Nursing: Taking Back Our Power

[oramar]

:urck:

A few months ago, I wrote an article on Allnurses about dealing with annoying co-workers. During the time I wrote that article I was mired in negativity about my nursing career in general. I would wager a bet that every nurse has been there at least one time in their nursing career.

I am not a positive person by nature. Unlike naturally positive people, I have to work at it. I want to be positive. I feel better when I am positive, but sometimes the negative bug bites me and won't let go. I am a voracious reader of psychology and "self-help" books and articles. They give me insight into the human psyche and help me understand my trigger points.

One of my trigger points is feeling a loss of control. I am no dummy. I know that a higher power is really in control of my life, but He sometimes lets me think that he is in control just so he can have a good laugh. Anyway...When I am feeling overwhelmed and under appreciated at work, I feel a loss of control. I like the illusion that I have a handle on things. When I lose my grip, I tend to get morose and negative.

A fellow Allnurser called me on some things I said in the aforementioned article (thanks, Interleukin) and I have been thinking of what he said ever since. I am glad he commented, because it made me clear my head and regroup.

I want to share with you the things I learned on this little journey of reflection. In nursing school, what we are lead to believe is that we will "practice nursing". I don't know about you, but I don't practice nursing...I do nursing, for 12 hours straight, often with no breaks.

For some reason, doctors, patients and administration seem to hold nurses to a higher standard than others. By this, I mean that they seem to think that nurses should tolerate the abuse dished out on a regular basis. They should gulp it down and say "Thank you sir, can I have some more?". Well, guess what? This nurse has had enough. I am not going to take it anymore. From now on, I am standing my ground. I am taking back my power.

According to Dictionary.com, the term "abuse" means to a. to use wrongly or improperly, b. to treat in a harmful, injurious or offensive way, c. to speak insultingly, harshly and unjustly to or about, and d. bad or improper treatment. Do any of these definitions describe your work environment?

Nurses are feeling demoralized, frustrated, discouraged and repressed. Rules and policies put in place by administrators who have never set foot on a nursing floor are the norm. They have a very unrealistic view of the process of nursing as a whole. By their choice, they have put blinders on, plugging away for the almighty dollar, while their nursing staff, the CORE of the hospital, takes the brunt of patient dissatisfaction. Most nurses are compassionate, caring people. One reason they decided to be a nurse was to be on the front lines of patient care. Yet, every day, nurses leave the nursing profession citing overwhelming stress and emotional fatigue.

We try to be patient advocates. We try to set limits with difficult patients and demanding families, but administration does not back us up. Instead, when complaints arise, it is often the nurse that the blame falls back on. As nurses, our plates are full, but each week seems to bring more and more responsibility and paperwork. The more we do, the more we are expected to do.

Co-workers and doctors often add to our stress level. As more nurses become disillusioned with nursing, it shows. We become disgruntled, short tempered and discouraged. Once the moral of the unit starts to suffer, it is very difficult to correct. Dealing with doctors who are less than cordial often causes unrelenting stress. I have seen nurses cursed, backed in a corner, called names and screamed at in front of their peers. All in the name of health care. Not once, have I heard a physician called down for this type of behavior. Why do we tolerate this?

One reason may be because we feel that, as professionals, it would rock the boat if we complain or stand our ground. We are afraid of being labeled "troublemakers". Well, I have decided that from now on, I will not allow myself to be talked to or treated in a rude or obnoxious manner. I will stand up to the person who is verbally abusing me. I deserve to be treated with dignity and respect.

Administrators, doctors and peers are not the only ones who can dish out abuse. The people we are paid to take care of, our patients, are often the worst offenders. For whatever reason, patients, and often times, their family members, can be verbally and physically abusive. Demented patients have an out. They are confused. But patients who are not confused should not be allowed to physically assault health care staff, nor should they use threatening language. Yet, again, it is tolerated.

As nurses, we need to take back our power. We need to start saying "No" to abuse, "No" to unsafe nursing ratios. We need to document and fill out incident reports on every incident that makes us uncomfortable. That seems like a ton of extra paperwork, but it must be done. If you are a supervisor, you need to support your staff, plain and simple. Your staff will respect you for it. Do not allow patients and their families to mistreat you. Let them know that their behavior is unacceptable. If they take it to administration, deal with it by handing management a letter detailing your side of the story (keep a copy for yourself). There are two sides to every story. More often than not, nurses are not allowed to share their point of view. Same with doctors. Stand your ground.

