Why are nurses so hard on each other?

[Dragonsmack]

I am not a nurse but do read the forums..just curious why so many nurses are hard on each other. I understand the need to be surrounded by competent people but wouldn't helping your coworker out be better than treating em crappy/blacklisting them?

Anyway, my 2 cents..

John

[metal_m0nk, BSN, RN]

4) No, most everyone who posts on this site seem to be newbies who get chased away by the shrill, vitriolic responses of you and your admirers, who are good at putting people on the defensive. You're pretty good at talking down to people, too. Fortunately, I don't care how many years experience you have in nursing, nor do I think your "I totally graduated in '77" claim lends your comments any veracity, unless they deal particularly with your area of expertise, which is clearly not relating to people.

Daaaaaaaamn, Gina...

[Jules A, MSN]

No one is innocent. Still, that is no excuse for lateral violence. If you (not you specifically, but "you" in the general sense) cannot, as a trained and educated professional and as an adult, endure the shortcomings of average people without resorting to ongoing belittling, deception, snubbing, excessive and/or unconstructive criticism, gossip, etc., then you are the one who needs help.

There are people who are particularly sensitive to lateral violence/bullying and may see it quite often in places that other people wouldn't. If you've never been bullied for an extended period of time, you might not understand the real physiological changes it produces. Its a form of post traumatic stress, a heightened sense of awareness and defense. Maybe to a bully, PTSD looks an awful lot like a bullseye. I don't know. Never actually been a bully myself.

However...

If someone tells you they've been bullied before, that should be your cue to respect their boundaries, back off, and try to build some trust rather then trying to convince them (and anyone else who will listen...) that they're actively inciting abuse.

But we really have to leave our personal baggage at the door. I wonder how much lateral violence stems from competency concerns as opposed to "accepting shortcomings of average people". I'm fortunate that almost all my team members, whether I like them personally or not, are highly competent and that makes things run smoothly but in the couple of cases where someone wasn't cut out for our unit it was pretty clear to everyone and that doesn't make us nasty or eating our young. It is expected that there is a minimum skill set that comes with being a nurse even for new grads, imo. Not every unit is going to be a good fit for every person. Whatever happened to accepting that you aren't suited for a particular situation and finding one that works for you?

[metal_m0nk, BSN, RN]

But we really have to leave our personal baggage at the door. I wonder how much lateral violence stems from competency concerns as opposed to "accepting shortcomings of average people". I'm fortunate that almost all my team members, whether I like them personally or not, are highly competent and that makes things run smoothly but in the couple of cases where someone wasn't cut out for our unit it was pretty clear to everyone and that doesn't make us nasty or eating our young. It is expected that there is a minimum skill set that comes with being a nurse even for new grads, imo. Not every unit is going to be a good fit for every person. Whatever happened to accepting that you aren't suited for a particular situation and finding one that works for you?

That goes for all people. Seriously. If a person can manage to leave the belittling, deception, snubbing, excessive and/or unconstructive criticism, and gossip (personal baggage) at the door, a problem would likely never develop. I said nothing about accepting the shortcomings of average people. I said endure:

Adults should know how to manage their desire to criticize and relegate it to a place, time and manner that is appropriate and respectful...

Adults should know how to manage their emotions so that their behavior doesn't threaten, but teach...

If a person can't manage to keep the disgust/anger/sarcasm/irritation/exasperation out of their voice, verbiage and body language when communicating in a professional setting, then that person needs to take a step back and go learn how to behave respectfully and professionally. If it's a behavior you (general you) learn from doctors/patients/etc, then realize that they have a problem, shake it off, and lead by example - don't continue to poison your work environment.

If someone is not performing their job functions appropriately or timely, then document and when you've amassed a large enough body of evidence, take it to someone who can do something about it.

If someone is not performing their job functions safely, document and present the information as quickly as possible to someone who can do something about it.

Honestly, your personal expectations probably aren't as important as you believe. Whoever hired the newbie thought they were appropriate for the position. You are likely not the judge of whether or not a unit in particular is a good fit for a person and if it was thought that you were, you would have likely had some input in the hiring process. You are however, probably expected to contribute to making the transition run a little more smoothly if you can. There is always a period of adjustment when someone takes on a new situation. If it goes beyond the point of adjustment (in your opinion - which may differ from the charge nurse/DON/etc) then (again):

If someone is not performing their job functions appropriately or timely, then document and when you've amassed a large enough body of evidence, take it to someone who can do something about it.

