Hostile environment in ICU

Dear Nurse Beth Advice Column - The following letter submitted anonymously in search for answers. Join the conversation!

Published  

I have a new ICU nursing job.  I understand that is is a tough job, and I need to learn a lot of new assessment skills and know how to react fast when a patient is declining.  I feel like I am getting mixed signals from the staff.  There are a few nurses that are condescending to me, and talk down to me over some decisions that either are not that important or against what I been taught.  Without getting into nitty details, I just feel they are doing it just to do it.  I am only just learning the culture, but I don't see them doing it to other new nurses to the unit.  I'm afraid to go to management about it because if they address it, it will be very obvious that its me and I don't want to add to an already tense and hostile environment.  My first question I have been asking myself is, do I place a time limit on my employment there... like "give it one year and if things don't improve, transfer." or do I give it an incidence number.  Like "If there are five important negative interactions (beyond a condescending tone, or an eye roll), then maybe its time to start looking."  I would definitely tell the managers when I leave, but I really don't want to say anything now because I fear retaliation.  I am almost 100% sure they would retaliate and I don't want to get fired or lose my license.

I am also wondering if this is a unit culture thing or if this is all ICU nurses and maybe ICU nursing is not for me.  I love the work and I am learning a lot!  The patients are great, and I get along with the families.  I'd hate to leave that behind over a few negative co-worker interaction.

Share this post

+ Add A Comment

3 Answers

Specializes in Tele, ICU, Staff Development.

I believe you are being bullied, and it can be stopped. I know this from personal experience.

I was bullied by a larger-than-life, diva-type nurse in a small department and again by a Doctor early in my career as a nurse manager. 

 Queen Nurse

This nurse considered herself Queen of the department. She had a very strong personality, excellent organizational skills, and was bossy and domineering. She undermined me and actually made things up about me to the manager so that I was in a defensive position. The manager was easily manipulated, so it was not looking good for me. The Queen made it so miserable that I could barely face going to work, and once, I even called in sick. I took that day to apply for my job back at my old hospital. 

Ironically, she was less experienced than me, but I was junior in the department, and she was trying to protect her status. Long story short, one day, she gave completely wrong information to a patient about her chest tube with an air of expertise. I had just had it. I called her aside and said I needed to talk to her privately. I shut the door and said, "Look, this stops now. I have been a nurse for 10 years, you have been a nurse for 4 years, and you don't know what you're talking about. I will write out the changes to the patient education, and that's what we'll do."

I could have worded it better but wasn't prepared for the transformation. She didn't fight back, immediately stopped bullying me, and we even became good colleagues.

Doctor with Anger Management Issues

Everyone was terrified of this Doctor. On my first day as unit manager, the Doctor called me out publicly at the nurse's station about a night nurse's mistake, along with a lab that wasn't resulted the minute he walked in. It was humiliating. I asked him to talk privately in my broom-closet office and really thought he'd say no, but he followed through the nurse's station, past the lounge, and in. I said, "Doctor. We both want the same thing here. Excellent care for your patients on this floor. But if you undermine me in front of my staff, this can't work. If there's a problem, let me know privately, and I'll do everything I can to follow up." He backed down, kept his promise, and we went on to have a mutually respectful relationship.

Bullies

 That is how I learned that bullies back down when you stand up to them. They back off when they realize you won't tolerate their behavior. Quite simply, they will look for someone else to bully. 

Bullies thrive on emotional reactions. Maintaining your composure takes away some of their power. Even when it's hard, remain calm and collected despite their condescension or criticism. Respond confidently (without being defensive or confrontational) and show you won't tolerate disrespect.

Tip: Practice deep breathing or mindfulness techniques to stay grounded when dealing with stressful interactions. This can help you control your reactions.

The nurses undermining you have singled you out as someone they can bully. You must talk to them. Often, it's best done in private, but sometimes, it's appropriate to call out the behavior when it happens.

For example:

"I noticed you rolled your eyes, Ashley. Is something the matter?"

"I appreciate your input, but I'd prefer to discuss this one-on-one so we can thoroughly review everything. Let's touch base after rounds."

