Debate in Nursing

At the outset of my conflict, I formed a ‘Professional Support Group comprising Senior Mental Health Nurses, Nursing Academics, and other Mental Health Clinicians from various disciplines.That group has monitored my situation, being privy to much of the relevant documentation. I have expressed no expectations other than that they monitor my story.

Sometimes members of this group have offered guidance on process, others have kept me on track with theory–base, others tolerate my often voiced frustrations with a quiet dignity, offering understanding and professional affirmation.

Throughout the process leading to my de Registration, none of the people who have passed judgements on my clinical practice, have had the relevant clinical backgrounds, experience, or qualifications to act in such a role. Recently I invited members of the support group to discuss the ethical issues involved in my case. Three chose to identify themselves with their professional opinions, one chose to the contrary.This is the ensuing dialogue.

I invite further comment and opinion.

Brian Stabb

13 th December 8-00pm

Overview

Received this call at 2-46 am Duration of talking time approx 45 min. Further call at approx 4-10 duration 30 mins. Both calls involved a man who initially was threatening both homicide and suicide with a loaded shotgun. I kept him on the phone whilst H/L (Annette and Vera) contacted the police and acted as a conduit between myself, city police, armed offenders team leader, and eventually police negotiator at the scene. Total talking time 1 hr-15 mins. As a result of this call I had to prioritise and message other calls, which, whilst all attended to, were documented later than the time of the actual calls. I I have kept the messages passed between Annette, myself, and police negotiator via police

Comms (Alex)..

Detailed account of interaction: :

Caller initially presented as intensely hostile and excitable, and physically agitated He was on a phone with a long extension cord, and was constantly moving around the house. Says he was seen by catt team yesterday and given 2 clonazepam, and they arranged to come today at 11- 30 am. He demanded that I contact Catt and tell them to deliver the meds out to his home immediately. I could do little in the first 10 mins other than listen to and acknowledge him, so intense was his anger and agitation.

During this tirade he spoke continually of the ‘mistreatment’ he had received from the police and MIlS. ‘1 was held down in the cell mate, and they all f. …sodomised me mate”. His level of agitation would fluctuate between demanding that Catt contact him immediately and attend to his need for meds, and a tirade of threats and curses, aimed mostly at .the police who were the main brunt of his threats .”I’m 6 ft 4 mate and ‘will take out’ any police that f. …come near me” I’ve been in the f. … system for years mate, and I know the f pakeha system”

(He clearly identified as Maori.)

This pattern continued with me listening mostly as he cursed and swore, and I occasionally reassuring him that I would pass on his message to Catt as he had asked. He continued to escalate,. And at one zenith of excitability, he said, “I’ve got a loaded shotgun ,and six cartridges here c… ! I’m going to blow my f head off, so tell the f. catt team not to bother phoning because I will be on the phone saying his goodbyes to my f. …friends. !

At this point I signalled to Health/Line to phone the police..

I expressed my concern for him and asked him please not to harm himself. He continued to rave, his paranoia against police and Catt team becoming increasingly evident. He then turned on me and said that he would now hang up the phone and that if I informed the police he would seek me out at MHL as he knew my name, and he would blow my F… head off, and f my family And did I. understand this clearly, before he hung up!.

Note:

We had been talking for 20 mins or so, I had already committed myself to the police negotiator by relaying my personal assessment of risk as being 85% hot air and 15% unsure. I had been conciliatory and placating in tone, and he had become increasingly abusive and threatening toward me. The police were instructing me to keep him on the phone as long as I possibly could ,as demos were incomplete. 1 then made a professional decision based on:

• - My experience of such patterns of behaviour have taught me that most bullies are cowards at heart, and invariably back down to confrontation whether mentally ill or not.
• - It is my experience that Maori are respectful and accepting of direct challenge.
• - It was my judgement to adopt an unorthodox and calculated response, to a dangerous situation.

I launched into an extremely loud tirade cursed him out, swore, and ranted that if he dared threaten me and my whanau I would have every policeman, police dog, in the vicinity allover him within minutes, and that I would personally call round and stick his shotgun where the monkey keeps his nuts.(not the actual metaphor used but representative nevertheless)I maintained this for a minute or so without let up, him listening, slowly backing off, mumbling apologies and saying ‘I just need my meds mate’ I need help mate. ..He told me he had been sexually abused as a child by policemen again, and started to tell me of the time he had spent in Lake Alice in 1977 in the National Security Block. He said he had been Dx as paranoid schizophrenic. At this point I shared with him that I also had worked in the security block at round about that time. I described the building and some of the staff .He became reflective and started to tell me bizarre stories of violence and sexual abuse, and from this point on his interaction became less and less adversarial. W~ reminisced together, I managed to acquire more info from him to relay to police. I reassured him that I would pass on his message to Catt,

He began to speak to me more as a buddy and I summarised several times, changing the amount of cartridges: ‘So you have a gun and five bullets?’ No, six cartridges, it’s a shotgun,. A little later:. So you have a gun and eight shells? No, six cartridges. I became concerned that he really did have a loaded gun, and with a last assurance that he would await catt. He terminated, and I then had direct contact with police.(This was the basis of my 15% unsure about the gun!)

During the next 30 mins the police activated the armed offenders team. They asked my how to contact Hutt Catt and I told them. I was unable to help with Psych Hx, as we only had one previous contact from his mother a week ago, when she had expressed concern about him and that info had been forwarded to Catt .And confirmation from himself that he would keep an appt with TW A .and that was forwarded to TW A.

At this time police were carrying out their procedures in the vicinity of his home. They were unable to contact him by phone.Shortly afterward I received another call from this man. This time he would range between camaraderie, saying that he now remembers me as Ben, the guy from Waikato, who gave him a kicking in a side room, and I said that I remembered it and I’d come round there and give him another one if he dared to do any harm to himself or any body else, and we both laughed.,

( I had earlier created a false persona for myself, subsequent to his threats upon me, and I said that my real name was Ben, and I was in a call centre in Hamilton)

Annette had again contacted the police, and she and Vera again acted as a conduit between myself and the police negotiator at the scene. I continued to keep him on the phone and elicit information for the police .

