Over the holidays, I purchased a cabinet from Ikea, the low-budget, lots-of-assembly-required furniture and household gadgets store. One of the largest pieces was broken, and my subsequent call to customer service only revealed that Ikea is not interested in my individual satisfaction. Like most twenty-first century, I-want-it-now Americans, I exchanged heated words with the person on the receiving end of that call. I didn't get my way, and I made sure to express my sentiments - loud and rude. Was it abusive? I didn't give this worker the chance to let me know.
You have employees who feel abused by family members and residents. And if you're a member of your community leadership team, many employees blame you for not intervening. There is not a healthcare professional reading this that cannot recall a customer sitting on the other side of their desk, or standing on the other side of the bed, or even in the hallway, vociferously expressing their anger over an actual or perceived breakdown in the delivery of care. I have been sworn at, had fingers pointed in my face, and threatened. I fully understand my responsibility as a community leader, though, and I've benefited from more customer service and crisis management training than most of our employees combined. I know that I have a responsibility to find solutions and prevention through root-cause analysis, and every concern is taken seriously.
When a direct-care employee such as a nurse or a C.N.A. is verbally reprimanded by a family member, it can be perceived as a personal attack on their intelligence, proficiency, or even race and socioeconomic status. The linked article above, from a great C.N.A. forum, describes the frustration felt by many nursing staff members first-hand. I admit experiencing the same feelings as an Administrator, and the helplessness that can accompany them. Patti's article along with the subsequent reader comments, calls for a policy shift in retirement communities that holds customers accountable for their own behvior.
The topic has forced me to examine my own views and approach to conflict resolution, and I agree that families do not have the right to verbally accost employees, regardless of the situation. While difficult to craft an umbrella policy that does not discriminate against residents or breach resident rights, I recommend reviewing your process for prioritizing family and resident concerns. This process must be transparent, accessible to families, and objective. I believe that most communities have some version of this in place, but I also know how uncomfortable the worst of these situations be.
What is alarming about the conversation is that some direct-care employees are searching for their own methods to deal with situations because they feel a lack of support from their Administration. Several commenters promote calling 911 when they have been verbally (even physically) attacked by a family member. Their presumption is that communities pander to families in order to maximize revenue:
"We must stand up for ourselves if the DON won’t. If we lose the job, so what. The job wasn’t worth US. Getting hurt at work isn’t worth it. The management CAN draw the line but usually won’t cause it’s all about money- the paying customer. Mind you, I question if the payment equals the worker comp bills.
When it is family who is abusing staff, that is different. They should be banned from the facility until they are made to take an anger management course. And then they must apologize to the staff. It’s one thing to yell and hoot and scream. It’s quite another to shake and rattle and otherwise manhandle the staff. Limits must be set. Just like with kids."
So how are you going to effectively convey the right message to both employees and customers? No Administrator or Director of Nursing enjoys asking a family member to examine their own actions, but allowing your customers to act out against employees certainly sets the tone for your community. Feelings of resentment will build and employee morale will suffer greatly if leadership fails to address each individual circumstance swiftly. While I still have some introspection to conduct on the topic, I offer three tips to begin your own journey:
1. Include "Addressing Angry Customers" as part of your Abuse Prevention and Reporting In-Service. The resentment created by an angry family member can turn into retaliation - against the resident.
2. Take ownership of the concern process. I receive all written concerns in order to ensure timely, objective follow-up, and review all concerns from the previous 7 days with our Concerns Committee. The Director of Nursing and I take time each week to sit down and call several families that have expressed concern or frustration.
3. Educate employees on involuntary discharge. The average employee believes that a nursing home resident can be "kicked out" at the whim of management. Involuntary relocation is an extremely cumbersome process, and rarely executed. Why? Because forced discharges are almost never to the benefit of the resident.
OH, the resident! We almost forgot about the resident. And that is what concerns me the most about this conversation. When employees become embroiled in family onflict, the resident almost always loses. By dealing quickly and honestly with family outbursts, leadership can minimize resident stress and undue harm. Focus difficult family conversations on how actions are impacting the resident's best interests, rather than scolding or threatening discharge. A successful Administrator or Director of Nursing can advocate for both residents and employees simultaneously - and should do so every time.
I look forward to hearing from you on this topic.