. It is a weighted situation that causes a slew of issues of which safety takes precedence over all. Let me reel you in a little deeper...

As a nursing student, I followed a wound care nurse that was performing a monthly study on the prevalence of wound progression while in the hospital. We rounded on a patient's room and whipped off their socks. In an instant, we were stunned to find a blackened foot that had completely lost perfusion-- when? No one knew. The report from the nurse, "I just didn't think of taking off their socks when checking pulses." When inquired as to why, 'I... I guess I just got lazy.' This patient lost their foot.

Once again, as a nursing student in the GI suite watching colonoscopy after colonoscopy, a woman came in for a study due to an extensive family history of colon cancer. As the probe was removed and she was slightly stirring from her twilight sleep, someone made an inappropriate joke at her expense. The entire room started laughing. The patient then looked up at me with tears in her eyes, "They are laughing at me, aren't they?" I lied in order to save face. Uncool my friends. Uncool.

A nurse I was working with a fellow comrade who felt too proud to ask for help with a blood infusion on a cardiac step-down unit. As I'm sure you can assume, this patient suffered from pulmonary hypertension as well as a very poor ejection fraction with apparent symptoms of heart failure exacerbation. They ran the blood too fast, didn't inquire to the MD about Lasix in conjunction with the infusion. Here comes massive fluid overload and a rapid response call. Avoidable? Indeed.

Taking a step away from nurses, call into question a physician who flits in and out of the hospital who thinks that a ticking time bomb of a case (pulmonary hypertension, hypertension, kidney failure without dialysis and COPD) isn't worth abrupt addressing. I walk in and find the patient talking one minute, unresponsive the next. After bedside intubation and a run down the hallway to the ICU, the patient almost died (bless vasopressors). When the physician rounded on the floor they peeked into the room-- "Oh, they are gone, I'm assuming to the ICU? [shoulder shrug] Okay." May I mention not answering pages (most of them stat) and the fact that physical compensation wore out and almost killed this man. The physician had no shame.

One last example... A CNA rounded on a patient in my unit. This individual was extremely confused, was assisted to the bathroom, then helped back to bed. Great right? Wrong. The bed alarm wasn't set nor were the bed rails up. I was running down the hall when I saw the patient literally roll out of bed and smash their head on the floor. It was a sound I would love to forget.

I am sure that many of you will look at these cases and think words like: negligence, ethical issues, etc. You are right for sure. But what I can also bring to the table about all of these stories is that each of the individuals involved had been approaching their jobs with a complacent attitude. All differing levels, but it was present, and it was absolutely affecting their care.

Complacency is a filthy animal. It makes Facebook at work more important than hourly rounding. It makes that extra long break of greater importance than double checking those pulses post cardiac cath. It means blowing off education and cheating on hospital required testing and skills check-offs because "we just don't have time."

We all know that our jobs hold immense importance and are very high risk, to us as well as those we see on a daily basis. If you think about it, the decisions we make on a daily basis can stop or even restart a heart. I don't know about you, but to me, this will always be an immensely frightening aspect of our careers.

What I ask of you is if you feel yourself sliding, none of us are above it mind you, take a step back. It is of utmost importance for us to draw the line when it needs to be marked (WITH BLINDING SIGNS). We need to understand our limits as caregivers. In order to save ourselves as well as our patients and our teams we have got to have to courage to state when our threshold has been met. I can recall in the last two weeks when I had to draw the line and ask for help because I couldn't take another [insert touchy situation here], or I would just break.

IT'S OKAY! YOU ARE HUMAN! We are fallible and at times inflexible. Let that crazy super-nurse idea in your head relax and take a reprieve.

I will never forget what an amazingly talented ICU doctor and anesthesiologist told me that day I left the GI suite with the laughing matter. The doctor grabbed me by the arm and reminded me in all seriousness, "It is our job to protect and do no harm. Every day this is our goal. As soon as you see yourself sliding, it's time to stop before you hurt someone."

So use those days off. Ask for help. Take a mental health day.

Because when we allow for complacency to take over and rule our care, that is the day that a nurse did more harm than good.

