ICU with a toxic environment

[OrganizedChaos, LVN]

What about covering lateral violence instead of just the "NETY" phenomenon? New grads bully experienced nurses & people of equal experience bully each other. Doctor's bully nurses & managers bully staff. It isn't just limited to new grads. I think it would go a long way to discuss every type of bullying instead of just the new grad getting bullied.

[traumaRUs, MSN, APRN]

Sorry you are having such a difficult time. Some suggestions:

1. Talk to your educator to see if they have suggestions.

2. Ask other new grads for hints about how to get thru your day.

3. Ask the experienced nurses, especially those giving you a hard time, for info, help, etc.

4. Clearly state your questions/concerns to the manager - most hospitals want to have a culture of competence and fairness.

Best wishes.

[booradley]

Sorry you're finding it tough. I found my new grad year challenging as well, in part because of all the different personalities you have to learn to work with. You don't have to like them or want to see them anywhere outside the hospital but you do have to be able to work together.

To be honest, if I were charge and was notified or noticed an abnormal sign and advised the new grad to notify the doctor, I'd be a little annoyed/confused if I found out later they didn't. I think you should have told her you wanted to try your intervention first instead of ignoring her advice and her only finding out later. The charge is a resource for all nurses, especially new grads agencies etc and as a new grad the only reason I wouldn't have followed their advice is if I thought it was dangerous or I was unfamiliar with it, in which case I would have asked. They are not doctors so of course you are not legally obliged to follow their directions but I'm not sure why you wouldn't have in this case.

[Workitinurfava, BSN, RN]

I understand. It happened to me when I was a new grad. It hasn't since then because I am experienced but also because I don't allow it. The nursing environment's in general especially hospital environments are stressful, so people take stuff out on those more likely to take it. It is usually those that don't know better about certain things because they are fresh and new. There is also typical stuff like jealousy etc. Nurses also don't have the voice (who really protects us and prevents unsafe work environments?) they should have and are made to take a lot from management and those above. Your critical thinking won't be at it's peak as you haven't had the chance to really use it in a real environment so sometimes you don't know what to ask and may think questions are dumb etc. The other thing is your preceptor will have so much going on and expect a ton more from you although you just aren't at that level yet. For my latest position my preceptor and I were always given max patients, when others were not because there are two of us, but is there really? She rarely had time to train me. Thank goodness I am a quick learner and didn't need much help. There are some great suggestions of how to handle this above. Studies have been done on why some new grads are not staying in this field and why they quit their first jobs within a year or so. In defense of preceptors, they don't get paid to train and are pretty much forced to do it.

[chemdawg, MSN]

Where I currently work there is a "culture" similar to what you propose here. I am not a new grad but work on a medical surgical unit in which the differing shifts look to tear down the other. You can walk into report and have 4 to 5 people from the oncoming shift not acknowledge or even make eye contact with you. Even after you have said good morning. I have to admit that it is very to be in that environment. Thank goodness it is only for 30 minutes physically but the constant CYA is there in the back of your mind as several look to bring attention to any perceived mistake you might have made to each other and the management. I am currently looking for ways to bless these, help them find joy and not let them steal mine. I look to the charge as a great resource and look for ways to help my comrades out.

[compassionresearcher]

OP I feel your pain, which is why I am studying this phenomenon for my dissertation. I believe it's not just the target who suffers but the patients being cared for by someone who is stressed out from the toxic environment.

It is not just senior nurses beating up on newbies, it comes from all directions, nurse to nurse, doc to nurse, admin to nurse, CNA to nurse, you name it. I've collected almost 90 stories and it crosses all age groups, years of experience, and geographical locations.

If you're interested you can take my survey or share it with someone you know. Everything is anonymous. Allnurses has given me permission to post here and I have IRB approval from school.

https://allnurses.com/general-nursing-discussion/why-bother-studying-1086211.html

You're right we all must stick together, I hope things improve for you sooner rather than later!

[Ruby Vee, BSN]

I however learnt that ICU nurses in that hospital were very competitive and hated when new grads came right into the ICU. I was told constantly that I needed med-surg experience first, which I understood the reasoning but felt like was not entirely true. That attitude from those ICU nurses led me to picking a bigger hospital ICU with a residency program because they were geared towards helping you along the way as you develop skills towards becoming a critical care RN.

Fast forward, I am now 7 months into working in this ICU and I love the work, but the environment is very toxic. I am very appreciative of the skills I am acquiring each day, and this is what helps me wake up and go to work everyday.

I however go home either crying or blood boiling in anger because of all the bullying behavior on my unit. The only person I would talk to about this issue is the manager, but I have seen too many people report issues to her and they have ended up leaving because she dismisses any "whistle-blowers" and things just get bad for them. ICUs are very team oriented, but our ICU has people who form cliques and constantly gossip about certain people. They pretend they are busy when they are needed to help, and when things are going well for you, they constantly come into your room and pick on things here and there, then spread lies about how you are not doing your job, you are lazy and dumb etc. I have overheard these types of labels in conversations.

