New hospital, but not a new nurse blues...

[abnormal_saline]

I recently got hired at a bigger hospital and I think I am not liking my charge nurses at night. Just a little background, I'm still working at my current smaller community hospital per diem where I love my coworkers for the most part, including all of our charge nurses. I have been a nurse there for 7 years on a busy Med Surg Tele floor, have been a preceptor, resource nurse, and relief charge. I have also had the honor of winning the Daisy award in the past. I have been told I am a great nurse by coworkers, doctors and patients. I did not want to leave my current hospital, but the pay was very low, and I needed to take a job with higher pay. However, this bigger hospital has me feeling like a horrible nurse and now I'm feeling like I made a huge mistake in joining their team mainly because of the charge nurses I have to work with!

At my new bigger hospital, I am currently working nights on a super slow stroke unit, where all of the nurses are 98% Filipino (older crowd) and they speak Tagalog for most of the 12 hours. I myself am Filipino American, so I don't speak Tagalog and I wouldn't want to anyway because I don't think it is professional to do so out in the nurses station. Patients have even written formal letters of complaints to the hospital about nurses speaking in Tagalog in front of patients (and saying horrible things--little did they know that the one patients friend is half Filipino and understood every word). I do understand the language and have heard them speaking badly about other nurses from other ethnic backgrounds. So the culture of "Tagalog speaking" has thrown me off and has me kind of feeling like an outsider even though I am Filipino American. Also, I feel as though they don't like me because although they speak to me in Tagalog, I always answer back in English.

Also, I've noticed different dynamics from day shift vs. night shift. I had the opportunity to orient on days where both the charge nurses and nurses were of a younger crowd, very welcoming, and spoke English! They always asked me if I had any questions, and were very supportive in my adjustment to the new hospital. However, night shift has the older Filipino crowd that mainly just stay to themselves and aren't very welcoming. The charge nurses at night don't ask if I'm ok or need any help. When I ask questions, I feel like I am annoying them. They don't say a single word to me the whole shift except to point out little mistakes (I didn't check off 2 boxes on a care plan I'm still trying to adjust to, or I didn't apply SCDs on a new admit pt. who already has Lovenox ordered, because apparently they apply SCDs on everyone no matter what, etc.) Other nurses from day shift have even warned me to be careful with these charge nurses because they will "do anything to get you in trouble." I've even had one of the night shift charge nurses urgently call me on my day off just to tell me I forgot to chart a Q4 Neuro check on a pt. with dementia. She said I forgot to chart the 0400 neuro check and to correct it when I get back. And the tone in her voice was very condescending, as if I am a horrible-nurse-who-killed-all-of-the-patients kind of tone. I apologized and told her I will correct it. I just don't understand why she couldn't email me this or just tell me when I'm back at work?!! In all 7 years I have never experienced a charge nurse calling me on my day off to correct my charting (nor have I ever done it as a relief charge myself) and I don't know why it's bothering me so much. I am trying my best to fit in with these nurses and just lay low and adjust and adapt, but I feel like it is just going to get worse from here and I've only been here for a month. And although I have 7 years of acute care experience, I am feeling like a new grad once again, with anxiety about returning to work, or what mistakes are they going to point out. I am missing my old job very much, but I need the money from this new job. What do you guys think? Advice please!

[Nurse Beth, MSN]

At my new bigger hospital, I am currently working nights on a super slow stroke unit, where all of the nurses are 98% Filipino (older crowd) and they speak Tagalog for most of the 12 hours. I myself am Filipino American, so I don't speak Tagalog and I wouldn't want to anyway because I don't think it is professional to do so out in the nurses station. Patients have even written formal letters of complaints to the hospital about nurses speaking in Tagalog in front of patients (and saying horrible things--little did they know that the one patients friend is half Filipino and understood every word). I do understand the language and have heard them speaking badly about other nurses from other ethnic backgrounds. So the culture of "Tagalog speaking" has thrown me off and has me kind of feeling like an outsider even though I am Filipino American. Also, I feel as though they don't like me because although they speak to me in Tagalog, I always answer back in English.

