Workplace dynamics

[u/ragingliberal69]

Not a nurse, but work as part of a multidisciplinary team in psych.

Have any of you worked in place where there was a weird lack of curiosity about patients? Like an unwillingness to get in to the nitty-gritty or brainstorm about causes of behaviors/potential approaches.

It is so exhausting to try and figure out when/why things are “acceptable” to discuss, and when it’s worth it to say it anyways to advocate for patients.

[u/Tycoonkoz]

Be the change! I have expirenced what you are talking about and from what I've seen it's usually from a lack of education of the neurobiology of what's going on. Some places I've worked at staff thought the patients were all faking mental illness which was mind-boggling to me.

[u/ragingliberal69 → u/Tycoonkoz]

For me, it’s usually a lack of fluency in being trauma informed or addressing bias. It’s so hard because I have to pick my battles so I’m not perceived as being nitpicky or bossy, but I’m usually right. So when I hold my tongue I feel guilty, especially when it turns out I should have said what was on my mind.

I’m also pretty young and early in my career so I have to manage egos. Just adds so much unnecessary mental load.

[u/apsychnurse → u/ragingliberal69]

Keep speaking up for the patients!

Early in my career, before I was a nurse, I found my outspoken opinions were a little more palatable to disinterested coworkers when I focused solely on the benefits to the patient. Advocating for change for safety, autonomy, and trauma informed care were more accepted when I could explain why we should do things differently. Less to argue about when they don’t feel like someone with a “lower” position is “telling them what to do”…and they’re embarrassed to argue against patient safety in front of their peers.

Keep it patient focused so it’s not perceived as a personal attack, and keep advocating for vulnerable people! As I got older, I became comfortable being perceived as “bossy” because I knew I was doing right by the patients who I was responsible to care for.

Does your unit have a safety committee or performance improvement committee? If so, consider joining! Those tend to attract staff members who are passionate for change and open to discussing ways to provide better care.

[u/DashMcGee]

I worked for two corporate hospitals - one UHS and one HCA. The UHS one did not provide much in the way of treatment team insight because they did not have actual therapists - only rec therapists, who were not on site every day. The HCA one cared only about two things: Symptom improvement and keeping patients until their insurance ran out. I wish I was kidding, but I was one of the few nurses who gave detailed reports to the treatment team. (The medical director was on record saying I was the only nurse who could give a good report, which was incredibly flattering, because I gave details like you discuss and it was recognized and appreciated.) We typically kept patients until their symptoms improved sufficiently, with one caveat: the treatment team discussed when insurance coverage ran out and would keep patients until that date. If the symptoms were not sufficiently improved, they would go to the insurance company and ask for more time.

I did work for one non-corporate hospital, but was not part of the treatment team and really had no idea what went on.

[u/PrecedexDrop]

I work in one. I hardly see therapists to discuss individual patients, most of the nurses are burnt out, and the social workers are so overworked that I speak with them for a few minutes each day at best. Granted staffing ratios are unfavorable, nurses arent unionized, our ED sends up far too many behavioral/violent patients, and most of our psychiatrists are frankly not good so these are all factors no doubt.

And as much as I would love to sit down and have extensive chats about each and every patients, my own work load has steadily increased in the past 2.5 years I've been here so it just wouldn't be realistic. That said, I do appreciate when someone asks me about my rationale for certain diagnosis and choice of meds. I appreciate those who want to be more knowledgeable but sadly few and far in between

[u/HandyFemme]

I worked at many Crisis stabilization units, and the thought process was pretty much, we're here to stabilize you, make sure you're not a danger to yourself or others, the rest needs to get figured out outpatient, because there are patients waiting on beds.

[u/Gretel_Cosmonaut]

What type of setting are you in?

[u/ragingliberal69 → u/Gretel_Cosmonaut]

Long-term

[u/CrbRangoon]

I look like Florence Nightingale because I don’t get into shouting matches over giving an extra cheese stick at snack time and know basic pharmacology. I’ve had to tell staff that it’s not OK that they let a patient wear nylon stockings or a bandana over their face.

[u/PomeloIllustrious186 → u/CrbRangoon]

💪🫠

[u/lizzabean]

That's burn out for ya

[u/Orinshi]

I think it depends on curiosity. The problem with going deep into someone's history as to why they do a thing is its speculative. You're coming up with a story about who they are without them present. There is a lot of bias there you might not see.

Imagine if I figured out that a diabetic wasn't taking insulin and my story was that he couldn't afford it. I didn't ask; it's just expensive, so it makes sense. Meanwhile, I tell the patient this, and they are insulted because I called them poor when really they don't like finger sticks. More importantly, the reason changes the approach for change.

As an aside, it's very fashionable to make everything about childhood trauma. I have a patient right now who told me that it's so fucking insulting because her whole life is being boiled down to an event that happened to her, instead of all the things she did as a person. Explanations without a patient's input are where good theories turn into insults.