This went on for about 20 mins. He was a little calmer, was still expecting the Catt team, but was increasingly suspicious of the police being outside.

As he calmed I suggested that he put the light on the porch, and walk outside with his hands exposed. He began to think that this was a sensible thing to do, “1 know the f. …drill mate, I’m not stupid” They ,d blow me away if I give them half the chance’ He then promised me that he would do this and hung up.

The police outside saw him do this, but they were hidden and he walked back in doors, before the police could apprehend him. .

Alex in police Coms said he would call back and let me know the outcome.

At the time of writing this report I had not heard from Alex , so I have kept all the written communication between myself and police, in case there was an undesirable outcome which will require legal scrutiny.

#

11-30 am

Contact with Police Coms who informed me that. the situation had resolved without incident, and the man had now been assessed and admitted to TW A. A message was conveyed from the police negotiator, congratulating us on our handling of the call.

I could not have managed this call without the help of Vera and Annette I have thanked them for their skill and endurance and ask that it be noted.

Crisis Assessment and Treatment Team

Private Bag 31 907

LOWERHUTT

Tel: 5666999 (Ask for CAT Team)

Fax: 570 940719 December 2003

Mr P. Coombes

Operations Manager

McKESSON HBOC -MENTAL HEALTH LINE

Dear Peter
LETTER OF CONCERN -Interaction I.D.I have received a fax copy of the above two interactions with a client of Hutt Valley Mental Health Services from a clinician of your service, Mr Brian Stabb.

The ‘Patient Encounter Detail(s) of concern includes and threats to the client in question from Mr Stabb. Not only is the verbal commentary of what transpired during the call on the PED sheet explicitiy entered as an interaction, but also Mr Stabb has faxed further evidence to Hutt Valley C often threatening and derogatory approach to
managing a dangerous and stressful situation. I will not refer to any particular instance of syntax, as the unprofessional nature is self-evident. Unfortunately, this is an unacceptable dialogue to enter into with any client in a crisis situation, and I would request that this be investigated as an incident of serious misconduct and would also seek reassurance from yourself that this unprofessional approach will not recur again,

Yours sincerely

GRIEG OLSEN

Team Leader. C.A.T.T. HuTT ValleyDistrict Health Board

High Street Private Bog 31907

Lower Hutt New Zealand

Telephone +64-4-566 6999

Fax +64-4-570 4424

Fox HospItal +64-4-5704401

OF THE NURSES ACT 1977

TO: Brian Stabb

29 Southgate Road

\ Melrose

Wellington

Complaint:

1.0 That on or about 12/13 December 2003, during a night shift, while employed as a registered nurse at McKesson, Mental Health Line, you verbally abused ***** a client of Hutt Valley Mental Health Service and Mental Health Line byswearing and threatening Mr .***** In particular:

1.1 You swore at Mr ***** and told him that if he “dared threaten you or your
whanau that you would have every policeman and police dog in the
vicinity all over him within minutes” or words to that effect-
.

1.2 You told Mr *****that you would personally call round and “stick his
shotgun up his arse” or words to that effect.

1.3 You said “fuck” and “shit” or words to that effect to Mr ******

2.0 That during the period 12 December 2003 to 15 December 2003 .while
employed as a registered nurse at McKesson, Mental Health Line you failed to
demonstrate expected professional knowledge and/or judgment in your
documentation of the incident involving Mr *****In particular:

2.1 You documented that your experience had taught you that most bullies
are cowards at heart, and invariably back down to confrontation whether
mentally unwell or not.

2.2 You documented that it was your experience that Maori are respectful and
accepting of a direct challenge.

3.0 That following your telephone interaction with Mr *****on 12/13 December
2003 you breached Mr ****** confidentiality by disclosing his personal details
and/or information about his health status to ********, a reporter from
20:20, Television 3.

I InvIte you to provide any written response you may wish to be considered by the
Preliminary Proceedings Committee by 11 August 2004.

If you wish to be heard by the Preliminary Proceedings Committee, the CommIttee will
hear you at the Nursing Council offices, Leve112, Mid City tower, 139-143 Willis Street,
Wellington at 1:00pm on 12 August 2004.

DATED thls 8th day of July 2004 .

Brenda Hall

Convener

PrelIminary Proceeding. Committee

Brenda Hall

Convenor

Preliminary hearing Committee.

2nd August 04

I am writing in response to Complaints 1 2 3.

Before I address those specific complaints I wish you to consider the following points:
It is my opinion that the notes in question are not Nursing notes? and should not be judged as such. Neither can this call be described as a risis call

To use such descriptions detracts from the ongoing complex nature of a rapidly changing situation.What was initially a crisis call quickly became an armed offenders incident which involved 2 other nurses, with me cast in the role of negotiator between police at the scene, and client.

This was not a service that I, or the other 2 nurses involved, had been trained to provide.
Total call time was approx 1hr -20 mins.Early in the call the client stated he had a loaded gun and was intent on using it. At this stage the police were notified and the situation escalated into an armed offenders call out with armed police at the scene, talking to health-line staff who conveyed their instructions to me.
At this point I considered myself to be under the instructions of the police at the scene, and indeed carried out many of their instructions regarding the movements of the client.

With regards to the style of my notes: I understood that my call was being recorded, as is procedure for all armed offenders call outs. I did not know the outcome at the cessation of the call and was pressured to write my notes before 7-00am.

I felt it important to write as accurate and as truthful an account as I could as there was likelihood that they would be scrutinized in the event of a tragedy.

I ask that the committee be aware that the software I was required to use was not designed to take such a call, and the word limit on the computer was less that 200 words, hence the segmented nature of the notes.
I would ask the committee to consider that between 4-00am and 7-00am when I was expected to document, I managed somewhere in the region of 11-13 calls, several of which were of an extremely delicate and sensitive nature.
I have described the initial mood of the caller in my notes.At this time my objectives were to keep him on the line, collect base line data, and attempt to de-escalate his frenzied presentation. I mostly achieved these goals by;
1)Using basic micro counseling skills in order to acknowledge and empathise with his concerns.2)]Anchoring him in shared memories, and getting him to focus and reflect.

