HSA staff speaks out on public disrespect

Dr Fiona Robertson, Director of the Accident and Emergency Department	Ann Marie Taylor, Emergency Room nurse	Dr Marilyn McIntyre, Paediatrician.

Tuesday,  January 31, 2006

A growing trend of lack of respect for many nurses and doctors at the Health Services Authority (HSA) is impacting morale, according to employees at the Cayman Islands Hospital. Racial slurs, verbal threats and shouting are now commonplace, which can be demoralising to nurses and doctors, they said.

And it is not just in the Accident and Emergency Room where emotions and panic may already be running high; this attitude is spilling over into other departments according to some doctors. 

The zero tolerance policy by the hospital on verbal as well as physical abuse has been in place now for a few weeks, but it is still too early to tell if it is having an effect. 

Paediatrician Dr Marilyn McIntyre has worked at the hospital for 28 years and said that as the population and the hospital has grown, the respect has gone down. 

However, patients at the Cayman Brac hospital continue to maintain a high level of respect for clinical staff.

“Now, respect for clinical staff (at the George Town Hospital) is at an all time low,” said Dr McIntyre. “I think this is a product of society. The world has changed. Some children are raised in an abusive environment, which is perpetuated from generation to generation. Many children are not taught how to respect others so how can they give respect.”

She explained there have been numerous incidents of patients and their relatives verbally abusing nurses and doctors in the Maternity Ward. 

She personally has had at least two incidents in the last few months, where a relative hurled racial slurs at her and threatened to smash all the windows. 

“The Maternity Ward is supposed to be a happy place. Patients are not sick and they are not about to die. They are looking forward to a newborn baby,” said Dr McIntyre. 

“I can understand that Accident and Emergency gets the brunt of it, because emotions and tensions are high. But you know things in the community are bad when it spills over to the wards,” said Dr McIntyre.

She explained the Paediatric Ward is on an isolated part of the corridor and dark after hours. Many nurses are not happy to be alone on the ward at night. 

She added that much of the public considers HSA clinical staff inferior to the private sector. Partly because most patients do not pay directly for their services so they do not value the health care they receive as much as they do when being treated in the private sector, which they may be paying for out of their own pockets. 

Dr McIntyre said it is common for a patient to pay their own airfare and expenses to see a general practice physician in Miami and they value that care more than a specialist doctor here at George Town Hospital, who has more experience and knowledge about their condition. 

The Director of the Accident and Emergency Department, Dr Fiona Robertson, said that although it is a small minority of people that are physically or verbally abusive, it still adds up to two or three incidents a week.

Most nurses can and do brush it off, if it is a mother who is worried about her child, or a drug related or mentally ill patient. 

But most of the problems come from patients who are not seriously ill and are using the emergency room as an after hours clinic. Then they become upset when they have to wait for a long time to be seen. The reason for the wait is the emergency room works on a triage basis, which places patients in the order of how serious their health condition is and not the order of their arrival.

Consequently, a patient that is having chest pains will be treated before the patient with pink eye, regardless of who came in first. 

“The flash point comes when the nurse is not immediately available at the window and the patient is worried about his condition,” said Dr Robertson.

“More often than not the patient is not trying to become aggressive, it is just the anxiety levels are so high.”

Dr Robertson explained it takes an average of 20 minutes to treat each patient. The waiting room may not look busy with six patients in the waiting room, but at an average of 20 minutes for each patient it adds up to two hours before they are likely to be seen. 

She added that most of the time the abuse comes from the relatives of the patient. Because the emergency room is designed to give the patient privacy, often people in the waiting room do not realise that it is very busy. 

Or if the patient is taken in the emergency room to be treated the relative does not know what is happening with the patient. 

“The accompanying relatives become agitated and loud. They are yelling and screaming. They don’t know what is happing to their relative that is back in the room. They are panicking and this turns into a tirade against the nursing staff,” she said. 

The effect on morale means the nurses are sometimes reluctant to take the triage window, because they are not prepared to accept the abuse. 

“The nursing staff understands when a patient is incapable as a result of mental illness or alcohol related problems. What is inexcusable is when they are threatened and when it turns into verbal abuse and physical assault, which has happened several times in the last six months,” she said. 

Dr Robertson noted there is now a full time security guard for the emergency room and there are now security cameras installed throughout the department. She would like to have a monitor where people in the waiting room can observe their own behaviour. 

It is hoped that these measures will help people keep their tempers under control. 

Ann Marie Taylor who is a certified emergency trained nurse from Jamaica, said that she has experienced verbal abuse including racial insults. 

“There needs to be more public education that in the emergency room we are trying to save lives, but we won’t turn our back on anybody even if the patient (is not an emergency situation),” said Ms Taylor. 

“It is natural for people to be upset and we try to calm them down and explain what the concept of emergency is, but some people don’t want to hear what you have to say and are blatantly rude. 

“People need to consider that in this setting we don’t know what is coming in. ER is unpredictable. There is no explanation for abusing someone who is trying to help you. 

“We are doctors and nurses, but we are also people like everybody else.”

The emergency room at George Town Hospital treats 25,000 patients a year averaging 80 to 95 a day. Because of a worldwide shortage of nurses, HSA has difficulty recruiting and retaining a full nursing staff. 

  shurna@caymannetnews.com

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