I constantly get misquoted and have been termed as rude and that I disregard whatever the charge nurse tells me. This is very frustrating for me because I feel as though if I ever came across as rude, it is subconscious from protecting myself from all these nurses who portray bullying behavior towards me. Second, if a charge nurse asked me to do something and I disregarded it (which in my opinion I have never done), she has authority to surpass me and do whatever it is I refused to do in favor of good patient care or tell me in person to do it ASAP because of ABCD..(the instance in question was reporting a critical vital sign to the doctor). I decided to try other methods to lower the vital sign (which is in the policy as an action an RN can take in this case), and called 30 minutes after my failed intervention. This charge nurse went ahead and put in a note in my pt's chart saying I had been advised by her and had disregarded the advice. (This note is a legal document that could get me in trouble if a court case was ever pursued or if they needed to fire me). A family member of mine has asked me to either email or talk to the clique/charge nurse, but I do not think this will solve the problem. If anything it will make the environment more unbearable for me and I will end up leaving sooner than I wanted to.

Other bullying behaviors are the constant sending the new nurse to do ABCD... regardless of whether they are in the middle of patient care or not, and failure to carry out whatever it is they asked you to, leads you to getting labeled as a non team player. It has been very frustrating to say the least. I am not over confident. I try as much to take the humble student path, but also prevent being walked all over.

The labels and isolation are the main thing. I try to ask as many questions as possible when in doubt, but I overhead people in a conversation with the charge nurse calling me dumb with dumb questions. English is my second language and I do hesitate at times when looking for what to say, especially when I am rushing, and I have had instances where this one nurse yelled at me, what?! (I find this to be very rude and unprofessional, I don't have a heavy accent, I just sound like am from somewhere else at times)

Majority of this behavior is from nurses around my age (20's). Older nurses are very nice and I always enjoy working with them. I have tried associating the bullying behavior with lack of maturity. I also work very well with floats and travelers because they don't sit around and gossip with this clique.

I would like to hear stories from you if you have seen this kind of behavior and what your actions were towards stopping it.

I have thought of giving it as feedback when we get employee surveys. I don't trust our manager and I really do not want to leave my job yet. I am learning a lot and would like to stick it out hoping that the better my co-workers get to know me and my work ethic, the easier things will get. I have hope

You say you "learnt that ICU nurses are very competitive and hate it when new grads come right into the ICU." How did you learn this? Were you listening to gossip? Reputable sources? This statement set up a red flag for me.

Then you say that the unit you chose to work on is full of cliques and gossips, that they nitpick your work and spread lies about you. You are constantly being misquoted and accused of disregarding the charge nurse's advice. You believe that this is untrue, although you shared a story of disregarding the charge nurse's advice because you thought you knew better. So you DID disregard the advice of a charge nurse, who is most likely far more experienced than you because you were sure you knew better than she did. (And you're right, that note in the chart can get you into trouble. In all of my four decades of nursing, I have never seen such a thing happen, and it makes me wonder how egregious was your error in judgement to make a charge nurse do such a thing.)

If a charge nurse asks you to ABCD, you do it, unless you're in the middle of CPR. Perhaps she wants you to do it because someone else is in the middle of CPR or events leading up to the need for CPR. If you habitually fail to do what the charge nurse asks you, you are not a team player. You have been correctly identified as "not a team player."

Are you asking dumb questions? Yes, there is such a thing as a dumb question. Are you asking for the same information over and over? Are you just firing off a question rather than seeking the information on your own? "What's the number for the pharmacy again?" is a dumb question. A better question would be "Can you show me where I can find the phone numbers for the departments we call most often?" "I have to give a transfusion? What do I do?" is a dumb question. "Mrs. S needs a unit of packed cells. She has a current sample and has signed the consent to transfuse. I've read the procedure and I think I have everything I need, but can you eyeball this with me to make sure I'm not missing something?" would elicit better results.

I would encourage you to take a good, long hard look at what you are bringing to all of these negative interactions with your colleagues. I'm reading between the lines here, but it sounds to me as if you don't know what you don't know and think you know more than you do. And that you're not a team player.

[mindy kaling, BSN, RN]

Ruby bee- Thank you for your feedback. It is obviously hard for you and other readers to know the exact scenarios that play out in my unit, to make a fair judgement. I like how you think.

1. The charge nurse has 2 years experience, I have 2 years non-ICU experience (as an LPN)in a different facility and 7 months in this one. I realize she has more experience in this particular ICU and respect that, she did not say "do this", she offered it as one of the options and then asked what I thought...and I said "I will do intervention ABCD...and if it doesn't work, I will call", to which she replied ok to and was agreeable.

2. The patient did not suffer consequences due to me calling the doc 30 mins later, but I do care about my ICU pts are realize how small things if overlooked can affect them. I also use my hospitals policy to go by and make sure I am not calling the doc at 2 a.m when I can try other things first

3. I think of myself as a team player. I am not rebellious and I have never refused or given an excuse as to not help others. I do not have a problem with anyone else other than the "cliquey kind" on my unit, and that is why I have stayed.

4. Trust me when i say if I don't ask questions without thinking about everything first, and even looking them up in my hospital policies. I usually approach other nurses beside me when I have a question and if they are stumped as well, I go to my charge.

Thank you for your feedback again

[mindy kaling, BSN, RN]

Thank you for your feedback, I agree with all you said. However I posted about my own experience and hope it can bring about change.