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

[PancakeSaturdays]

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.

[PancakeSaturdays]

Hey Bandbunny,

I LOVE it that you've got such great residents!! They sound ideal :) Oh, if only the co-workers (and perhaps administrator?) were more like the lovely residents.

You wrote that you "wish there were a way that [you] could let [co-workers] know that [you] just want to be a good nurse to these lovely residents."

Given that they ignore you on break, it seems very unlikely that them knowing that you want to be a good nurse is something a) they'd care about or b) that would motivate them to treat you any better.

I've heard this same thing from other nurses and want it myself when around not-so-nice people: if only they understood me. That's just not the answer, though, and I'd recommend not having the goal of getting them to understand anything.

Far better are your chances of getting behavioral change from them.

The first thing I'd recommend: for yourself and to yourself, identify in one sentence what you want them to do differently. (Eg. I'd like them to say hello when I walk in the break room. I'd like them to look at me when I speak, etc.).

Once you get clear on that, you then know for yourself what you want should you choose to mention it to them, the administrator, or DON.

There's more to this than I can write in the comment section! :) I've got more on my website (selfdevlab.com) about this type of thing. The free eBook gives an example of when I had to say something hard that I didn't want to. Once you get the eBook, just hit reply to that email to message me directly if you want to get in touch.

All the best, bandbunny. Hang in there; more than anything, it sounds like you need communication strategy for talking with mean folks. This is a different strategy than when communicating with "non-mean" or "normal" folks.

- Tricia

[Marisette, BSN, RN]

I just read this article after initially glancing and thinking it was about a nurse in some kind of distress and requiring a therapist. My interest peaked after a recent post "what do you hate about your job".

After reading article, I realize it's more about communication and getting our point across effectively. I enoyed reading this and realize the Amber scenario can happen to almost any nurse. Great article.

[Garden,RN, ASN, RN]

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.

Your first sentence is the truth of nursing, and it is because we are a field of women mostly. I have also seen this in education. Not only does the whole system depend on nurses absorbing managements problems, it creates animosity between us all and that is one of the reasons we have so many personality problems. We, I'll include myself, all think that the other is doing less than we are. The nurses are divided against each other, the CNA's feel like they are doing all the work and we are just sitting around. They tell us, RNs, that we are responsible for the LPNs and the CNAs work but we are not really their supervisors, so the relationships are all awkward. We even have issues with the doctors and the roles and restrictions of the nurses. Basically we are all divided, solving the systems problems for free. We are understaffed we work more and harder. We write or document endlessly for lawyers so the other nursing staff ( and to me we are all nurses, RNs, LPNs, and yes CNAs) resents us. Having been a supervisor in other fields, from day one this all looked like insanity to me.

While the article is great, the solution is for the powerless nurse to solve it, more introspection, more self-blame, if only we speak up with the right words. All the while the real problem is we are all being used by the system. The truth is the system does not work, never has but we keep doing the same thing. They tell us team work, that is code for work harder. So the end result is so many of us are unhappy with our work and many are just hanging it up.

[Garden,RN, ASN, RN]

I don't agree witht the need to unionize. Teachers have plenty of unions and are in the same boat. Based on my experiences, I would say both need different styles of management all together, I mean radical changes. Otherwise we are stuck as we are. We have all the tools for a great health care system but our population is very unhealthy because instead of our system being patient centered it is being directed by non-medical personnel from insurance companies and all sorts of others with financial interests.

[KatieMI, BSN, MSN, RN]

Well, there is one thing I totally and wholeheartedly disagree in the original post. This is lack of confrontation.

I was bullied unhumanely since I remember myself. Every time, I was told, again and again, all the sorts of mental junk of not being kind enough, not being good enough, killing them with kindness, accepting "them as they are", etc. I took it all so close that for quite a time in my youth I thought about myself as about the worst human being ever born. The process predictably continued during my first two nursing jobs, where I was eventually left with PTSD, stress cardiomyopathy and a few other things which took a year and close to $10000 to get under relative control.

Then, one beautiful day, I did it. I was a single agency RN in LTC covering 50+ beds and had one absolutely abhorrent LPN under me, who sat there minding her own business on Facebook. Shift was short as usual, and she had audacity to ask me for a favor: to pass her own meds, in addition to my own (for another LPN who called off) and all IV pushes.

