A Plea to Nurses Everywhere

[guest358111]

I don't seem to process everything that I see, hear and do at work until I am home. My lack of reflection until later might have something to do with running around like a Looney Tunes character for eight or more hours caring for the sick. It is difficult to be reflective when life has to be lived so much in the moment.

But after the last IV has been hung, the last lab value dealt with, the last medication given and the last note written, as I drive home, fragments of my day begin to surface as I try to unwind.

I have different "topics", I guess you could call it, that I mull over as I drive depending on the week or the day.

Some days as I drive home I am reflecting on my assessment skills. Other days I am reflecting on my patient education skills. Sometimes I think about a new disease I learned about, or a new drug.

There is always room for improvement and I often wonder if I would go back and approach a certain situation differently.

I don't always reflect about nursing: there are some shifts where I drive home listening to the radio and trying NOT to think about anything that I did that day.

I have noticed lately, however, that a lot of my reflections on the drive home have to do with communication. Not nurse to patient communication, but staff communication.

Nurse to nurse communication.

Nurse to provider communication.

And quite often, what I am reflecting on is the negative communication that I see.

I know that this topic is not a new one. It has been discussed from many angles by many people more qualified than I. But I would like to show you, if I could, some things that I have seen in over a few weeks time. I imagine that you have seen similar situations.

I have seen and heard:

• Staff nurses raising their voices (ok, screaming) at a charge nurse at the beginning of a shift because they didn't like their assignment (which, by the way, was not an unfair assignment). And no, I am not the charge nurse.
• A student calling a health care provider, who spoke sharply at the student after a suggestion was made. The student was tearful as she got off the phone. When the healthcare provider came to the floor, she was incredulous that the student had been upset, because she thought she was just explaining to the student why she would not do what was suggested.
• A nurse yelling at someone calling to give her report that "I will call you back when I am ready" and slamming the phone down.
• Another nurse yelling at a pharmacy tech over the phone when an order wasn't right and again slamming the phone down.
• A doctor trying to explain a unique diagnosis he felt a patient had to a nurse who then replied "So? Am I supposed to be impressed?"
• Nurses rolling their eyes at dietary techs, housekeepers, etc. who didn't do something they needed help with the minute they needed it.
• A doctor speaking curtly to a pharmacist about a lab value and then hanging up.

And I couldn't tell you about all of the little jabs that I have seen oncoming nurses give to off coming nurses during report. Quite often between 'older' nurses and 'younger' nurses over nitpicking things that don't amount to a hill of beans.

I understand that we work in stressful environments. We have to get things done. We can't always be worried about the other person being offended, and yes, some people are a little bit too sensitive.

But when this behavior is discussed, we seem to shrug our shoulders and say "Oh well, nurses eat their young. That is just the way it is. People shouldn't get offended so easily."

When I first graduated from nursing school and started in the workplace, I couldn't believe how vicious some nurses were to other nurses.

Trying to figure it out, I mentioned the phrase "Nurses eat their young" to my mother, who has no healthcare background at all. I had heard that phrase many times and it was just a matter of fact to me. "Well you know what they say, nurses eat their young" I mentioned to her offhandedly.

And she was shocked. I mean really shocked. As in stopped what she was doing shocked.

"What a horrible thing to say!" she said aghast. "That is just awful!"

She was incredulous that such a concept existed.

And so we should be.

I have whole chapters in some of my nursing books dedicated to conflict management. There are many great tips in those chapters. But isn't it sad that those chapters have to exist?

There is truth to horizontal violence in the workplace. But interestingly enough, I see a lot of lateral violence. Perhaps more that horizontal.

It's not just Doctors screaming at nurses I see. I see nurses screaming at Doctors. I see nurses screaming at nurses.

I see everything.

And usually I feel like just standing up and saying to my co-workers what my mother would say to me and my siblings when I was young: "Just be nice!"

I know that this topic has so much more involved than just 'being nice.' I know that sometimes, if you are too nice, you will get walked on and the job might not get done.

But theories and sayings like horizontal violence, nurses eating their young, stressful work environments aside, why can't we just be nice?

We DON'T have to disrespect other departments when they are giving us report. We DON'T have to get frustrated at the pharmacy tech because of a system error. We CAN check our tone of voice when we speak to other members of the team, including students.

We can THINK before we speak and we can CONTROL our emotions, and set the phone down gently.

We CAN respect a physician who wants to explain something interesting.

We CAN enjoy the challenge of a different assignment for the shift, and we DON'T have to yell to get what we want.

