I have tests I need to have done, yet can’t bring myself to go to the hospital to do them. I canceled one that was scheduled. My PTSD is triggered when I even think about going to a hospital in a rural area of this state that is known for workplace bullying. I can’t sleep before going for a test which normally would be a nothing event. It is knowing the hell some of the employees are going through that triggers the memories of what I went through. Even worse was not being believed on any level of the government in this state and having the judicial system corruptly target me and do everything they could to make me sicker and their attempts to demonize me on behalf of the serial bullies.

 They went so far as to give the newspaper lies, have the department of licensing lie to me, and corrupt their investigation. They had the public defender agency lie to me, ignored my complaints about my incompetent attorney, and set me up to be arrested for failure to appear(which I knew they had tried to do in the past) based on the lies of conmen. They then knowingly allowed one of these con men to steal my property and starve/torture my cat(law enforcement, 2 judges, department of law, Gov. Palin's staff, public defender agency, and more). The court system was used to facilitate this and neither of the two liars(that were covering up insurance fraud and other issues) were arrested on any charge. In fact the state troopers destroyed evidence I needed and had requested from them, knowingly. Two judges are involved, while one may have just been duped by being lied to, she should have listened to what I had to say(especially about the danger to my cat), or is the presumption of innocence no longer used in Alaska. I was not granted a hearing at all due to the incompetence or possibly purposeful behavior of the public defender agency in not telling me about a scheduled hearing and two judges were very aware of this.

We all know the story of the shooting at Central Peninsula Hospital in Soldotna., a murder/suicide. Suicide and murder/suicide are some of the consequences of workplace bullying caused PTSD. There is another case of an attempted murder from one of the hospitals on the Kenai Peninsula which there has been little publicity about. Shortly after I moved to Homer I found out about a case of a nurse who was clearly run out of South Peninsula Hospital because as manager of the OR she tried to get a doctor to wear scrubs and scrub into the OR., who the heck wants a surgery in that facility. I immediately knew this was workplace bullying and the corrupt court system in Alaska would not allow her to win her lawsuit. When there is no justice and incompetent mental health care the risk of violence related to workplace bullying is increased greatly. A procedure scheduled to be done at South Peninsula Hospital's  sister hospital here in Soldotna, Central Peninsula Hospital is one that I have canceled as I just don’t want exposure to a system where such breaches in basic infection control are allowed, especially with my immune system issues. Their workplace bullying does have a direct affect on the health of patients and the community.

My story could have ended in suicide certainly, but I had become dissociated that last day at work from the torture I had received over the twenty months I worked at Norton Sound Health Corporation and was unable to act in a rational way on that last day I worked at that hell hole. I took drugs from the lock up in such a way I was sure to immediately be caught. I was clearly disturbed, yet rather than being sent to get help my supervisor(one of the serial bullies) told the police I was not allowed to be admitted to the hospital. She gleefully had me arrested. This was after many months of being denied appointments with the psychiatrist, denied medication, and medically bullied when I went to the clinic. I was unaware that NSHC had destroyed many people over many years even at this point. The native people had told me they thought there were evil spirits in the hospital. I can’t deny there is evil, but it is man made evil, mostly white man made evil with one exception.

Nursing carries high risks. We are exposed to communicable diseases, the work makes us susceptible to injuries, we are assaulted sometimes, we are bulled by management, patients, patient families, coworkers, and physicians, given patient care loads that prevent quality care, and often work very long hours. For these reasons nurses can develop PTSD, depression, and chemical dependency. PTSD can cause physical illness which can cause debilitation and even death. Sometimes a nurse is taking something for pain to keep working due to an injury and becomes addicted or they start drinking due to the stress. It is rare for employers to offer long term disability as a benefit, nurses are often treated as throw aways when they become injured or ill, or addicted, even if it is directly related to the job. The American Nurses Association considers addiction to be a workplace hazard for nurses and are supporting efforts to bring non-punitive treatment to the ten states that have no alternatives to arrest of nurses who divert drugs in the workplace. Alaska is one of those backwards states and the director of the board of nursing in Alaska is not supportive of nurses who have been psychologically tortured end up with PTSD and have addiction issues. Neither apparently is anyone else including the legislators. Why would anyone who knows this come to Alaska and work as a nurse? Most who come were like me, unaware that the judicial system is so unenlightened, harsh, and that the board of nursing does not treat nurses with the same respect/fairness the medical board treats doctors.

