An Anonymous Nurse Writes: Was this Employee Scapegoated?

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Every once in a while I hear from healthcare professionals who share concerns, perspectives, or experiences about something they don’t feel safe discussing publicly.  Job risk or retaliation from others are perceived risks.  Yet their stories provide insights and clues about organizational cultures and delivery of care that consumers and healthcare professionals alike can learn from.  Opening the door to taboo topics and encouraging discussion, even if stilted with anonymity, will bring us closer to transparency.

An Anonymous Nurse Writes

I couldn’t believe Joanne had been fired. She was one of the hardest working aides and always trying to do whatever was asked of her.  By the patients, her colleagues, the nurses, and management.  She had been with the Longterm Care organization for 10 years working on the same dementia unit.  One day, she chose between two tasks, something we are always doing and…one resident requested help moving her from one side of the room to another while monitoring another patient who required constant supervision because of a history of aggression.

The patient requesting help had a demanding family and long history of entitlement behavior.  Putting the call bell on stressed woman3-5x/hour for things ranging from moving a pillow or taking a newspaper away to help on the commode or requests for pain medication.  A year or two earlier a lawyer representing the family had made a formal complaint about care for the patient and management held a special staff meeting to make sure staff responded to this patient’s needs right away.

Also, the unit was frequently understaffed and there were times that Joanne was one of two aides and at times the only aide for 18 patients, many of whom needed total care and could not use the call bell. Patients requiring one on one care were common on the unit, but staffing to accomplish this, was not adjusted.  Non of the staff, that I know of get through an understaffed shift without taking shortcuts.  And we do, get through the shift.

In the few seconds that Joanne took to respond to the patient asking for help, the patient with a history of aggression assaulted another resident.  A family member of another resident witnessed the attack,  was horrified and complained to the Administrator.  The other resident was frightened, but not otherwise injured.

Joanne was sent home and later fired.  My heart aches for her and all the hard work that she provided over the years.

 Questions Raised

This is only one perspective of a difficult situation and we can’t really analyze it fairly without a lot more information such as how was the termination decision made, other parts to the story,  and what exactly happened in that moment. Nevertheless, there are some important questions raised that may be worth discussing even if we can’t know the truth:

1.  Was this employee given a fair shake?

2. Was she set up to fail some day at some point?

3. How might other employees respond to a situation like this and how does this impact the culture?

4.  Does the organization/management have accountability?  Should they set any limits with patients and family?  How and when?

What troubles me is that I know how chronic understaffing can lead to bad habits. The normalization of deviance results when workarounds or bad habits go unnoticed much of the time because there are no known or visible bad outcomes.  These bad habits have  individual and organizational roots, but when something bad does happen, the individual is blamed.  Colleagues may feel bad or seek to justify the employee’s or the organization’s response either of which contribute to a “blaming” culture and the fear and mistrust that go along with it.  What thoughts or questions does this situation bring up for you? 

 

 

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5 Responses to An Anonymous Nurse Writes: Was this Employee Scapegoated?

  1. Pingback: Is it Silence that Kills or is Silence a Symptom of Much Deeper Problems?

  2. Actually this is an issue near and dear to my heart.

    Most nurses realize there is something fundamentally flawed about how we finance health care at the bedside level. That is my area and it is much worse than most nurses realize.

    If you listen to people like Kenneth Arrow, Nobel prize winning economist, you would think that health care providers can do a better job managing insurance risks than health insurers. Arrow, as do many, believe that if you transfer insurance risks to health care providers, the health care providers will become more efficient.

    Nothing could be further from the truth as I explain in many papers, presentations and my book “s should provide, on average”. When health care providers accept insurance risks (Capitation, the Medicare/Medicaid Prospective Payment Systems, the DRG system and episode and bundled payment schemes, their inefficiencies as insurers lead to a need to make drastic cuts in medically necessary and appropriate care than non-risk assuming health providers can furnish under fee for service payment mechanisms.

    These reductions are not modest, they can easily reach the levels that lead to chronic under-staffing, inadequate equipment and supplies and compromised care.

    It all makes a lot of sense when you realize that small insurers also cut policyholder benefits or risk bankrupting themselves.

  3. Jim Murphy says:

    This type of case shows why unions exist!

    But even in organizations with employees at will, there usually are written standards for personnel decisions and termination without prior discipline is generally restricted to the most serious of offenses, which perhaps could included gross negligence, but that would not seem to apply here.

    Of course Beth is right that we don’t have all the facts. But in an organization with a good organizational culture such things would not happen.

    • I’m not sure, Jim. I suspect that a picture could be painted for gross negligence in a blame oriented culture like this seems to be. Focus on leaving the 1;1 resident subjected another resident to an assault. In my own per diem job this last week end we had a resident who is supposed to be 1;1, along with 17 others many of whom need two people to assist in hygiene or related stuff, and only two aides and myself. Do you think 1;1 was really maintained?

    • Definitely supports the need for unions. I’m not sure if/how standards would have helped this EE can you say more? Especially how would the EE know about or access them? I suspect that a picture could be painted for gross negligence in a blame oriented culture like this seems to be. Focus on leaving the 1;1 resident subjected another resident to an assault. In my own per diem job this last week end we had a resident who is supposed to be 1;1, along with 17 others many of whom need two people to assist in hygiene or related stuff, and only two aides and myself. Do you think 1;1 was really maintained?

What are your thoughts?