I asked her to go to a corner with me and there told her to get going and do all her own job plus half of the rest. She tried to open her mouth, and I showed her the phone number on my phone I was about to dial. That was direct number to the State Boards. I told her, directly, that I am going to report her then and there, and then call my lawyer and sue the pants off her butt for whatever. She knew that I was not kidding. She quietly went and worked more or less diligintly while I called my agency, DON and ADON. She was fired within a few days - turned out, everybody were sick and tired of her antics and laziness long ago but I was the first person ever to confront her.

That was the first time in my life I won over a bully and I did the same a few times more since. I do pick my battles and do not attack people for small things, and rarely refuse to help if asked within limits. I am still kind and helpful - only for these who do the same toward me. But I do not coddle bullies anymore with my communication skills or anything else. They do not deserve my time, my efforts or any part of my only one life just because "they are what they are".

Luckily, I found a unit virtually free of bullying. When I had to encounter nurses from my past workplace, and that happens all the time, I behave within being civil, and not a millimeter more than that. And any attempt to play the old games of taking advantage, discrimination and denigrating are met with appropriate (and more surreptous) actions. People got to know and remember that after I found a nursing student crying in the restroom after she was publicly beaten into mental pulp by one so-called "instructor" RN, that RN somehow lost her contract with school. And that one other RN who was literally torturing me three years ago now just cannot get into any reputable graduate program in the state... somehow.

People who choose to be bullies deserve no kindness, no considerations. What they do deserve, and I hope to live to see it one day, is harsh discipline. If someone chooses to spend time, effort and money just in order to let them continue to be "what they are" can avoid confrontation for a while but eventually what has to be done gets missed, namely telling a bully in his or her face: you cannot do that, it is not acceptable; please stop... or else.

[Garden,RN, ASN, RN]

I have mixed feelings on your post. The problem for me has not been in standing up for myself, the problem has been when the powers that be either refuse to get involved or side with the bully. I hate fighting, I refuse to live life fighting. How are we, who are suppose to be kind, compassionate, ethical, we are caretakers and yet as a group we have these types of work places.

There are times when people call licensing boards out of spite, there is another thread about one such case, so you have to be even more cautious. When I get around bullys, I would rather leave than have to go through all the fighting. I am glad it has worked out in your situation but in many work places if you are complicated you are a liability, so even if yes the nurse gets fired or whatever, you may permanently taint your workplace. I will tell you that sadly some of the meanest women I have met in my life have been nurses-in the work environment. Yes it has been the women, and it has been in the workplace. Any nurse I have met outside of the workplace has been lovely.

[RNBSC]

I can relate, my super customer service skills come from survival technics learned as a scared child, safety meant not making parent mad, or better, anticipating what parent wanted....

[KatieMI, BSN, MSN, RN]

I have mixed feelings on your post. The problem for me has not been in standing up for myself, the problem has been when the powers that be either refuse to get involved or side with the bully. I hate fighting, I refuse to live life fighting. How are we, who are suppose to be kind, compassionate, ethical, we are caretakers and yet as a group we have these types of work places.

There are times when people call licensing boards out of spite, there is another thread about one such case, so you have to be even more cautious. When I get around bullys, I would rather leave than have to go through all the fighting. I am glad it has worked out in your situation but in many work places if you are complicated you are a liability, so even if yes the nurse gets fired or whatever, you may permanently taint your workplace. I will tell you that sadly some of the meanest women I have met in my life have been nurses-in the work environment. Yes it has been the women, and it has been in the workplace. Any nurse I have met outside of the workplace has been lovely.

So, do you think that a workplace which allows bullying and lateral violence is not tainted enough by this very fact? Such places invoke the worst liability upon themselves - by losing high quality staff, overworking those who stay, at the end, they endanger everyone from patients to physicians.

Please understand: running off is a strategy that can work for quite a bit but eventually you might see no other corner to hide from your own conscience. By letting a bully to go as he or she pleases, you very well may endanger lives of many others, patients and your colleagues alike. Like by allowing someone who is "just a little tipsy" to drive, you participate in all potential sequela, albeit indirectly. How does it align with compassion, ethics and all other wonderful qualities we're supposed to demonstrate as nurses?

