Nursing: Culture of inclusion, or culture of exclusion?

Thunda · Dec 9, 2011

whelp... had a nice post written... made the mistake of clicking the "bb code" link below this box and instead of opening a new tab/window it deleted everything I typed... /sigh

Ruby Vee, BSN · Dec 10, 2011

nurses are said to be the most trusted professionals. i've been in nursing a long time, and over that time i've heard many patients and staff express agreement with that evaluation. i've also heard a few nurses disagree strongly.
there has been a lot of discussion about how compassionate nurses are, how much we give of ourselves, how nursing is more a calling than a career.
i agree with those descriptions as well. i respect nursing as a calling rather than simply a job, and i treasure the souls who give their all to care for others.
there is occasionally another view of nursing, one that sees more humanity than saintliness.
we all know of nursing as a profession that can eat its young.
many of us know or have heard of units where the culture is all too often one of back-stabbing.
this thread is offered for ask if there are any nurses who would like to share their own views or experiences to answer the question:
"are there some work places where our ideals fall short, and the facility or unit culture needs healing as much as the patients in it?"
put another way, are we always kind to our own, or are there instances when the "team" culture is one of exclusion rather than inclusion?

on the one hand, you view nurses as all saintly and compassionate; more than human.

and on the other, you view them as young-eating backstabbers.

personally, i disagree with both views. nurses are humans and we are professionals; we do a job and earn a living to support our families. we are not angels of mercy. nor are we nasty backstabbers and young eaters. in this era of "everyone gets a trophy", too often "everyone" hasn't learned to handle criticism. any feedback that is less than enthusiastic or less than completely positive is viewed as "eating our young." i think we need to get over this "nursing eats their young" kick and learn to hear constructive criticism.

MomRN0913 · Dec 10, 2011

no one is ALWAYS kind to their own.

I have been fortunate to have never had a problem with the nurses eating their young situation except for the bitter old hag who has thinks she is better than everyone and needs to prove it. Otherwise I have been fortunate enough to have some great relationships with coworkers, both personal and professional.

Some units have more hostility and aren't such a united front, others are like family. Just like any other company or corporation you work for. I think when their is a bond in nursing, however, it is stronger, because in some units, like ICU, you rely eachother to keep a patient alive.

allnurses Guide · Dec 10, 2011

whelp... had a nice post written... made the mistake of clicking the "bb code" link below this box and instead of opening a new tab/window it deleted everything I typed... /sigh

I hate it when that happens! I've accidently hit an ad link or a back button and poof!! My "masterpiece" is in the ether. I usually step back for a breather and try again. We want to hear your thoughts.

I have had several careers in very large corporations before coming to nursing. I never felt so stressed out and felt such hostility in any other job for the 25 years before I became a nurse. It was quite a culture shock. Yet in spite of that, I :redpinkhe nursing.

There's been an influx of people who are in many cases accomplished in prior careers. I think your needs and our expectations need to be tailored as many of us still think "student" as a college age first career person. This leads to bruised feelings and miscommunication at times.

I'm sorry you went through that. I was so lucky to have great instructors and manager role models. When I started we had 2 weeks of classroom orientation and then we were assigned a "buddy" :) Yep, that's what they called them then.

To answer in more general terms I can say that in my experience the entire field is not a culture of exclusion because every environment I've worked in has been different. Only one of them was intolerable to the point that I quit the job. This was due to a big-fish-small-pond person (hired by the Medical Director who rarely showed up) who viewed her job as a dictator of a country of 7 people and buddied up with the unit secretary to systematically tear everyone else down as they gossiped and made snide remarks all day long.

That was a toxic unit. Other petty criticizing and one-upsmanship that has occurred is usually one person who chooses to disrupt things. Those people are everywhere, unfortunately.

