Drawing the Line: Shutting Down Verbal Abuse
Everyone has experienced verbal abuse at one time or another. Oftentimes, nurses are blindsided by disrespectful behavior, inappropriate language, and flagrant insults by physicians and co-workers. We all have the choice to draw the line and combat disrespectful behavior.
It's 3 p.m. The witching hour for any operating room.
As our medical director makes rounds, he tallies up how many late rooms are running, and compares that to how many surgical and anesthesia staff we have available to run the late rooms. If the numbers don't add up, then cases are put on hold.
While our director speaks frankly and with tact to the surgeons whose cases are being held, it never fails that the surgeons immediately call me and try to barter, beg and plead. End run at its finest.
I am the charge nurse for a busy OR. My job is to facilitate case movement, troubleshoot delayed cases, help staff to overcome challenges, tend to red traumas, make staff assignments, and put out fires.
Many, many fires.
I am busy assigning relief staff, and delegating duties to nurses and scrub techs that I have not assigned as relief. A new anesthesiologist takes over the anesthesia charge duties, and he has lots of questions. I answer them as best as I can while being constantly interrupted.
Our medical director is waving his hands at me, trying to get my attention through the crowd of staff. Shouldering through the crowd, he approaches my desk.
"Canes, we have too many late rooms. I've moved Dr. Y to OR 5 so he can get started with his last case. He told me it was a doozy and may need cell saver. I also held Dr. R and Dr. L. I told them that their cases will start when some of these rooms come down."
"Canes, line one!" my unit secretary shouts over the group of OR and anesthesia staff gathered near the charge desk. For some, the day has come to an end. They are sharing stories, venting, and socializing. I can hardly hear my secretary as a loud burst of laughter rises from the group.
I pick up the phone and cradle it between my ear and shoulder while writing out the answers to the anesthesiologist's questions and nodding to the medical director.
"This is Canes," I answer. The laughter and rising voices of the group near the desk makes it difficult to hear.
"I'm the fellow for Dr. K, and I just want to know why you chose to move another case into our room," the fellow demands in a clipped tone. "We have an add on case, you know," she continued.
I didn't catch her name. I began to explain my decision.
"Block times are by service, not by attending. Your colleague, Dr. Y is behind in his schedule. Our Medical Director, Dr. D decided--"
"There is an empty OR. We are ready, our patient is ready, and I don't understand why you made this decision," the fellow said. Her tone was singsong-that of an adult explaining something to a child.
"If you would let me explain--"
"This is totally nuts. I mean, here we are-all of us are ready to go, and you put another case in OUR room?!? It makes no sense at all!" she exclaims.
I take a deep breath and start over.
"Scheduled cases should always be done before add on cases. Dr. Y ran into some problems in his first case, which delayed the rest of his cases. His following case is a very difficult one. We made the decision to get him started in the empty OR so that our staff could have everything in place, anesthesia staff could place lines, and the room would be set up and ready to go when he comes out of the case he is working on," I said.
"But that is OUR OR!" the fellow shouts.
"I understand your frustration, which is why I asked you to let me explain. You are reading a paragraph, while I am reading the entire chapter. Of course the paragraph won't make sense unless you read the chapter," I explain calmly.
A vascular resident rushes up to the desk, posting sheet in hand.
Breathlessly, she said, "Canes, this is an emergency fasciotomy. We need to go back within the next 20 minutes."
I tell the fellow that I would like to discuss block time rules with her later in the day, but I was needed for an emergency case that was just posted.
Surprisingly, she continues to rant about how irrational it is to put her colleague's case in HER room, and how unfair it is to punish HER just because her colleague is lagging behind. I am half-listening.
All of the phone lines ring at once.
"Canes, there's a code in OR 9!" my secretary shouts. I put the fellow on hold while I deploy necessary staff to attend the code.
I pick up the phone again and apologize for the interruption.
"OR block times aren't based on the SURGEON, they are based on the SERVICE," I repeat for the third time. "I would be glad to discuss this with you some other time, but I have two emergencies that I must attend to now," I said.
"So you mean you don't have the time to explain why we can't follow ourselves in an empty OR? the fellow asks, her voice taking on a saucy tone.
"Correct. I don't have the time right now. An emergency case has been posted and another patient is coding. I need to coordinate many things right now," I said. I feel my anxiety level increase. I need to get off the phone and help my staff with these emergencies.
"You don't seem to have a grasp on continuity of care, do you?" the fellow asks sarcastically. "I guess the saying is true: management doesn't understand how to take care of patients," she spat.
