Working in the public healthcare system as a student has a number of challenges. You are expected to do the same work as a professional in your field, but you are not treated with the same respect. You often feel unheard and inferior. This is not the same for all placements, but it is an ongoing theme experienced among students in the public healthcare sector. When you are made to feel inferior it is often difficult to feel like you have a voice when it comes to speaking up about issues, especially when those issues contradict the qualified professionals. I have often found myself in situations where I witness something that I find to be immoral and unethical, but I feel like I don’t know how to report the situation without alienating the people I have to work with, learn from and be evaluated by.
Our main focus when we are on block is to get good marks, we are more worried about our clinicians and supervisors reports than standing up for what we think is right. It’s not always our clinicians or supervisors that are the culprits, it is also the nurses, doctors and other students we work with. Especially when it comes to nurses, if you alienate them your time in their ward will be extremely difficult so giving up their support and help to report them is a very difficult choice to make. I have had a lot of these experience over the two years I have worked as a student in hospitals and clinics but one of the most recent situations made me wonder what can be done to change this.
The situation was how one of the male nurses, whom I had become friends with over the few weeks we had worked together, handled the patients. To say he man-handled them is an understatement, he would lift them by one arm and dump them face first onto their beds and then flip them over rather violently. He doesn’t treat them with any respect or care but rather with indifference. He doesn’t seem to be malicious, but he also doesn’t seem at all caring in his interactions with the patients. From getting to know him as a person he seems really sweet and we get on very well, but I was shocked to see how he treated the patients. I honestly don’t know what can be done about the situation. If I report him and he knows it was me who reported him he could make my remaining time in the ward extremely difficult. On the other hand, if no one reports him he will continue to treat patients this way as no one is telling him to stop.
The rural health advocacy project put together a document that guides healthcare workers in the best way to go about report these kinds of issues (Nash, 2014). Unfortunately, it does not help much in the instance of students. For us, we answer to a multitude of different people, and often our only connection to the hospital is our clinician and if our clinician in not willing to stick their neck out our voice will often go unheard, and if our clinician is the problem then we have no one to go to that can actually do something about the situation. In this particular instance my clinicians reply was,” yeah, some of the nurses are like that”. Like it is just a part of life that we need to accept.
A study done by Dadzie, Aziato and Aikins in 2017 noted that there is very specific set of circumstances that make someone comfortable enough to advocate for a patient and it involves a specific cross over between the clients circumstances, healthcare workers traits and state of mind and the environmental factors (Dadzie, Aziato, & Aikins, 2017). This was represented by the conceptual model of advocacy categories and interaction arenas in figure one of their article. This showed that if the specific criteria in each of these areas is not met then it is unlikely the healthcare worker will speak up about the situation (Dadzie, Aziato, & Aikins, 2017).
Mansbach, Kushnir, Ziedenberg and Bachner mentioned that most healthcare facilities have internal route of “blowing the whistle” on ones co-workers and that these routes are designed to keep the whistle blower anonymous. Their study showed that students tend to be more willing to report misconduct than professional nurses, but they attributed that to the possible lack of knowledge about the consequences said action could have for them personally. They admitted that a limitation of their study was that it was done in a “would you do it” style not a “have you done it” style. This allowed people to say yes in a hypothetical scenario but does not show what they would do if they were in a real-life situation. They impressed the importance of using the available reporting routes to address these kinds of issues. (Mansbach, Kushnir, Ziedenberg, & Bachner, 2014)
It is so important for people to feel safe to speak up about these kinds of situations. It is difficult to expect someone to put themselves in an uncomfortable situation for someone that they barely know. It’s difficult to expect someone to subject themselves to possible alienation by their co-workers to report a small injustice to a patient. Even with the guidelines and steps in place for reporting these situations people are still very unlikely to report their friends for something small and unfortunately until the culprit does something seriously wrong it is very unlikely they will be reported and they will continue to act the way they do as no one is reprimanding them.
Putting together a guideline and system that helps students speak up about these issues is as important as the current guidelines for professionals because of how many students there are working in the South African health care system.
“There’s really no such thing as the ‘voiceless’. There are only
the deliberately silenced, or the preferably unheard.”
– Arundhati Roy, Author and human rights activist
References:
Dadzie, G., Aziato, L., & Aikins, A. d.-G. (2017). “We are the best to stand in for patients”: a qualitative study on nurses’ advocacy characteristics in Ghana. BMC Nursing.
Nash, J. (2014). A HEALTH CARE PROVIDER’S GUIDE TO REPORTING HEALTHCARE CHALLENGES: PRINCIPLES, TOOLS & STRATEGIES. Rural Health Advocacy Project.
Mansbach, A., Kushnir, T., Ziedenberg, H., & Bachner, Y. G. (2014). Reporting Misconduct of a Coworker to Protect a Patient: A Comparison between Experienced Nurses and Nursing Students. The Scientific World Journal.