Public Humiliation In Healthcare

[TheCommuter]

Close your eyes for a moment and imagine that you are Denise, a 46-year-old newly graduated nurse who works the night shift on a medical/surgical unit at a 170-bed community hospital. Denise, who had a successful first career as a high school biology teacher for 20 years before having decided to become a nurse, completed a 12-week new grad program at the hospital and has been off orientation for approximately three weeks.

One of Denise's six patients is the very pleasant, morbidly obese 40-year-old male in room 503 who had undergone a bilateral total knee replacement two days ago. Although this patient is pleased that he is going home tomorrow morning, he senses that something just isn't right. He tells Denise, "My right knee feels like it's on fire. It feels hot and it's hurting really bad. The pain medicine isn't working, either."

"Let me take a look," she responds with a reassuring smile. With gloved hands, she gingerly peels the dressing off and is horrified to see that purulent drainage is oozing from the stapled surgical incision. The area around the wound is slightly reddened, swollen, and very warm. She cleanses the wound, covers it with another dry dressing, and applies an ice pack to the area. Denise asks, "Did your surgeon see your incisions this morning?"

"Yes," the patient replies. "He said it looked fine. The knee's been burning since this morning, but he said it would go away in a few days."

She chimed, "I'm going to call your surgeon again to express our concerns. There's even a small chance that he might still be in the hospital since one of his procedures today took a lot longer than he planned." The patient nodded in acknowledgement.

Denise has dealt with this orthopedic surgeon on previous occasions. He is in his thirties, seemingly laid-back, and usually respects the concerns of the floor nurses. She calls his cellular phone number; the automated voice mail message popped on. She leaves a detailed message regarding the patient's right knee.

Suddenly the internal medicine doctor scuttles to the nurses station and slams a chart onto the floor. It is 7:45 in the evening. Several nurses, visitors, and the house supervisor are jolted by the sound of the chart as it struck the floor. With a heavy Spanish accent, she yells out, "Who in the hell is the nurse of my patient in room 303?"

"I'm his nurse," Denise responds with assertion in her voice. "What is the problem?"

The doctor rolls her eyes in disgust. She screams, "You must be the most stupid nurse on the planet! His knee is infected and you haven't done a damn thing about it! He's been complaining about that knee all day!"

Denise takes a deep breath and silently counts to ten while the house supervisor whisks the internal medicine doctor into the patient's room. She had never been publicly humiliated by any colleagues or adults during her years as a teacher. This was new to her. She could feel the rage building up inside.

______________________

Humiliation involves the experience of some form of ridicule, scorn, contempt, or other degrading treatment at the hands of others (Klein, n.d.). The humiliated person feels disrespected, lowly, and debased during and after the incident. There are three involved parties: 1) the perpetrator exercising power, 2) the victim who is shown powerless and therefore humiliated, and 3) the witness or observers to the event (Emotional Competency, n.d.) Healthcare workers may experience public humiliation from colleagues, patients, visitors, and others.

Individuals who have been publicly humiliated have several ways in which they can deal with the event. They can call the perpetrator out on his/her behavior and risk further humiliation. Or, they may reassess the public humiliation in a manner that points to one's perseverance in the midst of unpleasant circumstances. The final option is to exit the environment where the public humiliation is taking place.

The most effective way of handling public humiliation is to keep it from happening in the first place. Healthcare providers and workers need to be educated on the damage that humiliation can inflict on the human psyche. In addition, a little self-esteem goes a long way, because it is almost impossible to humiliate the person whose sense of self does not hinge on what others think.

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[sj20fame]

Commuter - - It was not a bit clear from your original post where you wanted to go with this. The fact is, behavior in the healthcare setting has gotten worse, not better, over the years. Many many years ago I was floated to an ortho floor, totally unaware that a particular MD had 'standing orders' for his post-op patients. They were written on a piece of paper that the head nurse had in her drawer. She was off that day, and I was the only RN on the floor. So a patient came back from the OR with NO ORDERS. I called repeatedly to the OR, and to the supervisor, for orders. The supe apparently knew the situation but didn't know where these orders were kept. Long story short, the patient was 4 hours late getting her first dose of post-op antibiotics and this doc starting screaming at me in front of the patient and up and down the hallway. I wrote a letter of complaint about the way I was treated. The letter ended up in MY personnel file!!! However, the supe didn't write up an incident report against me that I was ever aware of. And I refused to float to the ortho floor ever again.

