CASE PRESENTATION Confronting Destructive Workplace Behaviors in as much detail as possible and continue to documer Expansion of a case presented in Chapter 13. incidences as you observe them. He suggests that yo Sabrina works at a hospital that serves a multiracial and meet with him again in 2 weeks and bring both yo multiethnic population, many of whom are immigrants. documentation and a copy of the hospital's policies ar She is caring for Mrs. F., a middle-age Middle Eastern procedures for reporting occurrences of incivility, bullying woman who was just admitted with severe pneumonia. workplace violence, and unsafe practice. He also sug Several family members are in the room with her. A nurs- gests that you journal about your concerns, includin ing colleague, Louella, comments to Sabrina, "This is an- thoughts, feelings, fears, hopes for resolution, and wha other ignorant foreigner who let things go too long" and kind of risks you might be willing to take to address th tells her "to be careful because there may be terrorists in the room." Louella adds that they should all be arrested situation. and sent back to where they came from. Sabrina feels offended by Louella's comment but hesitates to say any- Think About It thing because Louella is good friends with the charge The Challenge of Speaking Up nurse, and she is concerned about repercussions. . What is your personal reaction to the described situation Consider that you are a nurse on this unit and ob- . What ethical issues are evident? serve this interaction. You talk to Sabrina in private about . Would you consider taking any different course how upsetting Louella's comments were to you and won- action at this point? dered why no one said anything. Sabrina says most of the . What do you think about your faculty mentor's sugge staff feel the same way, but when something has been tions? said in the past the person got terrible schedules and did What thoughts, feelings, and concerns would yo not get requested vacation. In the 6 months that you have include in your journal? Be specific. been working there, you have heard Louella making dis- . How would professional ethical codes and position paraging comments about other patients related to race, statements factor into your reflections? Be specific. physical characteristics, and socioeconomic status. She . What risks might you be willing to take? latters the physicians to their faces while making com- . How would elements of personal and professional en ments like "he's a womanizer" or "she's not very bright" powerment inform your decision? behind their backs. Your classmate, Meili, who was top of Presume that when you meet again with your facult our class and started working the same time you did, mentor you decide that your moral agency impels yo has been the brunt of Louella's jokes and harsh words. to speak up. What would guide you in moving forward One time when Meili asked a question about a procedure Would you seek other input or support? What would b that was new to her, Louella replied that she thought all your next step in taking action to speak up? Asians were supposed to be smart and if she didn't know Following the advice of your faculty mentor, you talk to how to do this simple procedure, how was she ever going Sabrina, Meili, and another trusted colleague abou to become a real nurse. Then she tossed a procedure your decision and ask if they would be willing to docu manual at her to read. You also notice that there is always tension among the staff when Louella is working a shift, ment what they have observed. They all agree to do so Why would this be important? and even patients have commented about her attitude; however, there is much more collaboration and collegiality . Your faculty mentor also suggests that you ask one o when she is not there. these colleagues to be with you when you report these As you reflect about the situation, you wonder concerns to someone in management. Why might this whether you can continue to work in this environment be a good thing to do? and even question whether you made the right choice in Your hospital's procedure for reporting situations of in- becoming a nurse. You feel you need to say something, civility and unsafe practice gives three options for an yet know your position might be put in jeopardy, You de- initial report. You may take it to the nursing supervisor, cide to talk to a former faculty mentor about the situation to the human resources director, or to the ethics and and get some guidance. After sharing your observations compliance officer. Who would you consider approach- and concerns and talking the situation through with him, ing first and why? How would you prepare for the he suggests that you write down what you have observed meeting? How would you present the information about your concerns in a professional manner