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.

[guest358111]

SarahLeeRN,

You are a gifted writer and it impresses me that you would use that gift to express this particular point of view. I have engaged in many discussions here on AN reflecting this topic and I see what you see.

As I have been integrating into the workplace after graduating from nursing school last year, I have had a few key musings of my own. Most notably, I have found that attitude really is everything. I can't control the attitudes and actions of the gruff, the disillusioned, the back-biting, self-absorbed and I don't ever hope to. But then, their behavior is not what I'm concerned with anyway. It's mine that I am concerned with. Because it is my behavior that I will ultimately be held accountable for.

I don't kill with kindness. No way. I kill with calm. I have learned from my experiences dealing with patients that most nurses dread - the irritating, the needy, the rough around the edges, gruff, accusatory, distrusting, belligerent, etc. - that when I dig my heels in and remain committed to calm, rock solid, self controlled responses, the anger, fear, and/or agitation that these patients project melts right off. Sometimes it's immediate. Sometimes, it takes most of a shift. But always, the end result is the same. They soften. They open up and become less tense. And that is the moment when a bond develops and suddenly, everyone around me is shocked that the most unruly, angry, agitated patient from their memory is polite and humble or laughing and joking. They're not on their call light every 20 minutes with some inane request. They express gratitude for the care they are receiving instead. I don't make apologies. I don't have to be a doormat. I don't hope that they like me. I don't try to be their buddy. I just maintain composure and basic human respect for them in all things said and done. I carry this same methodology over to my interactions with co-workers.

"Just be nice," might work for some who are far nicer naturally than I am. For me, "Just be calm," works well enough.

Great read. Keep fighting the good fight.

Thank you! I agree totally that "Just be calm" is also a great strategy. In fact, I think I may use that more than kindness as well now that I think about it...thanks for the perspective. "Keep calm and carry on," right? :)

[sneeds]

I think our work environment and the demands placed upon us foster backbiting behavior. You have to ask, why does management let this go on? Probably to keep us busy fighting ourselves instead of banding together to change our workplace into a more sustainable, safe place. Patient first? ha... Profit first.

[anotherone, BSN, RN]

Yes i have seen this . back in the restaurant business the bartender would yell at the waiter, the chefs yelled at the waiter, the waiters yelled at the hostess because someone else FAIRLY got a bigger table, the manager yelled at everyone. sarcasm and backstabing galore. human nature. in retail the floor managers and the merchaindising managers had their tiffs. The more stressful and adversarial the enviornment the morse this gets. crabs in a barrel

[anotherone, BSN, RN]

Sometimes the rudest behavior can be seen exchanged between close family members...just sayin

familiarity breeds contempt. i am a strong believer in that.

[anotherone, BSN, RN]

I have also seen people being accused of being mean or rude for bogus reasons. like not smiling enough, not caring about someones bany shower, not doing other people's work because they are slow or incompetent. if you have the wrong fluids hanging and someone points it out, did not give stat meds in a timely fashion or did not report

K of 6.9 to md or hgb 7 and someone in report says it should have been done. get over it . i have seen nurses so fed up with being accused of being mean by defensive, often incompetent nurses, that many seem to let them just go on and do things incorrectly. i try to do that but will not allow a pt to suffer due to hurt feelings . so

i say things in a "by the way " manner. most appreciate it .some get too defensive Nd go crying to the manager. well ok from now on sink, and i will be emailing management every little error instead

[joyouter]

An excellent article. describing varying symptoms seen in all areas of healthcare today. Two salient points mentioned;

1. Description of lack of knowledge around the art and science in communication. Communication is a core study subject at many levels. The lack of knowledge of how we affect ourselves and anyone around us when we inadvertently raise our voices in frustration, fatigue, overwork and being just dog-tired from trying to meet every request thrown our way and the fallout resulting in hostility, more fatigue, greater confusion and finally, discouragement and burn out is a topic overdue for students and professionals. Contrary to popular opinion, affective communication skills are not taught. In fact, it is a competence which is largely taken for granted. ie. `everyone knows how to communicate`- a belief which is very misleading. Body language, expression, raised voices and hostile tones also signify the levels of frustration and failure of the nursing profession to offer its professionals support and training around developing effective every day communication skills in the front line.

We are human beings and work in environments which are designed to give healing, hope and support to those in need. WE, as professionals are also in need of support, Nurses are not robots, in fact, this profession contains many levels of abuse and violence. Nursing leaders, academics and researchers are needed in this area more than ever.- and the starting point should be effective communication from its multiple asplects

2. Nurses eat their young.

I find this term an obnoxious and appalling statement which by right, should not exist as an excuse or reason. This statement actually allows, and even condones the rotten behaviours of nurses at all levels and is in direct violation of our professional objectives. If we can accept this as a raison d;etre, we inadvertently also condemn ourselves and perpetuate the problems of dysfunctional communication, lack of understanding, support and respect which we seemingly can supply to our clients but sadly fall short of among ourselves. The statement borders on violence and cruelty and should not be flaunted in any context. It is a sentence used repeatedly, without a valid defense..........

