By Janelle

February 3, 2019

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Addressing Dynamics: Insights into Lateral Violence in Nursing

I was a rookie nurse with about a year under my belt when I had a patient who gave me that first “gut feeling”. Stable vital signs, normal sinus rhythm, QT ratio within normal limits; a febrile, A & O x3… but something was different. Slowly I went through a checklist in my head: “Suction? Check. Good IV? Check. Crash cart nearby? Check”.  Later that night, my patient coded not only once, but four times.

“Hey! You did really well in there, I was pretty surprised? Even impressed… You smile a lot and laugh a lot and I don’t know… I guess I never really placed you as someone that knew what was going on around here but you proved me wrong tonight!”

I didn’t know if I had just been patted on the back or slapped in the face. That was my first encounter with lateral violence, and it has stuck with me throughout my entire career.  Lateral violence continues to be pervasive in hospitals though seemingly unrecognized and underreported. Nurse to Nurse, Nurse to CNA, CNA to Nurse, Nurse to Students, Nurse to Recruiter (ah-hem). So Why does this happen? How can we deal with it, or even stop it? How have YOU recognized lateral violence on your unit and what have you done about it?

What

Lateral violence can be verbal or nonverbal. My heart goes out to the Gypsies, who have both recently posted about lateral violence at their current assignments. Harsh body language, racial slurs, Emails, gossip … any form of displaced aggression that causes you to feel insecure, bullied, or upset is inappropriate and should be deemed lateral violence.

WHY


This may seem like this is a redundant question; it has yet to be discovered why people displace aggression or insecurities onto their peers. Little is known about the origin of entitlement at what point grandiose delusion is passed off as a personality trait. If I had to give my most professional opinion my conclusion has been that some people are just not nice people. As one of my (most favorite) Attendings once told me: “You cannot speak logic to illogical people”.

HOW to deal


Listen, if your mother never told you this I am telling you now: Not everyone is going to like you. It is OK. I have a bold personality and a German attitude, I am not everyone’s cup of tea and I totally understand that. However, I am a professional. I am considerate, empathetic, and polite; I expect the same from my coworkers. If you encounter conflict go to your source: approach the person in a calm manner, discuss how your feelings have been affected and seek out answers. If this doesn’t work, initiate your ladder! Management, supervisors, educators… get someone involved. This may or may not solve your issues, but with fingers crossed it will.

Finally, work on yourself. Do not react to a situation when your emotions are at a high. Take a step back… take an extended bathroom break if you need to. One of the best books I have recently read is “Presence” by Amy Cuddy. If you don’t have time to read it you should at least watch her Ted Talk. She is FANTASTIC. Recognizing your weaknesses, learning to put yourself in each moment as it is happening, dealing with conflict; she touches it all and she has been like a guru to me.

We cannot solve every conflict we will never save the world. What we can do, is bring our best face forward. Be confident in ourselves, our skills. We learn a hospital in three days, where others are given 6-12 weeks. Speak with kindness, work diligently, ensure you are part of the answer and not part of the problem. Place your entitlement in check, work with your peers and every day do your best. Most importantly “keep on keepin’ on”.

By Health Providers Choice

September 25, 2018

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Travel Nurses: What To Do About A Toxic Work Culture

This article is provided by: Health Providers Choice.

If you’ve dealt with a toxic workplace, you know how quickly passion can turn into dread. Unfortunately, bullying doesn’t stay confined to the schoolyard. Today, even adults are known for this type of harassment. However, their tactics are often more refined. Bullying is usually the leading cause of a toxic work environment in health care facilities. For travel nurses, toxic environments can feel particularly stressful.

The environment

Sometimes bullying occurs overtly, like when someone shows hostility. Other cases of bullying happen when the victim isn’t present to fight against it. Some workers describe being “thrown under the bus,” or blamed for mistakes that they didn’t make.

Workplace bullying has become relatively common in health care. One survey asked health care workers why they quit their jobs, and nearly half cited abusive behavior. Travel nurses in particular can become easy targets. Resident nurses may feel threatened by travel nurses. Some may think of travel nurses as “outsiders.” Every workplace has its own culture, and when a travel nurse has to learn the culture, other people in that workplace may be quick to point out mistakes.

☣ The impact of a toxic work culture ☠

As a travel nurse, your job is already stressful and emotionally charged. It carries so much stress that you certainly need a supportive environment. How can you find respite when other nurses and physicians want to add more stress to your workload? A toxic environment will erode your self-esteem, confidence, and attitude. In fact, stress can even impact your physical appearance and the way in which you carry yourself.

These changes rarely go unnoticed by your patients. They even feel residual stress, especially since many of them have to deal with stressful situations of their own. Furthermore, it causes you to have far less care and focus than you should have while caring for your patients. The results of this can be detrimental in many cases.