If someone is not performing their job functions safely, document and present the information as quickly as possible to someone who can do something about it.

[nursemike, ASN, RN]

No one is innocent. Still, that is no excuse for lateral violence. If you (not you specifically, but "you" in the general sense) cannot, as a trained and educated professional and as an adult, endure the shortcomings of average people without resorting to ongoing belittling, deception, snubbing, excessive and/or unconstructive criticism, gossip, etc., then you are the one who needs help.

There are people who are particularly sensitive to lateral violence/bullying and may see it quite often in places that other people wouldn't. If you've never been bullied for an extended period of time, you might not understand the real physiological changes it produces. Its a form of post traumatic stress, a heightened sense of awareness and defense. Maybe to a bully, PTSD looks an awful lot like a bullseye. I don't know. Never actually been a bully myself.

However...

If someone tells you they've been bullied before, that should be your cue to respect their boundaries, back off, and try to build some trust rather then trying to convince them (and anyone else who will listen...) that they're actively inciting abuse.

These are some very good points. I've lately found myself in the position of unofficial mentor to some newer colleagues (I'm doing charge, occassionally, and the poor, benighted dears assume that means I know something, until they eventually realize I just failed to duck when the "honor" was being bestowed). Most seem to be going through pretty much the same process I did. Being a new nurse is traumatic in itself, but along with learning the job itself, you have to learn who is more approachable for questions and help--and, hopefully, also knows what they're doing. (I, for one, am more than willing to rub my chin and looked puzzled for anybody. But I do have a good grasp on who probably does know, so I guess that's something...)

Clearly, some newbies are more fragile than others. Even among experienced nurses coming in from other facilities, there are challenges to meet as you integrate into a new team. In many cases, it may be well worth the investment to help those who are having trouble fitting in. The first-year nurse who is struggling, now, may be an asset to the team as a second-or-third year nurse. Besides, you get to feel good about yourself. But even in my fairly limited experience, I've noticed that people who have a fair degree of personal confidence are easier to deal with. Nurses who come into a new environment with the expectation that most people will like and accept them are free to focus most of their concern on learning the job itself, and if you need to correct their practice in some way, they aren't personally devestated.

Others, who seem more inclined to be a victim, can be hard to help. Contrary to what is often expressed on these boards, I think submissive body language and evident anxiety generally provoke sympathy and patience. I doubt there are many of us who see a coworker burst into tears and say, "Oh, grow up." Of course, repeated breakdowns can lead to impatience with the water works, and realistically, if you're in tears every day, this is probably the wrong field for you. But I have seen experienced nurses, and been one myself, who might tell one newcomer, "Well, that was dumb." and have a good laugh with them, correct a more fragile newbie in a far more gentle manner.

On the internet, we don't have body language. The poster who asks, "Why does everybody hate me?" isn't showing a submissive posture, so there isn't the automatic instinct to repsond, "Nobody hates you." Often, too, the poster isn't quite as inhibited as they would be in person, so what they actually ask is, "Why is everybody so mean?" So not only do they not look submissive, but what they're asking is somewhat accusatory. This is not as likely to provoke sympathy, especially among those who are tired of hearing how mean they are. Sympathy lets us understand that the person who has a history of being bullied, or PTSD, or is painfully shy, or doesn't speak English well, needs extra help from us. Take away the element of sympathy, and it becomes easier to see, and say, that whatever the person's problem is, it is, ultimately, their problem. If I had a childhood trauma that left me terrified of black people, expecting others to stop being black would not be the solution to my problem. In that hypothetical scenario, I don't think we would applaud a black person who says, "He looked so terrified, it made me want to beat him up." But I'd think we could understand a black person who eventually got so tired of assuring me that he wasn't going to hurt me that he eventually preferred just not to be around me and maybe thought I might be happier if I spent less time in predominantly black neighborhoods, or even points out that a couple of white guys harassed him, once, and he didn't like it, but he got over it.