He was able to give me his name and location but over a 20 minute period gave me 3 different phone Nos.

*Note
This became a problem for the police at the scene as they were unable to confirm that the man they could see on the phone through their riflescopes was indeed the man who was talking to me. This later became a critical factor in my decision to curse out Mr.******

In seeking information from Mr. *****I discovered that he had a long forensic history and had been a patient in Lake Alice Security Block in 1979.I had worked in the Security Block during 1977-78 and was able to use our common memories in order to anchor and focus his thinking, and deescalate his frenzied state.
From this point on I began to establish a trusting relationship with him.

During the ensuing discourse we shared many memories of Lake Alice, the buildings, the staff, the routines, and the constant observation. I began to share his use of the language of that institution. (Lock-up instead of seclusion, screws instead of nurses etc…) As his frenzy lessened, his thinking cleared, and he became more rational. He became more aware of the implications of his actions asking me several times if I had called the police.A short time later he began threatening me, as I have described in my notes. He stated several times that he was about to hang up.

At this time the police did not have his phone number and could not positively identify him as a target should they need to intervene. The police instructed me to keep him on the phone, and at this time I decided to adopt the response I have outlined in my notes.

I had by this time established a good rapport with him. I had learnt an awful lot about him, and our shared and unique cultural ties. I was very confident that my chosen strategy would be successful.I am well aware of the codes of conduct required of me as a Mental Health Nurse when engaged in dialogue with clientele.At this particular time establishing a therapeutic relationship was not my primary goal.I chose to breach this code in order to achieve a higher moral and ethical imperative, i.e. protect the life and safety of the client and the policemen involved by acting on police instructions.

Whilst my response to this situation was pretty spontaneous, it was not ill-considered and I have outlined my specific skills in other documentation

I drew upon all of my skills and experience as a mental health nurse to achieve my primary goal, keep him on the phone.I succeeded.
Shortly thereafter he gave me his correct ph No. He had calmed at this time and was happy to await the arrival of the catt Team. The police phoned him but he became incensed and hung up on them. He called MHL immediately and said he would only speak to me, hence the second call
Contrary to McKesson opinion of my ability to reflect on my practice, I have spent many hours reflecting on my response. I do not believe that I acted incorrectly or unprofessionally, and I would act this way again should I be in a similar situation.
As a nurse I have a primary responsibility to protect the safety of the client and the public. I acted according to these responsibilities.
I have been an unemployment beneficiary since this time. I will not practice again as an RN if Council consider me to be unsafe

Complaints 1.1 1.2

Yes, this is an accurate account of what occurred.

1.3

I may well have said ‘fuck and shit it would have been appropriate to the role I had adopted. I have no memory of doing so however, neither have the other two nurses who were with me at the time.

2.1

This observation was made in the context of my experience within the walls of forensic institutions over the years.It is my considered professional opinion that this observation is accurate.

2.2

Again this was written in the context of the Maori residents of the forensic institutions I have nursed in. It is my considered professional opinion that this is observation is accurate.

3.00

I wish to be clear that I have never lodged a Personal Grievance against McKesson, neither do I intend to at this time.
Shortly after my dismissal from McKesson I contacted Richard L. from 20/20. I was distressed by my dismissal and felt that I had been dealt a serious injustice.

My primary concern however was the overall standard of mental health care in the Wellington area that this incident exemplifies.

Richard L was exploring other mental health issues at the time with a view to a documentary, and we discussed in detail a number of incidents which had been heavily publicized in the Wellington area.

I discussed my personal circumstances at McKesson and the incident of my dismissal.

At no time did I reveal the name and personal details of the client involved.
I think Mr. **** may have been known to Richard L.
Shortly thereafter Richard L discussed the possibility of an interview with both me and Mr*****. I declined that invitation. I have not seen Richard L since that time. I left Wellington at the end of February shortly after my dismissal.

I have an idea I wish to pursue:

A member of this group recently expressed some feelings and thoughts about my situation:

‘I was sorry and angered when I read the interim decision. Sorry for psychiatric mental health nursing that it appears the complete lack of understanding of our philosophies, functions and roles extends to the top of nursing in NZ. Whilst this continues we will always be measured against expectations that do not match by people who do not get it.

Angered because from what I have read in the documentation, had Council been aware of the former they could have exercised discretion and subsequently taken the opportunity to embark on debate about psychiatric mental health nursing. I see us as on the same journey that midwifery took . We are as distinct from nursing as midwifery is. We have the same roots and value and recognise them, but must be recognised as distinct. Lack of recognition of this distinction in my opinion is contributing to the difficulties you are experiencing.’

Profession:

Qualifications:

Years Experience:

It is my intention to collect a montage of such professional/personal opinion. The above format allows for anonimity if you so choose, and I extend the invitation to each of you to write your opinion of my predicament.I emphasise that I have no expectation that statements be supportive of my position.

Regards

Brian Stabb

Anonymity isnt an issue for me!

I have read all the correspondence with interest and a distinctly uncomfortable feeling. Brian, I have once expressed the thought to you that I do not condone or agree with what you did on this particular clinical occasion. I stand by that opinion. We could argue till the proverbial cows come home, but in the end, I dont believe that what you said came under any kind of therapeutic umbrella. But that is my opinion, and as you pointed out to me, I wasnt there and can only judge by written reports. And, as you also point out – there was a good outcome in terms of no-one being shot on the night. I have reservations about other outcomes.That aside, though, I feel like the argument you are having with Council is being conducted on two completely different levels. It isnt meshing at all into anything that can possibly work. I totally agree with the previous message that:

We are as distinct from nursing as midwifery is. We have the same roots and value and recognise them, but must be recognised as distinct. Lack of recognition of this distinction in my opinion is contributing to the difficulties you are experiencing.