Years later, I watched an angry doc hang up a wall phone in anger - so hard that the phone came off of the wall. And nothing was done.

I taught for a time at a small school, and on payday our checks didn't arrive. I called the person who was supposed to take care of that, and he was not at work that day. So I asked to speak to his boss, who was not happy that I 'bothered' him. Ten minutes later, the person responsible called me back, screaming at me. I held the phone up so everyone could hear this, and calmly stated for him to call me back when he could speak to me in an appropriate tone, and I hung up. He called right back and spoke through clenched teeth. Our checks arrived the next day. But obviously our relationship was broken.

Why do we allow our peers and superiors to treat us so poorly? Why are so many of us afraid to say 'STOP'?

Why are people allowed to be preceptors without appropriate training?

What has happened to plain old civility???

If I get incorrect change in a store, I was taught to say 'Can you recount this for me, please?' Not scream and shout at the cashier.

As Rodney King once said - 'why can't we all just get along?'

I love this, WHY CAN'T WE ALL JUST GET ALONG ?

[sj20fame]

I work in an office as an admin, and this occurs here as well. It happens everywhere not just in the healthcare industry. With that being said, I'm a strong believer of standing up for yourself and standing up for your rights. No one has the right to come at you in a way to "attack", especially when we are all adults. I feel so bad for the people that let it get done to them and don't say a word(ex. co-worker of mine)

In my situation my supervisor came at me in such an unprofessional way yelling at me and telling me that she see's me on the internet all the time, and asking me if I was not happy with my job, and went on and on and on. Everything that she said to me was her yelling at me and out in the open since I'm at the front desk. She did not pull me aside(this was my first time getting in trouble in 5 years), I was STUNNED. I couldn't get a word in, I couldn't even think. All I remember is feeling the anger come over me, and I knew that if I said a word, all hell would break loose. With that in mind, I took a breath, admitted to my fault, and told her it wouldn't happen again. The next morning I asked to speak with her in the VP's office (VP was out of town) and when we went to the office I told her everything that was on my mind with out yelling without any bad words, I bluntly told her that I'm shocked she came at me that way since she is the office manager/HR mgr, She should know better and told her how unprofessional she was. She apologized admitted to her fault and we moved forward, plain and simple!

[DawnJ]

I agree that I've seen this in other fields and the tolerance of it is set at the upper management level. Specifically, the WORST place I ever worked was daily yelling and intimidation. Then the privately owned company was sold to a large well known corporation and very quickly those who couldn't control thier behavior left for other jobs.

I guess I can lean on my years with the bad company as experience for dealing with bad behavior in healthcare. Not looking forward to it, but I'm confident I can handle these yahoos.

[imintrouble, BSN, RN]

I have worked at the same facility for more than ten years. The MDs who verbally attacked, mercilessly I might add, ten yrs ago, are still attacking today. Nothing has changed. Since I'm honest, I'll admit it happens a little less frequently, but it hasn't stopped.

It doesn't take a rocket scientest to figure out it's not going to stop.

Since we can't stop the attacker, we can prepare ourselves for when it happens. I run scenarios in my head. When I have a pt that has one of these MDS as PCP, then I mentally prepare. Even when my shift has been uneventful.

[TheCommuter, BSN, RN]

It doesn't take a rocket scientest to figure out it's not going to stop.

Many facilities, especially the private for-profit places, will coddle the immature doctors because they are viewed as the ultimate 'money-makers' for referring patients that generate profits. Therefore, many of these places tend to tolerate tantrums, vertical bullying, and other despicable treatment because they do not want the childish physician to take his/her business (read: paying patients) elsewhere.

I have noticed more respectful treatment of nursing staff at major teaching hospitals, county-owned facilities, and nonprofit places.