So, there may be some truth to the idea that people with a history of being bullied act in a way that "incites" those who are inclined to be bullies. But I also think the more common situation is that those who feel more vulnerable to bullying are apt to perceive bullying where others would not. And those no afflicted want to say that if you act more confident, you'll feel more confident, and you won't feel bullied so much, but eventually that turns into, "If one more person calls me a bully, I'm going to punch them in the nose."

[Jules A, MSN]

Never mind. :)

[hoope, RN]

Well ! Not all nurses... you are generalizing... I have seen nurses that are harsh & bad with eachother, but they are few... We work as a team .. Team work is more important in nursing than in any other occupation. So , a way or other nurses have to be good to each other , back each other and help each other.

In the unit that nurses work in - we are one family..

[metal_m0nk, BSN, RN]

I see your point that attitude does have some bearing on experience. I don't dispute that. Where it gets a little hazy for me, is where the responsibility for attitude adjustment should be directed. I think it's a dual responsibility - one that belongs to both newbies and 'residents'. I hear an awful lot about addressing the attitudes of those who are sensitive to workplace violence, and not much about addressing the attitudes of those who perpetuate workplace violence - except those who shirk all of the responsibility for their own actions, saying, "The wallflower made me do it." And I want to say, "This isn't high school or some childhood sibling rivalry. Even if someone else doesn't hold up their end of the bargain, you are still responsible for your half of the attitude adjustment...." That kind of thing...

Again, I think a real, professional, healthy, mature attitude would alleviate much of the issue - it can only have positive results, so why not do it? What's the point of being nasty when it seems the result is clearly toxic?

Others, who seem more inclined to be a victim, can be hard to help. Contrary to what is often expressed on these boards, I think submissive body language and evident anxiety generally provoke sympathy and patience. I doubt there are many of us who see a coworker burst into tears and say, 'Oh, grow up."

Here's the rub though....If one person does this sort of thing routinely, it is highly likely that even though not every person will respond that way, very few (if any) people will call a person on this response. Much of workplace violence is perpetuated by people who don't wish to get involved or don't wish to become targets themselves, so while they may feel sympathy and patience, the person on the receiving end of that gruff and demeaning tone may never actually see it. And that's a problem.

If I had a childhood trauma that left me terrified of black people, expecting others to stop being black would not be the solution to my problem.

Similarly, if I had a childhood trauma that was experienced and perpetuated because I was black, telling me to stop being black would not be the solution to my problem. Self-protection mechanisms are essential to survival and are deeply ingrained physiologically and psychologically. PTSD like physiological states are (hopefully) short-term, but no more controllable when in the thick of it than controlling skin color. If someone's PTSD response is not hurting anyone - and really not doing anything more than irritate you personally - then maybe it is best to let it be, or better yet, try to be supportive. Try extending a hand in friendship rather than in criticism. You might actually become part of the solution....

(Why do I feel like I've said this all before, just exactly the same way...Twilight Zone-ish)

Often, too, the poster isn't quite as inhibited as they would be in person, so what they actually ask is, "Why is everybody so mean?" So not only do they not look submissive, but what they're asking is somewhat accusatory. This is not as likely to provoke sympathy, especially among those who are tired of hearing how mean they are.

The folks who staunchly believe that the responsibility for an attitude adjustment belongs to the person who's been bullied before, have also said in no uncertain terms that if a person is being picked on everywhere they go, then perhaps they are the problem.

Why does that logic not also work in this example? If you're (general you, as usual) consistently bing told that you're being mean, maybe people are seeing and responding to something you're putting out there that you're not entirely aware of...

These are some very good points. I've lately found myself in the position of unofficial mentor to some newer colleagues (I'm doing charge, occassionally, and the poor, benighted dears assume that means I know something, until they eventually realize I just failed to duck when the "honor" was being bestowed). Most seem to be going through pretty much the same process I did. Being a new nurse is traumatic in itself, but along with learning the job itself, you have to learn who is more approachable for questions and help--and, hopefully, also knows what they're doing. (I, for one, am more than willing to rub my chin and looked puzzled for anybody. But I do have a good grasp on who probably does know, so I guess that's something...)