We are adults. And we are nurses. We need to care enough for the other person to check our stressed out, negative, horrible side at the door and care for those we work with as much as we care for our patients.

I am not telling you to be a doormat. When you need to stand up for yourself, stand up for yourself! But think before you act.

We should be just as shocked at the statement "Nurses eat their young" as my non-healthcare mother was.

Nurses don't just eat their young. They eat each other and everyone around them.

Let's stop.

Think about all of the conflict that you see on your next drive home like I have.

Are you part of it? Do you have to be?

How does it make you feel? Can you change?

Is there something that you need to do to change?

Maybe you are burned out.

I don't know. I just see the behavior.

But since I have not stood up on the desk at the nurses' station and shouted this as loud as I could, I will just say it here.

Please, just be nice.

[SaoirseRN]

I don't know how many times I hear nurses complaining about the doctors, when they are just as guilty of the same poor communication about which they complain.

I make a point of trying to speak respectfully to everyone. I am not perfect -- there are times when I know I could have said something differently -- but I try. I also make an effort to know everyone by name and to use their names when speaking to them. Courtesy goes a long way.

[SaoirseRN]

I have my students call physicians when appropriate, which is basically any time that is not an emergent or complicated situation. It is good practice for them to learn how to make a physician call with full support from me before they have to do it on their own. Seriously, it's doing them a favour as future nurses and the docs, too (some of the calls I overhear make me cringe. Those poor docs!)

We prepare beforehand what they are going to say (including identifying themselves as a student nurse), and I am right there listening in and available to take over if need be. They can take an order, so long as I either hear the doctor say it to the student or have the doctor repeat it to me after (I usually go with the first option, though some ask to speak to "the nurse" after anyway to make sure). I would also co-sign the order on the chart.

[Multicollinearity, BSN, RN]

Screaming, OP? In a 9-year career as a nurse I have never witnessed screaming.

And I think "shock" at unprofessional behavior probably stems from some degree of naivete about people in general, or a belief that somehow nurses are set apart from the rest of the population.

In my (short) 3 years as an RN I have witnessed unprofessional behavior at 2 workplaces. I have witnessed an RN screaming, and I mean physically shouting an another RN. I have witnessed the DON screaming so loudly at a nursing supervisor that I cleared the area of patients. I have witnessed a nurse practitioner throw a chart at a CNA. That all was workplace number 1. At workplace number 2 I have witnessed an RN shouting at another RN in front of patients. I have witnessed yet another RN shouting at yet another RN and one quitting on the spot (abandonment) and the other being fired. I have witnessed "nurse wars' so bad that HR investigates for hostile work environment, and people get fired. And I have stayed out of all of it.

I believe these sorts of behaviors and incidents happen in certain areas of the country more than others. I believe I have seen more of these behaviors than some nurses because I have worked in rural areas with a severe shortage of nurses - meaning "problem" nurses are attracted.

Something tells me if I worked at, say, a big-city teaching hospital where they have their pick of applicants - I wouldn't have seen so much of this behavior.

[jadelpn, LPN, EMT-B]

I dunno, I think one can't be "too nice". Being nice doesn't equal being a "doormat" who is "walked all over". Perhaps it is this attitude that people feel the need to be aggressive. Being appropriate in a professional setting for some needs to be learned. (there must be an app for that LOL) In all seriousness, that there are so many threads regarding "eating one's young" and "rude co-workers" would lead anyone to believe they perhaps need to check themselves if they are aggressive on the job. But besides leading by example, it is the charge RN/Manager/DON/HR who needs to impliment an enough is enough culture. Behaviors as over the top as this won't change unless there's consequences.....

[mrsbacktoschool]

Wow. These were the things I was worried about when making a career shift into nursing...

I don't remember this type of stuff when working in long term care, but I wasn't nursing staff, so maybe I did not see it. I do remember being thrown under the bus by my DON and her telling me once, "Wow. You are smarter than you look." But I always thought of her as a bully who must have had a lot of insecurities to treat others with such passive aggression.

[amygarside]

Thanks for sharing this. This is the reality of nursing, sometimes it is not all bed of roses.

[LadyFree28, BSN, LPN, RN]

Something tells me if I worked at, say, a big-city teaching hospital where they have their pick of applicants - I wouldn't have seen so much of this behavior.

That may be a possibility....not just hospitals, but any well run organization, be it home care, hospitals, sub acute facilities, LTC, even nursing programs.

I live in a "big city". I currently work in one of those teaching hospitals. I have also worked in other settings. The places that couldn't keep people because of wages, location, etc, would attract "problem" or "issue" people, and would delay firing them. One person had been suspended ten times, mostly for things that were reportable to the board.

