Develop a Thick Skin - How?

  1. I am a new grad nurse, having worked for a couple of months, and only a short while on my own in a busy medical/surgical unit. I am a gentle soul, soft-spoken, and have manners ingrained in me from childhood. I strive to be respectful and professional, particularly at work.

    As a nurse, I am not surprised to be the "whipping boy." From HUCs sniping at me when I ask to a question, to PCAs rolling their eyes at me when asked to do something, to other nurses being blatantly rude to me if I have a question, to doctors chewing me out on the phone ... I knew this was coming and I know it is something that I need to get used to.

    My unit is not bad compared to what I have read here. But when working with people, each day, I know that some negative encounters are bound to happen. However I am very sensitive and it effects me. Mostly takes me aback and makes me upset. With the stress of the job, today I was almost in tears after a particularly rough afternoon. I do not want to be a blubbering mess at work. I can't seem to stand up for myself. What can I do to be more assertive in these kinds of situations?

    Some scenarios --
    Ask HUC a question, didn't realize she was on the phone, HUC snaps at me and basically tells me to shut up.

    PCA tells me she is leaving a patient's tab alarm off because she feels he doesn't need it. I tell her I think it is still necessary and to put it back on, and she walks away rolling her eyes at me and avoids me the rest of the day.

    Patient's daughter is a zooligist and is ranting on the phone at me because she thinks the patient needs X, Y, and Z treatment.

    Doctor yells at me because I called and asked for an order that was already placed. (my fault, it was during a rapid response)
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    Joined: Jan '10; Posts: 221; Likes: 189
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  3. by   classicdame
    people are short tempered and short of manners as well. I think I would write up an employee who yelled at me for any reason. That is called bullying or harrassement and is against policy in our facility, even if an MD. Thick skinned means you don't take everything personal. But I might have waited till a calmer time then tell the nurse I did not appreciate her yelling at me and tell the PCA if she has a problem with you then both of you can go to the manager. A lot of times it is best to let things slide. It actually makes people think you don't care enough about the situation to get upset and that is revenge enough.
  4. by   RNJill
    I, like you, am naturally on the soft-spoken and reserved side. Fortunately, I work in an environment that is not hostile, but even so I still have had my fair share of nasty encounters over the years. The best thing I have found to do is to remain as calm as possible in all situations (definitely easier said than done)-but one the flip side of the coin, I think at some point you do have to say something when you notice a pattern with someone. If someone consistently has a nasty tone with me (NOT just a few random times when it could be deduced that something stressful is happening), I tell them in a controlled way that I will not allowed myself to be talked to in that manner. If they start to argue, I calmly (sooooo hard to stay calm sometimes) tell them that it is not up for discussion; I am simply letting them know that I will not be having a conversation in this way with them.

    If you had told me a few years ago that I would say this to people, I would not have believed you. But seriously, a day will come when you will just find some steeliness in you that will transcend the quiet side without you even being fully aware of it. The amazing thing is that often after saying this, people have either apologized or been shocked enough that they have been much easier to deal with.

    Also, if your manager and/or charge nurse is approachable and these incidences are occurring frequently (especially with certain individuals), you should consider bringing your issues to them in an objective manner. You might find that they will deal with the issue in some way and the people you have difficulty with will be less aggressive.

    Good luck!
  5. by   Nascar nurse
    Quote from sagremus
    Some scenarios --
    Ask HUC a question, didn't realize she was on the phone, HUC snaps at me and basically tells me to shut up.
    - Let it roll right off your back. Not really a big deal and who knows what conversation she was in the middle of.

    PCA tells me she is leaving a patient's tab alarm off because she feels he doesn't need it. I tell her I think it is still necessary and to put it back on, and she walks away rolling her eyes at me and avoids me the rest of the day.
    - Again, I'd probably let it roll off my back - the first time. Second time, I'd take them aside and explain why I thought it was appropriate and make sure they realized that my decision was final. Remind them "no attitude needed, let's just keep the patient safe". 3rd time - Start putting it in writing. This isn't about you and PCA - this is about keeping patient safe. Don't let it work on you. Just deal with it and move on.

    Patient's daughter is a zooligist and is ranting on the phone at me because she thinks the patient needs X, Y, and Z treatment.

    Urgh! Most annoying. Let her rant a bit and then tell her you will take it up with the Dr. Again, this still isn't about's about the patient and you actually have little to no control on the outcome of this one. You are merely the messenger between the 2.

    Doctor yells at me because I called and asked for an order that was already placed. (my fault, it was during a rapid response)
    Oops - so who's perfect? Kick yourself in the rear, learn from your mistake, forgive yourself and move on. The Dr. has already moved on and has probably already yelled at 6 other people by now.

