Nurses are not alone in having positions where our work includes the potential for misuse of power over vulnerable people. As Australians have been appalled to learn in the last week, as footage of barbaric treatment of detained children was broadcast on Four Corners, there are professional cultures where egregious mistreatment (and that is an unquestionably mild categorisation) appears to not only be accepted but almost expected.
Nursing is not immune to that – several years ago I wrote about the horrifying treatment of patients at Mid Staffordshire in the UK, the contributing institutional factors, and the injustice of focusing on clinicians alone instead of the managers whose policies not only facilitated but almost demanded it.
It’s reasonable to expect that, at a bare minimum, those in our care are treated humanely and with respect. As I’ve commented several times on social media since the ABC broadcast, excusing corrections officers’ actions because of juvenile detainees’ behaviour misses the mark. I have been spat at, sworn at, threatened, slapped, pinched, bruised, groped, scratched, punched, and had projectiles from faeces to metal bed pans thrown at me; my colleagues have been sexually assaulted, knocked unconscious, partially scalped, contracted infectious diseases after being spat on, had bones fractured, and needed breast reconstruction after biting. Not only do we not retaliate by dropping patients naked and leaving them, restrained and alone, to do so would justifiably be condemned, by our profession and the public.
We are, however, human. We carry with us to work the same stressors everyone else does – relationship woes, family worries, financial concerns, inadequate sleep, colds that are enough to cause misery but not enough to warrant time off work… When work frustrations are added to that, sometimes something has to give.
I love what I do. I get to make positive differences to people’s lives every day: my colleague said, through education and support; family members, with explanation and reassurance; most of all my patients, through skilled, compassionate, experienced nursing care. After returning to the bedside after over a year of illness, my commitment to providing that care is even stronger.
I am proud of few things – I am privileged that most of my positive attributes come without work, so taking pride in something I have by good fortune would be ridiculous. I am, however, proud of managing my temper (which was once significant), and my still-evolving capacity to step back rather than engage and escalate conflict. These are not qualities that came effortlessly, for all their necessity in my position.
Despite one’s very best efforts at calm, professional, therapeutic distance, sometimes someone manage to find your last nerve and play it like a virtuoso. And I recently had a shift that was dominated by a patient for whom I could do no good, as I was repeatedly told, but who nonetheless called for me multiple times each hour, only to react with anger and disparagement despite my genuine best efforts to help.
It is fortunate that my other patients were stable, needing few interventions; I was certainly unable to assist and support my colleagues as much as I’d have liked.
I know my patient was scared, distressed, anxious, panicked on occasion, enormously fatigued, sleep deprived, and angry. I also know that we are often safe targets – our patients know we won’t abandon them, or retaliate. I certainly hope they know that.
And, despite my experience, my empathy, my knowledge, and decades of honing professional distance, I became frustrated – by not being able to meet my patient’s needs, by their expectation that I should know what they wanted without asking, by my every suggestion being shot down, by going over the same ground with repeated futility, by hours of belittlement.
I didn’t express any of my frustration to my patient – though I took a slow, deep breath before responding to each call, every interaction was polite, warmly professional, as long as my patient needed, and I responded in under a minute on every singly occasion.
The reason I was able to maintain this for my whole shift was because I vented my frustration to my colleagues. A little hyperbole, some fantasy, and I was able to optimistically smile the next time I walked through the patient’s doorway.
All of this has been preamble to the point of this post. I also wrote a Facebook entry where I described my venting. There, as here, as always, I omitted identifying details. I made it clear that the issue was not so much my patient as my frustration. And I wrote about how this informal debriefing allowed me to work effectively, to provide professional care, to put my patient’s needs first.
And I was reminded today that none of those aspects matter, because my post could have been enough to jeopardise my registration. The days of acknowledging the emotion labour of dealing with ‘difficult’ patients have gone – when text, absent tone, can make jest indistinguishable from the corrosive, toxic culture revealed last week, staying silent is the safest option.
Every week nurses and midwives attend disciplinaries, recieve warnings, and face employment and registration consequences of social media activity. Oftentimes this is completely warranted, because of confidentiality breeches, employment conditions (don’t take sick leave then tweet about being at a music festival!), and the like. Sometimes it may seem like an overreach. Either way, determination isn’t made by those who know us and our intent – it’s made by people whose job is to safeguard the public, and who understandably err on the side of caution.
I am no social media neophyte. As a union rep I have a better idea than most how inappropriate social media posts comprise a significant, and growing, number of disciplinary procedures. And even as I wrote my post I wondered how wise it was, even adorned with caveats and clarifying notes.
So, for myself and for any health professional who’s made it this far, a reminder: before posting anything remotely work- or profession-related, think twice. And if even the smallest part of you has any doubt, hold back – you can always write it later, you may not be able to retract it.