What might happen if Celia talks about her concern [the nurses commenting about Mr. Brown in front of him, which Celia interprets as abusive] with various parties?

Question

Celia O’Neil, a 39-year-old baccalaureate social work student, was assigned to complete her internship in a nursing facility where she had been employed for the past 12 years and continued to work three days a week as the Activity Director. The social work director, Betty Williams, LSW, was Celia’s task supervisor but new to the nursing home setting. Therefore, Sally Jones, LCSW, served as Celica’s preceptor. Celia’s client, Mr. Brown, was a 47-year-old man admitted to the nursing home in June 2001 with numerous psychosocial needs. Celia was frustrated by what she interpreted as Betty’s lack of effort to assist Mr. Brown. She began to wonder whether her supervisor cared about the client, and she found the nursing staff uncaring and non-supportive. In addition, the nursing staff made rude comments about Mr. Brown right in front of him, which upset Celia a great deal. She felt the comments were abusive and she wondered how to advocate for Mr. Brown.

Answer 1

Betty is probably the first person that Celia should approach to present her concerns. As Director of Social Services, Betty has a responsibility to advocate for all residents, and to ensure that their rights remain free from violation. Betty can advise Celia on the facility’s reporting and investigation policy, and assist her with the proper procedure. On the other hand, because Betty seemed to be too busy, she may tell Celia that she is “blowing it out of proportion,” and subsequently doubt that Mr. Brown was within earshot of the comments and therefore that he was unaffected by them. Celia’s past experience with various staff members who do not show alarm at her reports about negative comments may prevent her from wanting to report this to Betty.
Sally and Celia appear to have a trusting working relationship. Sally can assist Celia in thinking clearly about Celia’s concerns and observations, and guide her in following proper reporting guidelines. As a consultant who is familiar with the agency but also an “outsider,” Sally may have a different perspective than other staff members.
Connie [DON] may not welcome Celia’s negative observations about the nursing staff, and may choose not to do anything about it. After all, given the severe nursing shortage in our nation, she couldn’t afford to put any nurses on leave during an investigation or fire them without cause. Connie may also tell Celia to report it to Betty, and let Betty come to her about Celia’s concerns because Betty is the Director of Social Services.
As the administrator, Jeffrey has the responsibility to either investigate personally, or assign a staff person to investigate, the allegation. Jeffrey may also respond in the same way as Connie and in the same way he did before: that is, he may not welcome Celia’s negative observations about the nursing staff [”after all, good nurses are hard to find”]. He may well tell Celia to report it to Betty, and let Betty handle the investigation.
It will be important for Celia to consider the “chain of command” in the organization. While she might believe she should start with Betty, she may hesitate to start with Betty because she feels Betty does not care enough about Mr. Brown. This is an important part of the dilemma for Celia.