nursingforsocialjustice

Sometimes work is overwhelming. Not every day is a good day. Sometimes patients say things that are upsetting. Sometimes we are not our best. Conflict happens. Is conflict and patient dissatisfaction an expected health care norm? Should it be? Think about this in the context of your workplace and your experience.

Should we feel disengaged and angry at our patients? Should they feel angry at us? If the answer is yes, this might be opportunity for reflexivity. Everyday is not a bad day. If it is, this may be a cognitive distortion. The point where you are finding yourself in confrontational positions with your patients each shift, sometimes multiple times each shift is a point that is going to break your spirit as a nurse. That is where you might get to the point where you leave your shift questioning whether or not you did any good that day. And when you get to that point, it is heartbreaking. And, if the shift happened from it being heartbreaking to being the new norm, something is amiss. And we are not doing our co-workers who are in constant conflict, that are burnt-out and no longer providing safe and ethical care any favours by not addressing it respectfully, and directly. We are not doing our patients any favours by ignoring power imbalances and psychologically unsafe workplaces.

More than once I have heard a mental health in the Lower Mainland say a phrase similar to: “if a patient is not upset by the things I do then I’m doing my job” or “I judge how well I’m going as a nurse by how many times a patient swears at me” or something to that effect. If this was a nurse working in a pediatric unit, and oncology unit, a public health unit, cardiac surgery, any unit other than mental health then this would be unheard of, appalling, a reason to call into question the nurses fitness to practice, to questions the ethics of their practice. On the inpatient mental health unit, somehow this sometimes passes as okay, the accepted practice of some unit cultures. I think that it is time to reflect on the unit culture, the climate of care and the ethics of one’s practice if this is a nurses’s common experience and a common patient response their care. At some point I think that it may be important to try and unmask the distortion of perception when feedback and patient response to care that is critical, negative, even hostile is somehow the standard by which good care is judged. There may be value in exploring where such angry words and criticism come from, and if this is something that happens to everyone or that happens to only few.

I think that it is also important to acknowledge that, working in a place where people are detained against their will, where they may have anosognosia, they may be rightfully angry about this, but, it is still hard to experience the fallout of this. Can it change the nurses perception of the experience to contextualize it and try and view the experience from the point of view of the patient, with the patient’s perspective, life experiences, values and beliefs, and not the nurses superimposed onto the patient? And, perhaps, if this is the experience more days than not, it may be time to think about how to change the patient experience to, in turn, change the nurses experience.

Given that, in British Columbia, most people that come into contact with the inpatient mental health system at being treated involuntarily (Johnson, 2017) is it not reasonable to think that patients may be a bit upset by the circumstances of their situation? Given that most patients that come into contact with the inpatient mental health system in BC are in care involuntarily does it not make sense that nurses would focus interventions on decreasing power relationships and engaging patients such that they want care voluntarily? Is this not one of the ways that the system can actually shift?

The mental health care relationship inherently has a differential in power. The health are professional has the power, especially in those situations where the patient is admitted against their will. How do we get to place where people who have mental health issues, mild, moderate, and severe, feel both comfortable and confident that if they seek help that they will get help that will be useful to them so that the primary contact in the system is not at the point where they need to be detained against their will to gain access to treatment? Until we get there, we need to figure out how to build trust and engage the patient in a way that they not only feel safe, but that they are getting the help that they need. When we stop reflecting on our practice and the opportunities in the system to provide better care for the client this may indicate a shift from patient-centered to staff-centered care. When the focus of the job becomes about how best meet the needs to staff, some thing is wrong.

When we reach that point, where we feel disinterested, disengaged, anxious about work, and like we are more angry with our patients and their families rather than compassionate towards them, that is the time to take a step back and explore what is really happening. Did the workplace change? Or did you change? Are you a victim or do you have the agency and ability to make a change? Can the situation be re-framed? Do you still get a feeling of satisfaction from the work that you do? On those days when you do or did feel good about the work that you were doing, what specifically did you like about the job? What was intrinsically fulfilling?

Peace,

Michelle D.