Nurses need to support their fellow nurses. Let them know that you've got their back. Encourage them. Lift them up. Acknowledge their positive attributes.

In 2007, a bill was placed before congress. It is called the Registered Nurses Safe Staffing Act of 2007. Basically, if it passes, it would make it a law that hospitals would have to have safe staffing ratios or face big fines. Other nursing issues are also discussed in this bill. The American Nurses Association (ANA) supports this bill. If you are concerned about the future of nursing, write your congressman and ask for their vote on this issue.

One more thing: Stay Strong! :)

[BeccaznRN, RN]

I have found myself in your positions many times in my very short nursing career. I work with a MD who is notorious for treating nurses like second-class citizens who have no brain and went to nursing school only to learn how "to count to five" (referring to sponge counts in the OR). Admin and management know about it, have counseled said MD, but MD continues to abuse nurses and everyone has come to accept this treatment because nothing ever gets done or changes. I have been in tears while working with MD, have went up the chain of command regarding the abuse, had charge RN speak with him, etc. and still MD treats nurses with same disrespect. A terrible situation. What gives?

I have taken back my power with this situation by scheduling myself around the call schedule......and if I happen to schedule myself unknowingly when said MD is on call, I call out sick. And I made my manager perfectly aware of what I am doing. I refuse to work under such conditions.

[Bugaloo]

BeccaznRN, Good for you! It is sad when we have to work OUR schedule around a doctor's schedule to avoid working with them.

[Diary/Dairy, RN]

Thank you....

[greatshakes]

Terrific article. thanks so much

hassled

[interleukin]

"I will not allow myself to be talked to or treated in a rude or obnoxious manner. I will stand up to the person who is verbally abusing me. I deserve to be treated with dignity and respect."

Dear Bugaloo,

These are issues of fundamental of self respect. Nurses hate themselves for allowing themselves to be berated and belittled by bullies who need a whipping boy/girl in order to feel superior.

It is endemic in nursing because, in general, females are the great absorbers of injustice. They have forever "kept the peace." Since women dominate the ranks of nursing, their behavior is to smooth and/or absorb abuse rather than confront it. Women have been reared more for politeness than confrontation.

And, to be sure, that is all good...very very good for all of us in a society. But it has created an environment in nursing where this abuse has been allowed to persist for many decades.

But, as I have said many times to new nurses...practice/memorize a few short come-backs in preparation for those times. You will not be ready otherwise for you will be caught off guard and unable to respond.

Try;

1. "When you've calmed down perhaps we can talk."

2. "Your behavior is beneath someone of your position." When you've calmed down we can talk."

3. "I'm afraid your disrespect for me is unacceptable."

In each case, no matter what you say, or what the content is, you must always walk away after your reply.

This act alone immediately cuts the legs off the abuser forcing him/her to reconcile the behavior because he/she will now be talking to air

And if it's an error you made...it makes no difference.

Say..."Yes, I've made a mistake. How can we rectify it?"

If there is no rational response.. Do not just stand there...walk away!.

When you demand respect by behaving in a manner which clearly shows that you respect yourself...you will then get respect from others.

Then, you can help others who are struggling get back their self resepct.

HAVE THE COURAGE TO STAND TALL AGAINST ABUSE...YOURS OR ANYONE ELSE'S

[Music in My Heart]

Nice article...thanks for writing it.

Regarding the "Safe Staffing Act," it sounds like a lot of fluff:

(2) STAFFING SYSTEM REQUIREMENTS- Subject to paragraph (3), a staffing system adopted and implemented under this section shall--

• • • `(A) be based upon input from the direct care-giving registered nurse staff or their exclusive representatives, as well as the chief nurse executive;

• • • `(B) be based upon the number of patients and the level and variability of intensity of care to be provided, with appropriate consideration given to admissions, discharges, and transfers during each shift;

• • • `© account for contextual issues affecting staffing and the delivery of care, including architecture and geography of the environment and available technology;

• • • `(D) reflect the level of preparation and experience of those providing care;

• • • `(E) account for staffing level effectiveness or deficiencies in related health care classifications, including but not limited to, certified nurse assistants, licensed vocational nurses, licensed psychiatric technicians, nursing assistants, aides, and orderlies;

• • • `(F) reflect staffing levels recommended by specialty nursing organizations;

• • • `(G) establish upwardly adjustable registered nurse-to-patient ratios based upon registered nurses' assessment of patient acuity and existing conditions;

• • • `(H) provide that a registered nurse shall not be assigned to work in a particular unit without first having established the ability to provide professional care in such unit; and

• • • `(I) be based on methods that assure validity and reliability.