I do not like to fight, too. But when I got cornered, I did and thus, as it showed itself on a bit longer run, helped the facility I "tainted" by exposing one lazy, inept bully in a form of a nurse. Once that cookie left for good, the endless "call offs" of everybody else doomed to "accept her because she is what she is" came to their normal frequency, and eventually to the point that the LTC did not need agency nurses any more. I guess it was good for everyone (but myself, as I lost hours, but that is another story). Where I am now, people became to behave a bit differently even after just a couple of times when I succeded in quietly rustling feathers of the birds sitting higher than any of them could ever reach. It took quite some time, some studying of the existing laws and a very good deal of thinking the tactics and strategy out to protect myself and maximize potential results but it is all worth it if another nursing student will receive the training she pays for, not being a victim of someone's sudden craving for power trip. If another new nursing grad will come to work with a honest smile. If another good nurse like you will not have to run away yet another time.

[AvaRose]

Well, there is one thing I totally and wholeheartedly disagree in the original post. This is lack of confrontation.

I was bullied unhumanely since I remember myself. Every time, I was told, again and again, all the sorts of mental junk of not being kind enough, not being good enough, killing them with kindness, accepting "them as they are", etc. I took it all so close that for quite a time in my youth I thought about myself as about the worst human being ever born. The process predictably continued during my first two nursing jobs, where I was eventually left with PTSD, stress cardiomyopathy and a few other things which took a year and close to $10000 to get under relative control.

Then, one beautiful day, I did it. I was a single agency RN in LTC covering 50+ beds and had one absolutely abhorrent LPN under me, who sat there minding her own business on Facebook. Shift was short as usual, and she had audacity to ask me for a favor: to pass her own meds, in addition to my own (for another LPN who called off) and all IV pushes.

I asked her to go to a corner with me and there told her to get going and do all her own job plus half of the rest. She tried to open her mouth, and I showed her the phone number on my phone I was about to dial. That was direct number to the State Boards. I told her, directly, that I am going to report her then and there, and then call my lawyer and sue the pants off her butt for whatever. She knew that I was not kidding. She quietly went and worked more or less diligintly while I called my agency, DON and ADON. She was fired within a few days - turned out, everybody were sick and tired of her antics and laziness long ago but I was the first person ever to confront her.

That was the first time in my life I won over a bully and I did the same a few times more since. I do pick my battles and do not attack people for small things, and rarely refuse to help if asked within limits. I am still kind and helpful - only for these who do the same toward me. But I do not coddle bullies anymore with my communication skills or anything else. They do not deserve my time, my efforts or any part of my only one life just because "they are what they are".

Luckily, I found a unit virtually free of bullying. When I had to encounter nurses from my past workplace, and that happens all the time, I behave within being civil, and not a millimeter more than that. And any attempt to play the old games of taking advantage, discrimination and denigrating are met with appropriate (and more surreptous) actions. People got to know and remember that after I found a nursing student crying in the restroom after she was publicly beaten into mental pulp by one so-called "instructor" RN, that RN somehow lost her contract with school. And that one other RN who was literally torturing me three years ago now just cannot get into any reputable graduate program in the state... somehow.

People who choose to be bullies deserve no kindness, no considerations. What they do deserve, and I hope to live to see it one day, is harsh discipline. If someone chooses to spend time, effort and money just in order to let them continue to be "what they are" can avoid confrontation for a while but eventually what has to be done gets missed, namely telling a bully in his or her face: you cannot do that, it is not acceptable; please stop... or else.

So you turned into the bully instead?

[KatieMI, BSN, MSN, RN]

So you turned into the bully instead?

I just treat people the way they treated me.

When bullying happens, most people either run, early or later, or look another way pacifying themselves with the ideas like "she is what she is" and others, most of them essentially blaming the victim. When I was bullied luterally to death, a good hundred of people knew, none of them moved a finger. Doing so doesn't sit well with how I understand professional ethics. Even if bullying is not yet recognized as criminal action, it is still dangerous for lives of too many. So I fight it, within limits of what I can do. And I did not humiliate, denigrate and do anything bullies do - I seeked and found authorities who have vested interests in how things are really running, for their own purposes, because of administration, as usual, was playing role of those three famous liittle monkeys.

It is not an ideal decision, but, again, patients got care they deserve and nurses stopped calling off, students do not refuse clinicals in this unit.

[Lauracase13]

What about the nurse who is aggressive during report, and makes you feel as though your report is never good enough?! How do you say "that tiny detail is irrelevant, and will not impact your care in any way!"

[Horseshoe, BSN, RN]

What about the nurse who is aggressive during report, and makes you feel as though your report is never good enough?! How do you say "that tiny detail is irrelevant, and will not impact your care in any way!"

Didn't you just say it?