A few solutions

As a travel nurse, you have options to help you deal with toxicity. First, distance yourself from the problem. Of course, the term “distance yourself” doesn’t mean ignoring the problem. Instead, firmly let the bully know that you won’t play games, and then only interact with this person if you must.

Second, maintain positivity. Bullies thrive on control and they love knowing that they affect the surrounding environment. When you stay positive, you take away their control which helps everyone in the workplace.

Third, focus on your patients. Remember why you pursued nursing in the first place. This tactic helps you provide the care that your patients need. It may also remind you of all the things you enjoy about your job rather than all the difficulties.

Fourth, give yourself a mental detox. Think about why you chose your location. Did you take a job in the Pacific Northwest for the hiking? Take a hike on your day off. Did you move to a big city because you love culture? See a musical. Avoid burnout by enforcing a no-work policy on your off days. Time off is for rest, not for thinking about work.

Finally, keep in mind that you don’t have to stay forever. If you want to leave after your assignment, then, by all means, tell your recruiter. Sometimes the promise of change is enough to help you power through your current situation. Furthermore, your recruiter is also your advocate. If a situation has become overwhelmingly toxic, do not hesitate to tell your agency.

Toxic workplaces do exist and working in one can affect your morale. Just because you are a travel nurse doesn’t mean you have to put up with a toxic environment. By taking steps to protect yourself, you can make the most of a difficult job until you can finally move on.

By The Gypsy Nurse

July 11, 2018

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Why Nurses Eat Their Young! – A Nurse Perspective

The following is a Guest Post via Erica MacDonald

After reading The Gypsy Nurse’s Post Nurses ‘Eat Their Young?’, I wondered if anyone had a different opinion than me on the cause of this phenomenon.

A nurse “eating their young” is an almost accepted form of bullying by many nurses (the ones that participate). Most don’t admit (even to themselves) that they are eating their young but cleverly try to disguise their bullying actions by positioning their attitude/behavior toward the new nurse as “helping” or “providing an educational opportunity.” People who have worked in other careers agree that they have encountered this phenomenon in other jobs. However, they are shocked at the prevalence that it occurs in nursing.

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Personal experience

Indeed, I have personally experienced it and seen it done to others. So the question is, “Why would educated and professional nurses engage in such poor behavior?” I believe there are two main reasons this attitude prevails in nursing. The first reason is… High school never ends! Refer to the subject of Social Psychology. Social Psychology attempts to explain behavior such as cliques and groupthink.

Cliques and Group Think are the underpinnings of the complicated social culture of high school and most workplaces.

So when nurses form a clique that accepts it is the “cultural norm” to eat their young, even those who don’t agree to keep quiet, not to upset the status quo. The irony of it all is that we are consistently voted America’s most trusted profession. Yet, we can not even be trusted to treat each other with kindness and respect. It is really quite sad that this shallow Group Think occurs among such talented and educated people!

What spurs this to become the social norm

So the question remains, “What spurs nurses to allow this to become the social norm in their group?” This brings me to my second reason for such an attitude to prevail in nursing. The profession of nursing in our society is synonymous with sacrifice. This sacrifice starts in nursing school and continues into the workplace.

Think back to nursing school. First, nursing program acceptance can be similar to the rush of winning the lottery because it is such a competitive process. Then you realize that your nursing professors are on a mission to “weed” people out and make sure only the strongest students pass their classes. They want to eliminate the “weak links” because nursing is a high-stress, academic, and moral science (and the school’s pass rates are public for the entire world to see). As a nursing student, you begin to study with intensity, stop socializing, working out, and attending family functions. But it is all good! You rationalize that nursing school doesn’t last forever, and it is worth the ….SACRIFICE!

eat their young

You pass NCLEX and breathe a sigh of relief.

and say to yourself, “I can live again!” Then you begin the long struggle to find a job. But wait! You finally find a job and discover it is in the specialty you are not interested in, and you will have to work nights. Again, you encounter SACRIFICE! But hey, I have a job to pay bills (often large student loan bills).

Some nurses discover that adjusting to the night shift is impossible. The longer they stay on nights, the more dysfunctional their life and sleep become. If you have young children, they make comments such as “All you do is sleep.” You and your children are on opposite schedules, so to them, it seems like you are sleeping their lives away. Also, you work weekends, odd hours, mandatory overtime, on-call, and miss holidays/special events with your family.

Furthermore, some patients and their families can be complicated and unappreciative even when you do the best you can with poor staffing ratios. Not to mention you’re often dealing with burnout if you are working in a high-stress critical care area. By the way, you have not eaten, drank water, or went to the restroom during most of the shifts you work. Don’t forget the nurse bullies! The years pass, and you lose track of the numerous sacrifices you have made in the name of nursing.