[brandy1017, ASN, RN]

Most of the interactions you describe our not old nurses attacking young ones. Most of it is most likely stress overload and lack of control over one's work environment. We are not given the option of taking time out and are expected to jump right away and quickly whether it be a new admit or phone call or family or whatever, yet when we need the rest of the hospital personnel to assist most of them act in a leisurely way and take their sweet time and don't feel that they need to jump. Why is it the aids always get their breaks, but many nurses don't? Exactly, because they feel fine saying no and taking their time, but try that as a nurse and it will lead to instant drama that you must stop what you are doing and do this now! admission now! phone call now!

If we could have some control over our work environment and not be expected to jump stress levels would come down and things would mellow. Short of that, I don't think things are going to change! I do stand up for myself and it can lead to drama, but you know what I won't be walked on and I won't accept an unfair assignment or admission if it is unfair or unsafe. I will speak up and I don't care if other people don't like me. I don't usually refuse assignments or admissions, usually I take it in stride and accept this is how the day is going to go, but if something isn't right I will speak my peace!

How wonderful it would be if we could work in an unhurried environment, take our time, not feel like we are walking into an assembly line, quick, jump, pass the meds on time, the computer is big brother. If the assembly line rat race mentality wasn't endemic in nursing stress levels would come down and people would be nicer to each other! Scolding us to be nicer isn't the answer, system change to a sane work environment is! Some things that will help is having an effective union and a safe staffing ratio like CA has!

[brandy1017, ASN, RN]

I'm much more childish than that. I call every oh 2-3 minutes asking if now is a good time. After a few of those, I'll call the charge nurse to try and give report, then when they ask why I'm calling them directly I will explain to the charge why this is happening. Gets them in trouble by their charge and I can have my fun out of it. Oh and I usually will send them the second I hang up so there is no down time between report and when the pt gets there.

It only ever has to happen once before the next time they are much more polite

Calling every couple of minutes is rude and childish and only interrupts the nurse who is trying to get things settled with the present patients before taking another. Glad you recognize your childish behavior!

[minxiejinx]

My last facility was notorious for nurse bullying. It is now being termed "lateral violence". It got so severe that I went into a serious depression and started questioning if I was a good nurse because so many of my coworkers put me down. I tendered my resignation and went to a new facility. It was happening there too, although not to the extent of my previous facility. In my RN-BSN I wrote numerous papers on it. I'm now in my master's, and I was able to apply theory to the issue, and by applying a borrowed theory from the social sciences, I started to see not only how widespread the problem is, but also the complexity of the variables that contribute to it. There is much research on it, and I think more people need to be aware, and not accept it as part of "normal" nursing culture.

[Career2_BSN, BSN]

In fairness to SarahLeeRN, when one reflects on anything, it has the effect of putting a spotlight on that problem during the time of reflection and this spotlight can, at times, magnify the situation. I thank you for creating this thread. Judging by all of the responses, you've obviously piqued the interest of many. I was also glad to read that you enjoy your workplace even though you see room for improvement when it comes to peer communication.

I have to say I'm heartened by all of the posters who either don't see this behavior (or rarely see it). I, too, have heard of nurses eating their young and think "gosh, they were young once, too, have they forgotten??" I've taken MANY communication courses while in the business world, including communicating with people from other cultures (that seems to be a difficult one). It seems like no matter how many classes you take, you're still gonna rub someone the wrong way at least part of the time. And they'll rub you the wrong way as well.

I find I respect those who have humility, those who admit their faults, MUCH more than those who think they're perfect. I can only hope that as I admit my faults and strive to correct them that my co-workers will see this as respectable behavior and not a weakness that puts a target on my back. Perhaps members on here who find themselves in similar situations can do the same.

OR.......I may be wearing my rose colored glasses again. =)

[g8sushma, ASN, BSN, MSN]

I dont think this has anything to do with being a nurse or not. There are just some people that are mean and horrible and that is the way they choose to be. However, because we all have been tolerating it in the workplace is why this has become common place. No one is 2 years old or a dictator. And when the proper steps are taken to report such behavior it can be corrected or the person should be dismiss no one should have to tolerate such people and their horrible behavior all day. I am sure there are people out there that are qualified to do the job that will not be as nasty.

Please report people like this. They do not need to be a nurse.

[Cackalacky]

Ok, I just have got to say, I've been an RN for less than a year now and have already experienced awful behavior. As a student, I had a preceptor who was very rude to me multiple occasions and I went home crying daily and convinced and I didn't want to be a nurse if this is how it was going to be. When I graduated and began working, I had a DON write me an e-mail that brought me to tears! I then went to another job where I have gotten along with all the nurses, but there are nurses who aren't willing to help other nurses but fully expect other nurses to help them, and some of the nurses are known to get rude if you disagree with them.

I think witnessing this much violence in such a small amount of time is enough proof for me that there is way too much going on in the field. I love that there are nurses who don't have to go through this in their career, but you still need to know it's out there and needs to be corrected.