"I hear your concern, but based on my assessment and best-practice guidelines, this is the best course of action for the patient right now. If you feel a different approach would be better, we can review the evidence together during a break."

Here are some examples of what you can say in private:

General, Non-Confrontational Approach

For a more neutral way to address the behavior,  keep it focused on how you feel:

"I want to talk to you about something. I've noticed a few times when I've made decisions or asked questions, the response felt a little harsh. I want to learn and grow in this role, and I'd appreciate more constructive feedback."

This approach doesn't place blame but expresses that the behavior isn't helping you grow.

Direct and Assertive Approach

If you want to be more direct about how their behavior is making you feel, this can still be professional without being overly confrontational:

"When you said [specific comment or action], it made me feel like my decisions were being dismissed. We all work under a lot of stress, but I'd appreciate a more respectful tone. I'm just trying to learn, and I value any guidance you can provide."

This gives them clear feedback on what exactly was upsetting and expresses a desire for more respect without attacking them.

Addressing a Specific Incident

If there was a particular moment when you felt disrespected, you can bring it up directly:

"Earlier today, when I asked about [specific situation], your response felt a little condescending. I want to make sure I'm making the best decisions for our patients, and I'd appreciate it if we could have more of a collaborative approach when discussing care."

By using I statements, you own how you feel while also being clear about the incident. This keeps the focus on the behavior rather than the person.

Appealing for Professionalism and Teamwork

You can remind them that you're all there for the same purpose:

"We all want the best patient outcomes, and I'm still learning the ropes. I would really appreciate it if we could keep our conversations focused on improving patient care and keeping a supportive tone. It would really help me grow."

This focuses on a shared goal (patient care) and encourages a more positive, teamwork-based environment.

Requesting Constructive Feedback

If the nurse is frequently critical, you could ask for specific, constructive feedback that helps you improve and opens the door for a better approach: "I'm eager to improve my skills here, and if you have feedback, I'd love for it to be specific so I can learn from it. I respect your experience and value your input, but I'd appreciate it if we could focus on the solution, not just the problem."

This helps steer the conversation toward growth and development rather than simply pointing out faults.

Setting Boundaries on Tone or Delivery

If the issue is primarily about the tone or delivery, you can address that directly:

"I wanted to talk about something that's been on my mind. Sometimes, when you speak to me, it feels like I'm being talked down to. I know this environment is fast-paced, but I'd appreciate it if we could communicate in a way that's more respectful. I'm here to learn and grow, and I think it would be more productive for both of us."

By addressing the tone of their communication, you're setting a boundary around how you expect to be treated while also framing it in a way that encourages more productive interactions.

Expressing Vulnerability (if you're comfortable)

If you feel comfortable being a bit more vulnerable about how the situation is affecting you, you could say:

"I know I'm new and still figuring things out. When I get harsh or dismissive responses, it can make me second-guess myself and feel unsure about asking questions. I really want to succeed here, and I'd appreciate it if we could communicate in a way that helps me feel supported."

This is a softer approach that invites empathy and understanding.

Final Thoughts

This is actually an excellent opportunity for you to grow. You don't have to have a perfect response. Just being clear about your boundaries and how their actions affect you is usually enough to resolve things.

Very best wishes, I'm rooting for you!

Nurse Beth

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.

As a clarification, the poster has not indicated that anyone has alleged behavior in her part that would put her license in jeopardy. I have volunteered for a state BON and can tell you that if a complaint comes in that doesn't allege working impaired (alcohol, drugs, etc.), theft, drug diversion, records falsification, abuse of a patient or staffer, fraudulent credentials, egregious actions endangering pts or outside of licensed scope, or other felonious acts, it'll go right into the circular file. Saying no to the staffing coordinator for more overtime than you want to accept, not acceding to incessant family demands, parking in the doctor's lot, and rudeness/bad manners/bad personal hygiene might get you fired, but the BON won't care. They have much bigger fish to fry. 

Is there anyway you can give examples of what is happening?   It seems kind of vague to give an accurate response to what it is you're feeling, or would this be a dead giveaway in case they are members of AN?

+ Add a Comment