Amber on the Therapy Couch: How One Nurse Conquered the Mean Nurse Without Confrontation

Amber optimistically clocks in for her shift at Brookside Nursing Home. However, to her dismay, she learns is working with none other than the mean nurse that day. She has a horrible day, as she finds herself catering to the requests of the mean nurse against her own will. Accompany Amber to her psychotherapy session three days later, where she debriefs the horrible day and discovers a secret weapon for helping her conquer the mean nurse: communication skills.

Amber on the Therapy Couch: How One Nurse Conquered the Mean Nurse Without Confrontation

Five minutes before her shift began Amber stuffed her purse into her locker. The new patient yesterday had been so optimistic and grateful that the day had flown. Maybe today'll be the same, she thought with hope.

Her hope, however, halted abruptly when she looked up and saw -- oh no....no! -- her standing at the nurse's desk. Amber's heart sank and a knot formed in her gut at the same time.

The mean nurse.

She was working with the mean nurse today.

Three days later, Amber sits across from me in her counseling session sorting through the day with the mean nurse. She fills me in on some history before processing the day.

"Her name is Tami. She's worked at Brookside fourteen years. I started there five years ago. Before that I was in ER, so changing to a nursing home nurse was really different for me. At first, I was her favorite."

When Amber says "favorite" she smiles a dramatic, fake-looking smile and blinks emphatically like female cartoon characters do when they're flirting. Her sarcasm leaves no question in my mind that she has zero fondness for having been Tami's favorite five years ago. I smiled and nodded. "From day one, Tami trash talked the other nurses. I didn't see it then, but everything she said about them wasn't true. She was so negative....suspicious actually: 'This one's slow.' 'That one took her vacation days.' Or 'The new hire's going out to lunch with staff from OT.'" Amber added, "Ya, how audacious. Making friends from another department."

She proceeded to describe her shift three days ago with the mean nurse. I wasn't sure what sounded worse: the critical eye riveted on Amber's every move, or when the mean nurse quietly talked to the director of nursing in a hushed volume just low enough that Amber couldn't hear what was discussed, but could see obvious furtive glances in her direction throughout the discussion.

"The thing that bothered me the most was she sat there -- half the time she doesn't even do her work, or she's trying to get out of it. She's sitting there, and throughout the shift, asks me to do her stuff for her! Like go give PT a report she forgot to give them for her own patient! It wouldn't have been so bad, but she was just sitting there labelling supplies at the desk while I was doing her stuff or running her errand! Labelling supplies is something we do when there's absolutely nothing to do. So basically, never."

Ug, how miserable, I thought. I felt for Amber and wondered how often she had to work with folks like she was describing.

"I hate my job. I really hate it. I can't tell you how depressing Sunday night is," she says, shaking her head.

We finish talking through some of the initial details of the mean nurse shift. Then we hunker down to examine the situation.

"Which of those things bugged you the most? Of everything she did that day?" I ask.

"Her sitting there pretending to look busy while asking me to do her work for her," Amber said without having to think about it much.

"Okay, so when she sat there at the desk 'looking busy' and told you to go check on her patient go take her report to PT, how did you respond?" I asked, curious about how Amber had experienced the situation in that moment.

Just before answering, Amber raised her eyebrows and tilted her head down just enough so that it appeared she was looking up at me. She looked like a four year-old looking up at an adult. Like she was asking for a cookie she just knew she didn't deserve.

"I said, 'Well, ummm, sure I guess I can.... but I've still got a lot of things to do on my own list.'"

I took in what she'd just said and asked, "And what were you hoping to convey to her?"

"I was trying to tell her that I had other things to do, my own things to do."

This helped me understand what Amber's intent was. "I notice you said it like this," and raised my eyebrows and tilted my head down like Iwas the four year-old looking up at her, the adult.

"Huhhh. Uh...." She looked at the painting to the left of me, thinking. Her eyebrows were no longer raised. Making eye contact again, she responded, "Well, I was trying to be nice...." When saying "nice" her eyebrows and vocal tone both raised slightly in a way that reminded me of a fourth grade student saying "Tallahassee?" as a tentative answer when called on to identify the capital of Florida.

"Sure," I said nodding, sensing how important being nice was to her.

I wanted to get Amber's take on how she might have come across. "Okay. So, you tell me....what does it say to you when I say" -- and I did my best to emulate the non-verbals she'd had a minute ago -- raised-eyebrows, tilted head, and the questioning vocal tone. Then I repeated what she'd said -- 'Well, ummm, sure I guess I can.... but I've still got a lot of things to do on my own list'"?

She paused again, then answered, "That I'm gonna do anything she asks."

She added, "and it's a little confusing, cuz when you-- or when I -- say 'I guess I can' -- it's like I'm reluctant.... But I'm definitely saying 'I'll do what you ask.' That's the message."

I pondered, "So you were trying to politely tell her that you had other things -- your own things -- to do, but the message you probably sent was, 'I'll do what you ask.'"

"Totally," she said, punctuating her agreement with a slow, deliberate nod.