Erosion of empathy and self-confidence

So, the continuing atmosphere of sacrifice can contribute to the erosion of your empathy and self-confidence. Then enters a new nurse when stars in their eyes about the wonderful profession of nursing. You are unhappy with your situation and treat the new kid on the block just like you were treated; badly in the name of “education.” Or maybe you are a competitive type of person and want to maintain your status in the workplace you have earned. Or, unconsciously, you perceive a new nurse as a potential future threat. So you decide to test the new nurses and see what they are made of. Let’s mold a new nurse into a super nurse of steel!!

I think this is a general scenario of how nurses come to engage in nurse bullying.

Admittedly, some work environments are more accepting of new nurses than others. I realize that my example borders on the dramatic. Or does it? I have informally interviewed a large number of nurses during friendly conversations; the recurring theme is usually sacrificed. Sacrifice is the fertile ground that bullying behaviors come to seed in.

The nursing profession has decided to combat nurse bullying is similar to the approach we take in preventive care, awareness, and education. Nurse bully experts are focusing on the workplace. All over the country, hospitals are waking up and requiring education for their staff to prevent nurse bullying in the workplace.

However, since you can not control others’ actions, only your own nursing education specialty needs to step up to the plate. Nursing schools have just as much responsibility as the workplace. They have a moral obligation to help students pass the NCLEX and prepare them for workplace success.

Nursing schools should address, in their curriculum, this phenomenon and the tactics that new nurses should employ to fend off the “wolves.” Self-confident new nurses armed with the knowledge and concrete actions to defend themselves could be a deterrent for bullies. At least they won’t be blindsided when entering the workforce. We need happy nurses who want to stay in the nursing profession to care for patients and deal with the changes in healthcare.

What do you think? Is there another explanation for this phenomenon? What is your solution to the problem?

About The Author:

Author: Erica MacDonald is an MSN-prepared nurse whose mission is to empower nurses through self-employment by providing them with education and motivation. Erica blogs at http://www.selfemployednurse.com, and you can connect with her via Facebook at https://www.facebook.com/SelfEmployedNurse

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By The Gypsy Nurse

May 9, 2017

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This is. . . being a NURSE

Written by:  Rachel Baldwyn
Edited by: Candy Treft

Let me start by saying that “I LOVE BEING A NURSE.”

I graduated with my ADN almost 17 years ago. I have had the opportunity to hold hands with and give comfort to the dying and to cry with families left behind. I have been able to help bring people back from the brinks of death and give them the opportunity to go on to live longer lives. I have brought babies into the world and witnessed big burley men reduced to sobbing tears at the sight of their newborn baby and I have cried with them. I have had the privilege of being a part of human lives that without being a nurse I would have never had the opportunity. I have even had the opportunity to assist in saving my own husband’s life because of my knowledge and skills. Nursing is not just a job, it is an integral part of who I am.

Now, the other side of the story is not so glamorous.

Nurses work long hours away from family. We miss out on weekend bar-b-ques, weddings, holidays, our children’s ballgames and dance recitals. We work when the rest of the world sleeps, we try to sleep when the rest of the world is awake. If we work nights, we have to do without sleep just to take care of normal things the rest of the population never even thinks about. When is the last time you were able to take care of banking business at 2am? Have you ever had a parent teacher meeting at midnight? Even our family sleeps while we work, meaning we have to sleep when our family is awake and enjoying normal life activities, or we do without sleep in order to spend time with them during their waking hours. – This is being a nurse.

In the hospital, nurses are expected to do tasks that most of the world would never want to do.

We wipe butts, we clean up vomit, we sometimes wear masks with alcohol wipes under our noses when we are expected to take care of a patient with rotting flesh and the smells can be so overpowering that we don’t know if we can get through it without gagging or vomiting. – This is being a nurse.

We clean up the deceased patients after we have been unsuccessful in saving their lives, so that the family doesn’t have to see them in such a sad state, when what we really want to do is go somewhere alone and cry. We take a deceased baby into another room and clean them and dress them and take pictures of them so that the young mother will have pleasant memories of the baby she will never get to raise. We cry with and try to offer some measure of comfort to the parents of teenagers who we were unable to save, then we are expected to dry our tears, wash our faces and go on to the next patient. – This is being a nurse.

Those patients are never able to know that we just lost a young life, they still expect us to make their back pain a priority. Many times we are in tears throughout the entire process while wishing we could just go home and hug our own children. We are not able to go home and talk about our day, the laws prevent us from discussing patients with our families and besides most of us would never want to expose our families to the horrors that we see. – This is being a nurse.

“Nobody ever sees this side of nursing.”
“Have we made a difference?”
“I think so.”