Florence expects the best, our patients expect the best, their families, the doctors, even you.

So let's provide the best care we can. In doing this we need to know our limits and be willing to draw those lines.

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Jacqueline.Damm

About Jacqueline.Damm

Molded and formed by a drive to live up to her own expectations, Jacquie ultimately thrives on creativity. Dreams, testing her limits, and traveling all fuel the fire, thus leading to adventures of the past and yet to be: http://misadventuresofanurse.blogspot.com/

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Specializes in Flight, ER, Transport, ICU/Critical Care.

Nice article. You are correct with many examples of "complacent" behavior. There is a lot of complacency in healthcare & other occupations as well. Most occupations compacency only costs "time or money", but in healthcare - it can truly be costly with a LIFE. I have been a student of complacency as it relates to aviatation and healthcare. It is astounding the way we make mistakes and the way those mistakes have consequences.

The most complacent area of healthcare for nurses involves medications. Complacency attacks us in the things we do often and do everyday — the things that are almost on "autopilot" and it would be easy to see how med prep & administration would fall into that category.

Yeah, ah, we got it the 5 rights! But, then WHY are there so many errors? Complacency. You do what you expect to do, see what you expect to see. Look without seeing, do without thinking. Yeah, it's all right, until it's its wrong. And when it's wrong, it can go very wrong.

How do we stop it? No interruptions when prepping meds. Pedi dose specific carts, IV admixture dose controls (if you have to get 3-4 vials of something you are likely getting ready to OD someone), Bar codes, Double ID verify. High risk meds require 2 nurses to administer (blood, insulin, certain pressors, TPA, chemo). I'm sure there are are others.

So, what else? Complacency exists in other ways too. And what "kills" it?

Awareness — that it exists is primary.

Be Vigilant. Be Motivated. Learn something everyday. When you find that you are unable to learn something every day, or work becomes the weight that is unbearable. It might be time for a new speciality.

Respect complacency & resolve that you will not fall victim to it. Be aware in all areas of your clinical practice and resolve to approach situations with determination. Use the tools that are available to you.

Practice safe!

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A very important article that all nurses and health care professionals should read. Thank you.

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Once again, as a nursing student in the GI suite watching colonoscopy after colonoscopy a woman came in for a study due to an extensive family history of colon cancer. As the probe was removed and she was slightly stirring from her twilight sleep, someone made an inappropriate joke at her expense. The entire room started laughing. The patient then looked up at me with tears in her eyes, "They are laughing at me, aren't they?"

-- Lying to the patient to avoid conflict.

-- Not reporting the incident to quality control/management/HR/etc.

-- Accepting the verbal abuse of patients as the status quo or OR humor.

-- Using the excuse of "I am only a student" for not reporting patient abuse.

That is very...

COMPLACENT!

After the patient allowed a student(s) to witness the procedure (assuming that there was EXPLICIT INFORMED CONSENT for student to participate), which provided NO BENEFIT to the patient and a huge benefit to the student(s) at the cost of the modesty and dignity of the patient.

Please don't be upset if the patient didn't say (to the student) "you're welcome."

Forgive me if this seems like a rant (I have included journal references to back my assertions), but what I say is true according to the OP's article.

I have worked with too many patients who have suffered these abuses and end up suffering trauma as a result.

Most cope by avoiding healthcare all together.

Does one think that she did not hear the joke. She may not have remembered coming out of sedation, but she will remember days later when she is home alone.

How can she ever trust healthcare or the providers after that?

"Do no harm" includes mental/psychological and the spiritual as well as the physical.

Does one realize that these incidents can cause PTSD? Read this study on Taylor and Francis in the Journal of Reproductive and Infant Psychology, Post-traumatic stress disorder in women who have undergone obstetric and/or gynaecological procedures: A consecutive series of 30 cases of PTSD.

PTSD can result from the associated feelings of powerlessness, an unsympathetic assailant, and painful or humiliating experiences.

Note that the women diagnosed with PTSD in the study reported:

- a lack of information and consent related to the exam/procedure

- feelings of powerlessness

- feelings of being in an unsympathetic environment, and

- experiences of physical pain.

