Staffing Shortages, Poor Communication, Workplace Violence & Informing Patient Advocates!

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Transparency about medical errors and infection rates in healthcare facilities seems like an important step towards empowering patients and advocates to make informed decisions about their healthcare.  But what about some of our other issues?  In many organizations it is taboo to tell patients and families that we are have staffing shortages, communication problems, or horizontal violence, (aka lateral violence, aka nurse bullying) issues.  I’m not saying it is simple, but don’t they have a right to know?  Aren’t we all somewhat responsible for knowing?  Shouldn’t we at least be discussing the idea?
Not too long ago, I was having a conversation with Dr. Will Sawyer about making hospitals patient-safe.  He is a family doc in Ohio and an avid promoter of hand-washing issues as they pertain to MRSA prevention and infection control.  He made a comment that struck a cord with me, “We need consumer clout if we are ever going to make hospitals patient-safe”.
Will Sawyer, MD

Will Sawyer, M

Both he and I share some frustrations about the challenges of being change agents in our current health care system.  He is crusading for effective handwashing, I am doing the same for respectful communication.   I think he would agree that we see solutions to major problems and work relentlessly to impact them.

I think about his comment and potential consumer roles in patient safety a lot.   It is like seeing a fire and knowing where the water is!  Of course, unless we can get the water TO the fire it won’t be helpful.

It is interesting to me that very often people will share their healthcare ‘horror stories’ with me.  I listen and try to validate their concerns and understand their attempts to control future experiences.  Some are adamant that they will never go to that doctor or that hospital or that nursing home ever again!

Meanwhile, in my head I’m thinking, that may or may not solve the problem and further more, I feel a little defensive.  I know that many healthcare professionals have bad days.  Myself included!  But, I don’t usually say this.  Maybe I don’t want to interfere with their need to have some control over their health or appear to be defending bad experiences.  It’s just that I understand what can happen.

Often, when speaking with healthcare professionals, I like to make the point that we don’t amputate the wrong leg because we don’t know left from right!  That’s what it might look like, but it is way more complicated.

I believe that we are seeing increases in informed patients, but usually they are informed about their particular health care issues and not so much about what might be going on beneath the surface of the team or organization.  This 12 minute youtube called: “Interruption Awareness:  A Nursing Minute for Patient Safety” will go a long way towards helping consumers understand, really understand some of the stress we are under and how easy it can be to blame an individual when the real problems lie with the system.


When I can, I try to share some of my concerns about workplace violence, patient safety and communication. Ironically, as common as it is for people to have had or heard about terrible experiences, they seem to have little knowledge about the underlying problems.  I don’t want to frighten them, yet informing them seems important for the following reasons:
  1. It is the truth.
  2. More pressure to communicate respectfully, staff appropriately and be more careful.
  3. Additional help for problem-solving.
  4. May lead to more resources.
  5. Break down of walls that keep patients and HCPs from being on the same team.
  6. Better outcomes.
  7. We would have to become more accountabile
  8. Opportunities for increased accountability for patients and families.
  9. Save $ in the long run.

Ultimately, I vote for being truthful and support efforts by patient advocates and healthcare professionals to make our systems more transparent.  My hope is that all stakeholders will take time to truly understand how complicated our systems are and seek to collaborate even when blaming may be a first reaction!

What do other nurses think? Patient advocates? Colleagues?


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9 Responses to Staffing Shortages, Poor Communication, Workplace Violence & Informing Patient Advocates!

  1. Great post! I love your idea of transparency and working with patient, their advocates, family members. Your are so right that many advocates know a lot about the type of medical error they experienced. Patients and their advocates need to understand more about what medical professionals are dealing with so we can all work together. I applaud Dr. Sawyer’s comment about needing consumer clout. Excellent point.

  2. Cherrill Carter says:

    Excellent article! From a systems perspective, it is inspiring to read the nurse’s view. Your website is awesome.

    I think we will get there…we can improve…

    • Beth Boynton says:

      Hi Cherrill,

      Thank you for your encouraging feedback. I think we’ll get there too! A long ways to go, but we are moving forward. Take care, Beth

  3. This is an excellent post, I fully agree with its premise and here’s why: it suggests that by offering the complete picture, ‘everyone’ can be held accountable for their part in it…not just the medical community. I believe it is very useful for patients to understand the reality of today’s healthcare environment, from the perspective of the medical professional… what it is really like for nurses and doctors to do their job day in day out. Often as patients our own ‘situation’ blinds us to what is going on around us. Patients also tend to look to doctors and nurses as all knowing beings, counting on them to remember everything, thereby relinquishing all responsibility in a way one would never do in another area of their lives. How do we create an environment of mutual respect, understanding and effectiveness, with both sides working together to achieve whatever the result is? I realize in some cases this is not totally possible, but in situations where the patient is able to advocate on their part appropriately, and in ways that would assist the process, having a better understanding of ‘whom’ they are addressing, and what their true ‘needs’ and ‘workplace challenges’ are, might be useful in arriving at a better and healthier result for all.

    • admin says:

      Thanks, Alexandra. I think your comments about accountability are astute. I don’t know exactly how we can create an environment of mutual respect, understanding and effectiveness either, but I do believe that conversations are key and if “we” can be curious about each others experiences, I think we’ll be headed in the right direction. Sometimes, in nursing there is a very blame-oriented approach to problems. Liability for mistakes and fear of loss of license are very real concerns.

      I read an interesting article yesterday about a hospital in Tennessee. A nurse made an error that led to a baby’s death. So painful to read about and I felt for the family and the nurse and ultimately the hospital. The organization and nurse took very courageous steps to understand what happened and prevent future incidents. The article if you are interested, ” Hospitals Get More Open About Mistakes”.

      Take care,

      • Thank you Beth for your reply and the article.

        A ‘blame oriented approach to problems’ is sadly human nature… I found the above article profoundly inspiring for the way the organization and nurse ultimately handled the situation thereby disproving this cynical ‘concept’ and proving that positive changes can be put into place. This ‘over-extended beyond our limits’ problem is everywhere, and in healthcare, as we know, it costs lives. The more everyone understands that these problems, though universal, if addressed to completion, can be mitigated and even prevented, the more an environment to truly work together may evolve. Just a thought…

        On another note, one of my favorite articles (which you probably know) in this vein of putting measures in place to prevent medical errors is ‘The Checklist’ about the work of a critical care specialist at John Hopkins Hospital named Peter Pronovost written by Atul Gawande

        Good to be in dialogue with you and thank you for all your great work.

        • admin says:

          Hi Alexandra,

          Glad you like the article. I totally agree with you that “the more everyone understands that these problems, though universal, if addressed to completion, can be mitigated and even prevented, the more an environment to truly work together may evolve” I guess we can’t expect big change overnight, but plugging away in our best efforts can only help contribute to positive change. In healthcare and everywhere.

          The checklist IS a great tool and your resource link is much appreciated.

          Are you by chance a Margaret Wheatley fan? Her work on leadership and complex systems is very inspiring to me. If you don’t know her, I think you would like her work.

          I look forward to more discussions and am very grateful for your contributions.

          Take care,

          • Thank you Beth and no I do not know her. Just looking at her site now. What a wonderful resource! Thank you again. I will come back to you after I have digested some of her work. I too look forward to continuing our dialogue and am grateful for the opportunity to do so. Have a lovely day.

          • admin says:

            Thank YOU, Alexandra. Glad you liked Wheatley’s site. When I first read her book, “Leadership and the New Science”, I was so excited b/c I felt someone was making sense of our organizations and behavior. I’ve followed her work ever since! Take care, Beth

What are your thoughts?