On-the-Job Abuse of Nurses by Patients and Physicians
Xiamei Hu is a family nurse practitioner who works in a not-for-profit adult and pediatric clinic serving an inner-city–impoverished community. Most of the families served are African American and Latino. She was happy with her practice until about 8 months ago when a new medical director was hired to address the alarming financial status of the clinic, which was hopelessly in the red. With unemployment rates rising in the city and fewer families with employment linked health insurance, the clinic population had tripled over the last year and everyone was trying to do “more with less.” What Ms. Hu had most liked about her practice was the clinic’s commitment to its patients and to literally “moving mountains” to see that their complex and, at times, overwhelming healthcare needs were met. A cohesive interdisciplinary team was available to work with individuals and families.
Recently, however, every time she tried to advocate for someone who needed help getting medications, medical equipment, food, or shelter she was berated by the director who told her to stop trying to be Santa Claus and to just “get her job done. Move them in and move them out and do it quickly!” Recently she learned that the director was trying to eliminate the positions of two social workers who were invaluable members of the team. When she went to the director on their behalf he stood up, pointed his finger in her face, and screamed at her, “Don’t try to do my job, missy! If you value your own job you’ll shut your mouth!” Ignoring his condescension was one thing, but the abusive anger was another. She can appreciate the difficult task he has of balancing revenues and expenses—but she cannot accept this behavior. It is bad enough that many of the patients vent their anger on the staff and some, in spite of the team’s heroic efforts on their behalf, leave ungrateful and angry. Even more problematic are the family members who accompany many of the patients to the clinic. Often overwhelmed themselves by life in general and the burden of caring for sick family members, they frequently “dump” their frustration and anger on the clinic staff becoming verbally and, in a few cases, physically abusive. How should Ms. Hu respond? Until now she has not personalized the abuse but she fears that it will begin to compromise her own mental health and practice. Is she being disrespectful of herself if she puts up with these behaviors?