Clearly, some newbies are more fragile than others. Even among experienced nurses coming in from other facilities, there are challenges to meet as you integrate into a new team. In many cases, it may be well worth the investment to help those who are having trouble fitting in. The first-year nurse who is struggling, now, may be an asset to the team as a second-or-third year nurse. Besides, you get to feel good about yourself. But even in my fairly limited experience, I've noticed that people who have a fair degree of personal confidence are easier to deal with. Nurses who come into a new environment with the expectation that most people will like and accept them are free to focus most of their concern on learning the job itself, and if you need to correct their practice in some way, they aren't personally devestated.

Others, who seem more inclined to be a victim, can be hard to help. Contrary to what is often expressed on these boards, I think submissive body language and evident anxiety generally provoke sympathy and patience. I doubt there are many of us who see a coworker burst into tears and say, "Oh, grow up." Of course, repeated breakdowns can lead to impatience with the water works, and realistically, if you're in tears every day, this is probably the wrong field for you. But I have seen experienced nurses, and been one myself, who might tell one newcomer, "Well, that was dumb." and have a good laugh with them, correct a more fragile newbie in a far more gentle manner.

On the internet, we don't have body language. The poster who asks, "Why does everybody hate me?" isn't showing a submissive posture, so there isn't the automatic instinct to repsond, "Nobody hates you." Often, too, the poster isn't quite as inhibited as they would be in person, so what they actually ask is, "Why is everybody so mean?" So not only do they not look submissive, but what they're asking is somewhat accusatory. This is not as likely to provoke sympathy, especially among those who are tired of hearing how mean they are. Sympathy lets us understand that the person who has a history of being bullied, or PTSD, or is painfully shy, or doesn't speak English well, needs extra help from us. Take away the element of sympathy, and it becomes easier to see, and say, that whatever the person's problem is, it is, ultimately, their problem. If I had a childhood trauma that left me terrified of black people, expecting others to stop being black would not be the solution to my problem. In that hypothetical scenario, I don't think we would applaud a black person who says, "He looked so terrified, it made me want to beat him up." But I'd think we could understand a black person who eventually got so tired of assuring me that he wasn't going to hurt me that he eventually preferred just not to be around me and maybe thought I might be happier if I spent less time in predominantly black neighborhoods, or even points out that a couple of white guys harassed him, once, and he didn't like it, but he got over it.

So, there may be some truth to the idea that people with a history of being bullied act in a way that "incites" those who are inclined to be bullies. But I also think the more common situation is that those who feel more vulnerable to bullying are apt to perceive bullying where others would not. And those no afflicted want to say that if you act more confident, you'll feel more confident, and you won't feel bullied so much, but eventually that turns into, "If one more person calls me a bully, I'm going to punch them in the nose."

[nursemike, ASN, RN]

I see your point that attitude does have some bearing on experience. I don't dispute that. Where it gets a little hazy for me, is where the responsibility for attitude adjustment should be directed. I think it's a dual responsibility - one that belongs to both newbies and 'residents'. I hear an awful lot about addressing the attitudes of those who are sensitive to workplace violence, and not much about addressing the attitudes of those who perpetuate workplace violence - except those who shirk all of the responsibility for their own actions, saying, "The wallflower made me do it." And I want to say, "This isn't high school or some childhood sibling rivalry. Even if someone else doesn't hold up their end of the bargain, you are still responsible for your half of the attitude adjustment...." That kind of thing...

Again, I think a real, professional, healthy, mature attitude would alleviate much of the issue - it can only have positive results, so why not do it? What's the point of being nasty when it seems the result is clearly toxic?

For sure. There's nothing in this post I disagree with, just quoted part for brevity. The thing is, we never see threads from workplace bullies asking how they can stop. So when someone who is, or feels like, a victim asks for advice, my inclination is to look at the things they have some control over. And while I'm probably as guilty as most of trying to figure out whether a poster is a "legitimate" victim or just a big ol' crybaby, I don't really think that matters so much. Personally, I'm trying to adopt a policy of just ignoring posts that seem phony or foolish. I may or may not get trolled, but if I think I'm getting trolled, I'm free to not bite. Generally, if I respond to a post, I'm assuming what the poster says is true, or at least that they perceive it as true.

