Eating Our Young

Here’s this week’s reflection. I hope it resonates with you and ask that, if you enjoyed, please comment and share on your social media. Heartfelt thanks for all your support!

Keeping the light on for you,

Carol

My face burned fiery red as I left my patient’s room into earshot of the charge nurse’s bellowing rage, her index finger stabbing in my direction. It had been a busy night and with final patient care tasks complete, this exhausted newbie headed to the nurse’s station to report off on my patients. Stopping in my tracks, I took note of the more seasoned staff members looking my way as the one in charge repeatedly shamed me publicly for an inability to keep up. I had been out of nursing school but a few months, working in an intensive care stepdown unit. That was the day my education really started. A firing squad would have been more humane. I tearfully reported off and went home to lick my wounds and contemplate my career choice. 

***

An unfortunate yet well-documented phenomenon in the nursing world is that of “eating our young.” A quick internet search yields extensive content related to healthcare workplace incivility. Those employed outside this hotbed find it odd that one of the most nurturing professions would be so harsh toward those so nobly entering the fold. But the bullying has existed for decades, and the reason a staggering mass (as much as 34 percent by some studies) leaves the profession, adding to the already critical shortage of nurses. And it has only begun to be vigorously addressed within the last 15-20 years. 

With a daughter stepping into nursing and myself striding faster toward retirement’s exit, I now find myself reflecting upon this conundrum with laser focus. 

Having once been the powerless student, then timid newbie, my memory of less-than-stellar treatment from senior colleagues over the years has been a constant reminder to mitigate ugliness with civility, patience and kindness and, in so doing, mentor others. With age comes precious wisdom as I have gone from delicate, idealistic newcomer wanting to comfort the world to a much hardier demeanor easily able to confront difficult people (privately of course). Calling out bad behavior in professional relationships took forty years to grow into, (thanks to some much-needed assertiveness training), but the die was cast long ago on that condescending morning seared into memory. 

Throughout my bedside years I have noticed educational shortfalls in the nursing profession, possibly contributing to the bad behavior seen toward our fledglings. While these are only my observations and opinions, they have repeatedly played out. Nurses are often afraid to speak up because nursing didactics lack substantial assertiveness training and the confidence it inspires. Yes, we learn “therapeutic communication” techniques with our patients, take psychology classes, and understand the lifespan through clinical rotations, all of which can be applied to the workplace. But education in interpersonal communication with challenging colleagues is often lacking in the classroom and relegated to on-the-job exposure. An ill-equipped workforce leaves many of our most empathetic graduates defenseless against aggressive coworkers. Additional training (and cost) is left up to the individual, unlike other job sectors where “skill enhancement” is not only mandatory but often subsidized, especially for those wishing to enter management. 

Nurses are then often “rewarded” into managerial roles without any training in how to effectively manage. Again, other vocations take a more thorough approach with mentorship programs and course work to provide a framework in which to expand and excel. While the school of hard knocks so prevalent in healthcare does indeed educate, it sidesteps the interpersonal team skills required for managing stressful situations encountered at the bedside. Since healthcare is big business (with big egos) and nurses are in short supply, isn’t it in the best interest of nursing programs to better prioritize and provide further curricula in both their academic and orientation programs for professional communication and management skills? 

In the modern spirit of cost containment and efficiency (sarcasm alert), health care corporations love to “reward” (read: overextend) their most coveted nursing managers to cover not only their area of expertise, but other adjacent (and typically large) clinical areas. As a result, the now overextended nurse manager is no longer able to adequately tend to their own department’s needs. When personnel issues inevitably arise in their units from insufficient guidance, morale deteriorates and attrition rises. 

Is it any wonder that bullying or workplace incivility is rampant? Nurses are exhausted and left unsupported. As my daughter was nearing graduation, the paucity of “professionalism” topics overtly pointed to the advice tacitly being offered: Expect to be bullied.

EXPECT? 

It is high time we change the narrative. I am all for being a realist and preparing graduates for the bunkers, but that starts with a more comprehensive education regarding workplace hostility. This issue has become such a hot topic that the American Nurses Association updated their Code of Ethics in 2015 to include a clause admonishing the participation in any such behavior. Continuing education modules are now in place for all (including advanced practice nurses and physicians) to address the identification, reporting, and interpersonal skills required to start limiting the tolerance of bad behavior in the workplace.

Still, hurdles exist within the classroom for introducing and teaching to this multifaceted problem. To deal with the nursing shortage, a variety of training program types and lengths now exist to repopulate the workforce. While all these paths to nursing produce candidates who must pass the same national registered nursing board exam, the program lengths dictate how much time can be afforded to the crux of the profession – human disease and care – as opposed to other necessary, but not always prioritized pieces such as interpersonal skills among colleagues. It behooves the nursing profession to better prioritize instruction on effective communication skills at all levels. We (and most importantly, patients) all win when focused education leads to confidence that fosters the ability to speak up and shut down incivility in real time, making healthcare what it was intended to be – a caring environment. 

I will also add that patients, already compromised by illness and its associated stressors, readily pick up on tense environments. Patients have mentioned more times than I care to admit that they have felt more stressed and unsettled from the palpable tension of incivility among staff –the saddest testament as to why the culture must change.

As for my daughter, a lot of time has been spent with her discussing workplace incivility and how to effectively diffuse difficult situations – daunting for one new to being both an effective caregiver and colleague. She has the advantage of another family member having walked that walk … but other new nurses do not. As a profession we can, and should, do better to nurture our young, not consume them with the notion of having “paid our dues, and so must they.” 

***

The charge nurse from 1984 who publicly berated me? I sought her out after my few days off and led her to a back hall, away from others and told my superior, with shaking knees, that I felt her behavior was not only harsh, but unprofessional toward a new nurse, that she too had been new once and didn’t know everything right out of the gate. My voice cracked as I spoke, and I was nervous to the gills that she would find another way to belittle me. But I pressed on to state my piece with every ounce of courage my youth possessed. She proceeded to shed tears, apologize profusely, and share with me that she felt stressed and overwhelmed for a variety of reasons that busy night, having taken it out on me. And through her tears, she assured me: “We CAN work together. We CAN. WORK. TOGETHER.” And we did from then on.