I see that there is a fundamental difference here that can not be resolved while the philosophy and practice of mental health nursing are colonized into the general field, with no recognition of difference. And you, Brian, are bearing the brunt of this colonization. Im really upset about that.

Jacquie Kidd

I am with Jackie, anonymity isnt the issue for me, the only reason I havent replied to all? is to allow you to decide if and when you wish to use my name in connection with the statement.

Keith

Ps For the record I am more than happy for you to use the statement and the ID details are:

Keith Roffe, RGN, RMN, RN, MBA, MNurs

Currently a Psychiatric Mental Health Clinical Nurse Educator

Thanks for the prompt reply.

It ’s interesting that I have 4 responses so far, all of which differ somewhat ,yet have some common themes! This is exactly the point I want to make Jacquie! This is why it is so important that theses issues are debated, especially in an environment which is rapidly changing, where new mental health problems create new dilemmas for Psych Nurses. Ethics are no damn use whatsoever unless we can translate them into professional behaviour!

I’m afraid I don’t see ‘debating issues’ as being the same as ‘arguing till the cows come home about intransigent positions’.

I think that the very essence of Psych nursing revolves around being flexible and adjusting to the world (and language) of the client, in order to gain the privilege of entering their reality. This involves being none -judgemental about the presentation of the client and the language they use.( can’t resist asking you about the origins of your ‘distinctly uncomfortable feeling’ at this juncture!)

There is no prescriptive response to the situation I was in.

No ‘expert’ has ever told me ‘what I should have said’.

Another point I would make is that I was not attempting to enter into a ‘therapeutic’ relationship with this man. This was not the Nursing priority. The priority was to carry out the instructions of the police and keep him on the phone, in order to protect safety and save life. Now if this is not a fundamental priority of Nursing any more, then somebody should tell the 50,000 or so Nurses in NZ!

If I didn’t care , all I had to do was put down the phone. I like the way the Tidal model presents the act of caring as an expression of spirituality. Another point I would make, (which is so relevant to the core theory of the Tidal Model also) is the relevance of metaphor to my dialogue, which has been entirely ignored by Nursing Council.

This is a process of debate which I see as a professional duty for the likes of us. Oh for a National forum for such dialogue!

I do hope you are able to respond to my points. It is such feedback that helps me adjust my thinking.

Look forward to hearing from you,

Stay well,

Brian

PS still wanna be part of your research!!

Your points . . .

I’m afraid I don’t see ‘debating issues’ as being the same as ‘arguing till the cows come home about intransigent positions’.

Well, if we are talking specifically about what happened in your specific case, then it is an argument, because whatever I say, you can respond with aha, but you werent there so you cant know?, or well, it worked, didnt it?. Those are just points of argument, which is why I believe that you and NC are talking about 2 issues. They are only interested in your clinical actions at that time, and you are trying to engage in a larger debate. But by hanging it all on that one encounter, no-one else can win or even get a decent point across.

I think that the very essence of Psych nursing revolves around being flexible and adjusting to the world (and language) of the client, in order to gain the privilege of entering their reality. This involves being none -judgemental about the presentation of the client and the language they use.( can’t resist asking you about the origins of your ‘distinctly uncomfortable feeling’ at this juncture!)

My uncomfortable feelings come from my wanting to support you, but at the same time believing that you are in the wrong about this intervention. I dont think that any discussion about the privilege of entering their reality can possibly back up your use of a threat. Swearing with a person isnt the issue, but swearing at him is, as is threatening him in the way you say you did. Being non-judgmental is a far cry from the kind of give and take you reported.

There is no prescriptive response to the situation I was in.

No. There isnt.

No ‘expert’ has ever told me ‘what I should have said’.

No, youre right there to..

Another point I would make is that I was not attempting to enter into a ‘therapeutic’ relationship with this man. This was not the Nursing priority. The priority was to carry out the instructions of the police and keep him on the phone ,in order to protect safety and save life. Now if this is not a fundamental priority of Nursing any more, then somebody should tell the 50,000 or so Nurses in NZ!

Havent you just shot yourself in the foot here? You cant argue that you were being non-judgmental and had the privilege of entering his world and still say it was a non-therapeutic intervention. You also, if I remember correctly, called on psychodrama, the TM, and your years as a nurse in the same place he was incarcerated. You cant claim both things at the same time. And getting all global about it just looks like the act of a desperate man.

If I didn’t care , all I had to do was put down the phone. I like the way the Tidal model presents the act of caring as an expression of spirituality. Another point I would make, (which is so relevant to the core theory of the Tidal Model also) is the relevance of metaphor to my dialogue, which has been entirely ignored by Nursing Council.

You threatened the man, and abused him verbally. That isnt any part of spirituality, caring or the TM. And there can be a fine line for nurses, particularly mental health nurses, between caring and controlling. I would venture to suggest that when I have been in similar situations I have been driven far more by my concern for other people than for the person on the phone. In fact, Ive been furious at them and dead keen to get them punished for scaring and threatening. Parallel process?? Perhaps!!

This is a process of debate which I see as a professional duty for the likes of us. Oh for a National forum for such dialogue!

Are you a member of the College? A forum for discussion and debate has opened up via a New Zealand chat, and has had some great discussions so far. There is a clear movement towards reclaiming our separate identity – who knows how long it will take!

PS still wanna be part of your research!!

Im almost finished with the data collection. I hadnt gotten back to you because of the ongoing case, but if you feel able to do it let me know. I need to be all done by the end of October.

Take care

Jacquie

Box 95 193

Swanson

Wednesday 28 September

I understand he is experiencing difficulties at present. As a person who is driven by professional and personal integrity, I understand that Brians stand, based on his principles and a keen sense of justice, may exacerbate these difficulties. I would suggest that his stand indicates an integrity that may have been easily compromised in the interests of an ‘easier way.