Some of the phrases used by the women who took part in the study to describe their experiences include:

-‘dehumanizing and painful';

-‘degrading and distressing';

-‘my opinions were dismissed as irrelevant';

-‘hurting and feeling violated';

-‘it felt undeniably like rape'.

Is a colonoscopy NOT humiliating and traumatic enough? The problem is that this behavior is so common, it is accepted as status quo. (See Coutrhouse News, Unconscious Patient Says Doctors Mocked Him)

The entire room started laughing.

How many people were in the room?

How many were necessary?

How many students were present?

If everyone reported the incident and the person making the inappropriate comment, then the white wall would also protect the patient too.

If this patient was your mother, daughter, wife, grandmother, friend, etc., how would you respond?

The problem is systemic.

How many times have we ever asked a colleague that is on the care team of a loved one to "watch out for them," OR been asked to "watch out for" a colleague's loved one (because everybody on the inside knows what really happens)?

I am sure that many of you will look at these cases and think words like: negligence, ethical issues, etc. You are right for sure. But what I can also bring to the table about all of these stories is that each of the individuals involved had been approaching their jobs with a complacent attitude. All differing levels, but it was present, and it was absolutely affecting their care.

I do not dispute that complacency is one of the common factors in all the transgressions listed and many more that occur every day. I have to wonder though, if using the term "complacency" is just umbrella "technical medical language" for the causes of negligence, ethical violations, human rights violations, dignity violations, criminal conduct, abuse, etc. to lessen the impact and one's culpability in allowing these things to occur and go unpunished.

If so, that is very complacent....

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-- Lying to the patient to avoid conflict.

-- Not reporting the incident to quality control/management/HR/etc.

-- Accepting the verbal abuse of patients as the status quo or OR humor.

-- Using the excuse of "I am only a student" for not reporting patient abuse.

That is very...

COMPLACENT!

I doubt that OP lied to avoid a conflict. Why do you immediately jump to the least flattering interpretation possible? I feels like you're on a crusade and healthcare professionals are the enemy.

I think it's likely that OP lied to try to comfort the patient. She was a student and was likely shocked by what took place and only had seconds to come up with a response/reaction. She tried to be kind. I'm sure that OP can speak for herself but I find your conclusion that avoiding conflict was her only motivation, deeply unfair and probably inaccurate. OP never used the fact that she was a student to excuse anything. She's not defending what took place as "OR humor".

Our profession needs to always have ethics in the forefront of our minds and we accomplish this by talking about it amongst ourselves. In the work we do we face many difficult situations and ethical dilemmas. OP's post is in my opinion an excellent example of reminding us all of this important issue.

It makes me reflect and I believe that was the intended purpose.

I have to wonder though, if using the term "complacency" is just umbrella "technical medical language" for the causes of negligence, ethical violations, human rights violations, dignity violations, criminal conduct, abuse, etc. to lessen the impact and one's culpability in allowing these things to occur and go unpunished.

I practice in a way that I am at peace with my moral/ethical compass. However if I wasn't, the method most likely to get through to me and make me change my behavior would be calm reasoning and discussions, not being browbeaten by someone who most likely hasn't even faced the challenges of my profession.

I suspect this is true for most people.

After the patient allowed a student(s) to witness the procedure (assuming that there was EXPLICIT INFORMED CONSENT for student to participate), which provided NO BENEFIT to the patient and a huge benefit to the student(s) at the cost of the modesty and dignity of the patient.

The patients benefit in the sense that there will be trained nurses and doctors available ten, twenty and thirty years from now when the current ones have retired.

If students aren't allowed to watch and when appropriate participate, there won't be a next generation of healthcare providers/professionals.

I'm not sure why you feel that having a student present for a procedure equates a loss of dignity for the patient. When I was a student I always asked if I could be present and all patients said that they were okay with my being there and sometimes participating. It really didn't seem to bother them and many told me that I'd make an excellent nurse. Even the poor fellow who suffered through my very first peripheral intravenous catheter insertion.. My hero :)

How many times have we ever asked a colleague that is on the care team of a loved one to "watch out for them," OR been asked to "watch out for" a colleague's loved one (because everybody on the inside knows what really happens)?