Other nurses from day shift have even warned me to be careful with these charge nurses because they will "do anything to get you in trouble." I've even had one of the night shift charge nurses urgently call me on my day off just to tell me I forgot to chart a Q4 Neuro check on a pt. with dementia. She said I forgot to chart the 0400 neuro check and to correct it when I get back. And the tone in her voice was very condescending, as if I am a horrible-nurse-who-killed-all-of-the-patients kind of tone. I apologized and told her I will correct it. Advice please!

Oh, no. You landed in a closed-group clique. Or maybe the Mafia? I'm so sorry. They are showing you that they are the boss, and you are the newbie in their territory. This hazing may pass, but this group has its own behaviors, rules, and rankings, and it's clear they have been allowed to operate with impunity.

You can either choose to give it more time and ingratiate yourself into their good graces (doable with effort) or decide this environment is overall too toxic and leave. Best wishes.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

I think the majority of this could just be misguided perception on both sides. Perhaps you allowed the day nurses to invoke or embed their opinions of the night shift nurses onto you. If you speak the language that the other nurses are using when they are speaking to you, why do you answer in English? If these 'complaints' are not addressed in policy, don't concern yourself with them. Patients will complain just as hard, if not harder, about someone who speaks English if the spoken word is not stating what they want to hear. You have the better of both worlds in my opinion. Make it work to your advantage.

I've had some awesome Filipino co-workers and have not had any issues; and I only speak English...and slang, of course.:-) But I do know that some cultures are a stickler for detail, on and off the job. If the SCDs are ordered, put them on...unless the patient refuses. You don't know what issues those nurses may have had prior to your employment. Maybe they've had to deal with anal physicians that you've not yet had the pleasure of meeting. Maybe Risk Management or the Informatics nurse has ripped them a new one in the past about an incident regarding documentation...of lack thereof...on a neuro patient (hence the big deal about neuro checks). Trust me, in a larger hospital, the culture can be very cutthroat on some units. Going with the flow of the unit (if it doesn't affect patient care) will prevent a lot of daggers in the back.

You are in the perfect position to be the go-between and possibly effect change in your new position. Try injecting a little humor into your work. Show them that you are that team player. Offer to help even when you know they don't need it. Initiate conversations about patient care. Share your thoughts about an issue and solicit their advice and/or opinions. Show them that you are knowledgeable without appearing to be a know-it-all. And in downtime, if there is such a thing, bring up a topic of interest that you think you all may have in common. Better yet, talk about your years of experience in a small, rural hospital and ask them to help you to understand the culture and what is expected of you as a nurse working in a larger facility.

It is a different world in the larger hospital. There is limited time for chit-chat; you rarely run into your neighbors; and a lot of the people you encounter, you will not see them again until the next hospitalization. In other words, the environment is not as forgiving as the smaller hospital. Don't be surprised to start feeling like it's more about the dotted i's and crossed t's, and patient recovery and discharge is a welcomed side effect of your efforts to safeguard the infamous bottom line. Big Business is not just found on Wall Street and the like.

Make an all-out effort to get to know your co-workers and for them to get to know you and your work ethics, all on a professional level. Good luck to you!

[abnormal_saline]

Exactly. My cousin refers to them as "the Filipino mafia!" It definitely feels like hazing, and I am not thrilled about having to go through it. I am just baffled at how they are able to get away with such behavior. It is annoying to say the least. I have 3 months to think about leaving, after that I'm stuck with an 18 month obligation due to the sign on bonus that comes with the job. If I didn't need the money, I would've just stayed at my old hospital!

[abnormal_saline]

It actually is policy to not speak any other language other than English out in the nurses station, but they continue to speak to me in Tagalog, within earshot of patients and their families. All of the things you mention sound great in a welcoming environment, which is the exact opposite of what I have encountered. The crowd I work with have their own "clique" and just want to clock in, work, and clock out. I used to have a lot of humor with my coworkers and bosses at my smaller hospital and it made work awesome. No one laughs or makes jokes on my new unit and it's HORRIBLE. 12 hours goes by sooooooo agonizingly slowly.