A recent news report in the Washington Post shocked many healthcare professionals as well as the general public. The June 24 story headlined, “Anesthesiologist trashes patient – and it ends up costing her” reported that a Northern Virginia patient received a $500,000 award for defamation and intentional infliction of emotional distress.
Unfortunately, the team's banter, which took place during a colonoscopy in the GI Lab and, according to the patient was recorded by accident, does not shock many of us who have spent our careers behind the locked doors of Surgical Services. The OR is seemingly another world: a place where staff members are gradually desensitized to bad behavior not limited to physicians.
Perhaps the recent time I’ve spent serving on the American Nurses Association’s (ANA) “Professional Issues Panel for Workplace Violence and Incivility,” made me more sensitive to this particular story. To me, it symbolizes “the elephant in the (huge) living room” otherwise known as the “American Healthcare System.” While reading Medscape’s article about the event, “Anesthesiologist loses lawsuit for mocking sedated patient,” with follow-up comments by doctor and nurse subscribers, I noticed occasional comments regarding the rest of the staff’s failure to speak up. Was there a nurse present? If so, what prevented him or her from advocating for the patient?
This year has been a big one for Nursing: the Year of Ethics (ANA, 2015). The Nurses’ Code of Ethics with Interpretive Statements, the "Bible" of our profession, was revised for the first time since 2001, to reflect the ongoing change, complexity, and challenges in Nursing, as our profession redefines itself in the 21st Century. The Nurses Code of Ethics, the "Bible" of our profession, was revised for the first time since 2001; reflecting 21st Century change, complexity and challenges in healthcare. Nurses are ethically bound by it, just as we are legally bound by our state’s Nurse Practice Act. If a nurse was present during the aforementioned procedure, he or she was ethically and legally required to speak up and to advocate for that patient.
Assuming there was a nurse present, why the silence? Or worse, has this sort of behavior – admittedly “over the top” – become so “abnormally normal” that a nurse might even join in the fun, at the expense of the patient? Were workplace cultural barriers too high to climb, for fear of consequences after speaking up? Or was the facility too short-staffed to have anyone but a medical assistant to help? In the OR, there is always a Circulating Nurse, but perhaps not in the GI lab. Regardless, changes in healthcare, reimbursement, and a shortage of experienced nurses all affect RN staffing.
Despite popular opinion, the nursing shortage is not solely due to the graying hair of so-called “senior nurses” and lack of faculty. It is not simply because there are more insured Americans, many who are aging with chronic disease. There is another factor to consider: 50-60 percent of new graduate nurses leave their first position within the first year, and 20 percent leave it completely (Winfield & Myrick, 2009; Griffin, 2005). Why? According to Laschinger, et. al. (2010), job dissatisfaction and burnout are correlated with lack of empowerment. Regarding the lingering “Code of Silence” and barriers to nurses advocating for their patients, studies show this is due to fear of retaliation and job loss. To quote Pamela Cipriano, President of the ANA, “Say it isn’t so! (2015).
Nursing organizations work hard to influence public policy regarding bullying in the workplace, but Administrators have responsibility for enforcing institutional behavior policies. Creating a culture of psychological safety and empowerment begins in the C-Suite. Several studies place the cost of replacing a nurse anywhere from $50,000– $98,000; making nurse retention very cost-effective. And who knows? Had there been an RN present in that Northern Virginia GI Lab, empowered to remind the physicians that their behavior was (grossly) inappropriate, the lawsuit, along with resultant public outrage, might have been avoided and the Anesthesiologist might still employed. After therapy for anger management.
Susan S. Lipman, BSN, RN, CNOR
Memphis