[funky monkey]

I think the way the nurse responds depends upon many things. First, the personality of the nurse. When I graduated I was much more timid then I am now. Quite frankly some physician's terrified me. Secondly, the milieu of the hospital. Some facilities protect their physicians at all cost and a confrontation with a physician is always a losing battle. Thirdly, the environment in which you work. Some facilities I've worked in we supported each other to the hilt. Others, I was afraid to turn my back on my co-workers.

The article does not state if the nurse had seen the patient before or if she had just come on her shift - doubtful as it was 7:45 pm. Regardless, today, after years of nursing I let no one speak to me like that. Bullying by anyone is not acceptable. I would stand my ground and tell the physician that they were rude and unprofessional, that I had dealt with the problem and when they could speak to me like the professional they pretended to be, we'd speak, but not before. I would then go back to whatever I was doing.

If you don't command respect, you won't get it.

[Double-Helix, BSN, RN]

It's not just nurses who receive this kind of treatment. I've heard attendings berate residents in front of patients, family and other residents. I've heard nurses criticize CNA's in the nurses station. I've heard nurses yell at other nurses. It exists in all areas (and in all professions).

The fact is that some people take advantage of their position and think it is acceptable to treat their colleagues like dirt. As long as nothing is said or done about it, it will continue. Each of us, as individuals, need to learn to stand up for ourselves and our colleagues- whether it be a CNA, a fellow nurse, or a resident. There is absolutely nothing wrong with saying to a doctor, "It's not acceptable for you to speak to me like that. On this floor, we talk to each other like adults- with respect. If you continue to behave this way, I will be notifying your supervisor."

I believe that if we, collectively, took a stand in informing these people (whatever their job title) that we do not tolerate bullying, then we could change the culture of our workplace and this type of interaction would become the exception, rather than the norm.

[rnoutlaw]

Hi. I'm an older RN. I've been on somebody's payroll since I was 16 except for full-time college, serious illness, and the recent severe economic struggle. I've had all kinds of jobs - farming, retail, fast food, secretarial, corporate, you name it, and the most unprofessional people I've EVER worked with in 29 years of job experience have been in HEALTHCARE. It ain't you folks, trust me: this profession has a real problem with professionalism, hostility, respect, and understanding rank. It's costing units a lot of money to train nurses only to have them leave to go somewhere else because coworkers are humiliating and threatening. Not only that but when anger becomes a way of life, patient safety and care suffers. Professionalism needs to be part of training/orientation for all levels of healthcare personnel, and managers must reinforce rank because without any social organization, scope of practice and appropriate authority flies out the window. Also, women need to understand the concept of TEAM. A team is a unit that values its members and works together cooperatively, including the unit manager. Unit managers must know that if you write people up for every teeny tiny thing, then eventually, you ain't gonna have a staff.

[minnymi]

There are over 600,000 allnurses members....just think, if we truly banded together, oh the things we could change!

in a perfect world...

unfortunately, it's been proven on this very thread that can't happen

[TheCommuter, BSN, RN]

. . .the most unprofessional people I've EVER worked with in 29 years of job experience have been in HEALTHCARE. It ain't you folks, trust me: this profession has a real problem with professionalism, hostility, respect, and understanding rank.

Bingo!

[CathRN]

When I worked CVOR and reported the surgeon for throwing scapels, bloody towels, clamps, etc. I was called into the OR manager office and told "The surgeons bring in the money, nurses are a liability" We have worked with this surgeon for over 20 years and that is the way things are. I immediately put in my 2 weeks notice, then told my manager that I would be filing assault charges.

[jadelpn, LPN, EMT-B]

I definetely would say in a low tone of voice and in a calm manner "When you are through and prepared to listen to the interventions that have been implemented, I will proceed" Then back to what you were doing. I don't enjoy yelling over people, being a party to tantrum throwing, nor trying to figure out which doctor is winning the pis*ing contest. (as noted the surgeon was aware....and MAKE sure you document that). (When I would LOVE to say "do you speak to your mother like this????)