Nursing has a hierarchy of power and experience like any other profession; it also has a hierarchy that sometimes feels akin to the laws of survival on the savanna or in the jungle – the herd mentality at work.
Have you ever observed that the less experienced and more vulnerable nurses frequently get left on the outside, often falling prey to bullies and “predators”? This is the herd mentality at its worst, and many novice nurses are taken down by bullies and power-hungry colleagues who eat them alive when they’re demonstrating the slightest weakness.
Protection and Predation
Out on the African savanna, herds of gazelles keep watch for lions, one of their most fierce predators; the culling of the pack is a natural phenomenon, and lions need to eat just like anyone else. However, some naturalists notice that the sicker, older gazelles are left outside the herd, vulnerable to predation and outside of the safety of the circle. Young gazelles are naturally kept on the inside, their parents and elders protecting them and keeping them close, with the innate understanding that they are the carriers of the gene pool which need to survive into adulthood so that the species can thrive in the future.
In the healthcare environment, we often see a herd mentality; in this scenario, the experienced nurses make up the bones of the innermost circle of safety, and survival of the fittest is frequently the name of the game. But what about the newer nurses? Where are they in the hierarchy?
A Med/Surg Herd
Let’s consider a large Med/Surg unit where we find a mix of older, highly experienced nurses, some nurses two to five years into their careers, and several fresh-faced novice nurses in their first year.
Now let’s imagine a bully in the mix; she’s a nurse with 25 years of experience, a toxic personality, and a stranglehold on the unit culture. The administration is afraid of her, the nurse manager turns a blind eye to her egregious behavior, and most nurses keep their heads down and hope she doesn’t pick on or single them out.
The older, more experienced nurses may be relatively safe from the bully; they’ve known her a while, put up with her toxicity, humor her, or perhaps ignore her as much as they can to not call attention to themselves. Their silence is essentially complicity, and some may play into the bullying and tacitly empower her aberrant behavior. A bully can sometimes be a younger nurse who bullies older nurses, too; this power dynamic can work in both generational directions.
The New Nurse: Falling Prey to the Lion
Meanwhile, the newer nurses are fresh blood for the bully/lion/predator; they are unsure of themselves, need to ask questions, and are vulnerable to being singled out and stalked by the bully and her minions.
If the members of the nursing herd try to stay out of the bully’s way – or support her in being the bully – what does that mean for the newer nurses? It generally means they are kept outside the circle of protection and safety, left to fend for themselves against the nurse predator.
If you think of the nurses on the unit as a herd, the young are left outside to fend for themselves. The elders are primarily held in the center, cushioned against the attacks of the predator/bully; however, an elder nurse can also be deemed weak by the “herd” and thus ostracized to the fringes.
The calculus of this situation is untenable and unhealthy, with certain nurses receiving the short end of the stick; vulnerable novice nurses need nurturing and support, not the feeling of being thrown to the lion(s).
Extending the Circle of Safety
To counteract a situation that lends itself to the burnout and attrition of newer nurses (as well as those seasoned nurses who are vulnerable to bullies), the circle of safety needs to extend its protection to everyone. Rather than leaving more vulnerable colleagues to be picked off the edge by predators and bullies, the circle closes around those needing its reassuring sanctuary, whether older, younger, or somewhere in between.
Dr. Renee Thompson, one of the world’s foremost experts on nurse bullying and incivility in the healthcare workplace, has documented and communicated the subtleties and vicissitudes of this scourge through books, blog posts, articles, podcasts, keynote speeches, videos, social media, and the powerful work of the faculty of her Healthy Workforce Institute. As Dr. Thompson informs us, we must learn to speak up in the face of bullying and to protect those members of our team who are susceptible to a form of professional predation that sends many a nurse running for the exit, often leaving the profession altogether.
We must reject the adage that nurses eat our young; we can create and embrace a new paradigm where nurses nurture and empower their young instead.
This isn’t rocket science, but we nurses need to learn the skills that will help us to bully-proof ourselves, speak up in the face of bullying, end nurse predation, and enclose our colleagues in a circle of safety that keeps the lions on the outside and the vulnerable protected from harm.
We can make different choices, and it’s our daily decision regarding our path. I implore you to extend the circle of safety, protect the vulnerable, and bring a sense of community, safety, and symbiotic togetherness to your corner of the nursing world.
Minority Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
It is generally agreed that a vast majority of nurses choose the profession because they find fulfillment in being of service to others in their time of need.
Compassion, empathy, and kindness are hallmarks of what “nursesness” is all about, and even members of the general public are likely to associate those characteristics with nurses. And by now, we’re all aware that nurses have been at the top of the Gallup poll as the most trusted professionals in the U.S. every year for two decades.
