Soapbox
Helen Calabretto
School of Nursing, University of South Australia, SA
PP: 085 - 086
Article Text
Staff rights
Have you been abused by one of your patients lately? This may be an odd question, perhaps even controversial. But more and more in my working day in a major teaching hospital I am aware of incidents of abuse against health professionals. This is something which has always existed in the past to some degree but seems to have increased considerably in the past five years or so.
I realise that in some ways this topic is seen as taboo and I raise it at the risk of being accused of being unsympathetic or lacking knowledge of the illness response. But I can assure readers I do care for patients and have some appreciation of the difficulties they experience.
Abuse of the public health system is multi-factorial, ranging from nonattendance at outpatients clinics (thereby depriving another person of the time slot) to arguments over the costs of pharmaceuticals and theft of hospital equipment. None of this is new and steps have been taken to deal with such matters through initiatives such as patient liaison/ adviser services and the 'Hospital Watch' program.
However, in recent years it appears that a growing phenomena has entered our workplace. More and more of our staff, and nurses in particular, are being abused by patients (or visitors) who target individuals as an outlet for their frustrations when they encounter an overworked and under resourced public health system.
I am not talking about the emotional parent or the intoxicated young person in the casualty department. These events are par for the course in hospital life and all nurses should demonstrate patience and empathy relevant to the circumstances. I am referring to the angry, belligerent and abusive patients who seem to delight in making life as uncomfortable as possible for the staff who happen to cross their path.
The nature of this abuse is fairly predictable. It usually involves swearing and name-calling in order to embarrass or intimidate. On the odd occasion, it involves aggression or sexual impropriety and unfortunately, on rare occasions, violent actions.
Recently, I was talking with a senior nurse who was in charge of a heavy ward. She had been shouted at by a visitor after seeking permission from a patient before letting this person (and some children) visit. The abuse was loud and volatile and overheard by other patients and visitors. The nurse was accused of being racist and incompetent.
When I spoke to her, she was in tears and angry. Her actions were motivated by nothing other than consideration for her patient and were her normal practice for patients in her area. She had been acting responsibly and had not prompted the outburst in any way. The attack had been unnecessary and callous and left the nurse frustrated.
Unfortunately, the above scenario is not uncommon and many nurses I have spoken to in similar situations feel they have been treated with no respect, no recognition of their rights and often with an attitude that they are 'just a nurse' working in a busy public hospital. They almost feel that they are fair game for the patients and the public to attack.
I am not wanting to sound dramatic or to exaggerate the situation. I am merely wanting to raise this issue. I believe that there are many instances such as the one I have described. My guess is that most nurses deal with it as best they can, by trying to brush it off and get on with the day. Sometimes they seek help or counselling. Sometimes they don't.
It is a hidden 'work-related injury' which needs to be acknowledged. We also need to have a firm approach when dealing with such events in order to protect our staff. This goes against our normal everyday experience which is to provide care and to assist patients and the public. Therefore, there is always some discomfort when such action is necessary. Sometimes there is also a fear of bad publicity or a medico-legal claim, but hospitals cannot not afford to 'turn the other cheek'. Nurses and all hospital staff need to feel confident in taking affirmative action when necessary and of receiving the support of their organisation.
Let's not ignore staff rights!
Joe Hooper RN RPN BNsg Sc
Passive patient?
When editing submissions to 'Soapbox' and 'Exemplars', during the editing process I usually change the word 'patient' to 'client'. My reasons for doing this are the word patient implies for me, a passive recipient of care. Client on the other hand implies an active recipient of care for whom there is some negotiation of outcomes as the receiver of that care. It also acknowledges that many recipients of nursing services are not 'ill' and seek health promotion or disease prevention advice, well person checkups, counselling etc. Another term, 'consumer of health care' is too wordy although I see it as similar to client. Personal observation would suggest that colleagues who work in the acute care setting commonly use the word patient, while those who work in the community commonly use client. Why the difference? I am certain that nurses working in hospitals do indeed negotiate care with those in their care. Is there an implicit or explicit desire to maintain tradition? Not all people using an acute care facility are sick. Some undergo diagnostic tests and others undergo follow-up after treatment. Is there another reason for the continued use of the term patient about which I am unaware?
It is worth noting that beginning undergraduate students who are asked to state their understanding of the terms patient and client, provide some unexpected responses. They frequently associate the word 'patient' with caring by nurses for those who are suffering. Client on the other hand, has for many students, connotations of a detached, cold and businesslike approach. Maybe we need to clearly spell out to students, as well as practising nurses, the benefits of using the term client.
In Joe Hooper's Soapbox in this edition, I have left in the word patient throughout his text only because he refers to 'patient adviser'. Since this an actual title, it would be inappropriate to change it to client and the word patient has been maintained for consistency throughout the text. Unless convinced otherwise, however, I will generally continue to use the word client in teaching students and when editing, but I am interested in hearing from any readers who would like to challenge my viewpoint.
Helen Calabretto RNRM MEd Stud FRCNA
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