Today is a New Day and it Starts With Me

[deniseschmittrn]

Nursing is plagued by poor interpersonal relationships as evidenced by the term nurses eat their young. Poor interpersonal relationships among many nurses stem from poor communication, incivility and disruptive behaviors, misattributions of intent behind certain actions or behaviors and sometimes it stems from what Brene Brown describes as shame.

Many nurses treat each other in a way that is in direct opposition to what nursing represents-caring. Thompson (2018), a national workplace bullying expert, termed these behaviors as Nursezilla. You know that nurse, s/he is the one all of us have met and have tried to ignore or work with, or avoid over the years. This individual reigns over the workplace spewing their poison onto everyone they come into contact with creating a very unpleasant work environment. Not all of us are like that, and I for one, am so tired of hearing how badly nurses treat each other.

Nursing needs a counterculture to exemplify what we really want as a profession, respect, and recognition for the level of knowledge and expertise we are able to contribute. The change can come today and it starts with me and you. Facing the conflicts head-on with assertive communication strategies is the first step to healing our relationships-one at a time. We can do this by developing our communication skills. Taking the time to develop your competency in communication will prepare you to confront the disruptive behaviors without getting caught up in the emotionality of the situation.

Why? Well, for one thing, it isn't personal-and as women (sorry, most nurses are women) we have a tendency to take things personally. There are a couple of wonderful books that have helped me to realize this concept. The Four Agreements is one book and the other book is I Thought it Was Just Me. Both books helped me to see a different perspective-as nurses, we are hard on ourselves and on each other. Sometimes we just have to say and believe "I am Enough".

There are several assertive communication models published in the literature. Therefore, this leads me to believe that there is not a one size fits all. Skilled communication is not as intuitive as we would like to think. Therefore, it is necessary to experiment, find the one that is comfortable for you, and practice, practice, practice. Assertive communication strategies require practice to create a new habit and a new way of approaching difficult conversations.

I have discovered the D.E.S.C. model to be effective where D stands for describing, E stands for explaining or express your concern, S stands for suggesting an alternative, and C stands for consequence. This model is applicable to multiple situations. Another approach I have used is Cognitive Rehearsal as suggested by Griffin (2004, 2014). Use reflective practices, practice assertive communication without being aggressive when you are about to have a difficult conversation, and be aware of your own negative contributions to difficult interpersonal relationships.

Another assertive communication strategy utilizes scripted responses to incivility. Through scripted response, we are able to manage our emotions. Poor interpersonal relationships among many nurses stem from poor communication, incivility and disruptive behaviors, misattributions of intent behind certain actions or behaviors and sometimes it stems from what Brene Brown describes as shame. I think it is time for all nurses to step back and reevaluate our interpersonal relationships and the work environment and challenge ourselves to recognize that talented person with whom we work. The choice is ours to elevate the profession. The success of others does not diminish our value and contributions to the profession. Take care of each other and build each other up.

References:

Brene Brown

Renee Thompson

[Davey Do]

When I saw the title of your article, deniseschmittrn, and in the first paragraph read "nurses eat their young", I thought, "Oh here we go again..."

But then- I read

"Nursing needs a counterculture to exemplify what we really want as a profession, respect, and recognition for the level of knowledge and expertise we are able to contribute."

and thought "Hold on a minute!" (Any counterculture will grab my attention.)

Yes!

We each need to take action and be the example we want others to follow. Despite the onslaught of dysfunctional behavior and negativity, we need to be individuals of integrity and worthy of respect. However: More easily said than done.

But you, deniseschmittrn, gave the directions as to how we follow this path:

"develop your competency in communication" and "practice, practice, practice".

I plan to give your article more of my attention as time allows, to check out the links and ponder some concepts more, but wanted to give you my first impressions.

Until then, deniseschmittrn, I bestow upon you and your article:

Go now and revel in your Likes. I am reaching for my art supplies to play with the concept of "Nursezilla"!

Thanks for the article and the inspiration!

[Davey Do]

"Nursezilla. You know that nurse, s/he is the one all of us have met and have tried to ignore or work with, or avoid over the years."

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[CalicoKitty, BSN, RN]

I really enjoy the general amount of teamwork I get at my current job. I'm med-surg per diem, and I float around the hospital. I've gotten to know many of the nurses on many units (although, I'm TERRIBLE with names). The teamwork is great. I've even had a nurse give a patient (aaox4) pain medication (tylenol) and tell me about it later without asking (Yeah, I was kinda taken aback that they did something and asked later, but it also really gave me a good sense of the teamwork). I fillled out one of those "good job coworker" forms. Some people I work with are always just willing to help and go above and beyond. I'm trying to get better at publicly praising them (mention in huddles, fill out the forms).

When I started at my job, one of the "policies" seemed weird. It was "talk-up the next shift". I don't think I understood it at first, but I'm definitely finding myself doing it more when I give bedside shift reports. Some nurses are awesome, and I try to let the patient know. Maybe I don't talk-up nurses I don't know that well, but the great ones get a great review. And sometimes those cards and huddle announcements.

For "Support decisions of other nurses", sometimes that is really just having a united front with problem patients. Sometimes it is coming up with a plan to encourage a patient to do more for themselves. Sometimes it is trying to avoid the "well this nurse does xyz" expectation. Sometimes it is seeing something that may not be 'best practice', but it isn't harmful, or noticed too late to avoid harm, and you hold your tongue and talk to the person later about it (IE, don't call them out in front of the patient unless it is preventing harm), or maybe just 'helping' (and correct the problem) without making the other nurse seem incompetent in front of a patient.

But, it goes back to treat people the way you want to be treated. If someone asks, unless I'm actually busy, help. My documentation can wait a few minutes to help clean a patient with my tech or another nurse. We all need witnesses for meds and wastes. Just try to be available whenever possible. If you see someone that looks busy, offer to help. If you hear a patient asking for something, get it (maybe ask the nurse if it's okay first). Simple things to be good to each other and promote teamwork.