The Language of the Client.

Okay, I know I should see past this, but “Client” is enough to start me frothing at the mouth and needing a good lie down.

Is there a convenient clicky link for me, if I’m recovered sufficiently after a few biscuits?

Ah yes, I was juat about to ask you what was the website you were referring to in your post. I’ve edited the post to include a link.

Regarding your issue about the use of effective language, I think I gather by reading your website that what you’re referring to is an incident where you received a phone call from a Maori man who was threatening to shoot himself and others, and you decided to respond to this by yelling at him down the phone, and you’re now on a disciplinary because of this.

Now, I take your points that Maori tend to be culturally accepting of a direct challenge, and this did indeed result in the man backing down. Even so, I think it’s still appropriate to consider the “what if”s. Such as “what if he hadn’t backed down and had instead blown his own head off?” The strategy worked, but it was a high-risk strategy nonetheless.

Also I have to say that when your nuts are on the block and you’re at risk of getting fired/struck off then the best strategy to take is to hang your head low, tell them you’ve reflected on the incident and can see what you did wrong, that you were under a high level of stress at the time, that you had personal problems at home, that you’re very, very sorry and won’t do it again….Playing the martyr NEVER works. Certainly trying to turn it into a theoretical argument won’t either.

There certainly is a place for theoretical discussions about the use of language in mental health nursing. Whether that place is in the context of a disciplinary hearing…I’d have to say it isn’t.

I’m sorry but this reads to me like, “Nurse makes iffy decision, gets disciplined and struck off for it, then goes on to develop the mother of all martyr complexes.”

As for whether or not the patient wanted to complain or who your accuser was…these are simply irrelevant because the core issue whether or not your actions were appropriate, not who made the complaint. And yes, you may feel that you were being culturally appropriate by offering a direct challenge, but that doesn’t alter the fact that he still could have responded by munching on a shotgun barrel.

What you should have done was keep him talking until the police arrived, and then let them deal with.

Failing that, at the disciplinary, you should have said, “Sir, I acted in what I believed to be a manner that would defuse the situation, sir. However, sir, on reflection I also note that there could have been alternative outcomes that might have had serious consequences, sir. I therefore feel that if the same situation presented itself again I would act differently, sir.”

I’ve seen people do equally hazardous things, and get away with a period of supervision and a warning, because they accepted that they had done wrong. By strapping yourself onto a crucifix and trying to make it a theoretical issue, you probably talked yourself into getting struck off.

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Brian, you’re coming across as very defensive here, sunshine. You surely can’t fail to be aware that your approach of yelling and cussing down the blower to a psychotic man armed with a shotgun is - ahem - ‘controversial’, to say the least. Expect people to have a response to that, and not all of them are going to be patsies of the Nursing Council of New Zealand.

When reading your experience on your website I couldn’t help but think you may have watched The Negotiator one too many times.

Having had a similar experience [split second clinical decision leads to lots of questions by people who weren't there] - tho nursing council did not de-register me as I was reinstated after a similar failing of due process before it was heard at council - I was dismissed following some dodgy clinical decision making - I know there were at least two options and I chose one based on option 2 being of greater risk IMO at that time.
However, I recall my approach during my downfall to have been of a somewhat similar zealous and self righteous fashion and, in agreement with Z, principles get you nowhere. I was out on my ear.
Thankfully, as I say, the process was terminally screwed and I was reinstated following review of process and my clinical actions found to have been “not unreasonable”.
When it came to submissions to Council (they still wanted to know - and actually supported me in my reinstatement), I proffered them the response of a professional nurse - I honestly did not intend to do a bad thing - but if that’s what I’m told it was I will listen and amend.

I remain confident I had little alternative at the time but, nevertheless, once you’ve made that split-second decision I believe it has to be followed through for as long as the outcome appears potentially positive.

As for the language debate, I am frequently found to include course language in my conversations with patients - if it is the language of those patients. But what differs is the context.