I'm not sure how any of that protects a nurse from carrying 7 or 8 patients...

[proud2b1]

I can clearly see where you are coming from with this.I have been in ltcf for 15 years.Trust me,I

know for fact that you are not alone.I have so many nurse friends that would agree with you.Your article is so staight and to the point.I am ready to send it to the congress for review..lolNo,but you make such good points.My husband at least has a union,where they at least try to help.In nursing its always them against you when push comes to shove.We have no rights.You know,its one thing to be able to take the abuse from the patient,or even the adm.for the sake of your job,but take the crap we take from the families??It begins to become abusive at times.I really have not had any trouble with family members too much,I can hold my ground pretty good.My fellow co-worker has a family that actually is driving her nutz..She does everything humanly possible for their loved one.Even the doctor doesnt go all out,like she does.They have followed her down the hall and into other rooms,asking about things for their loved one.It is really sad and I wish we could all as nurses rally up and do something for our rights!!I try to take over for her some in dealing with them,especially when I see them making her so crazy,she cant do other stuff..

[interleukin]

They have followed her down the hall and into other rooms,asking about things for their loved one

No, she has allowed then to follow her.

Each nurse make draw limits, whether for herself, the doctor, or the family. If it is affecting her care, she must take a stand and know when the issue originates from herself, or from her inability to draw the line.

[acaringnurse!]

Absolutely! Amen sister! I totally agree and endorse what responses I read. Having been a nurse for a long time and have practiced in different areas of the country, I can atest that my nursing experience has ran parallel to yours. Be prepared that you will not be applauded when you step up for yourself. My charge is to you that you must be gracious and kind. We must speak the truth in love--love for ourselves and for the person who is out of control and have a "cruicial conversation" (I am sure you are aware of the 7 standards of a healthy work environment supported by the American Association of Critical Care Nurses...if not, check out their website at aacn.org--it is a up and coming thing--about true collaboration...also, check out safestaffingsaveslives.com--it is awesome and become a leader where you are, be a solver and not part of the problem, learn out to "partner up" and "manage-up" with your co-workers. As many of y'all have previously written, we choose nursing because we want to help others--such as patients. The probelm that I see is that the concept of what a "patient" is has changed--rather should be called 'consumers of health care'. But this is how it is and there is such a lost of personal accountability in every aspect of our lives. Just yesterday, I received a 77y/o male patient in the ER with a hx of 2 days of diarrhea with a questionable syncopal episode...to make a longer story short, he asked for something to drink and I assessed his age, circumstances and previous health history that cardiac enzymes would be ordered on him and if they were positive that would precipitate a cardiology consult and perhaps a cath--we have cath lab. So it was my advise that it was not in his best interest to drink or eat at this time (I am sure he was thristy and did later wrangle an order fo a bag of NS IV) and proceeded to give him and his family my "nancy-nurse" explanantion and he made gesture with his right hand of a gun and pointed it to me as if to shoot me and his family laughed! Did I share this with my charge nurse...no, because she would have told me to not take it personally but I do to the extent of my interactio/teaching/advocacy as I am the one engaged in a conversation with him. My response to this patient was that he was free to do whatever he wants (he isn't my hostage!) but I am being a patient advocate and am looking ahead and sharing a reasonable esplanation but they aren't bound to follow my advise. Our health care system is in crisis. I wish I knew how to reach more people to take on personal accountablitiy...that is my second love or calling in my professional life but my first is and has always been the bedside nurse...never have wanted a management position. I will continue to run up and down the halls as long as the Lord gives me strength! Just a quick P.S., back to the patient who 'shot' at me, later on his wife as if I could get one of my "girls" to bring her something to eat!

It is so good to have this website and be able to hear that it's not just happening in my little world! Be enoucouraged, just do your best! Take care of yourself and your heart---an empty heart will not have anything to give!:redbeathe

[Fooffies]

Hey! This is a good book for EVERY nurse out there :

http://www.silencetovoice.com/