10/17/09

WORKPLACE BULLYING OF NURSES WORSE IN SMALL TOWNS/VILLAGES

From the blog KevinMD:

Two nurses face jail time for reporting a doctor to the Texas Medical Board

October 15, 2009

There’s a disturbing case in Texas, involving two whistle-blowing nurses who reported a physician to the Texas Medical Board (TMB).
Apparently, they took offense at the physician who was peddling herbal medications in the emergency room, among other deeds. Unable to convince hospital administration to discipline him, they reported him to the Board.
And here’s where it gets disturbing.
Angered by the action, the physician then filed a criminal complaint, alleging harassment. According to hospitalist Chris Rangel, who covered the case, “the two nurses were indicted for misusing privately protected patient information for a non-governmental and nefarious reason (to harm a private citizen),” which is considered “a third-degree felony that carries potential penalties of 2 to 10 years’ imprisonment and a maximum fine of $10,000.”
Once they were identified, they had very little legal protection, and now both nurses face a real possibility of jail time. They are currently free on bond.
Dr. Rangel and David Gorski, who blogged about the case over at Better Health, both come down hard on the TMB. Indeed, Dr. Rangel writes, “the so-called anonymity provided by the TMB in the complaint process is largely an illusion and a pathetically weak substitute for real and effective legal protections. In reality, as this case shows, accusers can be easily tracked down and made to suffer.”
Dr. Gorski is no kinder: “This case is bad. Real bad. Nurses and other health care professionals are reluctant enough as it is to report a bad doctor or a doctor peddling dubious therapies as it is. What makes this case particularly outrageous is not only because it appears to be a horrible abuse of power by Sheriff Roberts, but, even worse, it sends the clear and unmistakable message to nurses in Texas: Don’t get out of line or the medical powers that be will make you pay.”
The sheriff was apparently the doctor's business partner in the sale of the herbs.
A tragic case, and hopefully the impetus for some reforms within the Board.

Well, if the doctors are ever run out of Texas they can always come to Alaska and continue their abuse to nurses, it is sanctioned here.

This kind of thing happens a lot in small towns where doctors are allowed to do whatever they want without regard for the safety of patients. The corrupt people in power in the community go after the nurses whose only interest is the safety of the patients. When I went to work in a small hosptial in New Mexico the only surgeon they had came up to me the first day I went to work having never seen me before and asked me if I had a vibrator in my backpack. Realizing he was an a****** I immediately opened the backpack and began rumaging around and said, "Yes, I have, it's a  pink bunny, I never go anywhere without it". He got a horrified look on his face and took off. The other nurses who did not know me were surprised by what I did and told me he does that all time to the new nurses because he likes to watch them turn red(which I did not). I asked them if they realized what he was doing was sexual harrasment. Now, once someone gets to know me and knows I like to joke around even inappropriately I would have found it funny, but that was a really strange thing to say to me not even knowing me. I guess he had done that for years and probably still is. He also would tell obese nurses to gain 30 or 40 pounds so they would qualify for gastric surgery for weight loss. I told him that was nuts and asked him if he was trying to pay for a new house or something. He loved me, she said sarcasticly.

 A nurse who was director of the OR at South Penninsula Hospital in Homer tried to implement standards of care which would be common place practices at most hospitals in this country and they made her pay for it. Two doctors got a workplace bullying campaign going against her for trying to get them to among other things wear scrubs in the OR and scrub in. Who would want these guys as their surgeon? Not me. I would not even want to have surgery done at that hospital. They should have kept the nurse and dumped the doctors. I do not believe the statement about low infections that was in the article. They probably did not report most of them. I salute her courage. That is the nurse I want in the OR if I ever have surgery. It is truly mind boggling that a hospital would not have supported her. Instead they went on a campaign to assasinate her reputation and try to make her look like she was incompetent. Do you think they hired her for that job without checking her background? This is a classic case of workplace bullying of a nurse in a small town. The problem with the rural communities is they have often never seen high quality nursing care and don't think it matters. It does big time.