I think it's also true that those of us who don't consider ourselves bullies have some responsibility to police ourselves when bullying occurs. I'm a middle-aged male. It goes very much against my instincts to see my younger, female colleagues abused. Fortunately, I rarely see it, but when I do, I have to bite my tongue and wait to see how my colleague reacts, because most of these little girls are actually strong, smart, capable women who don't especially need my protection.

Equally rarely, but it has happened, I see a new nurse devestatated over something that isn't bullying. If a preceptor asks, "Did you remember to get a UA on that patient?" and the orientee bursts into tears, it seems rather unfair to call the preceptor a bully. I don't mean it's okay to tell the orientee, "Grow up." But I also don't think it does them a disservice to let them know they are going to have to deal with much worse things, and try to point them in the direction to be able to do so. Gently, yes, but also firmly, because standing around crying is not a useful role in a code.

I'm almost sorry I brought up the race thing, but if I can play that card one more time: I'm 5'6" and 260lbs. If I tell myself I can't play basketball because I'm white, you aren't helping me by agreeing that black people are so unfair. I don't mean to apply that to the OP, except that she, like all of us, will have to overcome her challenges to be a successful nurse. And I see no reason to doubt she will.

There are problems in nursing, no doubt. There are some malignant personalities with no business in a caring profession. There are kind, caring people who, in a moment of frustration, can give a short answer or roll their eyes. And there are people who say, "nurses are rude," and never stop to think, for example, that the OP is, herself, a nurse.

[celticgirl]

I've been fortunate in that the places I have worked are not too catty and I often think that different people have different thresholds for conflict. Personally if someone rolls their eyes at me I'm not ready to pull out Joint Commission guidelines and demand an intervention. I will however be the first to admit that in the rare instances where someone isn't competent it really makes it difficult not to become resentful. I am in no way talking about not helping each other or not assisting a new member but in team nursing someone who can't hold up their end becomes a liability to my patients, my staff and my license. Sorry if that isn't all hearts and flowers. :)

I think you have hit the nail on the head. I have also seen it where an incompetant nurse has been the catty one, I think to take the eyes off of her. If that makes any sense.

[metal_m0nk, BSN, RN]

...So when someone who is, or feels like, a victim asks for advice, my inclination is to look at the things they have some control over. And while I'm probably as guilty as most of trying to figure out whether a poster is a "legitimate" victim or just a big ol' crybaby, I don't really think that matters so much. Personally, I'm trying to adopt a policy of just ignoring posts that seem phony or foolish. I may or may not get trolled, but if I think I'm getting trolled, I'm free to not bite. Generally, if I respond to a post, I'm assuming what the poster says is true, or at least that they perceive it as true.

I agree with you there, as I have that urge too. Unfortunately though, often times there is someone (or a couple of folks) who take the concept a little too far, using the fact that the blame/responsibility is shared as an all-encompassing, no holds barred justification for bad/bullying/passive aggressive behavior. As though the very mention of shared blame completely gives them the green light to behave any way they want to...

So I feel inclined to draw a line there too. Because what you do when you go to that extreme is make the person who might take that advice (as in, taking responsibility for their own actions) feel...

- helpless (that they were only imagining things - so where do they start with self examination?)

- hopeless (reinforcing the feeling that even if they could be a totally different person tomorrow, the world around them will always be exactly the same)

- and shamed

It ends up serving the purpose of further abusing the sensibilities of someone who might be actively trying to make a change. Making that kind of transformation without recognition either that the blame is shared or that the person's concerns were legitimate is probably pretty impossible for most people. It makes me wonder if that's not exactly the intention behind saying something as irresponsible as, 'It's no one else's problem but your own."

[nursemike, ASN, RN]

Just noticed I've been responding, in part, to a different thread, so my references to the OP won't make much sense. But, yeah, that Bill Clinton, he's really something...

[vegas2009]

Hmm... because they --> CAN.

Unfortunately, it's like asking the question: Why do people cheat? Because they can. What I mean is, cheating on their spouses/partners/etc. One of the ugly realities of life. Being mean is also one of the ugly realities of life.