I think it's also purely relative to the person...O can honestly say, working with "cantankerous" or "back biting" "Type A" or everything in between individuals, that does not equate to lateral violence IMHO.

I say to people to tread lightly on those aspects. I had a former co-worker "think" that a group of co-workers were laughing at her. She was new, and she had looked like she was in a recent incident or accident-no sure, because, to me that would be personal; however, she may have been self-conscious of it. I didn't realize she was including me in it until months later, she followed me into a patients room and threatened me, and the pt overheard it. I reported immediately to my supervisor. My patient was more upset than I was. I wasn't upset; I went to the right person and reported it. When they interviewed her, she stated two other co-workers confirmed to her that "we" were laughing at her, when that was not the case. These two co-workers eventually fired, for insubordination and she was fired for insubordination and abandonment.

I truly felt as though she had that "nurses eat their young" in the back of her mind, she gravitated to individuals who were unhappy at the job, and it was a recipe for her own undoing.

[JZ_RN]

While I wholeheartedly agree with your point, I have been screamed at at treated disrespectfully 100 times more often than I have done so to others. This should really be a plea to everyone to consider that the other people you talk to are humans and also work hard.

[beewink]

I haven't seen the outbursts to the extent the OP has, but I have experienced hostile working conditions. Two reasons I have seen. One is administration allows this to occur. They know which physicians yell, yet do nothing. They see the nurses who 'eat their young' and turn a blind eye. I don't know why their leadership is weak, but they are the wrong choices for their positions. The other reason is the customer service oriented model that is now the norm in healthcare. This, in my opinion, leads to much frustration among staff members and physicians. Our hands are tied by having to tell patients, 'I have time for you', when in reality we don't have time for their every whim. I worked in an ICU where the manager was mad at me one day when I hadn't gotten an alert - waiting to be transferred patient - the lemons she asked for. I was too busy hanging blood on one of my other patients.

[JacobBrown]

Wow I'm so glad my current hospital job is not like that! We all work together on night shift to get things done and the doctors are pretty decent. We get along we'll with pharmacy and lab.

[rnunley]

I volunteer in a huge hospital in Texas, and the environment is great. All of the medical staff is cooperative and respectful. Only on the rare occasion do I see a nurse stepping out of line from the rest of the group or a specialty tech acting arrogant. Throughout all levels of management, the hospital supports and reinforces this behavior. It helps with hospital ratings, is reflected in patient surveys, and other staff members know that good health care providers need to be respectful and cooperative to build an effective team.

If your environment is anything but this, see if upper management has an open door policy and go talk to them. The change must start at the top; you can't change that place alone from the lower rungs. If not, go to a better facility. There are lots of magnet hospitals out there waiting for someone who respects their coworkers and wants to provide great patient care. An ugly environment will always make you unhappy.

[guest358111]

I am somewhat familiar with Cheryl Dellasega's work on this topic.

The 2003 ISMP survey to which 1,565 nurses responded - 48% reported "strong verbal abuse". (52% apparently did not)

Intimidation: Practitioners speak up about this unresolved problem (Part I)

There were 2.4 million registered nurses in the US in 2003 (Women's Bureau (WB) - Statistics on Registered Nurses) I'll leave it to someone better versed in statistics than I am to determine the validity of a sample size of 0.065%.

"Screaming" is not a term I find in the survey summary -- and I cannot necessarily interpret all "strong verbal abuse" to be "screaming".

I believe the semantics are important. Screaming is a very different behavior than various other forms of jerkiness.

I certainly do not deny the existence of unprofessional behavior in general, or bullying specifically. But you yourself noted that your original post was "not necessarily reflective" of your work environment as a whole.

Thank you for your input. I agree that the semantics are important. In reflection-I think that screaming perhaps was too strong of a word for me to input into this post. If you note how I phrased the following "Staff nurses raising their voices (ok, screaming)" I can see how perhaps my version of loud voices raised in anger perhaps did not need to be represented as screaming. I did not realize that the word would be received so strongly.

However, once I have submitted here, it doesn't seem that I can go back and edit.

Thank you also for noting that this is not necessarily reflective of my work environment as a whole.

The above behaviors do NOT happen and have not happened to me personally in my work environment. If this was an every day occurrence, I assure you I would not be working there!

I have seen them happen, however, among different people in several different environments.

My intent is to bring up that unprofessional behavior does take place more than even perhaps I observe. And whenever I see it, it makes me sad.