Bashaw filed a lawsuit in 2005 claiming she was wrongfully dismissed from her job at South Peninsula Hospital in late 2004 in direct retaliation for her attempts to enforce safety procedures. Dr. Rene Alvarez and the Kenai Peninsula Borough were named as co-defendants in Bashaw’s suit, but Alvarez and the borough settled with her before the trial.
They settled with her because of wrongdoing yet in the lawsuits against the hospital and the other doctor the jury decided against the Bashaw. There should always be a change of venue when a small town is involved.
According to court documents, Bashaw insisted that surgical tools and sponges be counted at a specific time during operations. The issue wasn’t that counts weren’t being performed, but when counts occurred. Bashaw wanted quality improvement studies conducted, history and physical reports on patient charts prior to the start of elective surgery, and operating room incidents and errors reported and documented. She said she tried to enforce rules for surgical attire and other safety practices in certain areas of the hospital. Those efforts, too, were met with resistance, she said.
In Nome I couldn't even get them to put up alcohol gel dispensers and they did not practice universal precautions. I guess some agency finally did made them put in the hand gel dispensers. Health care in rural areas in Alaska is pretty bad and there is just no excuse for it.
Bashaw, hired in June 2003 to be the hospital’s surgical services manager, said Franz forced her to resign or face being fired, and that Franz’s actions were a direct consequence of her efforts during 2004 to implement and enforce standard safety practices and policies meant to prevent injury to patients — practices that she said were met with resistance and hostility from staff surgeons and other hospital employees.
This sounds kind of familiar, only they did not fire me, they just tortured me until I was suicidal.
The hospital countered, saying Bashaw was asked to resign because she had demonstrated poor clinical and managerial skills, and she had not taken advantage of numerous opportunities to bring those skills to acceptable levels. http://www.homernews.com/stories/032107/news_1003.shtml
Yea, I am sure they hired someone to direct the OR who had no proven record of the abilities to perform the job. This is a technique that human resource departments in hospitals have been using for years. It is also what happens in a right to work (for nothing) state. I can read between the lines and all it says is lies. This is very obvious workplace bullying which is epidemic in nursing.

Then their sister hospital in Soldotna had a shooting in which an ex-employee came in and shot two specific people, his supervisors. This is a clear cut sign of workplace bullying. It was reported that he had no problems anywhere else he worked and no signs of mental illness. He probably got PTSD there and lost it. He clearly committed suicide by cop also. Workplace bullying ends in violence. The victim either commits violence against others like he did or violence against themself like I did.


My story which I have told quite a bit about includes some doctor workplace bullying also. Most of the doctors I got along with very well and they told me they had no problems with me even after all of the crap that went on. There is a doctor who runs the EMS in Nome, Karen O’Neill. She hates nurses to begin with. Usually doctors who hate nurses are not very good and are threatened by the really intelligent ones. This is a bad situation. Research shows patient outcomes are much better with good physician and nurse cooperation. I showed up as a real nurse and having worked at big teaching hospitals with excellent education/training. She called herself a pain specialist which meant she gave out a lot of narcotics in Nome. In other places it means doing anything you can do to control pain and maybe using narcotics if you have to. I having gotten addicted to them due to pain from CFIDS/ME and was outspoken about doctor facilitated addiction. I would tell hospital employees to not go to her because all she did was give out narcotics. Some told me that was why they went her. She had people on unbelievable amounts of narcotics. Of course, she hated my guts. I complained to my boss about her behavior in the ER and how nasty she was. At the time I did not know my supervisor was a serial bully having never heard of the phenomenon. She told me that doctor did not like nurses and I should just ignore her. Later I realized they were working together on some of the bullying.