    How do you grow a thick skin = time. In time you will realize that most times the anger from others really had little to do with you. I used to wallow in situations but learned that others forgot some of these little incidents long before I forgot the sting. Once I learned to let it roll life got easier.
  6. by   MJB2010
    I think you just have to get used to it. Once you feel more comfortable in your job and have more confidence, you will not take that kind of crap anymore. It takes a little experience, and sometimes just getting pushed a little too far sometimes for you to stick up for yourself. And do not take it personal, everyone goes through it. The staff is overworked and overstressed and they probably do not mean it personally toward you. You also have to choose your battles. With a cna leaving an alarm off, that is one I would be certain the alarm was on, it is your responsibility to make sure the patient is safe.Maybe explain WHY it has to be on, educate instead of just order or argue with her. In time you will know who you can trust, and the cnas in turn will decide if they trust you. The secretary and Dr honestly just seem like they were too busy or too stressed. We all make mistakes, we all snap at each other on occasion. But we work like a dysfunctional family, too when we need to. 
  7. by   Davey Do
    I empathize with Your Plight, sagremus. Quiet, Even-Keeled People are often seen by Bullies to be Fodder for Fanforonade, and you've recieved Some Good Advice and Perspectives from the Other Posters.

    I have no trouble being Assertive and Calmly and Objectively Confronting anyone on their Inappropriate Behavior. However, My Lady Belinda tends to be more like yourself, sagremus. She worked with a Doctors Group for 17 years before going into Med/Surg Floor Nursing. She flowed with her Previous Place of Employment but was being somewhat Bullied by Some of the Staff in the Hospital Unit.

    I worked with her for Quite a While before she could be Assertive, yet be Herself, when Confronting Inappropriate Behavior from Supervisors, Peers, and Co-Workers.

    Belinda and I would discuss a Particular Scenerio, examine the OP's Behavior, Her Thoughts and Feelings on the Matter, and Brainstorm Ideas for Different approaches.

    In One Instance, when Belinda knew she was going to be Called on the Carpet by her Supervisor for an Incident she was present for on her Unit. We practised some Role Playing, with me Playing the Part of Her Supervisor. Being somewhat familar with Belinda's Supervisor's Behavior, I approached Belinda in a Similar Manner that I believe Her Supervisor would. Belinda and I worked on Her Answers.

    For example, I encouraged Belinda not to start a Statement with "I feel as though..." since Feelings are based on Emotions and Beliefs are based on Facts. If something is A Fact, a Belief, then state Your Belief as though it were A Fact. So, instead of saying something like, "I feel as though the Nurse did what she could in this Situation", Belinda rephrased her statement to say something like, "The Nurse acted according to Policy and Procedure in dealing with this Situation".

    Belinda and I worked on Different Questions and Possible Retorts in Our Role Playing Session, almost like a Lawyer and a Client. By the time Belinda had her meeting with her Supervisor, her Anxiety had decreased, she felt more Self-Assurred, and went through the Interrogation Process well.

    Some of Us are Naturals when it comes to Difficult Interactions. Most of Us are Uncomfortable with any Sort of Conflict. Until I learned a Few Techniques and actually put Those Techniques into Practise, I, too, was uncomfortable with Difficult Interactions. Now, after dealing with Aberrant Behaviors for the Majority of My Life and Creer, I feel much more comfortable. It took Practise, Trial and Error, Studying People and Their Behaviors, and finally, knowing that I was Correct in My Judgement before I could OBJECTIVELY approach an Individual and Confront Them on Their Inappropriate Behavior.

    Now, I don't Go Looking for a Fight and I Prioritize where I will Expend My Energies. Some Circumstances ARE best Left Alone. However, if Another's Behavior can Tick Off a Saint, then That Behavior needs to be deal with. And the Culprit needs to HAVE to deal with The Natural Ramifications of Their Actions.

    The Very Best to You, sagremus. Good Luck in Growing a Thick Skin without loosing any of Your Sensitivities. We need People like you as a Point of Reference for the Rest of Us.

    Last edit by Davey Do on Oct 3, '12
  8. by   RNperdiem
    Getting older and losing some of that youthful self-consciousness helps.
    Developing skill and better communication skills takes time, there is no shortcut.
    Learn to avoid negative self talk. Never say things to yourself like "I am so stupid", instead say "I am learning, and doing the best I can right now".
    For me, becoming a parent taught me most of what I know about assertiveness. The kids would have eaten me alive a long time ago if I didn't develop a thick skin.
    Best of luck.
  9. by   jadelpn
    Some people have no filter. The best thing you could do for yourself is continue to conduct yourself how you have been raised to do so, and don't get caught up in the less than desirable behaviors. It may not seem so, but people will take notice of your professional and polite behaviors. That you are well mannered WILL pay off in a multitude of ways in the long run.

    Doctors chew a number of nurses out on the phone, regardless if one is polite or not. It should not be a standard, but please don't take that personally. Be sure you are clear and well informed in your communication. I would most definetely start with " We are in rapid response for patient xyz, who is experiencing blah blah. He has blah blah ordered, do you want changes? Can we give ativan (be specific in what you are looking for) and are you coming in to see this patient, currently the ER doc is running this response, do you have any specific orders before we hang up? Verify and repeat if the MD does, if he doesn't than you have CYA in informing and asking.

