Seeing past the behaviour on the street to the person within.

Our personal comfort levels are high because have worked in this environment for many years. We can "read the street". We feel less threatened by crowds of people selling drugs and shooting up on corners and in doorways and alleys. We are aware of the street scene as a lifestyle. And, like any lifestyle, underneath the obvious chaos, there is a logic, a set of rules these folks use to get through the day.

We cannot forget that we are on the street and need to be aware of sudden changes in the social temperature. There is always the possibility of violence: fights, noises of anger breaking glass, body fluids. We have to be ready to get out of any place quickly. Never take the calm for granted.

Being alone on the strip will always feel uncomfortable but as you become more comfortable in the chaotic environment, you will be able to expand your personal safety zone and trust your own judgment. Greet people as you pass them in hotel corridors. Residents here have a generally positive perception of nurses.

There are things we learn.

  • We often don't get into a SRO elevator if we feel uncomfortable with the others getting in.
  • We walk quickly, make little eye contact. This just boils down to another aspect of respect for the people living here, their rules - conventions, if you like, their customs - say this is the way 'normal' people here behave.
  • React politely at open doors.
  • Don't stare on the streets or act too inquisitive since this makes them uncomfortable. This is, strangely enough, a private world. They are shooting up in the street because they have no place else to use. This is their home. They can't stop you from walking through their living room because it's public property. It's not wise to escalate the situation with bad manners.
  • Think in terms of pre-emptive de-escalation. Lie low if a fight breaks out in a hallway. Don't speak unless addressed directly.
  • Many of the same people who will speak easily with us at in their room will ignore us on the street.
  • Likewise, don't bother being offended by this; you're wasting your energy. It's like going to Paris and being annoyed by all the people who don't speak English.
  • Our presence on the street can be seen as invading their 'biz' territory. Act accordingly.
  • But don't delude yourself into thinking "When in Rome, do as the Romans do." You don't have a clue what these Romans do, so don't try to fake it. You are lying, they know it and resent it. Don't crash their party when you're there to serve the drinks.
This way of doing business, this paradigm if you will, has some powerful benefits:
  • We last longer. If one of us is having a rough day, another can pick up the slack. Since the understanding of the ABC approach is shared between us, we can keep the ball rolling.
  • We look at the same set of patients in two different ways. This is invaluable. Our usual conclusion is an amalgam of the views.
  • The close space within which we work forces us to rely on each other. We develop a deep understanding of our very complicated relationships with our clients and we share our ideas. When we see separate patients exclusively, this blending of ideas is far more limited.
  • There is less fear. Two nurses in a hotel full of very unpredictable souls have a much better chance of thinking their way through points of potential problems. Not only two minds to bear on the situation, but just as importantly two pair of eyes and ears. And voices: a technique we call "talk-n-walk" where one of us engages the patient in conversation while the other gets the job done has gotten us through many situations where one nurse would not have been able to do anything.
All of this leads to improvements in both effectiveness and efficiency. The efficiency is arguably measurable. Over time, a two-nurse team will average more measurable actions than two separate nurses operating in the same environment. Some of this may be attributable to fact that we know our clients well enough that we would be more efficient in any case. But much has to be made of the fact that two skilled nurses are more likely to come up with the right approach and solution the first time. Simply put, two-nurse visits are more likely to do the right thing. This reduces the number of errors and increases the likelihood that ensuing visits will be more efficient. No backtracking or floundering around for an alternative solution.

If we more often start the therapy off right in the first place, there would seem to be a good chance that the patient is going to more readily comply. And, in DTES, compliance is worth its weight in gold. Since we can show the residents a good track record, their confidence in us - and the confidences they share with us - goes up. And it certainly does improve our safety factor to have the residents thinking of us as trustworthy.