We then talk about rethinking "being nice." How when "being nice" is your highest priority, you wind up doing things you don't want to do -- things that often don't align with your values (like doing work on your own list that you're not especially proud of because you were completing someone else's list while they labelled).

How it especially doesn't gain you respect from mean nurses or people who generally are comfortable in the taker-role.

And how it ultimately can lead to low self-esteem and a lot of resentment.

We talk about how sometimes different communication styles are needed for different personalities, especially difficult personalities. Like with her friends, she could continue using less direct communication. With them, it worked. They spoke the same language and her friends generally didn't seek to take, take, take. With someone more prone to pushing boundaries? She would need to use more direct communication. Firm but kind.

"So let's pretend you weren't worried about what the mean nurse thought of you, and you weren't worried about being nice, what's your answer, stated as simply as possible?" In a neutral voice I repeat the question, "'Would you take my report down to PT?'"

Amber looked settled and "in her skin" as she thought about this -- totally different than when she had the four year-old look on her face earlier. This was in her real self now.

"'I've got my own things to do.' That's the real answer," she replied.

"When you just said that right now, how did that set with you?" I asked.

"Good. Like, normal." She thought some more looking at my painting again. "Like I was thirty-four -- my normal age -- instead of feeling like a little kid." She paused again, then said, "Ya....it felt good," like she was still discovering a new mystery.

I cocked my head a little, "You sound a little.... surprised."

"Well, ya. I guess I am. I just thought it'd be so mean to say something like that, but when I just said it now, it was.....like.... Normal. I was just saying what was true."

"It didn't feel rude to say what was true: 'I've got my own things to do,'" I said, wanting to make sure I was understanding her.

"Right."

"And how would that be if you imagined saying that to the mean nurse?"

Amber's face became less relaxed. "Thaaaat might be a little harder," she said with a slight grimace.

We kicked around some options to figure out what Amber would be most comfortable with. What would be direct, as kind as possible, and fit her personal style. After going through a number of options, she landed on one.

"'I've got my own list I'm still working on. I'll let you know if I get it done and have extra time though,'" she practiced out loud, thoughtfully. Almost like she was reading the words in her mind.

She continued, "Ya, I think I could do that one. Cuz I don't actually mind helping people with their stuff. Even if mine's not done and the task is something urgent, I'm happy to help out another nurse. I just don't want to do someone's stuff so she can sit and label things. Something that's, like, number 500 on our priority list."

Amber and I roleplay, her being herself, me being the mean nurse. She practices her new response, and I look scowlingly at her, imitating how I imagine the mean nurse will look when this happens in real life. We go back and forth with me asking her to do my work, and her giving her new response.

Each round, after she gives me her new response, we highlight what she did well, and figure out what doesn't yet match. Sometimes I demonstrate her non-verbals back to her so she can see how she's coming across. After about eight rounds, she gets it down to where she no longer has a vocal uptick question mark inflection at the end of the sentence, and to where she looks straight at me without insecurely raised eyebrows and a downward tilted head.

Over the next couple of weeks, we continued talking about ways Amber can make her message and non-verbals "firm but kind" with the mean nurse and other boundary-pushing co-workers. We do more roleplays to help her develop non-verbals that have the same message as her spoken words, rather than a different message. Amber practices the skills wherever she can -- friends, family, co-workers, and clothing retail cashiers (who ask for her phone and email address that she doesn't want to give!) while checking out.

A few sessions later, Amber reports that she had to work with the mean nurse again. She says she used the "firm but kind" communication skills, and was only "about a third as depressed and exhausted" afterwards. A few months later, after having worked with the mean nurse and, she "didn't feel depressed at all," and was only "a little uncomfortable" when using the new communication skills.

We agreed that she might always feel a little uncomfortable using the "firm but kind" direct style of establishing boundaries. Realistically, advocating for herself with boundary-pushing personality types was probably never going to be Amber's preferred style of communication.

"I use the skills anytime I need to now," Amber said on her last session. "And I don't hate my job and get depressed Sunday nights anymore." She looked at my painting, reflecting one last time, "If someone had told me that the way out of this whole mess, was going to be by my experimenting with new communication skills, I wouldn't have believed them."

"But hey, whatever works," she said with a smile.

Author's note: While this article highlights topics discussed with nurses in my therapy practice, identifying characteristics and details have been altered to protect patient confidentiality, and to uphold HIPAA standards.

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PancakeSaturdays

About PancakeSaturdays

Tricia Andor helps nurses and other folks learn how to use communication skills to leave work feeling content -- maybe even happy -- rather than drained.

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I can identify. I know that I am not good at advocating for myself; am too "nice" and worried what others will think. If I could change one thing about myself it would be this.

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Hi AnonymousLPN!

Thanks for your comment :) That's such an insightful, powerful thing you said, "If I could change one thing about myself it would be this.

Maybe for women especially, this whole notion of doing what's best is so difficult when it collides with "being nice."

Thanks again for sharing.

