The eyes, it is said, are the window to the soul they reveal our true emotions. A ‘shifty’ look makes us distrustful of a person. Averting the eyes also instils feelings of mistrust with the other party.
By the same token, we may doubt honesty or truth by the tone or expression of the voice. So clearly many forms of communication are constantly utilised in our engagement with others.
Art of artifice
As student nurses I always believed that we hid behind those elaborate uniforms, long since discarded in favour of more contemporary models. We knew little and were often uncertain, although the level of trust our patients had in us was so daunting. We ‘stepped into role’ with the donning of the uniform, and hid behind a facade of knowledge and authority.
The language we learned to use was another means of bravado. We were new members of a very exclusive club and the patients and the general public believed we were modern day Florence Nightingales or ‘Angels’ – a term that we now believe successive governments have used to restrict our pay and conditions to the point of hardship.
Did this insecurity and lack of confidence show in our eyes or in the way we interacted with our patients? Maybe some of us ‘pulled it off’ better than others? How difficult it was, after all, to admit that we didn’t know, and didn’t always have the answer.
Always believing in honesty, I found it difficult to be the font of all knowledge in what was a scary world with a growing dependence on technology – yet another area of conflict for me. So I vowed to look those scared and trusting patients in the eye and admit that I couldn’t answer that tricky question but would get the answer for them, and so we learned together.
On leaving the NHS for a career in OH, I saw my peers enacting the same charades in the world of business. Uniforms were worn and elaborate medical language was used to show that we were special, people to be revered. I saw too that it didn’t work: the eyes of HR and line managers would glaze over – we’d blown it.
Matter of trust
The issue of confidentiality is another area where we fail to communicate effectively by hiding behind ‘professional confidentiality’. We alienate our work colleagues by failing to engage with them. I’d even go as far as to suggest that by giving little or no useful and constructive information, we make life easier for ourselves. After all, these conversations and reports are difficult – they put us on the spot, test our professional knowledge and management skills and are potentially litigiously ‘loaded’, so we are tempted to say nothing and let cases drift on for as long as we can get away with it.
If we chose this route – and you know if this just might be you – trust has been broken. Our employers trust us to help them manage these cases. The rest of the staff trust us to be fair and not prolong sickness absence unnecessarily, as it will ultimately impact upon others. The employee in question needs and trusts us to help them return to work (if appropriate) and act in their best interests to restore their health and wellbeing by whatever means necessary. Families depend on parents to be able to undertake good work in a healthy and fulfilling environment and as patient advocates and public health nurses we are trusted to ensure the health and wellbeing of the communities we serve.
To be all things to all men, we need to examine our own motives and practices, be honest with ourselves, our patients and the client base we work with, whether clinical or business. If we need help with complex cases we should ask for it – none of us knows everything.
We should involve other stakeholders in the decision-making process if necessary. In protracted cases, the case conference is to be welcomed and utilised with all relevant parties involved to the good of the individual and the employing organisation.
Physiotherapists, counsellors, HR and line managers all have an interest in maintaining a happy, healthy workforce. They all have valid views and opinions, and maybe prejudices too, but failing to include them in the decision-making process just ensures that they’ll shout the louder, and far better to have them ‘on side’ and working to a common goal.
The final outcome of any case will most likely come from a range of shared views, opinions and facts. Attempts to prohibit or stifle this discourse by insisting on the one and only OH opinion which is ours is, I believe, unethical.
Being an OH nurse in the 21st century is challenging. It demands new and innovative ways of working. Honesty and integrity lead to trust. These attributes are not new, but the application of them to our practice may be. Will it be our eyes or the tone of our voice that gives us away? In the long term, it’s easier to open the door than to slam it shut.
by Sharon Horan, occupational health nurse consultant