Polishing Up Professionalism

1. 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

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

3. What is professionalism? Mirriam-Webster-exhibiting a courteous, conscientious, and generally businesslike manner in the workplace Social 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 Boundaries: Lines that are drawn to protect patients from being exploited by professionals who are more powerful Communication style and self awareness © The Patient Centered Professional

4. European Federation of Internal Medicine and American Society of Internal Medicine • Professionalism 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

5. Professional affects everyone Network Employee State Practice Acts Accrediting/licensing bodies Employer/Supervisors Patient © The Patient Centered Professional

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

7. Case Scenario 1 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

8. Case Scenario 2 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

9. Case Scenario 3 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

10. Case Scenario 4 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

11. Case Scenario 5 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

12. Case Scenario 6 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

13. Case Scenario 7 Patient 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

14. It’s not personal! Health 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. Patients come to dialysis with problems that existed long before they met the staff…it’s not personal! © The Patient Centered Professional

15. RECAP:Professionalism Pitfalls Over self-disclosure Breaching confidentiality Superman/Wonder Woman Complex– Super Professional Special treatment to a patient that you cannot provide another Creating unnecessary waits Accepting special attention or gifts Name calling (good and bad) Threatening Discussing employer/employee issues (salary, staff errors, etc.) Psychological diagnosing and gossiping Violating informed consent © The Patient Centered Professional

16. D-harmony: Dialysis Professionals and Patients Dating • Violation of: • Most State Practice Acts • Code of Ethics • company policy • Can result in lawsuits • Professionals are in a position of trust and it can be abused on vulnerable patients • It is the professional’s responsibility to set the boundary • Inappropriate dress and flirtations also not professional © The Patient Centered Professional

17. Control Freak?!!? Not ME!! We want to fix people Sometimes 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. Helpers struggle with this and it can impact professionalism. © The Patient Centered Professional

18. Proactive Professional Behavior Encourage patient self-determination Provide informed consent Maintain Competence Treat relationships equally Respect privacy/confidentiality Explain to staff our Codes of Ethics Empower patients rather than create dependency © The Patient Centered Professional

19. Baggage Claim We (professionals) have baggage Difficulties at home Challenging situations at work Time constraints Not enough staff Multiple losses Patients have baggage Decreased ability to function independently Multiple losses Difficulties at home © The Patient Centered Professional

20. Bag the Baggage Don’t air out your dirty laundry! MAINTAIN BOUNDARIES! What is your purpose here? Why are you here? What is the goal? Whose needs are supposed to be met? HELPING RELATIONSHIPS ARE NOT RECIPRICAL!! PROFESSIONALS GET PAID! © The Patient Centered Professional

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

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

23. Being A Proactive Professional Ask yourself these questions: Would this be allowed in another medical setting? How does this activity assist the patient in care of his or her ESRD? Can this be documented in the medical record? Or in a Court of Law? Are you willing to do this for all patients? © The Patient Centered Professional

24. Dealing with Uranium---the most toxic environments: addressing obvious unprofessionalism • Don’t light a fire! Toxic chemicals are flammable when met with fire! • Maintain no-blame culture • approach situations as learning opportunities, not fault in character • Use personal experience as a teacher • Express willingness to work on issues together • Take the high road • continue to do the right thing when no one else does • At the end of the day, remember it’s all about the patient. © The Patient Centered Professional

25. European Federation of Internal Medicine and American Society of Internal Medicine • Professionalism 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

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

27. You must be willing to invest to get return. Instant 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

28. “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

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

30. References • Mlettinen, Olll. (2003) “Elementary Concepts of Medicine: X: Being a Good Doctor: Professionalism.” Journal of Evaluation in Clinical Practice. 341-343. • Landro, 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, 2005. D1. • Saltzman, A & Furman, D. (1999) Law and Social Work Practice. Australia. Wadsworth Thompson Learning. • Thompson, R. (2002) “Readers Wonder How to Restore Professionalism in Healthcare.” The Physician Executive. September 2002. © The Patient Centered Professional

31. Thank you! Liz Anderson, LCSW lizbanderson@gmail.com 828-230-6951 © The Patient Centered Professional