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 3-5x/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.
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?