I refuse to take the bait and engage in verbal warfare. I replied, "I will not tolerate being insulted. If you continue to be disrespectful, I will end this conversation. As I said before--"
For the third time, she interrupted me. She spoke directly into the phone while talking to her attending, "Dr. S., I'm sorry, but I can't give you an answer as to why we can't follow ourselves in an empty OR, despite the fact that our patient is ready and we are ready. I am just as frustrated as you are....I agree...it seems like the charge nurse doesn't have a clue what's going on...I know...she must have no sense of logic."
I hung up on her.
This might seem like a very unprofessional thing to do, and it is.
However, the fellow not only disregarded my rationale and explanation, but also personally insulted me. She didn't take me up on my offer to explain block times, but continued to speak to me in a condescending tone. The most troubling factor with the above scenario is that she did not acknowledge that there were two ongoing emergencies.
This is classic bullying behavior, and we as nurses have every right to refuse to be bullied.
Recently, I lectured new OR residents on bullying in the workplace. While researching this topic, the message really struck home was that it didn't matter WHO was bullying WHOM, or what kind of alphabet soup followed their name. Nobody deserves to be spoken to in a disrespectful manner.
According to the ANA, a whopping 48% of nurses reported experiences involving strong verbal abuse (ANA, 2001). The impact of workplace bullying is often insipidus. Like a cancer, it grows slowly, silently, and has devastating effects.
Low staff morale, increased absenteeism, attrition of staff and the deterioration of quality patient care are some of the results of bullying (Hughes 2008).
To combat bullying, you must adopt a "zero tolerance" mindset. No one, no matter who they are or what their relationship is to you, has the right to be disrespectful to you.
1. As soon as you recognize bullying behavior, speak up and set boundaries. Point out that you are willing to listen to the content of the discussion, but you will not tolerate disrespectful behavior.
2. Do not reduce yourself to engaging in a verbal tete-a-tete. Speak calmly and resist the urge to raise your voice; it will only escalate the situation.
3. Clearly state the consequences of continued verbal abuse. Make eye contact and speak with confidence, not with anger.
4. Follow through on your stated consequences.
5. Privately seek out the advice of nurses whom you respect and admire about your experience. Avoid "bashing" behavior, and don't tell everyone within earshot about the exchange.
6. Keep a journal and write down what you felt during the experience. Don't include names, but write what your initial reaction was, and how you felt you handled yourself. Did you lash out? Did you freeze up? Did you speak calmly? As you gain more experience, you can look back on how much you have grown by reading your old passages. Keeping a journal is also very cathartic.
Nursing is a tough profession, no doubt. We are constantly on the move, we multi-task while triaging priorities, and we are constantly troubleshooting. It's no wonder that at the end of the day, we are both mentally and physically exhausted. When we are faced with bullying behavior, tension and negativity can become distracting elements in our daily lives. By setting boundaries and adhering to stated consequences, we have the power to diminish bullying behavior.
American Nurses Association. (2001). Health and Safety Survey. Hughes, N. (2009). Bullies in healthcare beware. American Nurse Today, 3(6), 35.Last edit by Joe V on Jun 16, '13
About canesdukegirl, BSN
canesdukegirl has '14' year(s) of experience and specializes in 'Trauma Surgery, Nursing Management'. From 'Southern USA'; Joined Jul '10; Posts: 2,899; Likes: 7,149.Jun 15, '13 by nurseprnRNIf you had already cleared this with the medical director Dr. D, I don't see why you don't just refer this fellow to Dr. D and leave it at that. I am assuming that Dr. D will back you up. If so, no need to waste another minute on the fellow.Jun 15, '13 by nursej22, MSN, RNThank you Canes. Although I work in a different setting I often sense bullying directing at me and my staff. I especially like your suggestion about journalling as an outlet. Bashing is the easy albeit ineffective response.
I do try to set limits, following through is where I cave.
The eye-to-eye part is tough when many conversations take place over the phone. Any tips other than hanging up?Jun 16, '13 by VivaLasViejas, ASN, RN GuideExcellent article, canes! Thank you, these are valuable suggestions in ANY difficult life situation.Jun 16, '13 by JeanettePNPSounds like you handled a very stressful situation with a lot of class. Well done!Jun 16, '13 by JoseQuinones, BSN, RNExcellent article. I found myself rereading it twice. I will keep this in mind as I begin working.
Another point too, if I may: It was a bit odd to see the word "fellow" applied to a lady. I realize that she was a medical fellow, but I had to do a double-take and go back and read it for context to understand that. Because normally, "fellow" only refers to a male in the way "gal" or "lassie" refers to a female. It reminded me as a newbie that medical terminology and normal English sometimes diverge, and it's useful for us to be looking out for these meaning shifts as we move into medicine.
