This was up on the board about 3(?) months ago. I made it further that time than I did this time, I think that time I made it about 5 minutes, this time I made it all the way through.
I didn't comment last time because I couldn't tolerate her smugness to watch the entire thing, so I didn't feel qualified. This time the amount of rum I've consumed let me tolerate her all the way through...so here it goes:
The basic problem I have with her (aside from things which largely have nothing to do with the content of her message.) is her basic definition of violence at it applies to new providers. Yes, the oldbies stamp all over the newbies vis-a-vis their mistakes. This is not a matter of enforcing their will by force, this is a matter of continuing the education. The only people that think you learn everything you need to know in school are a) people still in school, 2) people fresh out of school and iii) people teaching who have never worked in the field.
Now, there are various methods of teaching, for simplicities sake, I'll boil it down to teaching by the carrot or the stick (If you want more clinical terms, we can call it teaching by positive reinforcement or by negative reinforcement.). The basic difference (again, we're working on simplification here) betwixt the two is that the carrot leaves everyone feeling good about themselves, but it's slow, the stick is brutal, but it's fast. The other basic difference between the two is that teaching by the carrot is hard, you've got to swallow your irritation when the student screws up, gently correct their mistakes (And go back and fix those mistakes), and lavish praise on them for doing correctly something that you could have done just as well in half the time. The stick is easy, when they do it right, you tell them they could have done it faster, when they screw up, you yell at them for their mistake, and tell them how they should have done it.
America's (and I believe pretty much every first world country's) modern accepted definition of education is the carrot model. It's humane, ego-reinforcing, and gets reasonable results, provided that the teacher has the qualities and skills that make it plausible in the classroom. There are two problems with that when it comes to healthcare on the job training. The first is the notion that everyone has the skills to be a teacher. Short version: They don't. Long version: Teaching by the carrot is hard. A common simile used by teachers to describe this phenomenon is "'I've eaten all my life, I love eating, thus I know how to cook' is like 'I've learned all my life, I love to learn, thus I know how to teach.". The second is the difference between the classroom and the real world. In the classroom if you make a mistake, you get a lower grade; In the real world if you make a mistake, maybe someone dies. If we're honest, the life of our patient very rarely is expressly contingent on our performing the right actions at the right time in the right way, but it does happen. That's a a close enough margin that we have to do everything we can to eliminate those mistakes as quickly as possible, which is best done through the stick.
Moving on: "Tattle-taling". First off, as an aside, aren't we adults here? Do we really need that terminology? Moving on, though, here I almost think she has a point. To a large extent, I think that what happens on the truck, stays on the truck, if you have a problem with what I did, talk to me, I'll do you the same courtesy (In a way, this extends back to the first point.). There is, however, a limit to that. If the mistakes made extend to the point that they are legally actionable (a bar which is lamentably low in modern American healthcare), my operations director and the owner of my company need to know about it, they shouldn't be blind-sided by that.
Next: "A Medical culture of heirarchical bullying.". First off, She misses her simile, she shouldn't be comparing it to "old world religion" (I'm honestly not even quite sure what that means to her.), she should be comparing it to feudalism (to go even farther aside, the word she wanted was "bastion", not vestige). To take these point by point:
A) Why is the "exclusivistic" jargon (That would be the correct word for language particular to a profession) in Latin and Greek? That's pretty easy, the Romans and the Greeks pioneered the vast majority of modern western healthcare. Also, screw this "historically" BS, my surgeon had better damned well be educated. (Further aside, modern nurses and paramedics have WAY more education that ancient physicians did.).
2) "Graduated garb"? It's called a uniform. You know why we wear uniforms? It's so people can tell by looking at us what they can and cannot ask us to do. I wouldn't ask the first guy I run into on the street to go catch the guy who stole my car, but I would ask the first guy I spotted wearing a cop's uniform. I don't know about the rest of you, but my shirt has a patch on it that identifies me as a paramedic. In the normal course of business, it doesn't matter, I and my partner both know which calls are mine and which are theirs, it really doesn't matter if the patients do or not...in a mass casualty, however, it matters whether the IC can glance at me and know where to assign me.
iii) I'd really like to take the next three minutes and dismiss them out of hand, b. I've never worked in a system (both as an EMT and as a Tech) in which there wasn't a way to push ideas upstairs and have them be considered. To be absolutely fair, though, I don't think I can. Perhaps it's different for nurses (I doubt it, but perhaps.). Regardless of that, though, you know what having to keep the people above you happy is called? Having a job. This is not something that is unique to nursing or to healthcare, this is something you encounter when you're an adult. Beyond not actually maiming anyone, I didn't have to keep my teacher happy to stay in school. As soon as I got a job, though, I had to keep my boss happy, my bosses boss happy and all the way up the line to the owner (Including the first eight years of employment before I got into healthcare.).
The whole "nail" thing? Yeah, again, welcome to being a adult in America. Again, the bar for legal malpractice in medicine is WAY lower than it should be, but that doesn't change the basic premise that if you're doing a job in the US, you have to make sure you don't screw up in such a way that you can be sued for it, and that means you have to make sure your underlings don't, either.
Finally: "The anger of the circumstance". Hol-lee :censored::censored::censored::censored:. Is she serious? What kind of entitlement complex do you have to have to think that the need to compartmentalize your work and your home life is somehow restricted to those of us in healthcare. Do you think that the CEO of your favorite trans-national doesn't have to worry about whatever stupid-*** thing their teenager is doing to rebel while they're negotiating a merger, or if your checker at your local grocery store isn't worrying about whether their child is potty-training on schedule while they're getting a price check? (as an aside [wow, there've been a lot of those, huh?], The whole "go look up the origin of nurture" thing? MW defines it as "the care and attention given to someone or something that is growing or developing". Etymologically, it's from the Latin "nutrire" "feed, cherish". I'm not going to open a whole feminism debate here, but screw her.).
"Low pay"? She's clearly never worked as a paramedic. "Drudge work"? She's clearly never worked as a tech.
All of this together leads to anger? Yes, yes it does. Everyone one of us feels that we're a special snow-flake who should have the beautiful life that movies promise us, almost no one (If any of us) actually get that, and that makes us angry. Most of us, being adults, recognize that for the BS it is, and channel it into various outcomes, ranging from exquisite hobby craftwork to drinking.
Solutions:
"If you have questions, ask me." Hell, to the :censored::censored::censored::censored:ing yeah. If you have the ability to teach someone by the carrot, encourage them to come to you so they don't have to learn by the stick. If you don't, don't try it, you'll just hurt both of you.
"Not shaming people because they either don't know or got it wrong". There are two approaches to it being demonstrated that you're deficient in knowledge, either be ashamed, or be certain you won't be caught short again. On the job training (Not just in healthcare, but in any industry) is dependent upon the learner taking the second route.
"Don't tattle-tale". Leaving aside my issues of nomenclature, again, as much as I despise this woman and would love to tear her apart, she's got a reasonable point. One she enumerates much better in this section.
All told, this wasn't 19 minutes of my life, but rather an hour and 39 minutes of my life (Which grew increasingly drunk as time went on, if you couldn't tell.), but if I can save many people a few minutes of their own adolescent whining in response to hers, I'll count it as time well spent.
tl;dr: This woman needs to grow up and be a real adult.