The most important element in my experience is the manager. They set the tone. They deal with the back-stabbers. They should be aware of what is happening and not hidden away in a cubicle somewhere. I was blessed with good managers when I started out, so I had the gold standard to compare to.

kbdavis · Dec 10, 2011

Hi,

I have been a nurse for almost 20 years and I have seen both inclusion and exclusion. Unfortunately, the larger the unit, the larger the hospital, the worse it is most of the time. I think nurses are so eager to prove their worthiness that they can feel threatened by "new meat" I have been an instructor and had some units that are wonderful, appreciative, caring and loving with my students but others that were down right vicious. We need to help the new grads. Nursing school is so much harder now. They have to know so much more than us older nurses did. The patients are sicker, the acuity higher and the culture is much more tech. advanced. Please be kind.

msn10 · Dec 11, 2011

too often "everyone" hasn't learned to handle criticism. Any feedback that is less than enthusiastic or less than completely positive is viewed as "eating our young." I think we need to get over this "nursing eats their young" kick and learn to hear constructive criticism.

It all depends on how constructive the criticism is. Yes, some people are overly sensitive, but most people can handle feedback on performance. You can give feedback, even difficult 'you made a mistake' feedback without being critical. No one should get a trophy for making a med error or not understanding a policy. When giving feedback in these situations, it is important to figure out why they made a mistake and give them tools to make sure they don't make them again. Horizontal violence, backstabbing, gossip, & cold shoulders never really taught anybody anything constructive except how to be mean themselves.

just keep swimming · Dec 12, 2011

"Are there some work places where our ideals fall short, and the facility or unit culture needs healing as much as the patients in it?"

I had not really thought of this until we got a new administrator a few years ago. She immediately began weeding out negative staff who were dragging morale down. Now when she hires, she may not hire the most qualified if they do not seem to fit in with the culture of our unit. She says that skills can always be taught but personality cannot. I wasn't so sure of this approach in the beginning but the difference I have seen has been amazing. I think that sometimes we forget how much we are influenced by those around us and just get used to working amidst negativity and "toxic" employees.

Negativity encourages negativity. Nursing is not a culture of exclusion in itself but can be made to feel that way when negativity abounds.

CapricaNurse · Dec 12, 2011

.... I'm not sure that cultural purity and silencing dissent are ideal. If history is any indicator, they are far more toxic than one person's opinion.

Bravekids · Dec 13, 2011

I was raised in an environment where I could say whatever I wanted to say...I just had to watch how I said it. Of course we should tell nurses, experienced and new, the truth about their performance on the job. A patient's life might very well depend on doing so. However, who says this cannot be done with some class? I am sorry and ashamed to say that I have seen many nurses, male and female, treat each other poorly over the course of my career. I have been a Pediatric RN for 26 yrs and recently crossed over into adult medicine. I did this to become a better teacher...which is the end goal. I feel like a new RN in this foreign environment and I have not always been treated well or even professionally. Twenty six years ago the behavior I have seen would have made me cry...today it just makes me so angry I could spit. I respect the knowledge these adult medicine nurses have but being a good RN doesn't make one a good teacher/preceptor. I will admit that I underestimated how hard adult medicine nurses work and the extent of their knowledge base. But I am working hard and I will catch up. I have been told that it will not take me long to "lose my smile and mushy attitude". Wanna bet.

Rob72, ASN, RN · Jan 5, 2012

.... I'm not sure that cultural purity and silencing dissent are ideal. If history is any indicator, they are far more toxic than one person's opinion.

"Tolerance", "diversity", and "acceptance", have been the employment mandates for the past 25-odd years. Turnover in the profession is still high, compensation comparatively low, and satisfaction reports, from any given corporate facility, are also fairly low.

Press-Ganey's model of scripted service, and check-point satisfaction ratings are designed to remove the personal impact of patient care/sercvice, and replace it with a homogeneous, "purified" model- that we all recognize as dysfunctional.

Referring to history, and using the School of Business' own research- effective leaders are "born", not made. Granted, ego-dynasties are dangerous things, but having an empiracle professional model of responsibility, strong ethics, and positive outlook negates that risk.

We do not have such a professional model, we have a "customer service model", in which all members are equally disposable, unless insulated by sufficient layers of bureaucratic incompetence.