When I worked in the ER I often was also covering patients in the clinic too. The clinic was not opened on the weekends yet people came in like it was. If I was busy in the ER it was very unsafe to have patients in the clinic which was down the hall. I would circulate between both areas frequently. There were some medical students and interns who came there from time to time. They need lots of help and are often nervous understandably. As the workplace bullying got worse my bladder and diarrhea got worse due to the CFIDS/ME which we now know is most likely caused by a retrovirus. I had to go to the bathroom a lot. I just used the one in the ER, but it slowed me down a little. I told everyone I might be in the bathroom if they did not see me, so knock on the door. I had going to the bathroom down to an art and was very quick. When I had a critical ER patient and 6 or 7 in the clinic I called for help, usually there was no response unless one particular male nurse was on. They were too busy sitting on their butts shopping on line, drinking coffee, gossiping, planning sub-bullying attacks, etc. Having a situation where one group of patients is left totally alone for a period of time to go to the other area is insane.

Towards the end of my bullying they stepped up the attacks as the target before me had left and I was now the main target. A meeting was called of mainly physicians and my direct supervisor(workplace bully). I do not know all of the details that went on. My supervisor presented me with a strange note and she said it was originally written by a doctor and she recopied it so I could not tell who wrote it. Really strange. I wondered if my supervisor had actually written it and was lying that a doctor did. The person who wrote it was clearly disturbed and  kept repeating herself over and over, I still have it. I showed it to several people, they all said it was Dr. Karen O’neill that wrote it and she had done this many times before. The main theme was that she did not like to work with me, with quite a bit of crazy in it. At the meeting the medical director Dr. Head(yes, his real name) made the announcement that no one liked to work with Celia. Dr. Head did not like me because I was insistent that he come in to see patients when he was on call. The rest of the doctors would stay at the hospital when they were on so they could see the patients right away. Dr. Head felt he was extremely special and others should have to wait long periods of time to see him, especially on the Sabbath of his church, Saturday. He belongs to the Seventh Day Adventist church in Nome, perhaps it just took him a long time to get his special underwear on. They believe anyone who does not keep the Sabbath will receive the mark of the beast. I suspect from some of the things said there was an intern who complained about having trouble finding me, I couldn‘t even find myself when I worked the ER, it was dangerous. He would not have understood what was really going on there, he was just a na├»ve baby doc. When I told him good bye and said I would miss him, he almost started crying. That is how I knew he was involved. Someone probably explained the situation to him after that meeting. During the meeting Dr. Michael Mraz who is the only doctor there who knew anything about Aspergers, asked them if they knew I was autistic. He is a rarely competent and compassionate doctor who got the hell out of Nome.

Then I jokingly would thank doctors for working with me even though “no one liked to work with me”. One of them said, “ On the continuum of nurses that are difficult to work with you are no where near the top.” Another told me not to take it seriously, “look at the source”. Yet another, said, “You are just fine the way you are, don’t listen to them”. The problem is this was a tactic orchestrated by sociopathic workplace bullies. It was designed to destroy me professionally. This doctor who wrote the note had apparently participated in some other attacks on nurses in the past.

This is just one of the many incidents that occurred during my bully-ship at Norton Sound Health Corporation. The thing is I have always been considered an excellent nurse anywhere I have ever worked. The agenda at Norton Sound Hosptial does not include excellent nursing care. This is true of many small town hospitals and it is sad. Texas has some of the best medical care in the country at it's teaching hospitals. Why the Texas Board of Medicine would support this action against these nurses by a doctor knowing the damage it will do to relationships between nurses and doctors I can’t fathom.

Some background on Dr. O’Neill is she directs a system of healthcare in the villages of the sub-arctic that is administrated by what are called health aides. Theses health aides get about 15 weeks of training(yes, less than four weeks months of training) and generally are only required to have a high school education. Of course anyone would know this is crazy. Why does she not want nurse practitioners or Physician assistants or even a nurse with a bachelor’s degree? Because they would make her look bad. They claim they can’t find people to go to the villages who have those kinds of degrees and training. They aren’t looking for them. My reaction to this program was Whiskey! Tango! Foxtrot! That is why she loved me so much, she said sarcasticly.