    I don't know what a HUC is, but make sure you look to see if someone is on the phone--and I would write down questions so you will remember what it is you want to ask. Sometimes (at least for me) I have to or 20 minutes later I am forgetting details of specific questions. When this person is off the phone, I would say "I have just a couple of questions. Is now a good time? They are regarding my patient and I would like your thoughts/advice/guidance". Sometimes if you are clear that as the more experienced nurse, you are looking for guidance, the communication goes much better.

    And as far as the tech/aide informing you of not putting on the alarm....I would nicely state that although you appreciate her input, that for now, your assessment is such that you will keep the alarm on. But that you will go into the room and speak with the patient about the reason why. And thank you for advising me about the patient not wanting the alarm on, but please go place it back on, and let the patient know I will be down to discuss it is 15 minutes. Chart same, and education regarding same.

    And patient's families DO occasionally have to impart their 2 cents worth of web MD. The only thing that you can do in that instance would be to listen, empathize, and state that this conversation needs to happen with the doctor, as you will let the doctor know when he rounds that the family has questions. Or if appropriate, let social work know a family meeting has to happen to discuss plan of care, and let daughter know that you will do that.

    I have raised my children to be well mannered and polite. So I side with your parents on making it an important part of your upbringing. Please be wellll aware that there is not one thing wrong with that. It can be overwhelming when you realize that people in your work life may not feel the same way. That is them, not you. So do NOT pick up bad behaviors as a way of "survival". You will learn in time that once you leave work, you can surround yourself with whomever you choose to. But while you are at work, DEEP breath, you are OK, this is NOT personal communication, everyone has (or SHOULD have) the same goal of the best for a patient. Keep advocating, keep your polite professional tone, and do a little side research on the art of communication/negotiation, so that the tears will not come, as you are negotiating and communicating--NOT having a personal conversation that pertains to you, but what is best for your patient's outcome.

    Best of luck, and it is refreshing that there are still manners left in the world!!
  10. by   redhead_NURSE98!
    A zoologist? "So you want me to treat your mother like you would treat a zebra? Okay!"
  11. by   Wild Irish LPN
    What a timely posting OP....I feel you, I really do....I too am that same gentle soul, well mannered and respectful of my fellow nurses....well everyone I come in contact with to be honest...when I started my first nursing gig out of school I found my self nursing in Corrections, and people thought I had lost my mind for making this was no secret that my new peers thought I would be chewed up and spit out by the inmates, and by them....I was told my "politeness and manners" will only set me up for manipulation by these inmates, and that my days will be few if I didn't "toughen up"....but something interesting happened along the way, I was treated with nothing but the same kindness and respect that I gave out, to the inmates as well as my fellow nurses....point is, I didn't change a damn thing, I stayed true to myself and my own convictions....and so should are a rarity in my eyes, and nursing needs more of you....I am willing to bet that you're positive mojo will end up winning the day, maybe not today, but down the line....people cannot help but respect others that follow these principals, they may not show it, and in fact they may strike out against it....but that is only because they admire it, and they do not practice it themselves....stay strong, stay who you are....because honestly, you sound pretty damn good to me....

    Btw, at my jail where I work I have been assigned to the "Max" floor, and this was done because of my effect on some of the worst of the worst offenders....yes, they are criminals but my role as a nurse is to care for these people...not to pass my own judgement upon them, that has already been done by the justice I treat these people with the same amount of respect and dignity that I expect from others, and I get it back in buckets....being that I am the only male nurse on staff I think that these inmates are shocked that this is coming from a man, but they appreciate it and it makes my job much easier....

    Stay strong and never let them tell you that you need to toughen already are....Peace....
    Last edit by Wild Irish LPN on Oct 4, '12 : Reason:
  12. by   HippyDippyLPN
    I too was like you and still am a bit. very sensitive and took things personally. with time being on the job as a nurse and just growing a bit more mature I realized other people's negativity isnt worth my energy ( now of course is someone is harrasing you that is different and calls for management involvement) but when a co worker snaps at me, a md gets *****, or a pt is being difficult I just dont react to it and i brush it off. I have a natural happy disposition and I have spent way too long of my life/nursing career letting other's people negative attitudes affect me so I dont let it anymore. I kill my difficult pts w/ kindness ( works 95% of the time, most people cant be ***** for long enough towards a nurse listening with interest and being kind and if it doesnt they cant say I was rude!) with my md's I dont even get them a second thought if they are having a moment unless its something I can learn from, and with my co workers most of the time the snips are when we are all under pressure and I have done it myself too so I think we all have a mutual understand that we all might get snippy sometimes and to not take it personally.

    And I agree with pick your battles. If I am really offended or feel I have been treat un fairly I rate it on a scale of 1 to 10. If its a 1 through 7 usually its not worth my time to do anything about but if its a 8-10 I take action and its always worked well in my favor. Most of the times its a hey look I didnt appreciate XYZ, if you feel like I am doing something thats not working for you could you just discuss it with me in a appropriate time and manner and we can go from there? I think a lot of times people just dont realize how they come off and if you approach them in a calm/confident manner it can usually get resolved.