Polishing Up Professionalism Presented by Liz Anderson, LCSW Southeastern Kidney Council and NC American Nephrology Nurses Association Annual Meeting May 24, 2011 © The Patient Centered Professional

Objectives zDefine professionalism and describe its attributes relative to nephrology patient care zList the barriers and pitfalls that can encountered in achieving and maintaining professionalism z Give tips on being proactive in professionalism and avoiding team conflict © The Patient Centered Professional

What is professionalism? zMirriam-Webster-exhibiting a courteous, conscientious, and generally businesslike manner in the workplace zSocial Work Dictionary-the degree to which an individual possess and uses the knowledge, skills, and qualifications of the profession and adheres to its values and ethics when serving the client zBoundaries: Lines that are drawn to protect patients from being exploited by professionals who are more powerful zCommunication style and self awareness © The Patient Centered Professional

European Federation of Internal Medicine and American Society of Internal Medicine zProfessionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advise to society on matters of health. (Mlettinen) © The Patient Centered Professional

Professional affects everyone zNetwork zEmployee zState Practice Acts zAccrediting/licensing bodies zEmployer/Supervisors zPatient © The Patient Centered Professional

It’s a Tall Order! zWe are expected to be nice, respectful, knowledgeable, up to date, good listeners, good communicators, holders of confidential information to: yMore challenging patients yIn an environment that dictates complete adherence yIn a Bruised Economy: xLESS money = LESS jobs = LESS resources = MORE stress! © The Patient Centered Professional

Case Scenario 1 z Patient calls the Network and files a grievance. Among many things, he states that he refuses to have a certain technician cannulate him because the technician had been talking about the horrible divorce she was going through, and she was angry. He was afraid that she wouldn’t concentrate on his arm. © The Patient Centered Professional

Case Scenario 2 z A facility calls to report a behavior problem in a patient. He refuses to allow but one technician to cannulate him. It was discovered that this technician had been telling him that she would take the best care of him and that she would ensure nothing would happen to him. © The Patient Centered Professional

Case Scenario 3 z A grievance was filed by a patient who stated she had been giving a nurse $20 per treatment to provide her with the best care possible. Subsequently, the nurse did provide great care, but became overwhelmed with the amount of work it took to keep the patient happy. © The Patient Centered Professional

Case Scenario 4 z A Retired Colonel calls the Network disgruntled that the social worker is disrespectful because she calls him honey, sweetie, baby, child, cutie. © The Patient Centered Professional

Case Scenario 5 z A dialysis facility dietitian has been trying to explain the importance of monitoring potassium. The patient begins yelling at the dietitian that she didn’t eat much potassium, and she was sick and tired of being harassed. The patient continues to get louder and tells the dietitian, “What do you know? You are too fat yourself!” The dietitian says to the patient, “If you don’t shut up you can never come back here!” © The Patient Centered Professional

Case Scenario 6 z Patient calls the Network to state that proper sterile technique is not used, upper management won’t pay the nurses enough, and nurses aren’t getting a raise this year. Patient states that he doesn’t want to dialyze there any longer because of this. © The Patient Centered Professional

Case Scenario 7 zPatient called the Network and stated that last Friday the head nurse took him home from dialysis because his brother was sick. When he returned on Monday his brother was still sick, but the nurse wouldn’t take him home. He was upset that the staff didn’t care. © The Patient Centered Professional

It’s not personal! zHealth care professionals often wear their hearts on their sleeves, which is often makes them good at what they do….but it also can cause hurt feelings. zPatients come to dialysis with problems that existed long before they met the staff…it’s not personal! © The Patient Centered Professional

RECAP: Professionalism Pitfalls zOver self-disclosure zBreaching confidentiality zSuperman/Wonder Woman Complex– Super Professional zSpecial treatment to a patient that you cannot provide another zCreating unnecessary waits zAccepting special attention or gifts zName calling (good and bad) zThreatening zDiscussing employer/employee issues (salary, staff errors, etc.) zPsychological diagnosing and gossiping zViolating informed consent © The Patient Centered Professional

D-harmony: Dialysis Professionals and Patients Dating zViolation of: yMost State Practice Acts yCode of Ethics ycompany policy zCan result in lawsuits zProfessionals are in a position of trust and it can be abused on vulnerable patients zIt is the professional’s responsibility to set the boundary zInappropriate dress and flirtations also not professional © The Patient Centered Professional

