Knowledge or Information Hoarding

[LisaDNP]

I'm interested in hearing any of your experiences with nurses or other medical personnel deliberately not sharing important information that could or did have an effect on patient care. I know I've experienced this in the past with the "offender" stating they just wanted to see how long it would take me to figure so-and-so out. A trial by fire in their eyes, but a danger to a patient in mine. Anyone want to share?? Thx, Lisa

[flashpoint]

I can relate to this. I work with a nurse who will pass things on in report like, "We're still putting cream on that area." So, I ask..."What cream to what area?" and she responds with, "You don't know? Jeez...check the treatment sheets!" When I check the treatment sheets, I find something like, "Kenalog to affected area BID." I end up spending fifteen minutes going through the chart to find out what the affected area is. I also seem to walk out of report a lot and hear something like, "Your next neuro is at seven." When I ask for more information, I get responses like, "After someone falls, we do neuro checks!" One nurse also does things like get orders for lab and not put it in the lab book, yet is annoyed when the night shift doesn't manage to get the urine sample or draw the blood. When the night nurse defends herself by saying it wasn't in the book, the day nurse says things like, "I don't have time to do everything!" We also seem to have a bad habit of only passing things on to one shift and that is it. Things like a cancer diagnosis, medication changes, falls, change in condition, etc need to be passed on for several days.

I don't think all of it is intentional. Sometimes I think we just forget that just because we know something, that not everyone else does. I also think that friendships outside of work can cause problems. There have been many times something has happened in my shift and when I try to pass it on in report the next day, everyone already knows about it. We have a lot of employees who are socialize outside of work and they seem to spend a lot of time talking about work!

[cookienay]

I have experienced this during my very brief management career. Although our facility's culture has changed dramatically since then, I still wince when I think of it. Here goes:

We did not have a quality director at that time. This was done by the managers and the various facets were assigned. As a new manager I relied on the info given to me by the others, especially the team leader, to know what to do. My assigned part seemed very straightforward. Fast forward a couple of months and it seems I was leaving out very important info in my reports. (These reports were compiled together into one and that was where we got our quality stats that was reported to JCAHO, medicare, etc...) The team leader failed to advise me of all the necessary components required for submission. Yes, there were many areas in which I could have been more proactive, and yes, I was waaay too naive to think she would not knowingly withhold info. But that is what I thought.

It was more a lot of little things than that one big thing that led me to believe she was withholding info on purpose:

*asking me questions (about withheld information) in front of the VP just to make me look stupid.

*making rounds on my unit (huh?)

*completely ignoring questions I would ask regarding the quality issues/data (in front of everyone)

*questioning me publicly on why I did this or that, what is my plan to correct problem xyz, how could I not know blah, blah, blah....

Looking back I realized that this was a case of lateral violence. Add to this the daily harassment I was receiving by a physician, one could understand why I got the heck out of dodge. I left mgmt, went to the ER and have been there forever. The offending manager left abruptly due to health reasons, and eventually her BFF the VP was fired. I later discovered that the VP shared my evaluation with several other managers. I can't say that management is still that hostile of an environment, I just know I will NEVER go back.

So, to respond to the OP: Yes information hoarding exists, I am certain it affects patient care and outcomes, and creates alot of problems.

How I dealt with is was I left, because it went all the way to the top. THere was nothing I could do differently. I just wanted to run a good unit that gave good care. I did not have the time or inclination to deal with all the other crap. Hopefully, you have other options. Good luck to you.

[KeyMaster]

Sadly yes I've seen this happen. To many, knowledge is power. If they have the knowledge and you don't - guess what - in their mind (and unfortunately in the mind of some management) they have just validated their existence and assured their job security over yours. It may be that they get some sort of self-esteem boost from making you look bad or it could be that they are trying to make themself indispensable. I worked with a manager who was THE ONLY ONE who knew how to calibrate and troubleshoot a complicated piece of equipment. She even kept some of the parts locked in her personal locker, because security had a key to her office. Her excuse for not training others was that it was rarely used and that everybody would just forget what to do anyway. She made darn sure whenever we had to use that piece of equipment (it was an old ventricular assist device) she had to be the only one to run it. She even made sure the docs knew that the rest of us were incapable of caring for a pt on that VAD. It was all about power and security.

