If you eat your young... (venting)

[allie1230]

I have made it to my senior year and graduate in December. I have never experienced a "bully" nurse. As a matter of fact, I really enjoy the clinical aspect of nursing school. At least I did. Until last week. I was in the ER and a patient came in unconscious with a host of issues. Long story short, I made a HIPPA mistake (and not a huge one). I admitted to the mistake right away, I will never repeat the mistake, and I even thanked the charge nurse for bringing it to my attention (even though she did so in front of the tech, a nurse, an EMT, and the patient while in the patient's room). When the dust settled with that patient, and we (the charge nurse, tech, EMT, and RN) were back at the nurse's station, I thanked the charge nurse again for calling me on my mistake and explained that I did know better, but was doing what the tech had asked. I followed that up with the fact that I should have known for myself that it was a HIPPA violation and refused to do it based on those grounds regardless of what the tech requested. The tech who made the request even said, "She is right. I did ask her to make the call." I responded that it was still my responsibility to know better, and that I certainly learned from this experience. This was my first true mistake ever in the clinical setting. I was trying to convey that I own the mistake, recognize where I went wrong, and how to correct it going forward. I was trying to turn the embarrassing mistake into a positive learning experience.

In front of the same group, the charge nurse went on a rant about how I don't need to apologize to HERand how recently, a RN was fired for doing that same thing. Then, she began discussing a night-nurse who is a new grad, and referred to her by name (to me and the group). She began to talk about how incompetent she was, and how she didn't like the hospital hiring all these "new grads" in the ER because they weren't qualified to be there. She really ripped this employee apart. I could not BELIEVE how unprofessional this was and how no one was trying to de-escalate her. I wasn't about to say a word since I had just screwed up. I simply stepped back and let her go. I tried to ignore everything she said... and I was kind of thankful at that point that she handed me a paper to take to a patient room (it was obvious she was trying to get me to go away). I returned to the nurse's station, and when I did, the group was awkwardly silent. You know that I-am-being-talked-about-but-returned-too-soon kind of silence (insert awkward laugh here). The charge nurse glared at me, turned her back to me and said without even looking at me, "Why don't you go to the back and see if there's something you can do back there?" Ouch. It was apparent I wasn't wanted in her presence. I felt like an idiot. An idiot with a target painted on my backside. My wounded pride and I went to a different area of the ER. Thankfully, a nurse in a different area of the ER put me to work and truly treated me like an equal, and with respect and kindness. She was wonderfully unaware of my screw up that had got me sent to her area.

By the time I returned from a much needed 30 minute lunch, I found out I had been reported to the nurse manager (although I wasn't led to believe it was a "formal" type of report). The nurse manager saw me as she was taking her lunch to her office. I made small talk with her for a minute or two and thanked her for allowing me to continue my independent observation and how much it has helped me to learn and grow. She was very receptive. I told her how much I appreciate the staff working with me and always being willing to teach. In my mind, I think I was still trying to convince myself I had misread the whole situaiton and was taking it personally when I shouldn't do so. She then said, "I heard there was a hiccup this morning?" I said yes, but that I will live and learn. She only glazed over the situation with a broad, "I talked to a couple of people and straightened some things out. It's okay." I wasn't expecting this, but was very appreciative of her response. I didn't think the situation warranted being reprimanded in front of a group twice, then being asked to leave the area, and then being topped off by being reported. What adds insult to injury is that the EMT did the exact thing I was being reprimanded for, but did so boldly and gave out a LOT of personal information to a person on the phone whose identitify could not possibly be verified! Anyway, I told the manager that I made the mistake, I realized what I did, and that I learned from it and won't repeat it again. She seemed perfectly okay with that. I didn't mention any of the drama or that the EMT took my error and blew it up to a bigger error in front of the charge nurse and was NEVER corrected (at least not in front of the group as I was). I didn't want to tattle or make a mountain of a mole hill.