This type of PTSD that workplace bullying causes has been shown to be as bad as that suffered by war veterans and can go on for years causing the victim to be only a shell of their former selves. It is an especially heinous act to commit against people who go into a profession because they want to dedicate their lives to helping people. It is made ten times worse when the victim then has to deal with a corrupt legal system. It is made twenty times worse when targeted by a corrupt prosecutor and judge, wrongfully imprisoned, denied the medication for PTSD, and tortured.

One reason I got so sick in Nome was the lack of support from my coworkers. The staff had no understanding of what was going on in the nursing areas, but they did know about it in Behavioral Health, yet were practicing it themselves. Many of them participated in the bullying, demonizing, destroying of reputations, and then made statements like, “I am glad she is gone , she was crazy” when people finally lost it. Would it have been different if they had known about workplace bullying, for many the answer is no, they are very sick people and have no business working in a hospital, but for others understanding the cause and effect would have certainly made them more supportive.

The positive thing at many of the hospitals right now in Alaska where staff are fighting against workplace bullying is they understand what is going on and are supporting each other. Being supported by the nurses, doctors, and ancillary department workers makes all the difference in the mental health deteriorating to the point of suicide or murder/suicide, or perhaps even PTSD. That feeling of being singled out and pecked to death by chickens while being trapped in the very system that is destroying you can be greatly moderated by support of others. I had been workplace bullied before NSHC, but had support of others and it did not affect me much. At one hospital we had a system of protection from abusive screaming doctors, any time a nurse was being berated the other nurses would stand very close behind that nurse with their arms crossed and silently stare at the doctor. He would usually stop and scurry out of the unit. Later he would be called to the doctor-nurse relations committee and told to write a letter of apology if he wanted to keep his privileges. I have to say though, my best allies in these situations have always been doctors. Some of them have even told my supervisors in the past they would take their patients down the street if the attempts to run off a nurse who took good care of their patients did not end. Good doctors want good nurses. The problem in rural Alaska is there is no hospital down the street to go to creating a trapped feeling. This creates that added element that puts PTSD over the edge to Complex PTSD.

By Mary Catharine Martin

Many Bartlett Regional Hospital employees live in fear of being demoted, reassigned or fired for speaking out or disagreeing with hospital leaders.

That's what two surgeons, a nurse and a social work case manager communicated to the Assembly at a joint meeting with the Bartlett board of directors and hospital leadership Wednesday night.

Others said they were afraid to speak publicly, but expressed the same view.

Nurses and doctors said due to understaffing, nurses regularly work between 50 to 60 hours per week. Shifts can end up being 16 hours, they said.

Orthopedic spinal surgeon Gordon Bozarth said there is "a great fear of disciplinary action among the nursing staff" and added that the patient/nurse ratio is "highly inappropriate."

There is always a great fear of disciplinary action among nursing staff. It is used as not only a tool of workplace bullies, but as a way to make them work after they are sick from the PTSD they cause, adding to the torture. PTSD causes physical illness,. People start calling in sick more frequently because the stress and hormones secondary to the trauma and the physiological effects of PTSD render the immune system dysfunctional. They work in an environment where the sickest people in the community congregate and now due to immune system compromise or other effects of this psychological terror they are ill. The hospitals then use this as an excuse for disciplinary actions against them, causing more stress, which in turn makes them even sicker. They use threats, “I am going to talk to personnel to see what we can do to you”, is one of the ones I got from NSHC. So, now you are being terrorized, you are psychologically and physically ill, and your job is threatened. This is especially devastating to older people as they do not bounce back as easily as younger staff, it is a way to get rid of the more experienced, higher paid staff. The bullies who are hired by the hospital have caused your illness and are now using that illness they caused as a weapon against you.

