Categories
Public Health

Mandatory reporter **draft**

07/14/2020

Sometimes I feel like this moniker, which is often applied to healthcare or other frontline people who interface with vulnerable populations such as the very old or very young (teachers, I’m looking at you!), was a part of my personality before I became a nurse. And honestly, I do feel like everyone has a responsibility to help watch out for each other—or at least they should… because if we did, maybe we’d all be a little safer. Sometimes, though, it also feels feels like a burden, which is why I’m sure so many people turn the proverbial blind eye towards unsafe and potentially life threatening situations.

But the question that raises for me— how long can the blind eye truly continue to not see. Does the spirit see what the mind refuses to acknowledge? Is witnessing dangerous situations and yet doing nothing worse for your health than just finally mustering up the courage and admitting that it takes very little time to call someone for help?

I am a person who calls. Who reports. I believe that the consequences of not getting involved will impact me, as well as the victims of whatever violence or harm I am intervening in.

This started when I was in middle school, I realize now. I noticed a girl in my gym class with lots of injuries under her clothes while changing, and I talked to the guidance counselor about it. That counselor then reinforced my instincts about those types of injuries and the types of things I should tell her about. So funny to think back to so long ago to my childhood doing that for a classmate when I probably should have been trying harder to protect myself. But that was a different type of threat I was dealing with.

When I first moved to the “big city” I was also the “naive” girl who called police about the homeless person passed out on the park bench. I would still do the same, but I’d probably try harder to wake him up first, and I now know who to call for homeless outreach before the police (if it’s not a medical emergency).

I’ve had to report suspected elder abuse at work in the hospital… I’ve had to report actual abuse, once a sad case where an elder lady living with her grandson feared for her life and told us she was being forced to use drugs. Patients being abused by their spouses have refused help. I have reported things to Child Protective Services that I definitely shouldn’t talk about.

One thing I always struggle with, however, is how to report dangerous but not criminal behavior of individuals in the community that I think may be a risk to themselves or others. In other words, how do I get help for an acutely mentally ill person acting erratically who may or may not also be abusing some sort of substances?

My general rule is avoid doing anything unless the situation seems immediately life threatening. Erratic behavior +/- mental illness +/- substance abuse +/- person of color is not a good fit to police + weapon + restraint + jail.

But I live in the Bay Area, which has loads of homelessness and with it substance abuse and mental illness. Actually these three things are so linked that it is sometimes hard to tell which came first in any specific individual’s life. Twice I have had to call 911 because I needed highway patrol (the famed CHiPs) to come help a homeless person running around on the Bay Bridge— and no, not the part with a pedestrian path! A person running across 5-6 lanes of traffic on a bridge suspended over an ocean. Someone’s gonna get killed…. Someone might even be trying for that end?

I always have to stop and think before I call, though. Is this necessary? Will this do more harm than good? Is there imminent danger to the person themself or others? If there is immediate danger, I have to call. Even if that means someone spends the night needlessly in jail. It’s still better than a 20 car pileup on a freeway.

Should you call? Are you turning a blind eye? Is someone you know being abused? Are you being abused? Don’t be silent about it. Don’t let domestic violence just happen. Our silence about it perpetuates it. The same with violence against children, the elderly, the ill— whether physical or mental. Take a chance and use your voice. Now that we have learned the damage that silence causes, let us not continue to be silent about these issues. About black lives! About women’s lives! About children’s lives! About the lives of our elders and the mentally ill!

Resources:

Black Lives Matter

National Alliance for Mental Illness

Project Homeless Connect Resources (San Francisco)

How to report suspected child abuse (federal)

National Domestic Abuse Hotline

National Center in Elder Abuse

National Sexual Assault Hotline

Work In Progress
Categories
Quick Notes

I failed to act in the moment

On my middle night shift this week, a grueling 14 hours with multiple assignments and emergencies and ending in a tad bit of humiliation but NO EXCUSE, I witnessed something as I pulled out of the hospital parking garage that at first I didn’t even really process. But seconds later, as I turned right, the image absolutely set my mind and heart racing.

The exit of the hospital garage is oddly narrow, and this particular morning, there were a few cars coming and going. Approaching the exit, I noticed some security guards huddled together a few feet away from the temperature screening checkpoint. As I turned right at the corner, I kept thinking: Why were there four security guards squatting like that? Were they on top of a person? Was there a code blue happening because there were no doctors or nurses there… do they need help and should I turn around and go back??? Rapid fire thoughts were rushing through my mind. At this point, I was 2 blocks from the hospital. I could still turn around. But if it was a code, wouldn’t the day team have arrived by now and wouldn’t they all be more useful than an exhausted off-shift night nurse???

