BY ANNE NUGENT GUIGNON, RDH, MPH,
Over the years, I've come to realize that three factors can put a serious damper on whether we have happy, sustainable clinical careers: isolation, developing an injury, or getting burned out. Many work in isolation, often surrounded by doctors and staff members who don't really understand the rigors of dental hygiene practice. Without a curious mind and a strong backbone - both literally and figuratively - it is easy to succumb to one of these career threats.
When I graduated in 1971, the Internet did not exist. The only way to keep connected was to join the local dental hygiene association. I rocked along for the first decade as the solo hygienist in a small practice. Like many, I did not see the value of joining the association in the early years, and continuing education was not required. There were a few other hygienists in the building, but for one reason or another, our paths never crossed, so I spent the first 10 years in self-imposed "professional isolation," lacking a mentor who could have helped me grow professionally.
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During that time my body started developing nagging aches and pains. They were fleeting at first but gradually increased in frequency and intensity. No one wore loupes, lights, or gloves at that time. We were the first generation to do sit-down dentistry and used horrible, nonadjustable exam stools, most of which did not have lumbar support. All of our hand instruments were skinny. The polishing handpieces were heavy, long, out-of-balance, and attached to tightly curled air hoses. Power-driven scalers were used sparingly in favor of the more traditional hand instruments.
We were at terrible risk of developing career-altering, work-related musculoskeletal disorders (WRMSD), but none of us knew we were headed for trouble. The first paper about WRMSDs in our profession was published in 1984 when Gayle MacDonald, RDH, PhD, studied carpal tunnel syndrome among dental hygienists in California for her doctoral dissertation.
We now know that carpal tunnel syndrome is only one of a dozen physical disorders that plague those who practice clinically. Injuries develop all over our bodies, from the head to the ankles. And recent research has demonstrated that the risk of developing a WRMSD is greatest during the first 10 years of practice, although this is not to say we can't get injured later on. Injuries begin to develop even while we're in dental hygiene school. WRMSDs are the result of bad habits, one-size-fits-all workspaces, poor equipment designs, and the fact that clinical practice includes significant ergonomic stressors, such as awkward postures, static positions, force, repetition, and vibration. Given our understanding of the risks, it is never too early to begin protecting our bodies. And conversely, it is never too late to create a safer work environment.
Let's fast forward to today. Social media, smartphones, and tablets have revolutionized our ability to get information at lightning speed. In addition, ergonomists have spent decades studying ways to help people work in safer environments. Ergonomics is a science that focuses on adapting the job to the person - not the other way around. An increasing number of dental professionals are aware of WRMSD risks, and frequent discussions occur online regarding the prevention of injuries, what products work well, and what to do when an unfortunate injury occurs. Online dental hygiene groups allow us to come together to share thoughts, ask questions, and find moral support.
One year ago, a brand new graduate posted a story online that made me cringe. Her doctor insisted she wear latex gloves that were too small. Her hands and wrists started hurting. She begged for properly fitted nitrile gloves, but he kept insisting that she had to wear the gloves he ordered. He also insisted that she use broken, worn-out instruments and would only allow her to use one sickle scaler per patient. He got mad when she tried to use her own sets. Jobs in her area were scarce, and her gentle nature made it hard to broach the subject over and over. Nonetheless, she was miserable knowing that she was not providing optimal care and that she was, at the same time, getting hurt. He also made comments about her clinical skills in front of patients, as well as inappropriate remarks about her weight, knowing that she was following a strict diet.
When I learned of her story, my mentor gene kicked in at full force. Courtney and I had several one-on-one chats about her situation. It was very disturbing to see how beaten down she felt and even more disturbing to know that she was getting hurt by the conditions in her workplace. I told her that Microflex had several brands of gloves specifically formulated to reduce hand stress. She was able to secure some samples from the company online and found that the medium-sized Ultraform gloves were a perfect fit for her hands. Her pain went away. But he would not budge, even though the gloves would have reduced his cost by about 60%.
Both Courtney and I were discouraged with his disregard of her hand health. Even more discouraging, however, was his bullying behavior toward her and other staff members. I encouraged her to stand by her convictions, grow a backbone, and even purchase her own gloves, if need be, until she could find a better practice.
For months, I heard nothing from Courtney. I saw her chats online about her cute pets and a new hobby, but the silence was killing me. Was Courtney OK, or was she not? Today, I got my answer! Courtney is alive, well, and happy. She has a new job that she loves and an employer who is letting her do her job in safety and comfort. Please take the time to read her letter to me:
Standing up to a bully employer
Hey there! I just wanted to let you know that, after a very abusive year and a half, I finally got a great new job.
I spoke to Dr. D a few times regarding gloves and a few other problems (some were really big problems), and he would not budge.
He was so mean and cruel that I was afraid to give my notice in fear of him verbally attacking me.
But I got up the courage and put in my notice. He ripped me to shreds, told me I was ruining his practice by leaving. I cried the whole time, but I came out stronger, and now I am at a wonderful office - one that lets me do my job (and wear Microflex Ultraform gloves), all thanks to you!
My hands and wrists don't hurt anymore, and I am much happier. I would have never gotten the courage even to seek other employment without all of your encouraging words. You have helped me speak up for myself and grow a backbone! Never again will I let someone take control of my well-being.
If you are facing any type of situation in which your physical or mental health is at risk, please take Courtney's final words to heart: "Never again will I let someone take control of my well-being." It took a big dose of courage for Courtney to make these changes in her career, but now she is clearly in charge of her own comfort zone! RDH
ANNE NUGENT GUIGNON, RDH, MPH, provides popular programs, including topics on biofilms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971.