Even if you can go somewhere else for a job, which in rural Alaska is often not an option, you fear they will give you a bad reference. In healthcare corporations they have ways of getting around the laws about disclosure of information of former employees by using secret codes and secret communications when information about former employees is requested. They can destroy your career, even if you leave. This is one reason people stay in these situations, they are trying to find a way to repair the problem before they leave. They don't realize they can't repair it, all they can do is become sick trying.

General surgeon Allan Schlicht said what he sees is leadership not by inspiration, but by intimidation.

A key piece of evidence for workplace bullying being practiced.

At the Wednesday meeting, hospital CEO Shawn Morrow said personnel satisfaction has been "at the forefront of our minds for a long time." Board members said they have been working to address staff concerns, but change happens slowly.

"In my mind, it's no question it's been the priority," said board member Linda Thomas.

A 'touchpoint'

In testimony, Bozarth, Schlicht, Bartlett Social Work Case Manager Holly Cockerille and Registered Nurse Martha Leak referenced changes in senior leadership as contributing to the problem.

Schlicht called the relationship between staff and leadership "adversarial;" staff members said there was a much more positive atmosphere under longtime hospital CEO Robert Valliant, who passed away recently.

In August, 87 hospital employees signed a letter addressed to Morrow and distributed to the board of directors questioning why former Critical Care Unit manager Janice Gray, a 25-year Bartlett veteran, felt forced to resign, and expressing concern over nursing leadership.

I don’t know what the issue was, but I can say that one of the reasons for workplace bullying is to get rid of older, more experienced(carrying more education) staff. They cost more money, say things like, “I am not going to do that it jeopardizes patient safety”, complain about doctors who are substandard, don’t put up with abuse from physicians or administration, and have the ability to present research refuting poor standards of care. If you have a large percentage of new nurses with little experience you can manipulate them much easier than someone who is as I have been described by one doctor in Washington “a tough old ICU nurse”. This of course compromises the quality of care, less education and less experience cause huge problems. For example: if a doctor writes an order for a medication that is unsafe or non-therapeutic it is the job of the nurse to bring it to the doctor’s attention. Sometimes it is an error and sometimes they have a legitimate reason for an unusual order. If the nurse is inexperienced the checks and balances in the system are compromised. If a nurse who is a new graduate does not notice an error, or is intimidated by the doctor and afraid to say anything, a bad order may not be questioned. If the medication is kept on the floor they might give it as ordered, and the order does not get to the third line of defense which is the pharmacist.

"At present, we are afraid to ask questions or offer ideas for change. We are afraid to voice our thoughts, and fear that any difference of opinion may be seen as confrontational, negative, or trouble-making, and that our jobs may be jeopardized," the letter said.

I was labeled a trouble maker in Nome when I asked why medivac nurses were not trained according to minimal standards, why health aids with three months of training were used instead of mid-levels in the villages(or even RNs with BSNs), why narcotics were given out by one doctor like candy, why they did not use universal precautions, why MRSA patients were not put in isolation, why the native people were treated poorly, why people sent for educational opportunities were put in very expensive hotels, and I had to wonder if someone was embezzling money due to often not having supplies such as toothpaste for the patients.

When questioned by Assembly member Bob Doll about the board's response to the letters of concern, Hospital Board Chairman and emergency physician Nathan Piemann, who was not chairman in August but was present at the meeting by phone, deferred to then-Chair Loren Jones, who was not present at Wednesday's meeting. Piemann said he would follow up with an answer to the question at a later point.

Not showing up at this meeting where so many concerned staff were seeking help is a slap in the face and an indication management is not taking their concerns seriously. This is a psychological tactic used by workplace bullies to send the messages that those making complaints about the way they are treated are making it up, are crazy, and are held in such low esteem that their pleas will be seen as a low priority.