Changes in technology and politics have changed the way we take care of our patients.

We are expected to do more with less staff and resources. We spend more time with the computer than we are able to spend with the patients, yet we are held hostage to the patient’s satisfaction during the hospital stay. Our raises are determined by the patient perception of our care. – This is being a nurse.

We are living in an age of entitlement, our patients have become more and more demanding. They, many times, expect to have zero pain instead of a realistic expectation that we can control pain but not eradicate it. We are expected to cater to those who are addicted to meds instead of refusing to give drugs to an already addicted population because we are afraid of negative patient satisfaction scores. We can even be held responsible if someone doesn’t like the food served in the hospital. I have even seen many hospitals change to having room service where they can order from an extensive menu and dictate what time they would like their meal to be served. Not that I think patients should have no control of their care but many years ago, nobody expected to be treated like they were paying for a 5 star hotel while in the hospital.

It is no longer enough to use our skills to care for the patient’s physical and emotional problems. We now have to care for their unrealistic wants as well as try to make sure the wants don’t interfere with the needs. – This is being a nurse.

“We are the largest single profession and we can make a difference if we set aside the mentality of

– if I make someone else look bad I will make myself look better.”

Hospitals will hire brand new BSN nurses over experienced associate degree nurses.

Another issue we as nurses face daily is that we are the most caring profession to our patients but the most condescending and critical of each other. I have seen new nurses who graduate with a BSN come in to the hospital straight off the assembly line acting like they are superior to experienced nurses who only have an associate’s degree, Associate degree nurses act like they are superior to experienced LPN’s.

Last year my husband was in a hospital in a critical state, the floor he was on had no backbone. The most experienced nurse had only 2 years of experience. The “baby nurses” were teaching the even newer nurses. Experience is the only thing that will give nurses the knowledge needed to be successful and to recognize many problems our patients have. Experience is more important than I can ever express.

Many experienced nurses are leaving the field and either retiring or moving on to other less demanding professions, or they are moving up the ladder into management. New nurses are having to learn without the help or guidance of the backbone. They need experienced nurses to pave their way and take them under their wings to show them how to actually be not only nurses who can do the skills but will excel and become great nurses with not only the knowledge but the hands on experience to know when a patient is not as it seems, so that they will be able to recognize subtle changes that need to be addressed that is not in the chart or given in morning report. However because of the critical environment, many nurses with experience don’t want to teach the younger new nurses and the new younger nurses sometimes think they don’t need to be taught.

It is a constant cycle of abuse from both sides of the fence.

Because of the animosity and accepted culture of this pecking order in nursing, we cannot stand together to make the needed changes in healthcare. As long as this mentality continues we will never be able to demand fair salaries or safe nurse to patient ratios. People in the general community will never understand what we as nurses do on a daily basis, they can’t know. It is not something that the normal lay person can truly comprehend. We will never have the respect that we deserve for doing the job that we do. The only people who will ever truly understand are other people within the healthcare field. Yet those people as a whole are the very ones who keep our profession from becoming one we could and should be proud to do. This is also what is going to affect our population and put our patients in jeopardy.

We need to stand together.

We need to educate our communities on what is safe and how they can stand behind nurses to make sure that when their family member is hospitalized they can be comforted in knowing that their nurse has the knowledge and skills and judgment to be able to safely take care of them. Let our families and friends know that we are being expected to care for more than is physically possible to safely care for. We need to stand together for safety and set aside the pecking order for the betterment of our entire profession.

We are the largest single profession and we can make a difference if we set aside the mentality that if I make someone else look bad I will make myself look better. Patient safety and fair wages should be important to each of us.

My name is Rachel Laird Baldwyn, I went back to school to become a nurse with 2 very little boys underfoot and a very supportive husband who pushed me and encouraged me at every step of the way. I have been a nurse since 1999. I worked Med/Surg for about a year and a half, then went on to become an ER nurse for the next 8 years and most recently I am a labor and delivery nurse. I have been a travel nurse for a total of about 6 and a half years, 3.5 years from 2002-2006 and started travelling again in Feb. 2013. Travelling has allowed me to not only support my family but to give them opportunities that I never had. It has allowed me to meet some amazing and wonderful people from all across the country. I have seen more of our amazing country than I ever imagined I would see. At every assignment I try to not only take away new friendships, but also new skills that I can take with me and bring on to my next assignment. I am not sure where my career will ultimately take me but I do hope to be able to continue to use my vast knowledge and experience for the betterment of this amazing profession.


This was originally posted to our Gypsy Nurse Network Group on 10/20/15. I was so moved by the context that I asked Rachel if I could reprint her thoughts here (which she agreed to). Rachel makes so many valid points. I would ask that you share this with your family, friends, co-workers and help bring awareness to our plight.