In light of the mystique of compassion and kindness that surrounds nurses like a golden aura, why is it that stories of nurses being unkind to one another are so rampant? What about nurses making us treat one another so poorly, leading many nurses to leave the profession altogether?
Incivility Abounds
Stories of incivility, bullying and other unfortunate experiences are ubiquitous among nurses, and common refrains repeated again and again within the nursing sphere tell us that something is wrong out there.
A new grad nurse tells the story of a preceptor who seems determined to sabotage her orientation period, assuredly setting her up for failure and job loss.
A quiet, hardworking nurse becomes the undeserving target of rude and demeaning behavior by the “queen bully” on her unit. Other nurses follow the bully’s lead when it comes to treating this nurse with disrespect.
Several student nurses realize that their clinical instructor has it in for them, ignoring their requests for help during clinical rotations and harshly criticizing them in front of patients and peers.
Nurse bullying has received significant study, including the National Library of Medicine’s documentation of this unfortunate phenomenon:
Nurse bullying is a systemic, pervasive problem that begins well before nursing school and continues throughout a nurse’s career. A significant percentage of nurses leave their first job due to the negative behaviors of their coworkers, and bullying is likely to exacerbate the growing nurse shortage. A bullying culture contributes to a poor nurse work environment, increased risk to patients, lower Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores, and greater nurse turnover, which costs the average hospital $4 million to $7 million a year. Addressing nurse bullying begins with acknowledging the problem, raising awareness, mitigating contributing factors, and creating and enforcing a strong antibullying policy. Nurses and stakeholders also must actively work to change the culture, and understand that bullying has no place in the nursing profession or anywhere else in health care.
These statements are sadly true, and the problem is too well documented to ignore.
A Cultural Transformation
Within the nursing profession, a cultural transformation is desperately needed. Rather than nurses internalizing their oppression and taking it out on one another, members of this most trusted profession could choose to individually and collectively examine how they feel oppressed, mistreated, and otherwise overlooked. This type of examination can lead nurses to band together to create workable solutions without turning on one another like crabs boiling in a pot.
In terms of nursing education, schools of nursing need to confront bullying and incivility head-on. And since schools are so keenly focused on NCLEX preparation, this topic needs to become a part of the licensing exam curriculum so that schools have no choice but to talk about it. This ever-present reality must be thoroughly acknowledged, and schools should teach nursing students how to recognize such behavior and respond appropriately. And if clinical instructors and nursing professors are identified as perpetrators, they should be disciplined and fired if their behavior does not change.
There is no silver bullet that can singlehandedly change these dynamics overnight. However, one action by a nurse, executive, instructor, or manager can have a significant ripple effect. Nursing is uniquely positioned to be the largest segment of the healthcare workforce. We can squander or harness our potential power for our well-being. Nurses join collective action, striking for safe staffing, patient safety, or other needed changes. Positive change can be hard-won, but the camaraderie and unity it engenders are priceless.
Nurses deserve better from one another, and we can only effect change if we’re willing to do the work to dismantle a professional culture that looks the other way. Unfortunately, ignoring the problem won’t get rid of it, so let’s tackle it head-on and stop the hemorrhaging of nurses who would likely remain on the job if they were simply treated like the valuable human beings they truly are.
Minority Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
Nurse bullying is a big problem in the profession, but it’s under reported and not addressed as effectively as possible. And the reason isn’t as simple as nurses not wanting to speak up.
Sometimes nurses aren’t even sure the horrible behavior they are being subject to is actually bullying, says Dr. Renee Thompson, DNP, RN, CMSRN, and CEO and president of RT Connections, LLC, and author of “Do No Harm” Applies to Nurses, Too!,.
Bullying behavior can be quite obvious, but it’s just as often something so subtle the target isn’t even sure if the actions are intended. “Bullies will test the waters,” she says. “They will do something and see the reaction they get. If they are resisted, they will usually, but not always, stop it.” But if the behavior isn’t addressed immediately, the bully takes on power and the behavior can escalate.
What are some things to watch out for?
True nurse bullying behaviors and unintended coincidences can be separated by the pattern and the repetition you will see over time.
The most obvious, and for some nurses easiest to deal with, bullying is the in-your-face colleague who is yelling at you and insulting you. There’s no doubt what’s going on there.
But other things are much harder to really pin down. Dr. Thompson recalls hearing a story from a nurse who won an award and soon found herself with the most acute patients and more cases than any other nurses on the floor during her shifts. The nurse wasn’t sure if she just had a bad luck of the draw, but then she overheard a charge nurse indicating that it was on purpose to bring her down a few notches from her award. Startled, the nurse identified what was really happening.