Minutes from the August meeting indicate only that there were "several staff members and physicians present to voice their concerns over a recent termination of a long-term employee" and that "several letters were read regarding their wish for a 'shared governance.'"

Schlicht also wrote a letter of support for Gray, as did Dr. Henry Akiyama and Dr. Melissa Hynes. Hynes' letter was signed by numerous other Bartlett doctors.

"A highly effective, bright, and energetic nurse was essentially forced to resign," Hynes' letter says.

The Critical Care Unit staff also signed a letter to Morrow saying Gray's loss is "devastating" to Bartlett.

One very big clue here is management and even some doctors do not generally like critical care nurses as among them are often very outspoken, bright individuals with strong personalities. There is a history of consciously picking workplace bullies as managers in critical care. Remember workplace bullies are not about the work at hand, they have another agenda. This means patient care standards will always suffer under them.

Good doctors want well educated, experienced nurses who execute excellent nursing care. They are not threatened by nurses who carry a lot of knowledge and have strong personalities. Their agenda is excellent care for their patients and their community. Doctors who go to bat for nurses are gems. We went on strike in Yakima Washington due to a horrible situation caused by a CEO who was overheard by people in the community saying he did not think nurses were worth what they were being paid. Old St. Elizabeth’s Hospital(now a Providence Hospital) had the highest quality of nursing care I have ever seen and it was a small hospital in a small community. The reason was the nurses were in full charge of the policies and procedures for nursing and they had the best nursing education I have ever seen, including a six month critical care residency. We had a nurse manager in critical care who was well educated, demanded high quality care, and was a very nice person. They also had an excellent nurse educator on staff. This CEO was trying to destroy this system. The doctors would not park their cars in the parking lot during the strike and for weeks before admitted their patients to the other hospital. In the end the nuns fired the CEO. Hurray for proactive nuns who don‘t put up with any B.S.!

Gray, who was not at Wednesday's meeting and is in arbitration with the hospital over her resignation, said she couldn't comment on her situation, but added her situation is just "a touchpoint" in the problem.

"It's a culture," she said. "It's not just one thing."

Other managers are currently being or have been reassigned or demoted, nurses said.

"It has been said by leadership that these are subjective fears," Leak said at the Wednesday meeting. "Whether or not they're subjective, they're real, and many people share them, and unfortunately, it's not being addressed."

"Just because you're paranoid doesn't mean they're not out to get you," said Cockerille, who also spoke about the "undercurrent of fear" at the hospital.

In workplace bullying this is not paranoia, it is hyper-vigilance, watching carefully, protecting yourself, and fearing the attack because you have experienced it or seen it against someone else. Subjective, as the hospital prefers to use it refers to what originates in the mind and pertains only to the person having the thoughts. Claiming the tactics used against those abused in their system are only imagined is a hallmark of a workplace bullying culture. Being targeted by workplace bullies DOES mean they are out to get you. In fact that is their purpose, to go after those who are competent and knowledgeable. Because of the issues a bully internally has they feel incompetent and less-than around those they target and wish to get rid of them to decrease these feelings. It is time to put an end to these serial bullies who destroy the lives of the best nurses and decrease the quality of patient care.

Management in many businesses in this country knowingly select these people to get rid of those who don’t go along with their plans, because of course people who want to protect consumers and retain high quality in their work will balk at changes that cause deterioration. They also use these people to weed out those who would support unions bacaise they are the facilitators of safe working conditions and decent compensation.

Morrow said hospital administration has instituted quarterly forums and something called "the burning box," in which employees can drop anonymous "burning questions," and other measures to promote openness. They also said they are reorganizing to "clinical microsystems," or small groups of people that work together to provide care.

Board members said personnel satisfaction has been "a top priority."

