Abuse in the healthcare field

[Atonement]

Hi, guys. I guess this is more of a vent than asking for advice, because I do plan to escalate this issue and talk to my boss, but you have any input it is much appreciated.

As some of you know, I have been working as a nurse for about 9 months. I have had a lot of difficult patients in my time, but this was just awful.

I don't want to go into the details right now because it's late in the day and I don't feel like I have time to allow myself to think about it because I don't wan to get too upset before bed.

Yesterday I had a patient who physically and verbally abused, and sexually harassed me and other staff members. I was forced to care for this person and expected to enter his room alone multiple times over a 13 hour period.

This is just not ok. The whole day I reached out to other staff members for support and was told things like "This will help toughen you up" and "you can't let people like that get to you" and "you just have to learn to be more assertive" all day. It wasn't until close to the end of the day that the charge nurse called security and the supervisor on staff. Then they went in and talked to him, and told us that if he tried to hurt one of u again they would put him in restraints. While I'm glad they finally did take action, it didn't really help me a lot 13 hours into my shift.

The sad thing is although that was my first encounter with this patient (I had been on vacation), he had been there abusing staff for over a week and no one did anything.

I'm sorry, but I don't WANT to "toughen up" and I don't think I should have to. I realize that being a nurse is a 'hard job', but in NO job should it be the norm for someone to "toughen up" to abuse and sexual harassment. I was legitimately in fight or flight mode for an entire 13 hours and am crying a little now just typing this. I guess it might be a little worse for me as someone for whom abuse is a strong trigger, but I really don't want to have to explain my background to the people I work with, so they're just going to think I'm weak, and maybe they're right, but I don't give a damn. I'll be weak and mentally healthy over hardened and numb to abuse any time.

Right now I'm having pretty bad anxiety about going back to work tomorrow. I'm terrified that he will still be there and they will assign him to me again. And I have a higher probability of being assigned to him because he's racist and even though I am not white, I'm one of the few light skinned people working on the unit, so they thought I was safer than they were.

I'm definitely going to take it up with my manager, and I think she will hear me out. But there's still so much anxiety around the whole situation.

[Karyn]

I am so sorry you had to go through this, Atonement. What a horrible, stressful experience. You're absolutely right that no one deserves to be treated so terribly; the idea that you just need to 'toughen up' is absurd and I'm sorry anyone suggested that was the case.

I wish I had some helpful next steps to suggest, but perhaps one of the other staff can add something. I do think that taking this to your boss is a good move, and I hope you can take care of yourself in the next few days.

[Sunshine]

Oh Atonement, that's terrible.

Talking to your boss sounds like a good idea, certainly. Perhaps you might want to look up the legal situation where you live around matters like these - I know that in my country, no one is required to risk their own safety, not even at the cost of a patients' life. If you worked at one of the hospitals I have experience with, you could not be forced to take care of this patient. But I do not live in the US. So maybe, when you have the time and energy, try to find out what the rules are where you work, just so you know your rights in case your boss should be uncooperative, which I hope she won't be.

At the very least, you should not be required to enter his room alone. I have had to deal with aggressive patients / clients in the past and there was never any fuss made about me demanding that someone come with me. Likewise, I have been "backup" in such cases for other people. And some of the facilities I have worked at have been otherwise pretty shitty and also understaffed.

Keeping my fingers oh so crossed for you! Let us know how you are later, if you feel like it, okay?

[Heather]

I do want to make clear that you have the right to refuse to do anything at a job. By all means, we may lose a job sometimes if we do, but you are by no means obligated to do things like this that you know you cannot handle and that put you in harm's way. Sunshine also said some about this, and I'd cosign all of that.

And in this case, it seems unlikely to me you would lose a job by simply stating to a co-worker that this particular patient is abusive past your abilities, and you need to not be the person providing them care. People get to do that in medical work, including you.

It sounds like you did not feel able to simply say no to this and make clear you needed to be assigned to another person, and not this one. Can you give me a sense of what you feel like kept you from doing that (and if this is ongoing and you haven't done that, what is still keeping you for that)?