I've had two coworkers, one nurse and one physician, ask me to be their pacu nurse after their surgeries. They did so because they think that I'm a good nurse and I was both flattered and honored. They didn't however request me because the other pacu nurses are prone to "negligence, ethical violations, human rights violations, criminal conduct and abuse". These acts aren't an everyday occurrence in most healthcare settings. I'd say that they're quite rare.

I've asked that a specific physician care for a person close to me. Again, not because I believe that most other physicians are evil, but because I have great confidence in the skill of this particular doctor.

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Specializes in Med/Surg, Onc., Palliative/Hospice, CPU.

Great replies all!

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Specializes in Med/Surg, Onc., Palliative/Hospice, CPU.

You make some very good points banterings, for sure. I have to agree with macawake with the below stated:

I doubt that OP lied to avoid a conflict....

I think it's likely that OP lied to try to comfort the patient. She was a student and was likely shocked by what took place and only had seconds to come up with a response/reaction. She tried to be kind.

I think it's important for people to remember that the decisions we make and the things we say and do can cause PTSD for those we come into contact with. I hope and pray that this patient from the GI suite did not suffer from those who made fun in the room as I stood there stunned. (Maybe patient advocacy education in all forms needs to be a MAJOR piece of nursing school education)-- where to go, what to do, what to report, when, by what means, etc.

All of your points go to show that there is room to grow, for everyone. For us to point fingers and say that x, y, and z are the exact culprits is a bit extreme. I honestly believe that behavior in the workplace is just as much a trickle down situation as it is with one's own ethical standards. What happens at the top will also occur at the so called "bottom". Big whigs are just as responsible as the bedside, no matter what we all face on a day to day basis. What we are given has to be put to the test with what we KNOW is right. We ALL need to perform to our best ability and also be willing to accept when we're wrong. Our role models and our own ethical standards make us who we are. We have to choose what we will do with that power.

One of the greatest tools I've come into contact with when concerning patient safety has been a SAFE report (not sure what this is called at other facilities) and furthermore contacting unit managers and as high up as the chief of medicine (yes, I've also asked for an audience with the President of the organization). It's important to face the truth with professionalism and protect what is important. I encourage all to utilize this.

Either way, I am glad that we all can see what the problem is here. That there IS complacency and YES it comes in MANY FORMS. So there it is folks.. There's work to be done!

(Really, it feels like there's ALWAYS work to be done!) : )

Being aware is the first step!

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macawake,

I never accused the OP of anything! If you read the post, the OP is relaying stories that were told to her, she witnessed, read, etc. (I assume told in the first person).

The OP writes:

I am sure that many of you will look at these cases and think words like: negligence, ethical issues, etc. You are right for sure. But what I can also bring to the table about all of these stories is that each of the individuals involved had been approaching their jobs with a complacent attitude. All differing levels, but it was present, and it was absolutely affecting their care.

You go on to say:

I doubt that OP lied to avoid a conflict. Why do you immediately jump to the least flattering interpretation possible?

...I think it's likely that OP lied to try to comfort the patient. She was a student and was likely shocked by what took place and only had seconds to come up with a response/reaction. She tried to be kind. I'm sure that OP can speak for herself but I find your conclusion that avoiding conflict was her only motivation, deeply unfair and probably inaccurate. OP never used the fact that she was a student to excuse anything. She's not defending what took place as "OR humor".

Our profession needs to always have ethics in the forefront of our minds and we accomplish this by talking about it amongst ourselves. In the work we do we face many difficult situations and ethical dilemmas. OP's post is in my opinion an excellent example of reminding us all of this important issue.

So lying to a patient telling her that she was not abused when in fact she was (verbally) abused is ethical to you?

Then you go on to defend her as being a student. So students do not need to uphold the ethics of the profession either?

I agree that discussing these issues are good, but we must also condemn them for what they are.

Please, describe lying to a patient about being abused in a "flattering interpretation."

The facts remain, a patient was abused and a student lied to the patient about the abuse.

Then you berate me for pointing this out as if somehow I am in the wrong.

