Manners (Rant)

Today I feel ranty. What happened to people having manners? Yes, someone was rude to me today. Usually this does not bother me, but today it did. I won’t go into what exactly happened but it did get me thinking, so here we go with a ramble as my thoughts spill out.

In my job as a mental health nurse I do expect some rudeness, let’s face it many people who are acutely unwell with mental health problems are frightened or angry, they often don’t have the capacity for manners. This I can understand, it is not their fault, they are reacting to an extreme situation. Many do have manners, lots of patients say please and thank you, ring me to ask for favours and are generally pleasant to talk to. If I can I oblige, it is my job to accommodate when I can, and understand the difficulties people may face, and of course to listen. Sometimes I can say to someone “Don’t speak to me in that way” or even just “Say please” when it is appropriate. Mental health problems are not necessarily an excuse for bad manners. What I don’t understand is when people do have the capacity to be polite, I do help them and they are still rude to me. This can be patients, relatives or colleagues, over the years they have all to some extent irritated me in this way (thankfully not too often).

This has raised the question, is there some sort of scale between duty of care and desire for good manners (or just lack of rudeness)? I sort of know there is, I can’t expect someone who is really unwell to be polite all the time, that is elitist, there should not be an “us and them” culture between nurses and patients, there just needs to be understanding when appropriate. However, when someone is able to understand the consequences of their actions or behaviours then I and many ward areas do not tolerate abuse. And in my opinion, rightly so. After all I go to work to care for people not to face abuse or intimidation. I have unfortunately seen cases of verbal and physical abuse at work, sometimes the hard line is taken and patients are discharged or the police are called. Of course there has to be some weighing up of the risk to fellow inpatients and staff, and the risk to the patient in question if they are discharged. I can see how the police can struggle to take criminal charges to the extent they should, when many people within the legal system do not appear to understand when mental health problems do and do not impact on such decisions to be abusive. See, there are lines which should not be crossed but it is complicated. The same goes in dealing with patient’s relatives, I have to put myself in their place, how angry would I be? What is reasonable behaviour?

With colleagues it is a different matter, in general abuse is not tolerated. This doesn’t mean it is always reported. It is such serious action to take, a formal process (one which I have some experience of). It is not for the occasions when people are just rude, it is for the extreme. So how do we tackle general lack of manners? A simple example is that I run clinics, within which I schedule 1 hour for lunch, this is never an hour long break, NEVER (to be fair it should only be half an hour). Usually, a few morning patients are late, I have urgent phone calls to make, notes to catch up on and people who did not attend to contact, then the morning patients arrive early. The result is I often have 5 minutes for lunch in a very long and busy day. Again, I try to be understanding, there are problems with buses, some people think it helps to be early rather than late, some don’t mind waiting a few minutes (I do keep in mind that many of our patients are anxious about the appointment and the needle). It is when people are rude and demanding in such situations and think I am not entitled to my break, especially if colleagues do it. I addressed this with some staff who bring patients recently, thankfully they were understanding and didn’t realise how busy things can be (only seeing their part of the picture… amazing how often people do that isn’t it?). See, it is the small things that matter in such cases, a phone call to say you will be early or late, then you would be told what time afternoon clinic starts or when there are appointments free, and I get a 10 minute break… simple manners and we are all happier. Unfortunately not all of my patients who attend alone are able to have such forward thinking, so I still don’t get much of a break, this I don’t mind so much. (The above is not what happened today to annoy me, it was another matter entirely). This is just an example of when manners could help.

So when should I look after my own welfare? To have a break, some food, a drink (a wee)? To not be offended, shouted at? Or even to just be spoken to with some respect? (of course I demand I should not suffer any physical abuse, and would do all I could to prevent such situations and deal with them appropriately). But how much can people get away with? Where is the line? People are complicated. Mental health problems are complicated, as are their families and carers. Politics within teams and between teams of colleagues are also complex, when should we not ‘rock the boat’ or when should we ‘fight our corner’? The answer is, I don’t know. Today I was busy, felt stressed and did my best, I did not feel like my needs were being met to have some of the above privileges (are they privileges or rights?). But once the hectic day was over and I had chance to talk to colleagues I gained more understanding of the situation and felt a bit calmer about the whole thing, I gained some perspective. Sometimes you need time to do so before you react (I did keep my nerve at the time and remained polite).

So, please make an effort to be polite to people who help you in any way. In fact people in general. I don’t mean just nurses, but people who work in shops or restaurants, delivery men, anyone… my point is, please remember if they are helping you, they probably have helped a lot of other people that day, not all of them may have been nice to them. A please or thank you and a smile goes a long way, whether you feel like it or not it may be needed and appreciated.

Thanks for reading, any feedback is always appreciated either here or on twitter.