The EMS under Dr. O'Neill also had nurses who were not flight nurses and did not even have bachelors degrees going on medavac missions to the villages. They would not let anyone go except the circle of bully minions and made a lot of money on overtime. This is very dangerous as they were not critical care trained at all and there are special things flight nurses need to know. In fact most flight nurses are also certified flight paramedics because it is so specialized. People told me they did not want me to go on the flights because I was, “too ethical” and they did not want me to see what they were doing. When they would go to Anchorage they charged the hospital for rental cars, hotels, and flew back all kinds of things including washers and dryers in the medavac planes. I would have definitely had something to say about it and they knew it. One time a pilot got a DUI while they were in Anchorage. I once asked a travel nurse who I had to sleep with to get to go on a mission as she was going all the time. Everyone laughed because that was the reason she was going.


Here is an excerpt of an interview with Dr. O’Neill at the UAF.

DR. O'NEILL: So there are a few things in the CHAM where if a health aide has been through a process and the process includes being evaluated by a health aide trainer, taking a written test, and being signed off by a doc, they are given a medical standing order for some certain simple things that we feel that they can diagnose and treat without a call.


So some health aides, and not all of them, have orders that they can treat a sore throat or a earache or a cold or something like that without calling the doc. But most of the things they have to call about. Anything that's not really straightforward and everyday.

(Sometimes a cold or sore throat is not a cold or plain old sore throat)

KAREN: Because of the liability issues involved?

DR. O'NEILL: Because they are not doctors. And because we need to know that they are able to diagnose something. You know, if you can't make the right diagnosis, then you can't provide the right treatment.


And even nurses aren't supposed to diagnose, even paramedics aren't supposed to diagnose. They can make assessments or, you know, collect information, and again, health aides collect the information for the most part, and we come up with the diagnosis of what's going on.

(These people with 15 weeks of training are describing a physical assessment that pretty much everyone else feels takes a nursing level or medical education to learn and then tell the doctor on the phone what they found. Then it takes a lot of practical experience to get competent. There is a reason why nurses who are not nurse practitioners don’t prescribe medications, even if they have a bachelors degree and twenty years of education. It‘s that little M.D. thingy they don‘t have. Nurse practitioners go to school for at least a year and usually longer depending on their specialty. Physician assistants go for usually two years.)

KAREN: How does it work with the medication? Because they have medicine out or some medicines out in the villages.

DR. O'NEILL: And unless they have a standing order, they are not allowed to dispense it without an order from a physician. So that's the only time.

Even a Tylenol or aspirin, they are not allowed to dispense any of those things unless they have a standing order or a verbal order from a doctor.

KAREN: So if they call in and they give the information, the doctor says, okay, you can prescribe this medication and then they give it out.

(AAAAHHHHH!)

DR. O'NEILL: Uh-hum. And so people have to come back for a second trip to the clinic to get their medication after that.

KAREN: And they receive training or -- on the medication?

DR. O'NEILL: As far as how to dispense it, how it mix it up, how to count it out.

KAREN: So they are a pharmacist, as well?

(Very dangerous due to having to understand interactions and physiological reactions to medications and just plain guano crazy. It takes several years to become a pharmacist. )

DR. O'NEILL: They are everything. They are the secretary, the billing clerk, the pharmacist, the lab tech because they draw the blood, they do the whole thing. They are the nurse, they are the doctor, they are the...

This is the definition of insanity.

This is an unbelievable situation which should have been remedied a long time ago by legislators. When is the government going to wake up and send appropriate health care professionals who can diagnose and treat illnesses to the villages? There are a lot of people who would go if they were paid right. I believe the main reason for this program is health aides are cheap and Nurse practitioners and Physician Assistants are not. I know there is one midlevel provider in at least one of the villages. Is this the best IHS can do for the native people in that region? Why don't they pay for native people from that area to go to college to become mid-levels and have the payback as ten years or so in the village? I know a lot of the health aides are dedicated and hard working, but this is this is a crazy situation.

http://jukebox.uaf.edu/CHA/htm/koneill.h

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