By the end of the day, I felt awkward everywhere I went in the ER. The charge nurse never spoke to me or even looked at me after that incident, like I was a ghost (and I received the same from the EMT, the RN, and the tech). I felt HORRIBLE and INCOMPETENT. I was mad at myself for making the mistake, and their behavior only made the guilt and anger worse. I wasn't really mad at them, but I was very hurt. When it was time to leave, my nurse I worked with that day hugged me and thanked me for being there. I told my friend who was in ER with me that I was taking my bad day bruises and going home and kind of smiled to avoid crying. My nurse heard this, and asked, "Oh no. WHO was mean to you?" I was taken by surprise that she would just go to that right away. I tried to deny anything of that nature. I told her that I made a big mistake in regards to HIPPA, that I was upset with myself. She again said, "Was it the charge nurse?" Ugh. I denied any personal issues at all and just kept it about me feeling bad about my error. She was awesome and tried to point out all the things I did RIGHT that day and how much my patients "loved" me, and what a help I was to her. I could feel the heat rising in my face and tears welling up. I knew I'd been ostracized by the others all day, and this nurse was so kind. She explained that the charge nurse is one who likes to "eat their young," and that it was an unfortunate thing about nursing. Several times she kept saying that the charge nurse was "one of those nurses" and a "type-A personality" and many on staff find her difficult to work with and avoid her when possible. I insisted it had nothing to do with her, but that I was just upset with myself for my mistake and my embarrassment that the nursing manager was made aware of it, too. My nurse then asked, "Wait, she told the manager?" I said, "Yes." She assured me that the manager is direct, but fair. She said if the manager had a real issue with what I did, she would take me aside and discuss it with me. She said the fact that it was glazed over the way it was was a pretty good indication that she either didn't think it was a big deal or that she felt like I was not likely to repeat my mistake. Her support meant a lot to me, but as much as I appreciated her support, looking back now, perhaps it was a little unprofessional of her to say those things about the charge nurse...but I have to admit, in that moment, it was nice to hear.

I really wanted a job in this ER because it's really good, has a great reputation in the community, and MOST of the staff has been awesome. I felt like that opportunity has completely been destroyed because of this situation. I truly regret screwing up...but won't we all make mistakes and learn from them? Is that not the point of preceptors and being a student? Ugh. I felt horrible all day. I felt like the charge nurse, her nurse pal, the EMT and the tech HATED me after the incident. I tried to not make it personal, but at the end of the day, I think it truly was. I was reprimanded in front of a group twice (without discretion), belittled, compared to another "new-grad" nurse that was incompetent (and it was made clear that the nurse in question wasn't welcomed), banished to the "back," and completely ignored and made to feel non-existent the rest of the day by that group.

The bottom line is I did what I felt was right. I owned the mistake without blame. I took the reprimand with grace. That apparently wasn't good enough. I had to be reported, be ostracized, gossiped about, and ignored the remainder of the day. By the CHARGE NURSE, the one who SHOULD be leading by example. The same person who was tearing apart an employee by name who wasn't even there to defend herself! I now will probably never be considered for a position in this hospital's ER (which is why I sought to do observation in this hospital to begin with), and all because I followed instruction blindly without thought of my boundaries.

I don't need to be beat over the head with a freakin' mistake. I don't need to be bullied or intimidated to learn. I don't think her goal was teach, and if it was, she needs a lesson, too. I am sick of the dismissive, "Nurses eat their young" nonsense. If you eat your young, there will be no one left to fill your shoes - and our profession will suffer the consequences. It's bad for the student, the nurse, the hospital, and for patient outcomes. The catch phrase doesn't excuse the action, if anything, it dismisses it, and that's not right. Bullying isn't tolerated in schools, in the average work place, and certainly shouldn't be tolerated in a place where people's health could suffer because of it. The stress I've carried from this has been high, and I haven't really talked about it with anyone since it happened. I just needed a place to vent where maybe I can find some direction. So far, I've read a lot of articles, stories, and recommendations, but nothing really concrete in any literature. I am shocked there is no law, no EVP, and nothing really substantial on the subject since it seems so prevalent. And calling it "lateral-violence" doesn't make it a syndrome, a disease, or something that is excused. It is bullying, plain and simple.

So, if you are a RN assigned to a student and you don't want the student, please let us know so that we can find another RN who is willing to take a student that day. That will make sure we both have a good day. Aside from that, any advice? Thoughts? Do I hang up the idea of applying for a job in this ER? Do I even return? The rest of the staff has always been really nice to me and has never acted like this. This isn't a school clinical, it's my own personal observation I arranged myself to complement my clinical. I wanted to do ER nursing, but this really shook me a bit. If you have been bullied, how did you handle it and what was the outcome? I haven't returned this week (I usually go weekly a couple of days per week) because of other circumstances unrelated to this.

Thanks for letting me vent.