I dont know all the details of the situation, but I would make the following point. Brian apparently used an ‘unprofessional strategy while talking to a person on the phone. Given the situation I would suggest that this strategy was one that should be viewed in context and some weight might usefully be given to Brians rationales for his actions and words. I have confidence in Brians ethical and professional sense, and integrity. I would have no hesitation in supporting this view to any person or organisation if it would help his situation.

Chris Cottingham

RPN, RGON, BA, Dip Soc Sci, MEd.

Point 1

Well, if we are talking specifically about what happened in your specific case, then it is an argument, because whatever I say, you can respond with aha, but you werent there so you cant know, or well, it worked, didnt it?. Those are just points of argument, which is why I believe that you and NC are talking about 2 issues. They are only interested in your clinical actions at that time, and you are trying to engage in a larger debate. But by hanging it all on that one encounter, no-one else can win or even get a decent point across.

Agree completely that Nursing Council and I are talking about two different issues:

This is the situation because the whole structure scrutinises and judges individual clinical action with the premise that if it is not ,’according to the code’, then it is by nature ‘unprofessional’. This is my simple understanding of the basis of ‘deontology’.

You however are not of this way of thinking. you take into account the broader picture, you are aware of the unique nature of each interaction, the societal context, the physical environment, you are open to change and learning, and are reflective. (As should be the governing body of the practice of mental health nursing). So I reckon you are worth debating with……….

Point 2

My uncomfortable feelings come from my wanting to support you, but at the same time believing that you are in the wrong about this intervention. I dont think that any discussion about the privilege of entering their reality can possibly back up your use of a threat. Swearing with a person isnt the issue, but swearing at him is, as is threatening him in the way you say you did. Being non-judgmental is a far cry from the kind of give and take you reported.

You have been and are a very valued support to me. You continue to be with your openess and preparedness to ‘engage’!

You miss my point:

It is Council’s judgement that I threatened. Mr W. Now it is your judgement too, (bit worse in a way cos you say ‘possibly back up my use of’ which infers I’m being nefarious!!)

When you take words so literally, you exclude the use of Metaphor. As you have agreed with me in the past, it is Mr Ws Right to decide if I threatened him,…. or if he saw it as a joke, or as a challenge, or whatever…… As I assured you in the past I would do everything I could to protect that Right…when you read the transcript you will see that I have been as good as my word………

I think that you should reserve your judgement about this until you read the transcript and learn about Mr W s perceptions of our interaction……..likewise with the swearing……

Point 3

But I am very clear about what I would not have said and I would certainly have tackled you about your interaction, too.

Really understand your conviction here….but think about it……. with the complexities, stresses, ethical dilemmas, protracted changing nature, etc. …….How can you be so certain about what you ‘would not say?’

And no! You would most certainly not have tackled me about my interaction!! …..Because to do so you would have had to be there with me to help, and I wouldn’t have been so damn isolated!!

Point 4

Havent you just shot yourself in the foot here? You cant argue that you were being non-judgmental and had the privilege of entering his world and still say it was a non-therapeutic intervention. You also, if I remember correctly, called on psychodrama, the TM, and your years as a nurse in the same place he was incarcerated. You cant claim both things at the same time. And getting all global about it just looks like the act of a desperate man.

No… and quite definitely Yes! …..I could non -judgementally, enter a client’s world, and be very non-therapeutic, destructive, malicious, cruel……and indeed so could others and often do….ask any Consumer/Tangata Whaiora!

Yes I have cited my psychodrama experience, the TM, and our shared experiences, as a basis of various interactions. As you will recall from my notes, the nature of our relationship changed when he said he had a gun. Broadly speaking when it became an armed offenders call out, forming a therapeutic relationship was not my priority .Acting to protect life and safety, and working with the police to do so, was. But even that wasn’t a sudden clear change….., it was a complex dynamic protracted situation….How much so , again will become apparent .Core services had totally failed, and there are more factors you will become aware of when you view the transcript….

This was a situation when I had to consider Core Nursing Philosophy, like a nurse who does a tracheotomy at the roadside, or the midwife who employs, a medical or even surgical procedure to save life…….At a time when we are all confronted with the reality of natural disaster, the barbarity of mankind, and NZs vulnerability to both…… to refer to a global nursing identity I believe, is not generally viewed as the act of a desperate man.

Point 5

You threatened the man, and abused him verbally. That isnt any part of spirituality, caring or the TM. And there can be a fine line for nurses, particularly mental health nurses, between caring and controlling. I would venture to suggest that when I have been in similar situations I have been driven far more by my concern for other people than for the person on the phone. In fact, Ive been furious at them and dead keen to get them punished for scaring and threatening. Parallel process?? Perhaps!!

I have already addressed the first part .(such judgements are the Right of the client to make…)

I remind you of a previous point we have already covered and you have agreed with:

“To take out a piece of language from a 2hr dialogue, put it under the microscope and assume it is disrespectful, is the sort of reductionist way of thinking which is the antithisis of the Tidal Model. It can only be judged within the societal and environmental context. There are many ways to show respect and caring for a person…..this is often culture specific, gender specific….or affected by other variables….When I swore I did so knowing that I was ‘at risk’ of these charges, even moreso when I wrote my notes…..I acted to protect safety and save life. .In doing so I used ‘his language’ and entered his world ….even more legitimately as it has been part of my world too…..I can show no greater respect for a customer than to knowingly risk a highly valued career in order to protect their physical safety.”

Regards brian S

Brian has a long history of mental health nursing in New Zealand. I believe he has a sound educational beginning with the early work of Hildegard Peplau and other theorists. He has worked as a nurse from the perspective of person to person which is appropriate for mental health nursing. I believe he has a strong commitment to his clients and has good intentions for the outcome of his work.

He furthered his expertise by becoming involved with training in Psychodrama in Wellington and later in the Waikato with respected trainers. He also trained in Perth.

