Category: nurses

Pushing Back Against Fear

I am not very good about guarding what I say. I  am awkward and often say the wrong thing.  If an act, statement, or policy is harmful, unproductive, or meant to limit my ability to improve, I tend to speak before my passion can be tamped.  I have gotten in trouble for making a “thing” out of a moment and bringing a concern to light.  Unfortunately, there have been plenty of inopportune misunderstandings,  and my actions negatively hurt myself or others, creating fear instead of change.

We encounter fear in many forms; fear of loss, fear of harm, fear of the unknown, fear of physical, psychological, and emotional pain, fear of inadequacy, fear of punishment and repercussions for ourselves and those we love, and more. 

The use of fear to align others with a specific ideology, behavior, or action is written throughout history.  Fear motivates positive and negative responses and can create those responses en masse if utilized correctly.  Fear can motivate a kind of peer pressure so intense that those who do not conform encounter danger to themselves and their family simply by choosing not to follow and not to be afraid.  Fear shut down the world and had neighbors calling authorities on neighbors for simply being outside their front door. 

I understand that fear is an amazing change agent! Targeting one person on a team, when that person is leading a policy change or encouraging transparency and a better environment for the team can quash all momentum and stop any movement toward change.  Using fear to set an example works. 

This is especially true in the patient care setting, where the use of coercion, threats, gaslighting, narcissistic behavior,  deflection, and fallacy is used to gain patient compliance.  It can happen to anyone, even the most seasoned patient advocate I know.   

I encountered the use of peer pressure and fear of failure in a recent conversation with an MD influencer.  This MD used her platform and personal success with an elective 39-week induction to encourage her followers to comply with her preferences.  I spoke up, but the replies were invalidating, and some were downright mean because I was not a doctor. It did not matter what  ACOG statement I shared (the doctor’s governing body) supporting informed choice or the research indicating the benefits of spontaneous labor in low-risk pregnancies and the risks of elective induction…I was told my experience did not count because I didn’t have the ‘right’ credentials and did not know what I was talking about.

As a nurse, I have stood at a patient’s bedside listening to their provider use these tactics to gain consent or listened as the patient is told that they do not have the experience to make medical decisions regarding healthcare interventions. 

Fear is used to create doubt and compliance en masse, because if the system can make you feel like an outsider, it is easier for it to control you.  

So....what is the answer?

In my experience, finding those who think and believe like you.  Want a homebirth? Find others who have birthed at home.  Want to give birth in a birth center, extended breastfeeding (breastfeeding > 2 years old), not circumcise your son, or make other care decisions considered not mainstream?  Find those who have made those choices, and the fear is melted away with support and knowledge. 

This is a special note to those we turn to for support in our choices.  To those who help us navigate informed choices and our options, please remember yours is not to convince but to guide, support, and ease the fear that comes when we venture away from the influencers and followers.   It is easy to become the fearmonger when you have convinced yourself that your choices are right for everyone or that you know best because of your training and credentials. We need you to push that aside and support informed choice so that every voice can be heard.

Fear...it has had enough control!  It is time to be brave!

Remember That Catastrophe…

Plainly said, hospitals as they are currently run are unsafe for patients.

You feel a twinge of pain in your back on the right side, and you wonder should I go see the provider, but you talk yourself out of going.

Three days later you feel sick, have a fever, and you have pain when you urinate. Now you have to go see the provider, who promptly sends you to the emergency room to rule out a kidney infection (pylonephritis).

You are triaged at the emergency room and then asked to take a seat. You wait 1….2…..3 hours.  People rush past you, bleeding, unconscious, screaming children, trauma patients, and you wait.  At 3 hours you ask how much longer, as your pain is worse and you feel dizzy.  You are told they only have enough staff to use 3 out of 8 patient rooms, and you will be brought back when they have an open room.  So you wait, 4…. 5…. 6 hours.

In a place you are supposed to get better, you are getting worse. 

Finally, they call your name.  You are assessed by a nurse, labs are taken, an IV is started and you are given IV fluids while you wait to see the ER provider. After 2 more hours  in walks a provider who says they are admitting you for a kidney infection.

45 minutes later you are wheeled into a Med-Surg room, helped onto a bed and you wait… A nurse comes in, takes your vitals, says they will be right back. An hour later you push your call light because the pain is getting worse.  Unbearable pain  along with fear that you will be left helpless takes hold. In a place you are supposed to get better, you are getting worse.  Staff flutter by with barely a moment to spare.

Billable patient care not the patient is the priority for the system.

– Speaking of staff: hospital staff, especially nurses, work in such a toxic environment that every moment is under intense pressure to get done what can’t be done. There is little time to care for their patients needs, and no time to care for their own needs. It is common for a nurse to not have meal or bathroom breaks through a 12-14 hour shift. For many sitting, hydration and snacks occur while charting the mandatory documentation. Up to 60% of new nurses leave the nursing profession within 1 year. Hospital administrators and the systems they work in focus so completely on their income they have cut support staff, increased nurse to patient ratios, shorted patient care supplies, and refused adequate pay; yet their salary has continued to increase, sometimes drastically, while they decry lack of funding. To that fact, it should be stated clearly that nurses are NOT a chargeable cost. At no time have insurance companies or administrators suggested billing for hospital nursing care. Your nursing care is wrapped up in your room cost. Nurses are not a credit to the hospital monetary system, they are a cost, and are treated as such. Yet, hospitals cannot function without nursing care for patients. Billable patient care not the patient is the priority for the system.

As a patient, you lay in your hospital bed, alone with only the call light as your connection to your helpers. That call light often gets answered remotely, or not at all. In some facilities a telenurse on a screen asks you what your need is. Your medications will be late, your mobility will be limited, and your pain uncontrolled, because there are too many patients and not enough staff. The most critical patients will get what little time the staff has. This is the experience that many hospital patients are having. This environment is harming our patients, and causing unnecessary injuries and deaths. Plainly said, hospitals as they are currently run are unsafe for patients.