[Ruby Vee, BSN]

i think it depends on how you would define information hoarding. are we talking about the experienced nurse not telling a new grad what a drug is in an effort for them to encourage finding out on their own? i've seen plenty of folks complain about that but i don't really consider it such a bad thing...

or, are we talking about watching you give depakote ivp rather than telling you that it needs to infused over an hour (or saying you can't give it ivp and need to look up the proper administration).

sometimes giving information will make a person's job easier, but that's not always the best way for them to learn. allowing a patient to come to harm rather than provide information is a bad thing, allowing a co-worker the opportunity to figure something out on their own (even if they'd rather be spoon fed!) may not be.

sometimes the only way to get information to stick is to look it up yourself. if i just go ahead and tell you you cannot give dilantin through your tpn infusion, you may never remember it. but if you look it up yourself, you will. while allowing a patient to come to harm in pursuit of teaching a lesson is a bad thing, spoon feeding information is also a bad thing.

[morte, LPN, LVN]

sometimes the only way to get information to stick is to look it up yourself. if i just go ahead and tell you you cannot give dilantin through your tpn infusion, you may never remember it. but if you look it up yourself, you will. while allowing a patient to come to harm in pursuit of teaching a lesson is a bad thing, spoon feeding information is also a bad thing.

yes and yes

[LisaDNP]

sometimes the only way to get information to stick is to look it up yourself. if i just go ahead and tell you you cannot give dilantin through your tpn infusion, you may never remember it. but if you look it up yourself, you will. while allowing a patient to come to harm in pursuit of teaching a lesson is a bad thing, spoon feeding information is also a bad thing.

right, and of course that is not what i was referring to at all.

i can't tell you how many times a week i tell my son to "look it up" instead of giving him the answers!

i'm looking for incidents more like cookienay and keymaster described.

[caliotter3]

I would report this to the supervisor and if asked by the offender, tell her you wanted to see how long it would take her to figure it out.

[cb_rn]

Sadly yes I've seen this happen. To many, knowledge is power. If they have the knowledge and you don't - guess what - in their mind (and unfortunately in the mind of some management) they have just validated their existence and assured their job security over yours. It may be that they get some sort of self-esteem boost from making you look bad or it could be that they are trying to make themself indispensable. I worked with a manager who was THE ONLY ONE who knew how to calibrate and troubleshoot a complicated piece of equipment. She even kept some of the parts locked in her personal locker, because security had a key to her office. Her excuse for not training others was that it was rarely used and that everybody would just forget what to do anyway. She made darn sure whenever we had to use that piece of equipment (it was an old ventricular assist device) she had to be the only one to run it. She even made sure the docs knew that the rest of us were incapable of caring for a pt on that VAD. It was all about power and security.

WTH? Did she intend to work 24 hour shifts if you had someone on the floor with that VAD?

[TDCHIM]

I haven't experienced this in a direct patient care setting, but I've been through it in other professional settings, and it's miserable. The situation I went through was similar to cookienay's, and unfortunately I had to leave the job for reasons that were similar to hers. I wish I could give you some good advice on how to deal with it effectively, but it seems as though this sort of scenario flourishes when the info hoarders are well-connected in management and the leaders allow (or sometimes even foster) the behavior to continue. It is a very passive-aggressive move, so perhaps being direct with that person ("Is there a reason you didn't share that information with me earlier? That lapse clearly had a negative impact on the patient.") in front of a reliable witness might be a way to short-circuit it. Many passive-aggressives will back off when you call their bluff in a calm, confident way a few times. However, that's just a theoretical suggestion; I haven't test-driven it in that sort of professional situation, only in personal equivalents.