...I practice in a way that I am at peace with my moral/ethical compass. However if I wasn't, the method most likely to get through to me and make me change my behavior would be calm reasoning and discussions, not being browbeaten by someone who most likely hasn't even faced the challenges of my profession.

I suspect this is true for most people...

Have you ever been abused as a patient or worked with people who have been abused as a patient? They are no different in their pathology from people who have suffered sexual or physical abuse.

...The patients benefit in the sense that there will be trained nurses and doctors available ten, twenty and thirty years from now when the current ones have retired.

If students aren't allowed to watch and when appropriate participate, there won't be a next generation of healthcare providers/professionals...

This way of thinking is absolutely wrong! This PubMed examines the ethical issues and defines what is a benefit to the patient. Read:

Refuting patients' obligations to clinical training: a critical analysis of the arguments for an obligation of patients to participate in the clinical education of medical students.

Waterbury JT. Refuting patients' obligations to clinical training: a critical analysis of the arguments for an obligation of patients to participate in the clinical education of medical students. Med Educ. 2001 Mar;35(3):286-94. PubMed PMID: 11260453.

...I'm not sure why you feel that having a student present for a procedure equates a loss of dignity for the patient....

The colonoscopy by its very nature is undignified. That is what I referred to, that this procedure is so much more undignified that simply taking vitals. Again you are focussing on the student/nurse. This deficit thinking is just further example how the patient is not put first.

...I've had two coworkers, one nurse and one physician, ask me to be their pacu nurse after their surgeries. They did so because they think that I'm a good nurse and I was both flattered and honored. They didn't however request me because the other pacu nurses are prone to "negligence, ethical violations, human rights violations, criminal conduct and abuse"...

It is commonly known that providers (physicians, nurses, etc.) are VIP patients and treated differently than regular patients. They do not have to worry, but many providers worry about loved ones going in for treatment who are regular patients.

See: Groves, J. E., Dunderdale, B. A., & Stern, T. A. (2002). Celebrity Patients, VIPs, and Potentates. Primary Care Companion to The Journal of Clinical Psychiatry, 4(6), 215–223.

...I've asked that a specific physician care for a person close to me. Again, not because I believe that most other physicians are evil, but because I have great confidence in theskill of this particular doctor....

Did you also ask for a bunch of students so that YOU could receive the "benefit in the sense that there will be trained nurses and doctors available ten, twenty and thirty years from now when the current ones have retired?"

...feels like you're on a crusade...

I am not Obi-Wan Kenobi, King Henry II of England, or King Philip II of France. Everything I have spoken is truth.

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All of your points go to show that there is room to grow, for everyone. For us to point fingers and say that x, y, and z are the exact culprits is a bit extreme.

I never point fingers. When one points a finger at someone there are 3 fingers pointing back at one's self.

I honestly believe that behavior in the workplace is just as much a trickle down situation as it is with one's own ethical standards. What happens at the top will also occur at the so called "bottom". Big whigs are just as responsible as the bedside, no matter what we all face on a day to day basis. What we are given has to be put to the test with what we KNOW is right. We ALL need to perform to our best ability and also be willing to accept when we're wrong. Our role models and our own ethical standards make us who we are. We have to choose what we will do with that power.

Forgive me, but to a patient this would all sound like sitting around and singing "Kumbaya." How do you reconcile causing harm with the ethics of "do no harm?" There is no excuse that any patient should ever be harmed. "Why should a patient ever have to "accept when you're wrong?"

That was my very point about "complacency." It is this abstract concept that we cannot point to and blame for these and many other failings. Being abstract bakes it difficult to change and it is just accepted as a "ghost" that haunts healthcare.

In all this debate I have heard nothing about accepting responsibility. I have heard excuses made for the student (being a student) and a consensus for improvement. There seems to be no recognition of the patient as an individual.

Why is there no rage about this? The same reason that the whole room laughs at the joke and no one expects any accountability to the patient.

This is the attitude that cellphone companies, utilities, and most big corporations take; "It does not have to be good, only good enough."

I ask you Jacqueline.Damm, can you not see my point here?

