As an experienced nurse working in a senior management role, I sadly get to deal with increasing numbers of incidents of health care related trauma, usually affecting the already most marginalized and traumatized patients.
Despite our education of nurses in the realities of trauma, our hospitals and health care facilities are in constant danger of re-traumatizing patients through brutal care, dismissive attitudes, active prejudice and burned out staff. So what happened to compassion? For our patients, for each other? When I ask this question in my own organization I get the usual answers of too much work, too many patients, feeling overwhelmed and not enough resources. When I examine how specific incidents of poor care are dealt with, it is through performance improvement plans and disciplinary channels. However, what is clear is t that it is not just our patients who are living with overwhelming trauma – we are too.
As we train our next generation of nurses to work in trauma-informed models of care, we must take the larger leap by looking at how health organizations themselves are responsible for responding to the vicarious trauma experienced by its employees. Clear, considerate, empathetic communication and the promotion of social support should be the primary objectives of any organization that hopes to reduce the occurrence of compassion fatigue and protect its staff and patients. This can only occur in environments that recognize that the presence of secondary stress is a normal reaction to abnormal situations and ones which condone the need for continuous, positive social support as the normal standard of behaviour for each individual employee and the group as a whole.
These environments are increasingly rare in contemporary Canadian health care. Instead, we see a rise in organizational dynamics of conflict, secrecy, scapegoating, self-protective behaviours, rigidity, turnover, decreases in morale, diminished innovation and disengagement of staff. Often, organizational responses to external stress (funding, competition, cuts) leads to greater authoritarian measures, which in turn increase chronic stress on the staff and increase the likliehood that extreme attempts will be made to silence dissent. Empirical evidence has demonstrated that this creates a vacuum of ‘organizational silence’, where certain topics become ‘undiscussables’, the mention of which are seen to threaten unity. As a result, the ability of the organization to learn, analyze problems and make rational decisions further deteriorates into a cycle of increasing paranoia. This silencing of dissent is dangerous, as it serves as a corrective feedback mechanism. Hence the birth of the Radical Nurse.
Radical Nursing is a commitment to restoring sanctuary in our hospitals and clinics. It is recognizing that places of sanctuary are at risk of devolving into places of brutality if we don’t address the trauma of our patients, our staff and organizational responses to stress and distress. Radical nursing is about asking the difficult questions and speaking out against organizational silence. It is also about knowing we are not alone. So today, I am speaking up in my own workplace and asking ‘What happened to compassion?’.
Scott Harrison, RN, BScN, MA, CCHNC, Director Urban Health & HIV/AIDS, Providence Health Care – St Paul’s Hospital, Adjunct Professor of Nursing, University of British-Columbia
 Bloom, S.L., Neither liberty nor safety: The impact of trauma on individuals, institutions, and societies. Part I.Psychotherapy and Politics International, 2004. 2(2): p. 78-98.