I do also want to add that I think it's not just okay, but smart (as well as in your own interest AND something that helps hold good precedents for anyone else with this history), that you have abuse in your life history and may need some limits and helps with doing your job every now and then -- like with this -- because of that. You don't have to say any more than that.

I am thinking about this mostly about you, but I do think it's important to bear in mind that not everyone can provide good care to everyone, and it is always in any patient's best interest that they are with someone who is a good, able fit for them. Not everyone will be, and that doesn't make you or anyone else weak, it just makes you someone who has a sort of disability due to abuse history (PTSD and anxiety from abuse are medical issues, remember, and shouldn't be treated with bias just like other kinds of illness or disability shouldn't).

Perhaps think about it like this: not everyone is going to be able to life a 200 pound patient. Not everyone has the mobility to stand while doing something. Someone Asian isn't going to be the right choice for a patient who is strongly racist and refuses to participate in their own care with an Asian doctor or nurse. None of this is about weakness, just about circumstances and situations that illustrate the fact that not everyone can -- or should -- be doing everything. And that is something employers, including in healthcare, if not ESPECIALLY in healthcare, where room for disabilities or specific needs should be something where there's more awareness, need to make room for, and in many cases, are legally obligated to make room for, no less.

One last thing? Doing and saying what you need to for your own self-care isn't weakness. It's absolutely the opposite. Do what you can to make sure that your OWN perceptions of all of this aren't standing in the way of you standing up for yourself and asking for fair, sound working conditions that are in the best interest of staff and patients alike.

[Atonement]

Sorry it took so long to respond. I got distracted and just wanted some distance from the subject.

To answer your question, I actually BEGGED the charge nurse to reassign the patient, but she refused to saying that I was the only person who could take the patient due to the "fair distribution of workload" and the fact that I was the only light skinned person there that day besides one person who was training a new employee. They were not willing to work with me, and it was the weekend so I couldn't go to my manager.

Also, In most jobs you have the freedom to just walk out and quit. Even if I was willing to lose this job (I'm not sure I could get another one with less than a year experience, and also I'm under a contract that would force me to pay the company money to leave), if I walked out on a patient assignment, I could be legally charged with patient abandonment and would probably lose my license.

Part of the problem is that I have been placed on a neurology unit. So while this is by far the worst, I end up with angry patients with altered mental status almost daily. This was NOT my choice, and as you know the history and what happened in my like in 2010-2011, you probably understand exactly why it's so triggering.

I did end up talking to my boss the next day, and I told her I was having difficulty. I did not tell her about my history, but she probably could make an educated guess.

Today I also talked to the lady in charge of my new grad program, and I didn't hold any of the history back. She suggested that I talk to my manager again, and also get the lady in charge of the new grad program at my specific location involved too. She seems to thing that there may be a way of getting me out of that unit before the full calendar year is up as is required by my contract.

[Heather]

Personally, then, this sounds like that nurse, rather than you, wasn't doing her job as a managing supervisor. We have labor laws here in the states, and workers not being in danger is part of those laws.

I get that you can't just quit -- many of us are rarely in that luxurious position -- but I do disagree that had you refused due to concerns about your safety, that would have been on you in any way. Walking out on a patient is a very different thing from informing a supervisor you feel your safety is at risk by being with them alone and asking they reassign them to someone else who does not feel unsafe.

I would encourage you to do what you are already doing here and keep up with what you can do to get a placement that works for you, and a supervisor who is a better manager.

[Heather]

(That all sounded a bit curt, but you hopefully know I'm not being dismissive and care about you and your feelings. Just in problem-solving mode.

I've actually had the experience of being physically assaulted by someone in my care in a job I really, really needed, and that happened after I made clear to my supervisor before it did the situation felt unsafe to me -- and they only came back after I had already been hurt, and went to pretty great lengths to covers their butts with not having stepped in earlier. So, I can certainly empathize with this situation and I know how much it can suck in all the ways.)

[Atonement]

The thing is, my unit manager is very good, and is always helpful when I reach out to her about these kinds of things. But, she's only there on mon-fri until about 4. So, that's 3 hours without her every weekday, and not having her at all when I work the weekend, which for us is every other week. I suppose I always could have escalated it to the nurse supervisor on duty for the entire hospital, but I feel like dong something that big for what they see as "me complaining about an assignment I don't like" would make me a lot of enemies really fast.