- Tricia

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I grew up with a rather volatile stepfather. It was best not to anger him. I think that is the root of my too nice; not wanting to anger or upset; worrying what others think issues. 25+ years of adulthood just can't seem to change the patterns learned in the 15 years of childhood lived in that situation.

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I so get that.

It's like the coping style of "being nice" was one of few options in the first 15 years (probably the best option, I would guess).

But when we're out of the dire situation, creating a different way of coping that fits our current resources (ability to leave, ability to communicate boundaries, ability to choose who we affiliate with / how much we give of ourselves to them) -- well, it's rewiring our brains!

A worth-it thing to pursue, but not easy by any stretch.

On my website (selfdevlab.com), I talk about having to go back and say "no" to a speaking engagement I'd originally said "yes" to. It's astonishing how long it took me to realize that it was okay to go back and rescind my original answer!

Kudos to you for *getting* the connection and understanding that the drive to "be nice" didn't come from out of nowhere!

- Tricia

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Wow!!! I think I need a few sessions on your couch!!! "Amber" could be me! My "need to please" came not only from poor parenting, but also from bullying at school. I would do literally anything to please others! I'm just starting to break those patterns now, and I'm 56! Sometimes its still a very real struggle!!! I appreciate you posting this article. It is very helpful.

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Hi billswife,

Thank you!

Oh, that's so good to hear -- that you're breaking those patterns! No matter what your age! I think we get to making changes when we're ready. So 56 must be the time you're ready for newness :)

I'm curious, what's been the hardest thing you've run into when trying to change the "need to please" patterns?

Here's to change at any age!!! :)

- Tricia

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This sounds a lot like me. I'm new to being a nurse in the hospital. I'm a believer of being a team player but sometimes I've felt very taken advantage of.

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Hi Beffers81,

Yes, there's definitely a difference between being a team player and being taken advantage of.

In a team sports situation, the goal is to conquer something outSIDE of one's own team -- not one's own teammates!!!

I feel for you, being new *and* feeling taken advantage of at the same time. It's hard enough to take on a whole new professional identity when starting a new profession. But navigating "new identity" along with figuring out how to handle others who are willing to take advantage.... Not fun at all.

I'd be curious to know what strategies you've tried to reduce being taken advantage of by co-workers, if you're willing to share.

Hang in there!

- Tricia

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The whole system counts on nurses not speaking up for themselves, always taking the "extra" shift or "extra" patient, always being wanting to please. Part of it is the power structure but part of it is the understanding of the nursing role and how it developed. And - there is also the fact that people go into the "helping" professions who have their own problems with boundaries, past trauma, self-neglect... Our society still values the picture of the nurse who gives up everything and anything to serve other people.

Management has used nurses for decades and will not hire sufficient staffing but instead push everybody to do "more" and most nurses will happily comply and see it as the "normal" part of nursing. Nurses are notoriously bad about boundaries.

I worked at a place where there was never sufficient staffing. The overall excuse was that there were not enough applicants but to be honest, they were just not paying enough and the work conditions were so bad that people would come and leave - revolving door. Instead of fixing what was not ok, they just continues to bully everybody into taking extra patients. Win win for management because it is cheaper for them to do that and easier. They did not care about nurses burn out. When I drew a line and stuck with those boundaries and used the effective "nice" communication approach "no - I can not take an extra patient" there was a lot of upset from management but also from my fellow nurses who had fallen into the idea that always working more is normal and to be expected. At the same time, everybody was complaining about the work conditions, the lack of private life, lack of time and burnout. Staff did not want to unionize and they did not want to draw boundaries. Instead of putting the blame where it belongs, they blamed the person who was drawing healthy and necessary boundaries.

Nothing changed - so I left.

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I am a new nurse and I work in a suburban nursing home. I love the residents at my job because they are relaxed, carefree, and appreciate everything that I do and if I make a small mistake they take it with grace and know I am learning my way. On the other hand, I have some co-workers that have worked there for 20+ years and the administrator is a 90 year old man who doesn't pay any attention to the work environment at all. The co-workers I am speaking of don't possess a grain of professionalism and band together in their click and are the only managers on the unit. Every day when my DON punches the time clock to go home, I am getting bullied by her click counterparts. It is very intimidating and I wish that there was a way that I could let them know that I just want to be a good nurse to these lovely residents. I have tried taking a break at the same time that they do in order to perhaps find some common ground and at least make some small talk but, then I am treated like I don't exist and then there is just awkward silence as if I am crowding their space. Any suggestions? I am desperate to know. Thanks

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Hey Nutella (great name by the way :),

A couple of things I really like about your comments.

1) You describe different parts of the system that help maintain a lack of change for nurses. Three in particular:

A) the power structure, B) the history and development of the nursing role itself, and C) Personal factors common to those who go into "helping professions."

I like how you identify that it takes more than one strand to create the web that makes change so hard in the nursing profession.

2) Management and your fellow nurses not liking your boundaries, yet having all the problems that result from (ahem) lack of boundaries. (Lack of private life, lack of time, burnout).

Sad and somewhat laughable at the same time.

Thanks for sharing your thoughts! Hope you're in a better environment.

- Tricia

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