Control Freak?!!? Not ME!! zWe want to fix people zSometimes the best way for adults to learn, is to be allowed to make bad decisions, that professionally trained helpers KNOW is going to be hurtful. zHelpers struggle with this and it can impact professionalism. © The Patient Centered Professional

Proactive Professional Behavior zEncourage patient self-determination zProvide informed consent zMaintain Competence zTreat relationships equally zRespect privacy/confidentiality zExplain to staff our Codes of Ethics zEmpower patients rather than create dependency © The Patient Centered Professional

Baggage Claim zWe (professionals) have baggage yDifficulties at home yChallenging situations at work yTime constraints yNot enough staff yMultiple losses zPatients have baggage yDecreased ability to function independently yMultiple losses yDifficulties at home © The Patient Centered Professional

Bag the Baggage zDon’t air out your dirty laundry! zMAINTAIN BOUNDARIES! yWhat is your purpose here? yWhy are you here? yWhat is the goal? yWhose needs are supposed to be met? HELPING RELATIONSHIPS ARE NOT RECIPRICAL!! PROFESSIONALS GET PAID! © The Patient Centered Professional

Being a Proactive Professional zTake an Outside Approach -Imagine yourself in the balcony looking down at yourself in the situation. zTake an inventory of yourself yWhat pushes your buttons? Don’t let someone find out for you. yWhat is your tolerance level? zAnticipate and have a plan yPositive outlets and coping skills © The Patient Centered Professional

Being a Proactive Professional zDO NOT overreact zDO NOT internalize feelings zWe are not able to control our baggage or their baggage, but we can control how we react zThis is OUR responsibility, not the clients’ zOur response can either escalate or de-escalate the situation. © The Patient Centered Professional

Being A Proactive Professional zAsk yourself these questions: yWould this be allowed in another medical setting? yHow does this activity assist the patient in care of his or her ESRD? yCan this be documented in the medical record? Or in a Court of Law? yAre you willing to do this for all patients? © The Patient Centered Professional

Dealing with Uranium---the most toxic environments: addressing obvious unprofessionalism zDon’t light a fire! Toxic chemicals are flammable when met with fire! zMaintain no-blame culture yapproach situations as learning opportunities, not fault in character zUse personal experience as a teacher zExpress willingness to work on issues together zTake the high road ycontinue to do the right thing when no one else does zAt the end of the day, remember it’s all about the patient. © The Patient Centered Professional

European Federation of Internal Medicine and American Society of Internal Medicine zProfessionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advise to society on matters of health. (Mlettinen) © The Patient Centered Professional

How to Promote Professionalism in the Dialysis Unit zBe a leader- take the initiative to change professionalism with those around you. zBe a role model! It’s contagious! zBe aware- if you deny power you are at risk for misusing it. zBe nostalgic--- remember your roots. Why did you in into healthcare to begin with? (Thompson) zBe proactive- do at least 3 patient centered things that are not mandatory. (Thompson) zBe an educator– in service over and over again. © The Patient Centered Professional

You must be willing to invest to get return. zInstant gratification isn’t going to happen. Professionalism must become a part of the work culture, which means it must be kept on the front burner all the time. Keep a long range view and changes will happen! © The Patient Centered Professional

“IT CAN ALL SOUND VERY POLLYANNA-ISH, AS IF WE ARE ALL SITTING IN CIRCLES AND SINGING KUMBAYA…BUT ONCE THEY EXPERIENCE IT THEY CHANGE THEIR MINDS” Landro © The Patient Centered Professional

Where to go for help z“Drawing the Lines of Professional Boundaries” NKF zThe Ethics of Relationships zMary Rau-Foster z“Professional Boundaries: A nurse’s guide” zDialysis Patient Provider Conflict yhttp://esrdnetworks.org/special- projects/copy_of_decreasing-patient- provider-conflict-dpc © The Patient Centered Professional

References zMlettinen, Olll. (2003) “Elementary Concepts of Medicine: X: Being a Good Doctor: Professionalism.” Journal of Evaluation in Clinical Practice zLandro, Laura. (2005) “The Informed Patient: Teaching Doctors to be Nicer; New Accreditation Rules Spur Medical Schools to Beef Up Interpersonal Skills.” Wall St. Journal Sept 28, D1. zSaltzman, A & Furman, D. (1999) Law and Social Work Practice. Australia. Wadsworth Thompson Learning. zThompson, R. (2002) “Readers Wonder How to Restore Professionalism in Healthcare.” The Physician Executive. September © The Patient Centered Professional

Thank you! Liz Anderson, LCSW © The Patient Centered Professional