Can you run it up the flagpole or rattle some cages to get me a response, please?

I always find myself a bit crestfallen when action isn’t taken to solve underlying issues between my shifts; that is, to return to the same quagmire of problems.

And so it usually is with respect to issues relating to mental health – in both the residents and the staff.

The pervasiveness of mental health issues (in any type of healthcare discipline) and subsequent patterns of behaviour are really quite astounding. And, for the interests of the reader, I thought to share a few to highlight some of the challenges they pose to the working environment.

To be absolutely clear, I am a strong advocate for anyone suffering from a mental health challenge and support obtaining curative treatments.


Working with residents who have a diagnosed Personality Disorder.

Bit of a touchy subject, I realize… but let’s lean in.

There are several distinct PD (personality disorder) diagnoses but ‘PD’ is typically used in frontline parlance as the umbrella term signifying someone who has trouble relating (in a healthy/constructive way) to the people/circumstances around them, often due to having rigid patterns of thought or behaviour.

Any healthcare client with such a diagnosis may require additional time and attention from staff – the very commodities already so scarce on a day-to-day basis.

Given the high proportion of casual and part-time staff, high rates of staff turnover and reliance on outside staffing agencies, there is often a dearth of familiarity, proper and consistent approach to care for such clients. As a result, the amount of confusion, disruption and time allocated to simply getting through the basics of providing care throughout day balloons to being disproportionately onerous (at the expense of other residents, no less).

For example, imagine being charged with the responsibility of providing full care for a resident (bedridden) who refuses help multiple times (and that’s putting it mildly; we’ll forego the yelling, cursing and throwing of objects at staff whenever they attempt to approach) only then to ring for assistance when they are perfectly aware everyone is in the common dining room at mealtime; this way, they can play the victim as nobody was around to see to their ‘urgent’ needs when they rang.

Staff aren’t innocent, either… even if they make efforts to appear so.


Manipulative behaviours by staff are rife.

Aside from the well-known mental health issues of bullying, addictions, etc., I see more insidious examples weave their way into the daily grind. Sinister examples. Clever, too.

As there is such need for healthcare workers, with many vacant lines at the moment going unstaffed, combined with the logistics of working multiple units, 24 hours a day, 7 days a week, human error in scheduling is simply an accepted fact.

It’s really annoying to be left short due to a preventable mistake, misunderstanding or miscommunication but that’s the just nature of it.

But therein lies the opportunity to make a calculated, manipulative move and blame it on an honest mistake and it go unnoticed. Repeatedly. Even when it’s clearly in your favour. What a coincidence.


Typical examples may include:

  1. Calling in ‘sick’ for the shift you didn’t want to work, only to pick up an overtime shift the next day (i.e. work the same number of hours in a pay period, albeit more convenient to your personal schedule, and get paid more);
  2. Coming in for overtime but only when you know the bulk of the day’s work will have been finished by the time you arrive;
  3. ‘accidentally’ coming in for the shift that you wanted to work rather than the one you were actually scheduled for (and, of course, now that you’re at work, you couldn’t possibly leave and return again later when you’re actually needed… you’re simply not available to do that).

As with residents diagnosed with a PD, these recidivist staff’s behaviours aren’t dealt with nearly often enough. And while outside my sphere of influence, I do make concerted efforts to share my observations as to any patterns I witness which hold predictive value. I owe it to the residents who need care… and those employees who show up regularly and properly to do so. Not fun – and, worse, take time away from clinical matters.

So now you know about other types of challenges you may not see in the healthcare environment.

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