When you allow the excuse "she was a student," you then allow "our role models and our own ethical standards make us who we are."

Going back to the colonoscopy story you relay, I accept "complacency" for all who heard the joke, but what about the one who told the joke? What is their excuse? Even more troubling is why all the ones who heard the joke (sans the student) find that behavior acceptable?

This is what is referred to as the hidden curriculum.

See:

Phillips SP, Clarke M. More than an education: the hidden curriculum,

professional attitudes and career choice. Med Educ. 2012 Sep;46(9):887-93. doi:

10.1111/j.1365-2923.2012.04316.x. PubMed PMID: 22891909.

Karnieli-Miller O, Vu TR, Frankel RM, Holtman MC, Clyman SG, Hui SL, Inui TS.

Which experiences in the hidden curriculum teach students about professionalism?

Acad Med. 2011 Mar;86(3):369-77. doi: 10.1097/ACM.0b013e3182087d15. PubMed PMID:

21248599.

Rogers DA, Boehler ML, Roberts NK, Johnson V. Using the hidden curriculum to

teach professionalism during the surgery clerkship. J Surg Educ. 2012

May-Jun;69(3):423-7. doi: 10.1016/j.jsurg.2011.09.008. Epub 2011 Nov 3. PubMed

PMID: 22483148.

Coulehan J, Williams PC. Conflicting professional values in medical education.

Camb Q Healthc Ethics. 2003 Winter;12(1):7-20. Review. PubMed PMID: 12625198.

Oancia T, Bohm C, Carry T, Cujec B, Johnson D. The influence of gender and

specialty on reporting of abusive and discriminatory behaviour by medical

students, residents and physician teachers. Med Educ. 2000 Apr;34(4):250-6.

PubMed PMID: 10733720.

I think it's likely that OP lied to try to comfort the patient.

The student demonstrated that the lessons of the hidden curriculum were learned by the student lying to the patient.

Lying is justified as aceptable because it comforts the patient.

Everybody seems to accept lying to a patient is acceptable but me.

The lessons of the hidden curriculum are reenforced and lying to a patient becomes the status quo.

...but we should try to do better.

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Specializes in Critical Care, Education.

This is a great thread. Lots of thoughtful responses that really resonate with newbies and experienced nurses alike.

Being a patient advocate is not for sissies. It takes courage to call attention to sloppy practice - and take measures to correct it. If you're a staff nurse, your sphere of influence may be limited, but there are actions you can take. Use the tools available such as incident or 'near miss' reports. Use the ethics line. From a professional standpoint, complacency = collusion. If you don't speak out, you are also part of the problem.

Nurse managers need to enforce accountability, but they cannot do so if they are not aware of slipshod practices via incident reports or other quality/safety mechanisms. Change starts with us.

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macawake,

Then you berate me for pointing this out as if somehow I am in the wrong.

I was simply trying to convey to you that if your goal is to have an impact on healthcare professionals, attempt to inspire ethical behavior among them and be a champion of mistreated patients, your current strategy might not be the best.

Personally I seldom take the advice from what I perceive as angry people with rigid and set in stone opinions in real life, and I'm even less inclined to do so on an anonymous forum.

Of course I don't know what you wish to achieve with your posts, I'm just guessing that you want to increase healthcare professionals awareness of a subject that you find very important. ?

Have you ever been abused as a patient..

That would quite frankly be none of your, or the internet's, business.

or worked with people who have been abused as a patient?

I know, have met and have worked with many people who've been abused in many different ways in many different settings.

It is commonly known that providers (physicians, nurses, etc.) are VIP patients and treated differently than regular patients. They do not have to worry, but many providers worry about loved ones going in for treatment who are regular patients.

No doubt there's an advantage in having knowledge about specific providers. I think that you're missing my point though. The inside scoop I might have is who's the most skilled physician or nurse. Just like in any other job, some are very good and others are more average. There's nothing strange about that. But again, it's the healthcare professionals skill I have information about, not this:

negligence, ethical violations, human rights violations, dignity violations, criminal conduct, abuse, etc.

As I've told you before; the above isn't something I witness on a regular basis. I don't think it happens as much as you seem to think it does.