The way the charge nurse system works, since hospital nurses typically only work 3 days a week, there will be at least 3-4 nurses each that take turns being charge. So, I doubt you would be able to find a unit where all 8 charge nurses are people you can depend on.

I guess their rationale was that no one felt safe with that man, and they didn't see why I should be given any special treatment. I guess that's why I do need to share my history with my manager, and I do feel like I can trust her. But I absolutely don't want most of the charge nurses on that floor knowing. Some of them are in various cliques on the unit and I don't think it would be too long before every single person on the floor knew. And I really do feel a need to keep the most difficult personal things I've faced in my life private.Some of my closest friends only know bits and pieces of this story. I think only 2 of my current friends know the whole story.

What I can do, though, is get onto a unit that is more suited to my strengths. I REALLY want to get onto a Labor and Delivery or Postpartum floor. I am so good with those kind of patients and am really passionate about that branch of healthcare, and it's alway where I've ultimately wants to end up, but with all these struggles on my unit, I want it so badly I can taste it.

[Heather]

Perhaps you can ask your unit manager for some advice or help when working with this other supervisor? Or even to call a meeting to mediate and resolve this event?

I'd encourage you (I think I have already said this to you before?) to consider your abuse history to be, in some ways, like a disability. If someone wasn't able to do something because, for instance, they have a pain disorder that thing triggers, or needed specific work because they have mobility disabilities, I don't imagine you'd think those were anything to be ashamed of or that they should hide rather than asking for what they need as far as accessibility goes. Same goes here. Your history -- which effectively created an emotional injury that has lasting and ongoing effects and impacts -- isn't anything for you to be ashamed of and it creates some needs and limitations. And just like with disabilities, you are also entitled to boundaries and privacy with it as needed.

So, I'm glad you're telling your boss, and I also agree with you that you have the right to ask the information you are giving them is limited, and it's not something anyone is just entitled to. But it's also not something I'd suggest you hide out of shame, rather than privacy, so far as care for yourself and healing from that trauma goes, if you follow me.

I really hope you can get into the arena of this work you want to. Knowing you in the way that I do, I can see that area being a really good fit for you, too.

[Redskies]

I have a couple of extra thoughts around this, in case it's any use to you, Atonement.

I wonder if your hospital has any written policies for your rights as staff when a patient is potentially or already unsafe for you, and any framework for what staff are supposed to do about that? Mistreatment by the public is a possibility for someone in any kind of public-facing role, and as unacceptable as it is, it's a thing that people know happens sometimes to healthcare workers, so any sensible place should have a policy. Knowing whatever they say officially might give you some leverage in the future for any similar situation. What's really bending my brain is that clearly there were security who could have been called, but your superior just didn't call, despite your clear and repeated statements/requests about your own safety. Are there perhaps circumstances where you have the right to call security yourself, or is there some rule you could invoke to get a superior to see that they have to call? (I'm not meaning to imply that you didn't do enough. You did far more than anyone should ever have to do to get someone else to act for your own safety, in any professional or personal capacity. Just trying to think of ways to get you the appropriate protection in future - sometimes people like that respond to rules when nothing else will shift them.)

I want to address the general attitude of the rest of the team that day, too. Karyn, Sunshine and Heather already covered the parts where they're wrong that toughness involves having to put up with abuse or danger. They were wrong in a broader sense, too. As part of our work here, we touch on personal and team issues to do with carework (as this is one kind of carework); one thing we know and try to work by is that it's important to care for fellow careworkers. Not even just for the individuals themselves, but as part of creating an overall atmosphere and environment of appropriate caring, so that the cared-for have a safer environment and more appropriate care. I'm not a healthcare worker, so obviously I lack the specific insight to that professional world, but it seems to me that your colleagues fell very far short of something basic. Really, I'm wanting to back up your feeling that people should've responded very differently and that what happened wasn't right. You were right about how the world should be and should have been for you on that day.

I really hope things go well with your manager, and absolutely everything crossed for your being able to transfer to another unit!