But then another image came to mind. These were security guards. Four of them. Huddled around and possibly on top of a person laying on the ground. WERE THEY RESTRAINING SOMEONE???? ON THE GROUND? Were four large security guards holding down a person, probably a black man, near our hospital entrance, and was it possible this man could die this way?

In my head was just a stream of panic. Surely something like this could never happen at MY hospital in MY town… by now I was six blocks away. Freaking out and lucky I hadn’t caused a distracted accident, I pulled over and had an idea. I called a colleague on the day shift, the nurse who was acting as our Rapid Response Nurse (RRT) that day and who I had trained personally a few years earlier. I knew she was ballsy enough to get a guy out from under security and skilled enough to save his life is she had to.

She understood immediately and told me she’d get back to me.

I took a few centering deep breaths, knowing I’d taken the fastest action I could based on where I was. But vowing that I would not keep driving next time my brain even hinted to me that something wasn’t right. I need to stop immediately in these situations. I owe it to my fellow humans, to people of color especially who find themselves unfairly targeted in a society plagued by both overt and institutional racism that extends through through every level— from basic human rights and healthcare to policing to employment policies to the way the government as a whole is run.

And I especially owe it to those I work with, if these events are happening where I’m employed. Healthcare needs to be better. We need to set an example for how people should be treated. And personally speaking for our security guards, I want them to feel enabled to find new ways of dealing with people that is less dangerous. Security guards (or officers as they’re called at my hospital) exist in that space also occupied by police where the culture can lean toward a violent military style. But is this necessary? Is this right??? Should this be the first line tactic if most of the people dealt with are 1) agitated & aggressive patients, 2) homeless people living around or seeking inappropriate care at the hospital or 3) family members on drugs or alcohol who abuse medical staff? I think not.

I arrived home that morning to find a text from the nurse that I’d called for help. She told me that when she’d gotten there, the guy wasn’t on the ground anymore. He was sitting in the back of a cop car. “Being arrested, don’t know what for…” her brief note read. I felt a small bit of relief that he’d survived his encounter with being restrained on the ground. But now I also felt another twinge of sadness. I wondered if he was just a homeless person who had been bugging the temperature screeners. Maybe a schizophrenic off his meds? Maybe never on them. I wondered if being arrested was really necessary. I texted this in response. But the message I got in return made me sad: maybe there was a restraining order against him. Maybe, but in this case I’ll never know. Maybe I’m too soft, but I think there are other ways to wait for the police to arrive than with a person restrained on the ground.

Categories
Quick Notes

The Truth

In the Bay Area, find a therapist at https://www.twochairs.com
Categories
pandemic

Mental Health & Nursing

May is Mental Health Month, and I haven’t addressed it at all yet. But I have a lot of thoughts. Every time I sit down to try to write about nursing and mental health -even just in the context of only my own life -I become overwhelmed with the enormity and complexity of the topic.

A year ago next week, actually, I had to take a leave of absence from work due to what I thought was burnout. It actually turned out to be PTSD, and over the last year, I have learned exactly how far back in my life trauma goes. But the strange and traumatic event that happened to me one night at work, and brought about my need to go on leave–it is still hard for me to believe that things like this at work can be so traumatizing. Why? Maybe because these types of events are so common. Maybe because being an ICU nurse is fraught with high-level stress and emotional highs and lows, as patients “miraculously” get better or succumb to their illnesses. And supporting the families in both of the these instances is so very difficult. It just seems like I should be able to handle it, because it’s my job…

So, how has the pandemic affected nurses’ mental health? This article (found almost by accident), really conveys a lot of what is going on, and offers some great tips.

“Nurses Are Facing A Mental Health Crisis In The Midst Of The Coronavirus Pandemic”

Healthcare workers in hospitals with COVID-19 patients reported higher than usual rates of depression, anxiety, and insomnia, according to a survey published in the JAMA Network Open journal in March. Among those with the most severe symptoms were nurses. This is especially concerning when you consider that they already have higher suicide rates than the rest of the population, according to a study by UC San Diego Health published in February. 

Molly Longman, 5/8/2020, “Nurses are facing a mental health crisis,” Refinery29