This started as a thread in response to something at Bluesky (which I usually like, but which is, like the entire internet in 2024, frequently poisoned with too much binary thinking) and I decided I wanted it here. Comments are off.
So, I deleted a bunch of replies to a high profile account because I’m not someone’s punching bag when they’re getting dugeony about a profession they profoundly do not understand.
These are my comments, in reference to this story at Jezebel and elsewhere. Let’s be clear now: I do not blame the staff for this. They were at the mercy of their administration and the lawyers who have “risk management” control over medical decisions.
The hospital admins who refuse the stance that we, the hospital, will 100% back you and your medical decisions to the fullest extent, including against the government, and will not punish you.
Because that’s 180 from what the hospitals are telling their staff. The admins are driving this.
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When admin is telling you that you’re unemployable (or worse) if you refuse their directive, the decision is no longer in the employee’s hands. It’s become coercive, and in coercive situations, we don’t blame the person forced to comply, we blame the extortionist.
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Oh, I know.
And they’re more than happy to throw any member of staff under any number of buses.
Plus they’re the ones who are usually cheerleading the indenture contracts they use to trap staff in dysfunction. (Hiring “bonuses” that must be repaid immediately if someone quits or is fired, etc)
I’ve worked in a VA hospital, and with hospital systems. Never again, because of all of the abusive systems I’ve worked in — public mental health run by fundies, startups that were two meditation sessions from a sex cult of personality, an utterly unqualified set of people running a totally unproductive system for a flailing industry — the hospital systems I’ve been around or near have been the absolute worst for viciousness and retribution.
Employees have little power in a hospital system. Few hospitals are unionized at all, and when they are, they’re not site-specific unions, they’re profession-specific unions. So nurses have one union, environmental staff another, doctors often don’t have one, etc. The administration knows this and gleefully weaponizes it against every employee. A wall to wall union for a hospital is an administration nightmare and they will fight to keep it from happening.
Even the union shops often have no strike clauses in the contract, so “work to the rule” is the only effective means of protest, and work to rule is a delightful tool for admin, because it gives admin excuses and examples to fire workers for “performance based issues” that are not performance based, they’re complaints about management and management’s reckless attitude towards safety, staffing, and solidarity.
Patients don’t have much of a choice about crossing a picket line, if one can exist (many contracts don‘t allow pickets, either), because patients have few choices, between using an in-network hospital, and where they’re brought in an emergency.
And people need to be aware that there is a common indenture practice used to force employees to stay in dysfunctional hospitals — Billing employees for “training costs” or giving them significant hiring bonuses that must be repaid if the employee quits or is fired. Often a half-year’s salary or more. And people use those bonuses to move and establish themselves.
Only after arriving do they realize how awful their working environment is. How much sexual harassment, understaffing, poor scheduling, and general abuse the administration uses. They’re often 24 month contracts. Ideally, people would keep those bonuses in an escrow account as literal fuck you money to get out, but realistically? Hardly anyone can do that, if it’s a bonus. If it’s a training cost, it’s sent to collections, and a bad credit report can make it impossible to get a new job, because bad credit is considered a risk marker.
This is intentional, from the admin side. That it exists at all is evidence of dysfunctional, abusive workplaces, and that it exists widely across the industry says the whole industry is between problematic and broken.
Losing accreditation/certification is a risk for any hospital, and that risk rises exponentially if the state has made it clear that violating a law made by profoundly ignorant car salesmen and estate lawyers is this year’s metric for keeping the doors open.
Lose accreditation? You’re no longer a hospital. You’re just a big building with high fixed costs and no possible income. Does it happen often? Often enough that the threat is bad enough.
The administration will always take the state’s hard line against their employees. As HR is not there to protect an employee, hospital administration is not there to protect their workers. The orders will come down from on-high, and if anyone refuses, that will be grounds for discipline, from being moved off of a preferred shift to being fired. There is no Article 99-ing possible in a 21st century hospital. Everything is documented.
This is a coercive system, period. We do not blame people for following coerced orders because they have economic and professional guns to their heads. The coerced are not the extortionists here — the hospital administration and the state legislature are the criminals holding patients hostage.
Ideally, yes, doctors and senior nursing staff would figure out how to serve their patients, but welcome to this reality, where a significant percentage of doctors & nurses are virulently anti-abortion and consider anyone dying of an unwanted or ambivalent pregnancy to be getting what they deserve, or if it’s a miscarriage gone horrifically bad, it’s God’s Judgement and she still deserves it. So that means someone on your own team is likely to turn you in or turn your patient in. And they’ll have the paperwork to make it stick. Your best case scenario at that point? Weeks on administrative leave while it grinds through a couple of courts, tens of thousands in legal costs you have to pay yourself, because admin told you they wouldn’t. And a permanent black mark on your record that will come up at every interview for the rest of your life. Worst case? Fired, and going to prison, which means loss of medical license.
You cannot forget that nursing is the approved career path for authoritarian women, as being a cop is for men. And even if those authoritarians are only a quarter or a third of the nursing staff*? The rest of the staff has to work with them every single shift. There are a lot of ways to inflict petty and not so petty revenge and retribution on a coworker, and authoritarians have no qualms about doing so.
(*They’re usually around half, more than half in hard red state hospitals. Christian colleges pump out a lot of nurses.)
When I say dysfunctional workplace? I’m not talking passive aggression, I’m talking stabbing with a dirty needle or scalpel. Stealing meds from someone else’s cart. Using a stolen password or changing a record. Truly cruel and brutal gossip meant to end careers.
(Those are all things I heard from people during COVID, while doing emergency therapy, because it got so bad.)
Is it admirable for medical professionals to accede to the demands of their employers? I don’t know. Is it admirable for an accounting staff at a software company to give in to the demands of their employers? Is it admirable for developers to work on a military project because that’s the source of the company’s income?
Should these things happen? Absolutely fucking not, but again, sorry reality intrudes, and yes, accounting staff get fired for refusing to cook the books, or get thrown under the bus if they do; developers get fired and coerced onto projects they don’t want to participate in. And developers on H1B visas are also held in indenture to their employer and forced to give in or be turned over to ICE. And remember: there are a lot of H1B workers in healthcare. Capitalism indentures us all, but some worse than others.
The difference is if an accounting staff gets fired, their absence may result in some slow or weird payments, not the people in the 4 car pile up and the gun-shot 3 year old rolling into the emergency room to die without care.
There is an absolutely horrific utilitarian logic at play — if I’m fired, if I’m in jail, I cannot help anyone. The first rule of emergency response is “don’t become a casualty yourself.” And that applies to hospital staff, too. If the emergency OBGYN surgeons commit a felony to save one person, then they cannot save the next 25 or 100 ectopic pregnancies and placental abruptions and premature ruptures that come in the door. The needs of the many outweigh the needs of the few.
There is terrible algebra at play here. And there’s no way to fake it, to pretend the heartbeat stopped early, to slip someone some misoprostol to make the miscarriage go faster, to exaggerate the danger to prevent the death that’s coming. Because your own fucking team contains people happy to turn you in.
And it’s algebra that only exists because of ignorant estate lawyers and car salesmen, and the suits that run the place. If the law forbidding abortion does not exist? These specific ethical quagmires disappear.
These laws are MEANT to foster and encourage distrust and generate division. And they do the job incredibly well.
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