Other times, nurses create situations to have other nurses fail. Maybe during hand off you weren’t given all the information you needed. “They set you up to make a mistake and then write you up for it,” says Dr. Thompson.
And what about the times when all the nurses wear the same jacket or they all order out lunch together and exclude one person? Or if a few nurses gossip at work and spread rumors? All these behaviors seem petty, but they really happen at some workplaces.
If you have ever seen or experienced these behaviors, Dr. Thompson says it’s a good idea to track what you see. Carry a small notebook and jot things down over a couple of weeks. “You are looking for a pattern,” she says, “not a one-time incident.” Even if you end up doing nothing with the information, Dr. Thompson says the very act of documenting can help you because it can help you establish a clear pattern of bullying. It can be a relief to know it’s not just your imagination.
Then you can choose a few options. You can confront the person in a respectful manner that’s supported with facts (which you now have thanks to that handy notebook!). You can say something like, “I noticed this is the fifth time in a row when you were in charge that I got all the patients with the highest acuity. Can you help me to understand why that is?”
If you aren’t comfortable going to your direct supervisor, you can consider going to your supervisor’s supervisor. You can also approach human resources, says Dr. Thompson. Check your company’s policy on destructive behaviors so you can present a clear case on what specific behaviors have been violated.
And, of course, if you can relate what is happening to how it impacts patient safety or patient care, you have a greater chance of someone doing something about it, says Dr. Thompson. If you went to a charge nurse at 2 am and asked about a patient in crisis and were told to handle it yourself, you have a clear example of how the actions are impacting patient care.
And Dr. Thompson doesn’t wear rose-colored glasses when it comes to nurse bullying. If your boss is best friends with the VP of human resources or with everyone in her line of command, you might want to just leave. “Get out,” says Dr. Thompson. “It’s just not worth it and you can go find a better place. You deserve to work in a great place.”
If nurse bullying is such a problem, why aren’t nurses talking more about it with each other?
According to Dr. Renee Thompson, DNP, RN, CMSRN, and CEO and president of RT Connections, LLC, and author of “Do No Harm” Applies to Nurses, Too!, most nurses don’t openly discuss bullying in the workplace because of some really basic reasons.
“We don’t talk about it because we are afraid,” she says. “We don’t talk about it because of the fear of retaliation, because we fear we might get terminated, and because we don’t know what to say.” And while nurses want to hear they won’t lose their jobs or they won’t get the worst assignments if they speak up, in reality, those very things could happen.
Nurse bullying isn’t new, says Dr. Thompson, although it seems to be getting worse. And while nurse bullying is a hot topic in the industry, it pops up in the media sometimes. Why? Well, the public has a hard time digesting the topic and they don’t want to think the nurses taking care of them could be tormenting each other. “A lot of people are shocked that nurses who are so caring and compassionate to their patients can be so horrible to each other,” says Dr. Thompson.
But if bullying isn’t halted, what happens? The industry feels the effects already, says Dr. Thompson. “Sixty percent of new nurses quit their first job within the first six months because of bullying behavior,” she says. “Forty eight percent of graduating nurses are afraid they will become the target of bullying.”
Just like the nursing profession, the roots of nurse bullying are complex, says Dr. Thompson.
Competition
Part of the problem, she says, is competitive nature that turns negative. “Instead of celebrating others’ accomplishments, we are thinking of ways to downplay or sabotage,” says Dr. Thompson. That means a promotion for a nurse could make other nurses turn on her.
Jealousy
And there’s plain old jealousy and envy. Lots of nurses, says Dr. Thompson, won’t even tell colleagues when they are going back to school. In fact, she says, some even forgo tuition assistance from work to keep it under wraps. Their ambition can make them a target of bullying behaviors.
Stress
And nurses are under increasing pressure at work, making an atmosphere that can turn tense. “Nurses are being asked to do more with less,” says Thompson. If they don’t have effective coping skills, some nurses can lash out at others.
Generations
Nurses have been tagged with the unfortunate label of “nurses eat their young,” but Dr. Thompson says that’s not always the case. She hears frequently from older nurses who are targets because of their age, because they aren’t as adept with technology, and because younger nurses see them as out of date. “This is the first time we have four generations in the same workplace,” says Dr. Thompson. “Now we are seeing bullying across all generations.”
Diversity
Nurses who are different from the norm might find more bullying as well, says Dr. Thompson. She remembers being a new nurse and overhearing some of the older women complaining about a new young male nurse. “One said, ‘I don’t think men should be nurses, and I will do everything I can to make sure he doesn’t last here,’” recalls Dr. Thompson. So although men aren’t immune to the bullying among nurses, Dr. Thompson says they tend to react in a different manner. Men, she says, will often address the behavior immediately where many women won’t.