Maybe someone experienced in nursing could compile a sort of glossary of terms that mean one thing in normal conversational English and another thing in medical terminology.Jun 16, '13 by TopazLoverI doubt I would have "wasted" so much time with explanations. Your job is to steer the boat. They need to learn that. If you have to justify every decision you have to make I can see why they think browbeating will work. I am not saying you were wrong. A great deal depends on the backing you have. Since the director was making decisions I suspect I would have used that power as part of the decision making process to explain. Knowing me I probably would have ended the conversation with "the decision has been made." "I suggest you have your attending make an appointment with the director so we are clear in the future about the use of rooms."Jun 16, '13 by Altra, BSN, RN GuideQuote from aknottedyarnAgree. "Verbal abuse" doesn't happen unless you remain on the phone long enough after snarkiness has already reared its head. Question answered ... caller directed to manager who made the decision for further discussion ... other phones ringing and patient emergency taking place ... conversation ended.I doubt I would have "wasted" so much time with explanations. Your job is to steer the boat. They need to learn that. If you have to justify every decision you have to make I can see why they think browbeating will work. I am not saying you were wrong. A great deal depends on the backing you have. Since the director was making decisions I suspect I would have used that power as part of the decision making process to explain. Knowing me I probably would have ended the conversation with "the decision has been made." "I suggest you have your attending make an appointment with the director so we are clear in the future about the use of rooms."Jun 16, '13 by netglowYou are the master of THEIR universe.
Let it be written, so, it shall be done!!!!!
[then, after they understand this, they will learn that you can be kind and considerate (added bonus with Canes on the job)]Jun 16, '13 by prmenrs@Jose--"fellow" in this case refers to the doctor's place in the teaching hospital heirarchy. She is one step below the attending (professor) on the service. She has completed her residency and is receiveing advanced education in the specialty. She has been around long enough to know better how to interact w/other members of the team in a productive manner. Apparently, in this case, she missed the class on how to play nicely and the one on listening.Jun 16, '13 by canesdukegirl, BSNQuote from AltraYou are right. I should have ended the conversation earlier. I knew that this fellow was new, and likely didn't understand block times. Part of my job is to explain the whys and hows of processes in the OR. That's why I was explaining it to her.Agree. "Verbal abuse" doesn't happen unless you remain on the phone long enough after snarkiness has already reared its head. Question answered ... caller directed to manager who made the decision for further discussion ... other phones ringing and patient emergency taking place ... conversation ended.
I expected that she would be angry, because most surgeons are angry when their cases are delayed. I didn't expect that she would turn the conversation into a personal insult, and that's where I drew the line.
Snarkiness is something that I deal with every single day. When staff/surgeons/anesthesiologist approach the charge desk, it's usually because they are angry about something, need to vent, need to lodge a complaint, or need clarification on something.
One of the things that I love about my job is that it's challenging. Ninety percent of the time, the snarkiness comes from a misunderstanding or some kind of miscommunication. I like to be able to resolve issues in real time, as they occur.
In this situation, I felt that I needed to explain the decision making process. I could have routed her to the Medical Director, but I wanted to try to resolve the issue first. The emergencies occurred almost simultaneously. I handled one, while my secretary was posting the other, and calling staff to get an OR ready (yeah, she's da bomb!).
Here's the bottom line: I knew that Dr. D personally spoke to this fellow about holding her case. She didn't speak to him the same way she spoke to me. If she had, then it would have been dealt with in his office. Since Dr. D and I agreed on this plan, why is it that she had no compunction to be disrespectful to me? Because she thinks that she can bully a nurse. I thought it prudent to stand up for myself, and send a very clear message that rudeness and bullying will not be tolerated.Last edit by canesdukegirl on Jun 16, '13 : Reason: tenseJun 16, '13 by i<3uThank you for this article!! I'm a new grad RN but I've been working as a LPN for the past year or so. I've dealt with a bully (another LPN) and it really makes me dislike being in the facility. I've been yelled at, called late at night (after my shift) to be questioned/yelled at about the location of a pt's neb (all the nurse had to do was turn her head to see the neb sitting on the pt's nightstand), and belittled (because I am a "PRN nurse not a full-time nurse"). One day during end-of-shift report, I was questioned/yelled at because I didn't give a pt a new med. The order was not clear so I did not give it. Yet, this nurse insisted that I should have given it. I discussed it with my supervisor and she agreed that the order didn't make since and got it clarified by the dr.
Sorry, I went on a tangent but you get the point. I've been dealing with this for too long. If I come in to work a shift to find out that this nurse is coming in for the next one, I get this tense feeling in my body just thinking about it. I can't stand bullies. Again, thank you for this post!
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