At that time (1970-1980) there were several mental health nurses training in this modality as a way to deepen their self awareness and improve their skills to understand and assist their clients. I know from my experience, psychodrama training is demanding, challenging and requires many hours to qualify as a practitioner. Psychodrama is an effective method to assist individuals to make important and deep changes in their lives. This form of therapy is based on role theory as developed in the writings of J.L.Moreno. Part of the process involves role reversal with another person using their frame of reference, when it is not uncommon to use their bad language as a means of deepening contact and empathy. I think it is unwise to extract words or sentences used in this interaction, out of their original context. As I understand the allegations, these extractions may be somewhat unfair.

This is not the first struggle Brian has had as a New Zealand Registered Psychiatric Nurse. I think this is because he has a strong commitment to do what he believes is best for his clients and for the Community. He is not afraid to challenge the current societal issues which exist within his and others nursing practice. He works at the edge of what are the usual boundaries of nursing. His psychodrama training would have provided additional courage I think, for him to tackle difficult nursing situations.

With the closing of large psychiatric institutions in recent years, there have been several instances of poor care for deeply troubled individuals, reported in the media. Experienced mental health nurses are in short supply in this country and for those who are still with this service, the demands are many in their daily work. I know the allegations against Brian Stabb are serious and have to be considered this way, but I hope the social context and the high level of difficulty contained in the phone call are considered with the same degree of interest.

CC Geof Annals

Dear Jane OMalley,
As you are aware I have recently had contact with Geof Annals regarding my employment situation with Mckesson NZ. Please allow me to sum up my contact with NZNO:
In late December I approached NZNO with regard to Membership and representation. I had previously applied for membership but had withheld monies as I learnt that NZNO were not able to offer representation until there were at least 10 members in the employing organization

In 1995 I was sacked from my position at Waikato Polytech and was ‘disowned by NZNO when the executive made the political decision not to support me despite me being a member for many years. I went on to be reinstated in The Employment Court although my career as a Nursing Tutor was effectively finished. I therefore feel that NZNO has an ethical obligation to at least explore my situation thoroughly, and provide me with a full written explanation of the professional rationale for not representing me this time. I expect this decision to be fully informed which means that you require to interview me in depth before you make a decision. I expect also that this decision be apolitical, and be based solely and exclusively on the professional, ethical, moral, cultural and historical basis of my practice as a

Registered Nurse.

My perceptions so far :

The CEO of NZNO, Geof Annals, accompanied me at y sacking, and being acquainted with the facts of the incident, the documentation involved, and the overall picture of my employment situation, came to the firm personal conclusion that I had valid basis for PG. Geof also felt that I had been dealt with unjustly, and in a way that should be of paramount concern to the Nursing profession as it has great ramifications for the concept of autonomous practice.

I understand that you feel that my dismissal was justified, and that you are not prepared to meet with me as ‘there is no point .I do not understand or accept the basis of this decision.. Furthemore your refusal to meet with me and explore the matter, is downright sinister, smacks of discrimination and political interference, and should be made known to the wider membership of NZNO.

At this stage it is not my intention to pursue Personal Grievance. Rather I have decided to politicize my situation for the greater good of both our profession and the consumers of mental health services and their families in New Zealand.
I ask you to rethink your decision for the greater good also.

I expect the professional courtesy of a written response in the immediate future,

Yours Sincerely

Brian Stabb

RMN, RGON, RPN,Advanced Dip in Nursing(Psych Social.)

N.R.T.T.C.

April 04

NZNO Legal Adviser.

CC Jane O Malley

Dear Sue Johnson,

Thank you for your letter of 8th April .I have not yet read it personally as I am traveling, however my daughter has read it to me over the phone and I think I have the general gist of it.

I understand that your refusal to represent me is based on the technicality of my membership fee not being paid upon my initial application, and my subsequent membership occurred after the initiation of my industrial conflict, right?

In 1995, after a three year battle to uphold Nursing Council Standards of education, I was sacked by Waikato Polytechnic as a result of an article published in Kai Tiaki Nursing New Zealand, our professional Journal.

Shortly before I was sacked I learnt that the union representing me ASTE, had also supported and lodged PG on behalf of nine tutors who were demanding my dismissal on the grounds that I was culturally unsafe.

On the day I was sacked I went to NZNO offices at Waikato hospital. James Richie was the Rep. I was told there was no record of my membership and I was refused any kind of audience. That afternoon I went to my lawyer, and only after his intervention did NZNO arrange for me to see NZNO President Brenda Wilson, and I was flown to Wellington a few days later.

I had been supported by NZNO President, Gay Williams in the earlier stages, and she had given me written support with regard to my stance on standards.(this later became significant in my Employment Court settlement)
Upon my dismissal however Brenda Wilson withdrew support, despite my requests to the contrary. She told me that I was best represented by ASTE as ‘they were familiar with my case She was fully aware of the situation with regard to ASTEs duplicity. I have often wandered if NZNO also supported those nine tutors who were all NZNO members, perhaps you can enlighten me?

So in a nutshell NZNO deserted me and left me to be represented by a union that was also supporting the demands of those who would have me dismissed.

ASTE personnel involved with my case were:

Lorraine Webber Terri Burling Glenn Barclay.

I doubt that ASTE will be too keen to discuss it though….

Verification of what I say can best be confirmed by Michael Reid QC who represented me in The Employment Court and was aware of ASTEs duplicity..

I went on to be reinstated to my former position and compensated. All in all my conflicts went on for over 4 yrs.The record of that conflict is recorded in the archives of Kai Tiaki Nursing New Zealand..

I believe NZNOs decision was then politically motivated by its support of the concept of Cultural Safety in nurse education, so that is why I suspect that it is motivated by discrimination and political interference this time.

I do not say this in the heat of the moment.

I understand that my letter to Jane O Malley is considered to be threatening, and that if I continue to make my story known to the membership, you will sue me for defamation, right?

During my conflict with Waikato Polytech I was threatened with a defamation suite. Like any average citizen who finds that he is being sued I was petrified. However I believed that I was doing the right thing and I fought the defamation action. It cost me many thousands of dollars but the defamation action was dropped. I learnt from that experience that I have nothing to fear from defamation charges as long as I am truthful. I learnt also that it is not necessary to employ a lawyer, and that I am quite able to defend myself.