[sugarmagnoliaRN]

I can understand why the charge nurse was upset, as violating HIPAA is a big deal. Especially since if you were there on your own accord, not as part of your school's clinical rotations, that liability would fall completely on the hospital. However, she does sound like she handled the situation unprofessionally. It's good that you rectified things with the nurse manager, as she would be the one to decide if you were hired there. Don't give up your idea of working in the ER because of this situation, because let me tell you - you will find nurses (and people in general) like this no matter where you go. I think you handled the situation well when you realized that you had made a mistake, so you obviously have a good head on your shoulders. But please realize that a HIPAA violation is definitely a big deal (so don't let the RN you were following that day convince you it's not).

[classicdame, MSN, EdD]

The charge nurse was out of line. Her gripe was that you were being unprofessional but she was as guilty. I bet the supervisor was trying to get you to discuss how you felt about the charge nurse's reaction. In fact, I bet she heard about it from another staff member and this nurse has been a big mouth for some time. Do not take it personal. You will make mistakes and, as you can see, being experienced does not mean you will not make mistakes. She spoke out of line. When you have more confidence you will be able to tell her "we can talk about this later in private".

[sugarmagnoliaRN]

Totally agree that she was out of line to call you out in front of others - definitely should have discussed it with you in private. Clearly, it devalues everything she wanted to say to you by doing it in such an unprofessional way.

[llg, PhD, RN]

Yes, the Charge Nurse behaved badly -- and it sounds like most people in the ED know that. Apparently, she already has a bad reputation.

But ... you need to learn how to deal with people who behave badly. You need to recognize that you are never going to find an environment in which everyone (including you) is perfect all the time. I'm not saying you should tolerate being treated badly -- you should learn to be strong and learn to prevent it from getting out of hand. Don't let this one relatively small incident prevent you from succeeding in this ED. Don't blow it out of proportion and slink away in the belief that nothing can ever be right there again. It sounds as if there are some really good people working in that ED. Go back, do better, learn, build relationships, etc. while you can -- and make the most of the experience.

Good luck to you.

[whisperingsage]

Yes, this is common. I graduated as an LVN (CA) in 2004 and got my NV LPN license a year later. Most facilities have some abuse. One occurred in 2008, when they were just going into the recession. The bosses (a married couple) of a Medicare/ long term care/ rehab, informed us that there would be no more paid overtime and they would have to reduce staff. I was primarily working in the long term care. But when this occurred, a 99 bed facility went from 4 nurses to 3. My patient load went from 27 to 52. On days. And the added patients were in the medicare/rehab side, so I had to stretch myself between two floors. This was not easy to anticipate what patients needed me when I wasn't there. In addition, there was NO key control. Instead of arranging the carts so each nurse could have control of her own cart, they made us share carts- and these were not electronic keypads. So either the nurse kept the keys in her pocket and you had to search for her to get into the cart, or she put the keys in the MAR and we all hoped nobody would go outside normal civil behavior. Not safe. One CNA got mad at her nurse and stole the MAR and it simply disappeared. I don't know what happened with the facility being fined $50,000 or if they were able to muddle through and not let the state know.

The CNA was never held accountable, because , well it wasn't able to be proven. But we all knew.

Other stresses were that we had just become, by force essentially- the Medicare folks pressured our Boss to cave- we became "no restraint". And the falls began immediately, we had 4 black eyes our first week. And a broken hip, which turned into a clot that caused a stroke.

This was also the same time Medicare made a statement they would no longer cover injuries r/t falls, so this must have put the facility in the hole.

The stack of paper for a fall was oppressive. So oppressive that commonly, the nurses quit doing their weeklies or even monthlies. So the patient care committee was frantic, and begged me to do weeklies on the patients that they needed for their review. This was all because OT was barred, and most were making a statement that there is no time to finish the paperwork. I would stay and do it, (free) but that is just me. There were a few others too.

In this atmosphere of oppression, nurses began to turn on each other.

There was a drug auditor, from the pharmacy we were told, who would watch each nurse pass a few meds and make sure they did it right. When my turn came, I had a pt on "high dose" vitamin D. Now I am a D enthusiast for various reasons, the immune system, the ability to have balance, the bones, the parathyroid- it does wonders for old folks who are frail and have poor balance. It is a much underused nutrient.

I started on 10,000 Iu's for my bowels, and reduced to a daily 5000 regular- I may have to increase again as my labs showed the figures went down.

Anyway, the dose was high enough they used OTC commonly available 400 mg, and I had to add those up to 5000IU ( a dose that normal healthy people should get daily if you read the research.)

I took too long to count those out so the auditor reported me stupid I guess and the word spread that I was an idiot. I had been there for almost a year and nobody had thought I was an idiot before.