The cause of nurse bullying has many layers, and few of them are easy to navigate. Knowing the causes, being alert to behaviors, and talking with other nurses about bullying can help halt the problem in the long run.
Congratulations! You’ve managed to graduate from nursing school and pass the NCLEX-RN exam. In addition to that, you have successfully obtained a new-grad RN position after submitting thousands of applications. You’re now gainfully employed and about to embark on your new journey as a registered nurse. You’re very elated and excited to embark on this journey—and you deserve it. You have worked very hard to get here. However, that elation and excitement is short-lived due to the fact that you’re a new registered nurse, and as the saying goes, nurses eat their young.
Bullying towards new nurses isn’t new, and it’s a major problem. There have been many documented occurrences of new-grad bullying, but it’s not alleviating the problem. Unfortunately, this action is accepted and often swept underneath the rug. It’s as if the field of nursing is a sorority and new grads have to undergo a pledging process. It’s not enough that you’ve battled the trenches of nursing school and proven yourself to be a safe and sufficient nurse via passing boards. Now, you have to undergo the brutality and wrath of a negative, experienced nurse who sees you as an annoyance and, at times, a threat.
During my second week of orientation as a registered nurse, I was told by one of the nurse supervisors to watch my back because the experienced nurses could be “vengeful” at times. Her saying this to me was shocking for two reasons: 1) I couldn’t believe she acknowledged the fact that being vengeful towards a fellow nurse was happening on the unit. 2) As a nurse manager, wouldn’t you want to put an end to this behavior happening on your unit in order to maintain peace and order for the sake of patient safety?
Sad to say, this is a game, and new-grad RNs need to know how to play it. I come from a long line of nurses in my family, and when I spoke to them about this situation, they acknowledged that it happens and that I need to take special precautions to protect myself. Here are 10 tips to deal with new-nurse drama that they shared with me:
• Keep a journal and document your days at work. In this journal, keep a record of the date and time of specific events. This way, if you’re ever called into a meeting and/or you’re challenged concerning a situation, you will have a personal record of what was said and done.
• Come to work early and give yourself enough time to get organized. Being organized is key to nursing—and when you’re a new nurse, your coworkers are going to try to find any reason to be negative towards you. Being early and organized helps to alleviate this.
• Maintain a locker with a lock on it. It’s really unfortunate, but your coworkers could be the kind of people who would be “vengeful” and try to steal your items or tamper with your equipment.
• Don’t share any personal information. If you’re talkative like I am, this might be hard to do, but do it. You’re there to work, not to become best friends with anyone. Gaining friendships is fine, but your main priorities should be to protect your patients and yourself.
• Don’t be afraid to speak up and defend yourself. Often, new-grad RNs are made to feel inferior and fear speaking up due to retaliation. Don’t feel that way. You have a right to speak up and defend yourself, especially if you’re being threatened. Legally, you can’t get fired for that. Additionally, you can’t change whatever you tolerate. Therefore, you should acknowledge you deserve respect by standing up for yourself.
• Don’t do anything that is uncomfortable and/or wrong. During my orientation, one of the experienced nurses wanted me to help her distribute medications because she was late. She didn’t want me to look at the Medication Administration Record or any other vital information about the patient. Instead, she wanted to hand me the medications and give them to her patients. I told her no because that was a threat to safe patient care and my license. She became upset and irate with me. Did I care? No. Patient safety and the safety of my license come first. The fear of harming someone or losing my license was greater than the fear of making her upset by denying her request.
• Know your rights. This is important on any job, but new-grad RNs fail to understand their rights because they’re so consumed with learning the rules and regulations of their employed facilities. During your orientation, take the time to speak to Human Resources about your legal rights. It never hurts to know what legal protections you have at your place of employment.
• Mind your business. When you hear other nurses speak badly of a coworker, don’t join them. Walk away and divert your attention to something else. Entertaining the conversation not only makes you look bad, but is also an easy way for you to get trapped into the role of being negative. Besides, what goes around comes around, and if you start talking negatively about someone, you’re going to be the target eventually as well.
• Always take the time to learn something new. This is a great time to be a human sponge. Doing this makes you look like a team player, and it’s a great way to advance in your career. This also makes you too busy to entertain negative thoughts and/or conversations. Learning isn’t limited to learning nursing skills. You should also take the time to learn about the environment in which you work. Learn what’s acceptable and what’s not acceptable. Also, observe and be mindful of the different personality traits of your coworkers. You may like some and you may not. It’s better to learn in order to be prepared.
• Leave work at work. When you come home, it’s time to relax. Nursing is hard work, and you don’t need to worry and stress about it when you’re at home. Whatever happens at work isn’t to be brought into your personal life. Bringing your work home is a sure way to burn yourself out quicker, and it will make you not want to work at all.