I voiced my suspicions in full consideration of NZNOs previous treatment of me, in the light of the apparent ‘difference in opinion of the executive, and because no explanation for your refusal to represent me had been forthcoming.

Geof Annals informed me of Janes decision approx 1 week after my sacking. I was quite distraught by this.
Although Geof made me aware that he could not make the decision to represent me alone, I was buoyed by his belief in my integrity and his personal support. He was after all the CEO, and had personally attended my dismissal. I was very distressed to learn that Jane had overruled him.

I have no means to pursue PG proceedings without NZNO. I attempted to contact Jane but she was unable to take my calls. I e/mailed her but she did not reply. I was informed that she would not meet with me.

The first explanation as to why she decided so, was given in your recent letter almost 2 months after the expiry of ‘the 90 days I have to legally lodge a Personal Grievance

I know from my personal experience that NZNO makes politically expedient decisions about who it represents that have absolutely nothing to do with membership fees.
That being so it is quite reasonable to suspect that I have been discriminated against dont you think?

I have already described my experiences with NZNO 8 yrs ago. History IS Important. I understand that there are some on Committee who believe that was 8 yrs ago and as such nothing to do with us

Not good enough . My grievance is real, and can be graphically and substantially evidenced by all the documentation from that time. The cruel and politically motivated decision made by NZNO not to represent me, had a very negative effect on my physical ,mental, and spiritual health. I have paid a great personal price just as Maori have paid for the cruel and politically motivated decisions made by the Crown 150yrs ago.

Like the Treaty I will not go away, and like the supporters of the Treaty I will continue to voice my grievances for as long as I can draw breath.

Your assertion that I had 8yrs to make my concerns known is fallacious. Such injustice has no timeframe by which it must be remedied.
I believe that by every principle of natural justice and human decency you should represent me this time. That NZNO boasts of its dedication to the principles of Partnership is a great hypocrisy if you refuse.

My circumstances have changed drastically since that time. I live in a campervan. I am an unemployment beneficiary and live on $161-50 per week.( I will not practice as a nurse until I am assured that I am safe to practice, because there is very little I would change about my conduct in the incident in question.) I have very little in the way of material things, assets, cash, etc. so there is little you can gain from suing me .(Perhaps you could stick my old campervan in the Sounds and use it as a retreat for old whistleblowers).

I will not be intimidated by threats of defamation.

I choose to keep my integrity and to exercise my right to freedom of speech, and I wiIl tell my story to whosoever I wish.

Why will I do so? It is true that I experience a great sense of injustice, but that is not my primary reason for telling my story. My main concern is for the greater good of the New Zealand public, and for the Nursing profession.

I have already outlined my situation on the discussion pages of NZNOs website, so I guess you can start suing me straight away. Perhaps you could put your reasons for suing me on the website to, you have my complete unconditional permission to do so.

I think it important that the membership realize that they can be sued by NZNO if they dont tow the line. Please dont bother me with all the legal letters, just tell me when I have to appear and in which courtroom and I will attend and defend myself.

Finally I wish to express my disappointment in your response to me. I did not write to a lawyer, I wrote to a Nurse about nursing issues. I do not have strong geographical ties to a particular culture. The culture I identify with mostly is the culture of mental health nursing. I wrote to a Nurse in the language of that culture and I expected the reply to be from a Nurse not a Lawyer.

I would like NZNO to return to its Nursing roots in order to deal with my issue.

I suggest you put my grievance before the Te Rununga group, they will probably have a greater understanding of my situation. To this end I request that each and every member of the committee of NZNO be given copies of this letter plus other pertinent material about my case. I include also extracts from some other writings I am working on , which will tell my story from a human perspective. Perhaps those who are not too immersed in political and personal agendas will be able to identify with my position. Please let me know if you are able to do this. If not I will post copies to each personally.

Yours Sincerely

Brian Stabb

Dear Mr Stabb,

Thank you for your letter, which was sent to our Wellington office so hence the delay in it reaching my office, though when it did I was in court out of town for a week long hearing. Your email of today was also forwarded to me. I appreciate that you are stressed, and also that you have shared details of your health , which will remain confidential to me. I do however need to point out that NZNO cannot assist you with your personal grievance as it relates to a matter which occurred when you were not a member. Neither myself nor NZNO will enter into any further correspondence on that point.I do hope you continue to reamain an NZNO member as you will of course be entitled to our services for matters that arise whilst you are. I trust though that things will go well for you professionally and you will not need our services.

I am sorry that I cannot further assist you. I wish you well for the future.

Yours sincerely

Sue Johnson LLB (Hons)SRN RSCN;Barrister and Solicitor

NZNO Legal Adviser

Thankyou for your e/mail. It is reassuring to me that you are able to appreciate the stressful nature of my situation. Please do not feel obliged to keep my health status confidential Sue, it is my intention, to make my situation public knowledge. I understand that NZNO will no longer correspond with me regarding a PG against my previous employer.
As you are aware I am subject to a complaint of professional misconduct from my previous employer, and will appear before Nursing Council in mid-August. What is NZNOs position with regard to this situation? Are you able to offer support /representation? There are many aspects of NZNOs overall behaviour toward me that I find deeply disturbing both professionally and personally. *I believe that I have been subjected to discrimination. believe that this will be of serious concern to the offices of The Mental Health Commissioner and The Human Rights Commissioner.

I may pursue these concerns. I feel just a tad suspicious that I have been denied access to the membership. I placed several accounts of my ethical dilemma on the members only discussion page, inviting comment and opinion.

I had notice of a number of responses, and then suddenly hey presto! it disappears! I am informed thereafter that there is a technical glitch and it will not be available indefinitely…….. That was 6 weeks ago! Really Sue! What next! Can I expect a ” late night knock on the door from 2 NZNO Reps who will whisk me away to the Gulag!! Throughout my recent contact with NZNO, I have requested korero, the right to speak face to face, and this has been refused. As a mental health nurse I find this refusal to discuss ethical issues professionally disturbing. Again I request the opportunity to have meaningful, constructive, face to face discussion, about all aspects of my present situation, with a view to finding a solution.

