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How often have you worked with someone who is "difficult",
"intense", "emotional", or "not quite right"?
Do you have colleagues who keep to themselves, who are angry all the time,
who are very preoccupied, who may be absent frequently? Do you work with
others who you consider "weird" or "strange"? Have
you been concerned about a colleague or a coworker whose behavior has
changed recently? How often have you or others merely given this individual
a label and then tried to avoid him or her? Just as many of your colleagues
and coworkers have heart disease, hypertension, cancer or diabetes, they
may very well also have a psychiatric disorder.
Nursing is often identified as a holistic practice. As nurses, we consider
the patient from a biopsychosocial perspective. However, in reality we
often compartmentalize the physical and the psychiatric. From a holistic
perspective, both the physical and psychiatric aspects contribute to the
entire being. Do we really look at all aspects?
In the workplace nurses would likely identify and possibly intervene,
if a colleague showed signs of a physical illness such as hypoglycemic
reaction. So might we need to identify and possibly intervene in a coworker's
psychiatric illness. Just as we might consider a diabetic coworker's dietary
needs when planning a work-based celebration, we might also consider a
depressed coworker's fatigue and difficulty concentrating as a health
problem that could contribute to the decreased quality of their work.
As a society, we have long held biases against those with mental illness.
Mental illness was thought to have been the retaliation of angry or insulted
Gods. Later in our collective history, "evil spirits" were driven
out of the afflicted individual through prayer, drilling holes into the
head to allow "the spirits" to escape. Persons with mental illness
were subjected to a variety of clearly questionable "treatments",
including flogging, drowning, being chained, being subjected to insulin
shock, cold packs, etc. We did not understand the nature of mental illness;
even today, despite much progress, there is still much to be learned about
mental illness. Despite our current biopsychosocial perspective of the
etiology of mental illness, one thing that has persisted: those with mental
illness continue to be stigmatized.
Persons with psychiatric disorders work in a multitude of occupations-including
healthcare. Identifying and understanding symptoms, and providing helpful
interventions, or at the very least, reframing the meaning of behavior,
can help to make the work environment a more healthy and productive place
for all. It is important, however to remember that our colleagues
and coworkers are not our patients. We will not provide treatment or care
for them. We must honor the boundaries of our working relationships.
Let's look at a few examples:
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Judy W., an ICU nurse for 20 years, is the nurse manager on a unit
in which the nurses have generally worked well together as a team.
However, for the last 2 months the nurses, as well as the physicians
and respiratory technicians have had a number of conflicts; several
staff have requested transfers to other shifts or units and one nurse
is threatening to quit entirely. Judy has been trying to problem solve
the situation, however, she believes it comes down to personality
issues among the staff. Looking back, she recognizes that the problems
began about 3 months ago when Maura transferred from the emergency
department to the ICU. Maura is younger than most of the other nurses
and is quite excitable and has had several shouting matches with coworkers.
She also has an exciting social life, which she has often talked about
in great detail. In fact, since she came to work on the unit, she
has had 2 boyfriends, one of whom she had moved in with after just
a week of knowing him. That was 2 weeks ago. Today, she called in
sick after taking 20 aspirin -- she was so distressed because this
new boyfriend now wants her to move out! This is the 5th day she has
taken off since working on the unit, due to emotional distress. The
other nurses have been complaining that she is so preoccupied with
her chaotic life that she is not a productive member of the team,
others frequently having to follow up on her work. Judy now realizes
that several physicians and respiratory therapists have complained
to her about Maura and her frequent outbursts of anger and tearfulness.
Judy has generally only seen Maura behaving in a relatively professional
manner, but recalls a situation in which a patient's family member
approached her to request a day off for Maura because she was so overworked
and had so many personal problems.
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Jan has a reputation among her coworkers as being "weird".
Some days she is fairly productive and attentive to her work, and
other days she seems to focus on just one or two patients or activities,
neglecting the larger work unit. Jan tends to dress in an erratic
style, often layering on multiple items of clothing; her hair often
looks unclean. Jan is frequently preoccupied and anxious, and several
staff members have begun to complain that Jan is mumbling or giggling
to herself a lot. She is frequently irritable and often not at all
easy to get along with. Several of the nursing assistants have complained
to the nurse manager that they do not want to work with her because
she is so difficult. The nurse manager recalled that a few years ago,
Jan also went through a period where she was irritable and anxious
and complained that her coworkers were talking about her and plotting
to take her job. She took a sudden medical leave right after having
an incident with a physician in which she accused him of reporting
her to the Board for Nursing. After she returned to work from the
medical leave, two months later, she was less moody and more able
to get her work done.
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Sam is an evening supervisor of a long term care facility in which
he has worked for 12 years. Other employees are noticing that over
the past year, Sam is often irritable and short-tempered. His frustration
tolerance has decreased; he now struggles with situations that he
used to handle with good natured skill. He used to volunteer for social
activities at the facility, often chairing the committee on employee
morale. He has quit the committee and no longer volunteers for staff
activities. He has also stopped meeting some of the other nurses for
coffee during breaks. Sam's wife of 30 years died in a car accident
about 2 years ago. He was sad and quite distressed after her death,
but with the help of his grown children, other family members and
his friends he seemed ok. But for the past year, Sam has become increasingly
irritable and isolated.
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Laura is a relief nurse on a surgical unit on the evening shift.
She is often called in to work when Mark, another RN, is off. Laura
has been replacing Mark approximately once or twice per week, apart
from his scheduled days off. Mark usually volunteers to pass medications,
so when Laura works, she is usually assigned this task. Laura is confused
by the patients' comments that they like it when she works because
the medication always works well when she gives it. During her break,
Laura chats with one of the other nurses, who mentions that Mark is
out sick often and even when he does come to work, he is generally
passing meds, or is in the bathroom or on break. She confides that
she thinks something is going on with Mark.
Would you recognize the above symptoms of a psychiatric disorder in your
colleagues? What you learned in your nursing education about psychiatric
nursing was related to the patients in your care. However, mental illness
is everywhere. It can affect you, your family, your friends, and your
coworkers. Recognizing symptoms and accessing assistance for ourselves
and/or our colleagues can help to make the work environment significantly
less distressing and more productive and collegial. This course will help
you to apply basic psychiatric nursing information to the non-psychiatric
clinical setting, where our colleagues as well as our patients can be
assisted.
© 2004 NYSNA All rights reserved.
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