Use of humour, camaraderie, allegiance or simply showing the patient that you are also a human and not a govt automaton can, on times, perhaps be useful. When in confrontational ‘mode’ due to patient’s increased aggressivity, expletive language should not be used as it is provocative and aggressive and likely to be perceived threateningly. Threats generally lead to retorts and ‘upping the ante’ may well have led to increaswed risk to himself or others. I understand it was part of your perception to ‘challenge’ him as being culturally safe, but calling him a “bully” was a poor summation of a man who was desperately seeking someone to help him or to at least take control for him. I would consider it preferential to have applied assertion rather than aggression, if at all.

Telling him to shove the shotgun up his arse…. might not be one of those times to have used expletive languages and may perhaps be construed as being more aggressive than assertive. (ya think?)
Confronting others, Maori or otherwise, does not require the use of violent or aggressive threats and equal or more measures of positive response can be achieved through firm yet professional management using assertion.

In the split second heat of the moment - you probably did the first thing that came to mind (and whenever I consider the process of our work being critiqued by others who are not ‘on the frontline’ I always want to recite Jack Nicholson from A Few Good Men - “You can’t handle the truth”), I believe [mental health] nurses (or other unfortunates) operate under extreme pressures on times (and on high levels at all other times) that requires not only to think on your feet to help the patient, but also protect yourself, others and to also try to remember every exchange for the file report that is required to follow.

I would not condone your approach, yet I would understand it in the context of the situation.
I would not consider it to have been professional, yet I would not condemn you for having been in what sounds like a position I myself would have found equally if not more stressful than you may have yourself and that many others might have simply imploded.

I also think the fact he was not willing or wanting to complain does not mean complaint should not be made. If he wasn’t offended or if no greater harm occurred due to your approach then I would suggest it was more by chance than by expert mental health nursing.

On balance I empathise with you but I rationalise with Z.

I’m curious to know what sort of clinical supervision or debrief you received after that call/shift and whether you have sought private counselling since this event.

Ok I’m going to put my view point forward.No I’m not medically qualified so forgive me for this Brian.I have read the stuff you have posted on your site about your case.Have also noted comments on here & I appreciate has been a shite experience for you.But you have got to move on !!!!!!!!! You say you have 40 years in the profession, so you have a lot to offer.Please don’t let this case take over the good you have contributed to your profession.

I’m just going to express my broad agreement with the views expressed by Beakie, Mr Ian and Seratonin Sister.

I agree with Beakie that you’re sounding a little defensive. At the risk of sounding like Freud in his consulting rooms, I can’t help but feel that all this talk of “models of mental health care” is a bit of a defence mechanism, perhaps for yourself as much as anyone else. Saying, “I employed a Helping-Self model” perhaps might feel easier for you to say than, “I told him to shove his shotgun up his arse.”

I agree with Mr Ian that maybe you should reflect on the difference between being assertive and being aggressive. They’re not the same thing, and I’d ask you to ponder the difference.

…and I agree with Seratonin Sister that it’s time for you to move on. You’ve got your registration back, so why are you still fighting this battle? What have you got to gain? I think that rather than trying to wage a one-man war that you simply won’t win, it might be better to think about how you might do things differently in future, and then move on with your career.

To be honest I can`t really be arsed reading the whole story but it raises a few interesting general points.

When Terry Waite was asked why he went out in Beirut in the full knowledge that there was a fair chance he would be kidnapped, he relied “it was the right thing to do”. Policy and procedure, which are largely nonsense in my book, do not, by any means, always correspond with the “right thing to do”. If you achieve your objective, albeit by unconventional or controversial means, you achieve your objective. There are too many people in the mental health world, many of whom studiously avoiding those with mental health issues, who are far too enthusiastic about second guessing the actions of front line practitioners.

Additionally, gaining a certain seniority in nursing seems to miraculously bestow investigative skills on you. The vast majority of nursing managers have no clue, whatsoever, about invvestigation of any kind. Then we wonder why these disciplinaries go on interminably. Whatever happened to short, sharp bollockings.

Glad the Magna Carta is still viewed with some reverence in the antipodes. In this country the P.M`s wife has the ability to dismiss 800 years of British history.