The colonoscopy by its very nature is undignified. That is what I referred to, that this procedure is so much more undignified that simply taking vitals. Again you are focussing on the student/nurse. This deficit thinking is just further example how the patient is not put first.

I still don't understand why having a student nurse or doctor present is automatically at the cost of the patient's dignity or modesty. When I was a student I always asked the patient's permission and never had a problem getting it. I feel like you're not hearing me.

From your previous threads I've noticed that it's usually surgical/invasive procedures (usually involving the nether regions) that you seem to focus on. In this thread it's the colonoscopy. I agree that it's an ugly example but I must tell you that as a nurse I find some of the other incidents mentioned by OP equally, or even more, scary. They're all bad though.

Did you also ask for a bunch of students so that YOU could receive the "benefit in the sense that there will be trained nurses and doctors available ten, twenty and thirty years from now when the current ones have retired?"

No, I didn't specifically ask for "a bunch of students" but two were actually present for the procedure. And they both asked for and received the patient's permission.

Nor do I personally, in case you're wondering, mind having students present when I'm the patient.

This way of thinking is absolutely wrong! This PubMed examines the ethical issues and defines what is a benefit to the patient. Read:

Please note that I didn't say that patients have an obligation to allow the presence of students, but we'd be in serious trouble if all patients said no.

Are you arguing the point that if all patients denied students access, that one could produce competent healthcare providers? Would you want to be treated by an RN or MD whose first real live patient contact is you? I'd be scared senseless and I definitely prefer that they learn as students under the supervision of an experienced provider.

Then you go on to defend her as being a student. So students do not need to uphold the ethics of the profession either?

Of course they should.

If you can, try to put yourself in this student nurse's shoes for a moment...

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I was simply trying to convey to you that if your goal is to have an impact on healthcare professionals, attempt to inspire ethical behavior among them and be a champion of mistreated patients, your current strategy might not be the best.

Personally I seldom take the advice from what I perceive as angry people with rigid and set in stone opinions in real life, and I'm even less inclined to do so on an anonymous forum.

Of course I don't know what you wish to achieve with your posts, I'm just guessing that you want to increase healthcare professionals awareness of a subject that you find very important. ?

You seem to give advice anonymously.

I just speak truth....

That would quite frankly be none of your, or the internet's, business.

I know, have met and have worked with many people who've been abused in many different ways in many different settings.

I will just take that as "NO" and "NO."

No doubt there's an advantage in having knowledge about specific providers. I think that you're missing my point though. The inside scoop I might have is who's the most skilled physician or nurse. Just like in any other job, some are very good and others are more average. There's nothing strange about that. But again, it's the healthcare professionals skill I have information about, not this:

I am not talking about the doctor's skill, I am talking about watching that other people in the room are not making jokes about the patient.

As I've told you before; the above isn't something I witness on a regular basis. I don't think it happens as much as you seem to think it does.

I don't see murder on a regular basis, but I am sure it happens much more than anyone thinks.

I still don't understand why having a student nurse or doctor present is automatically at the cost of the patient's dignity or modesty. When I was a student I always asked the patient's permission and never had a problem getting it. I feel like you're not hearing me.

It is the procedure itself that is undignified. Has nothing to do with who is in the room.

Please note that I didn't say that patients have an obligation to allow the presence of students, but we'd be in serious trouble if all patients said no.

So what are you saying. Sounds to me like.......

Are you arguing the point that if all patients denied students access, that one could produce competent healthcare providers? Would you want to be treated by an RN or MD whose first real live patient contact is you? I'd be scared senseless and I definitely prefer that they learn as students under the supervision of an experienced provider.

Ethically it is the responsibility of the profession to competently train the next generation of practitioners. If all patients refused, I am sure the healthcare professions would return to "peer training" (as they once did).

Unlike the other situations, the colonoscopy one had the (i assume student) nurse actively participate in the abuse where the other cases was passive participation.

By your own words you continue to defend the student and refuse to acknowledge the abusive nature of the student's actions.

If you can, try to put yourself in this student nurse's shoes for a moment...

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