Regards

Brian Stabb

Dear Mr Stabb I respond to the points in your email as follows:

1. Your words;- ” I am subject to a complaint of professional misconduct from my previous employer, and will appear before Nursing Council in mid-August.What is NZNOs position with regard to this situation? Are you able to offer support /representation?”

- Our response ;- NZNO will only provide support and representation to a member who was a financial member at the date of the alleged incident.As you were not,NZNO is not in a position to assist you. This is clear NZNO policy and if it wasnot, then nurses would simply join up after an incident. Your NZNO indemnity insurance does not cover you for the Nursing Council hearing as you were notcovered at the time of the alleged incident. This is normal insurance policy for any type of insurance.

2 Your words;- ” I believe that I have been subjected to discrimination”

- Our response ;- There is no discrimination against you. NZNO is simply applying normal policy in not acting for someone who was not a member at the date of the incident in question. You are not the only nurse to find yourself in this position and other nurses accept it; it seems astonishing that you do not. It is no different to the situation that you would find yourself in if your car was not insured until after an accident and the insurance company refused cover for the accident.

Presumably you, in line with everyone else, would not feel that that was discrimination.

It is up to you whether you choose to pursue our policy as discrimination, but to succeed you will need to show actual discrimination, not simply your belief of it.

3 Your words;- “I feel just a tad suspicious that I have been denied access tothe membership…members only discussion page…

“Our response ;- NZNO has over 35,000 members not just you. The website isfrequently experiencing difficulty and is not just visited by you. This part of the website went down some time ago and NZNO has had other IT priorities to attend to.

4. Your words:- “I request the opportunity to have meaningful, constructive,faceto face discussion about all aspects of my present situation.”

- Our response ;-As you were not a member of this organisation at the date ofthe alleged incident that put you in your present situation, there is no pointin discussion. NZNO will not be assisting you with that matter and no amount of discussion with you will change its mind. The bottom line Mr Stabb, is that at the time of the incident involving your previous employer you were not an NZNO financial member. NZNO does not act for any person who was not a member at the date of the incident. It is astonishingthat you consider that you should be treated differently to other nurses in thatposition. Please note that no amount of letters, emails, threats or otherconduct on your part will cause us to change our minds.

Sue Sue Johnson LLB (Hons)SRN RSCNBarrister and SolicitorNZNO Legal Adviser

Thankyou for your prompt response clearly establishing the parameters of your total non-involvement with my present industrial situation.Yes Sue, I really do consider myself to be a special case deserving extra consideration from NZNO. I have written to you clearly outlining the exact reasons why.

You have chosen to ignore/discount my history with NZNO.

I have outlined to you the details of the injustices I have experienced, and the relationship between that experience and my physical, mental, and spiritual well-being.

You have chosen to ignore/discount my consumer experience.

I have specifically requested that you put my situation before the Te Rununga group, as I believe that they are better equipped to understand the long term effects of injustice and grievance.

You have chosen to ignore/ discount that request.

I have pointed out that such behaviour is not conducive to NZNOs commitment to Treaty principles.

You have chosen to ignore/ discount NZNOs stated Treaty commitments.

I experience your letter as inappropriately hostile and adversarial.

Maybe it is my sense of humour that has offended you. I use humour in order to give perspective to the issues in Nursing that I feel passionate about. This has been an important strategy for me on my personal pathway to recovery.

Equally so it has been important for me to protect my rights as a consumer of mental health services, and ensure that I am not abused or discriminated against.

You interpret my stated intention to protect my rights as aking threats.
I find this astonishing, particularly as I see from your qualifications that you are a RN.

This exemplifies the sort of discrimination that I feel will be of concern to The Mental Health Commissioner.

Again I request the right to korero. The issues at hand are professional issues of ethical conduct and natural justice as related to my present and historical dealing with NZNO. That those issues are integral with your rigid, inflexible position regarding my representation, is now incidental.

The website?

I can only suggest to you that as a multi million dollar organization representing 35,000 Nurses, it is an absolute priority that you have a professional discussion forum for the numerous ethical dilemmas that arise for front line nurses. How better can such matters be addressed in these rapidly changing times? I suggest you review your IT priorities, and I look forward to a return of the on-line discussion forum in the very near future.

So where to from here Sue?

I have no wish to damage the public image of my profession or NZNO. I wish to address my issues within the profession. However, be assured that I will continue to pursue my professional concerns for the overall welfare of the NZ public, and for the overall benefit of the nursing profession.

I have always felt it courteous to inform NZNO of my professional intentions, however in this situation I dont quite know what to do….I do not want you to feel threatened or intimidated by me and Im unsure how to behave so that you feel safe.

Perhaps its best I don't write to you again, leastwise not in your capacity as a Lawyer. If you want to resume dialogue, or even meet with me personally I am open to constructive meaningful dialogue at any time.

I shall continue to remind you occasionally of my request for korero with the NZNO executive.

Regards

Brian stabb

It is some weeks now since I wrote to you. I have sent you an e/mail regarding my request for my documentation to be circulated to all of NZNOs committee and the Te Rununga group. You have not responded.

It seems to me Sue that you must eventually respond to me in one of 2 ways:

1),

You will put on your legal hat and threaten me with things diabolical.

2)

You will act according to the ethics of the Nursing profession NZNO represents, and invite me to korero.

I have definite responses planned for both contingencies.

In describing my current situation to NZNO I have shared the personal details of my health status. I did so with the understanding that nurses will have an empathic appreciation of my situation, linking both physical and mental stressors.

I must tell you that I find your ongoing silence stressful.

It is important that I care for myself and avoid unnecessary stress. If I have not heard from you within the next 10 days I will assume that you have chosen ‘option 1 and I will then act accordingly.

Hoping to hear from you in the near future,

Yours Sincerely,

Brian Stabb