Gang warfare

In 1961, French historian and philosopher Rene Girard described a concept of mimetic desire, through which all human conflict is mediated. Based on his principle, the desire for possession of a singular item by two or more parties is likely to be settled through violence of action in order to take control of the object of desire. To imagine this in real life, picture that two children were given uninhibited access to a toy store. One child was allowed in first and began playing with a toy. A second child following shortly enters the store. Though both the children are allowed any toy in the store, which toy would the second child want to play with? What further degrades the situation is that the first child laid initial claim to the toy and is certainly not going to give up. Therefore, in a room full of toys two children fight over a single item without ever noticing they could both seek another play item and be happy. What sets the stage is the inferred value of an object through its admiration or possession by another. Rather than be left out, we must obtain this valuable item for ourselves. The concept expands into the global arena as an explanation for everlasting conflict between parties. I see the same concept present in healthcare.

We often only see our input to patient care as an item of control. John Nance’s book for the conference discusses this very point. It is often surprising and sometimes challenging to physicians when nursing is able to keep pace with a discussion of complex pathophysiology or pharmacologic interventions for a given presentation. The knowledge of that which constitutes a diagnosis as described per a nurse should not be viewed as an interloper moving against the castle. Would it not be beneficial to have someone monitoring a patient who has a deeper understanding of patient care than is expected of them?

As well, do nurses not demonstrate intimidating and humiliating behaviors with others in their own peer group? Bullying is a very real phenomenon in nursing. An example of nurse aggressiveness is the following: Other staff entering the rooms of patients assigned to certain nurses are treated as burglars entering a private residence, rather than someone providing additional vigilance for a patient. I’ve witnessed nurses tell physicians, especially residents, to enter their patient’s room only with the nurse’s knowledge and permission. We nurses are notorious for eating our young, certainly within the ED or ICU. Often, new nurses entering these arenas are humiliated or “pimped” as a consequence of their preceptors’ own experiences being made to feel insignificant earlier in their careers. The condition of transference of violence is one of the greatest single impediments of the advancement of nursing.

Healthcare is some respects has deteriorated into turf battles, in which all the professionals are scrambling to grasp the largest amount of control or influence. Let’s move beyond psychological shackles and rule our practice with objectivity. Let’s understand that we all share the same goal of 100% safe and effective patient care and each professional has an impact to provide for the common goal. Let’s not separate ourselves with razor wire across a demilitarized zone. Reach across the aisles and shake hands with others. Cease fire.

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