Hospital staff, however, said leadership's actions aren't in keeping with its language. Bozarth said he is "not seeing or hearing anything I haven't already heard in the past year," and some said staff are afraid to attend the quarterly forums.

Morrow declined to comment publicly after staff testimony and was unavailable for comment Thursday.

Chief Nursing Officer Cathy Carter was unavailable to comment.


Moving forward slowly

Nurses and other staff emphasized that the hospital still offers, as Bozarth put it, "incredible quality of care."

Of course the quality of care if affected. It is well documented that nurses or anyone else working in these kinds of situations are not performing as well as in a healthy working environment. There are many factors that affect the quality of nursing care, most are affected by management. Forcing nurses to work long hours is another problem that has a big affect on quality of care, as well as the number of patients a nurse takes care of.

From The San Francisco Chronicle:

Findings of the nurses-to-patients ratio study

-- California nurses cared for two fewer patients on average than nurses in New Jersey and 1.7 fewer than in Pennsylvania,

-- 468 more Californians would have died in 2006 from general surgical deaths if the state had the same nursing ratios as Pennsylvania and New Jersey.

-- Adding one patient to nurses' workloads increased patients' odds of dying by 13 percent in California, 10 percent in New Jersey and 6 percent in Pennsylvania.

People under siege do not function well, neither cognitively or physically. This affects not only those who are directly targeted, but those who are afraid they will be targeted next, and even those who watch from the sidelines. Watching coworkers slowly destroyed and picked apart, seeing the hollow look in their eyes, watching their hands shake, seeing their tears, having them tell you they throw up every day before they come to work, and knowing the quality of patient care is suffering is devastating for everyone.

Not only does workplace bullying decrease the quality of work, it also costs the business money. In this case Bartlett appears to be owned by the tax payers. Workplace bullies are notorious for costing lots of money. They get rid of the most experienced/educated people, this causes costly errors. They run off nurses and then have to replace them with new nurses who have to go through orientation which is non-productive work. In Nome they have to fly the new nurse and any family to Nome and pay them a bonus for moving expenses as well. The operations of facilities are affected because workplace bullies are not about the work at hand. This is not cost affective. They also cost society by taking the best workers out of the workforce and putting them on disability. They stifle the ability of nurses to move the quality of care forward by taking away their voices. The cost is so staggering to those who are targeted that many take their lives.

"We'd like to make this hospital our own and be brought in as far as making changes," he said. "We feel like essentially, we're not in the loop."

"We want to provide the very best care for our community, and a healthy workplace is conducive to achieving that goal," said Registered Nurse Susan Thompson.

"Shared governance doesn't come from the top down, and that's a bit of how it's being approached now," Leak said. "Staff needs to be much more involved on a unit level on what's being done."

Taking nurses out of implementing policies, procedures, and systems of care is like taking the wildlife biologists out of the board of fish and game.

Hospital board member Kristen Bomengen said the improvement process is "painfully slow."

Only because that is how you want it to be.

"We wanted to make sure we got as much information as we could before we made a decision to move in one direction," she said. "The involvement on the part of board members has been very intense. Seeking agreement among a large group of people takes time."

Piemann said the board takes comments "very seriously."

"I think it's important we spend some time reflecting on this and coming back to employees and medical staff," he said, adding that the board has been discussing these issues. "We appreciate what you've brought forward, and we are listening. Thank you."

Bartlett Hospital is owned by the city. Its operations are controlled by its board, which is appointed by the Assembly. The Bartlett board and the Assembly will meet again in about three months.

A slap in the face. The message is you are irritating little gnats and we will go through the motions of appearing to listen to you, but we are not serious about it.

"We try to hold boards accountable," said Mayor Bruce Botelho. "In this respect, the briefing (Wednesday) night was an exercise of that function."

How is allowing the board to just think about the situation for three months without a response or action holding them accountable? Of course we have to look at the fact that the board was appointed by the assembly.

• Contact reporter Mary Catharine Martin at 523-2276 or maryc.martin@juneauempire.com.


No comments: