The Best Defense is a Good Offense

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    There are many examples of when a nurse feels defensive in their practice. Sometimes, the best nurses fall into a habit of reaction that seems like a defensive response to questioning. Sometimes, the best nurses have "used up" most of their coping mechanisms, and are left feeling overwhelmed and under appreciated.

    Nurses reacting defensively is more common than one would think. Nursing in itself is an occupation that takes a great deal of schooling, continuing education, more schooling if one chooses to advance their practice. A nurse has a license to protect. It is one of the few occupations where there are clear differences from who we are as people and who we are as nurses. We have ethical and moral obligations, most of which have to be carried out under the spotlight as opposed to behind the scenes. They may be wildly different than our moral compass outside of work. The culture in which one practices has a great deal of say in how a nurse reacts when presented with questioning regarding said practice.

    There are more than a few nurses who are new to their practice feeling overwhelmed. Clinical rotations are important to increase skill, but are controlled. So most of the undercurrents of a unit are not always known. When a nurse enters a unit as a peer as opposed to student, part of the feelings of being overwhelmed can have a great deal to do with the added nuances of the culture in the unit. Because of this stress, the reaction to a number of lines of questioning can be defensive. To recognize this as a symptom of being overwhelmed can go a long way in nurturing one's practice. To take a moment and really listen to what is being asked of you and answering with what you know, as opposed to "making something up" will help in grooming yourself to be a trusted, knowledgeable nurse.

    It is ok to say that you don't know something. We can't all know everything all the time. We need to be mindful in what skill set we are good at, and what skill set we are not. Always use your resources. Know where they are, how to get to them, and how to use them. Healthcare is changing all the time. It would be foolish to think that we can all keep up on everything. There are units that are understaffed, everyone is overworked, there's a sense of urgency. Take a moment and think about what you are doing, how you are going to do it and remember, if one is overwhelmed chances are so are your co-workers. It may take one voice or many, once or numerous times to change a culture. To acknowledge that the questions your are posing are for general information and not a personal attack can change a tone. To react as a professional and a co-worker is seeking information can change a culture.

    Even the most seasoned nurse can get defensive. If a co-worker is coming at you with questions, "why did you do this" scenarios, and questioning your nursing judgement, we need to look at this as an opportunity to learn or educate, as opposed to personalizing. This is easier said than done. However, most people don't become nurses or stay nurses because they are mean, spiteful people who want to experiment on patients. Nor re-live their glory days as a bully. I often wonder what would happen if nurses took control of their own staff meetings, brainstormed, and asked the difficult questions of management. Many voices, one shared goal.

    I like to believe that the core of every nurse is the chance to make a difference in some else's life. Sometimes at great odds. To try and create and maintain a positive culture on a unit with a shared goal of taking care of patients at their most vulnerable can start with you.
    Last edit by Joe V on Jul 5, '13

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  2. About jadelpn

    jadelpn has '25' year(s) of experience and specializes in 'ER, Med Surg'. From 'Massachusetts'; 49 Years Old; Joined Nov '08; Posts: 3,583; Likes: 8,180.

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    5 Comments so far...

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    Well said!! Good on you.
    jadelpn likes this.
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    The atmosphere on any unit is set by those in charge of it. If they are into blaming, insecurity results. If they're more like a nourishing teacher, the staff will be open to positive exchanges of information. Rather than phrasing a question offensively, as "why did you do that ?" A nurse who asks, "Would you like to know another way to do that?" might open a matter for discussion, not blaming, critical, and judgmental. Picking an appropriate time for that is essential, as well as keeping it on an adult to another adult level, rather than taking a parent talking to a child demeanor.
    Last edit by lamazeteacher on Jul 10, '13 : Reason: Improve wording, correct typo
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    A unit I have worked on has a manager who micromanaged her staff and didn't seem to allow others besides herself to opportunity to make decisions. It was a very unhappy place, lots of turnover, and much of the nursing that happened was defensive. Lord help you if you ask a question during shift report...
    joyouter and DizzyLizzyNurse like this.
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    A well written article which highlights the weakness in organizational knowledge and management development. We are well aware of the damage a poor nursing manager can produce, the permanent damage they can leave behind and the expectation of the floor nurse to accept harassment, micromanagement and lack of judgement, and skills. The second aspect is the nurse who feeds into this cycle of negativity, protecting her position and fermenting problems with destructive and disasterous results.
    Nursing must improve its organizational knowledge to better address the gaps and weaknesses within the profession. All organisations essentially function in similar ways, the difference in nursing is that we at the patient level hold a special role in quality care and will not speak out in fear of retaliation or job loss. This is not professional caring, this is bullying and coaptation - we need to learn how to recognize symptoms, and to change - education being one of many methods.,
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    Great points from all, including the OP. A wonderful article to put into the "advocacy" toolbox. I was discussing this with a new nurse at my facility. Advocating and understanding practice is what we encourage; this new nurse is still transitioning, and still feels overwhelming to the whole process. This is her first nursing job. I am a new RN, transitioning from a LPN, and I shared with the new nurse that I, too have those transitioning challenges, with me having the background, I was able to provide support for them and strategies. As a preceptor for this facility, I am proud of my track record of new nurses staying and expanding their practice and being confident and competent; it still is strange for me to have that base, and I realize I have expanded, and will continue to expand my career; it would be much more difficult if I did not know how to advocate for myself, which includes asking questions, and being open and honest in making sure I am making the steps to be on par and part of the healthcare team.
    jadelpn likes this.


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