So the boss even derided me evidently in a meeting with the other staff that I wasn't present at. After that, I had one RN, who was an NP in another job and was moonlighting, and she pretended to be my friend and told me the others were hostile, because I was stupid and weird. I never quite believed her even though she was "nice" because she called another nurse a sociopath, and I am still friends with him still, we go out to dinner with our spouses together.

Anyway, I chose to quit, because not only was the job now impossible, I was being harassed by the DON over other things, (she even falsified a document to prove to me I had given a Lovenox shot improperly. She claimed in the evening I was supposed to take this man's INR's right before the shot. It was on the Medicare side and those pt's change frequently and their orders change frequently so I was always careful to read everything and make sure I understood it before doing anything. This had never been common practice there. and I saw no note on the MAR claiming that. The INR's are taken first thing before breakfast (they have a very cool handheld machine that I just loved, much like a glucose monitor but bigger), twice or three times a week and the doc would adjust the doses on those readings. I asked the regular nurses on that side if they ever had to do that with that patient. They all said no, and one used to be a pharmacist. He said he had never heard of such a thing.

What the DON showed me was a copy of an otherwise blank page supposedly with that order on it. I should have gotten a copy of it for legal purposes. But it probably would violate confidentiality ( unless the name was blacked out) (by the way Confidentiality has been a part of nursing from the beginning- look at your nurse's oath. HIPPA is a straw argument- it is the Health Insurance Portability Act and if you look at your paperwork on it as a PATIENT, it is all about them sending your info to other companies so that they can sell you something. Look up the Act in it's text. The very name suggests sending your insurance information to others- it is portable. Also, it is to cover you if you aren't home. So that hospital has a right to know who is paying them. )

Anyway, she drummed that up and it was a false charge. And I quit, I already had to drive 120 miles back and forth to work. And they were good at changing the schedule and not telling you. I showed up for my two days (I stayed the night for two 16 hour shifts to make it worth my while) and found I was off the schedule, and by rights, they owed me 4 hours for showing up, but they never admitted it and they never paid me.

Also, when my schedule went down to one 8 hour shift a week, well, that wasn't enough to be worth the gas.

My RN friend still works there and asks me to come back, but My husband says no more SNF's. They are just too much drama and ethics violations. The DON that gave me and others so much trouble has been let go, because enough people complained. But she still is also a DON at an acute hospital- she did both jobs while she was at the one I was at. I don't know how.

[metal_m0nk, BSN, RN]

I don't need to be beat over the head with a freakin' mistake. I don't need to be bullied or intimidated to learn.

You're doing half the work for her. You need to learn to let go and take the bigger lesson.

1. There are type A people in the world. Not all of them are nice or happy or supportive of your hopes and dreams. But the fact that they exist and still manage to hold down jobs (and many of them do their jobs very, very well) means that one day you will have to figure out how to work with them. Nurses especially should develop a knack for communicating and collaborating with an array of different personality types.

2. If you felt that the charge nurse's verbal treatment of another employee was so unsavory as to be completely unprofessional, that was your cue to show that you've got some guts and say something about it. You don't have to beat her over the head with it or stoop to an unprofessional level yourself, but it would have been fitting to say that you felt awkward hearing such disparaging remarks about someone who wasn't there to defend herself. Sometimes you have to give people a reason to respect you.

[metal_m0nk, BSN, RN]

Too late to edit, but wanted to add...

As a type A personality, myself (not the bullying kind, but a type A nonetheless), I can tell you that I haven't met a type A personality yet who doesn't have a weakness for flattery (though, most of them would NEVER admit it). It's hard to not get defensive in a situation like that and swallow a little bit of pride, but if you had responded to her with something like, "Wow. I'm really glad you pointed that out to me. I wouldn't have even noticed my mistake if you weren't so keen. I wish I were so observant!" If you'd said something like that in the most genuine tone you could muster, she'd have shut right up and probably been your new best friend (after she took a moment to wonder if you were actually serious).

[nurseladybug12]

I myself have been embarassed in front of patients by nurse instructors and nurses when I was in nursing school. It is very unprofessional and uncalled for. However, violating HIPAA is a huge deal and is something you could be fired for on the spot, and in some schools even kicked out of your nursing program for. Yes you will learn from your mistakes, but patient confidentiality is more important than someone learning from a mistake that was not that little-any violation of HIPAA is still a violation and grounds for termination. No gray areas here.