Q&A With Nurse B: How Do I Get Help While Being Bullied?

Boynton_profilePic.jpgBeth Boynton, RN, MS specializes in communication, collaboration, and workplace culture. She offers advice on how to navigate common conflicts in nursing and healthcare with an eye towards shared accountability and co-creative solutions.

If you’d like to have a conflict or situation considered for this column please submit to keith@fullbeaker.com.


The Situation

Dear Beth,

I’m a new RN finishing my fifth month as a med/surg staff nurse on evenings in a 200-bed community hospital. Some days I feel very competent, yet at times need a lot of support; I’m concerned that I may not be learning fast enough. Some of the nurses I work with are very willing to help and some seem irritated when I ask questions or seek assistance. 

For instance, yesterday I was concerned about setting up a stat blood transfusion for one of my post-op patient, and I approached two nurses who were at the desk, talking. I asked if one of them would mind helping me with the procedure; I told them I had only done two and was a little anxious about the stat order. They looked at each other and smirked; one rolled her eyes and said, “Weren’t you checked off on that?” The other one continued smirking and after a lengthy sigh and in an irritated tone, said, “Why don’t you get it started and if you have a problem let me know? I’ve got a new admit coming.”

At that moment, I was stunned. The charge nurse had just left on meal break and had been very stressed all shift and no one else was available. I reviewed the protocol and got the transfusion going ok; I was very nervous about it and think my patient could tell I was flustered. This kind of thing has happened before and I feel awful. Should I have paged the charge nurse? Have I chosen the wrong career? Am I not confident enough? I’m glad this doesn’t happen every day, but when it does, I feel miserable. Do you have any advice? 

— NEW & DISCOURAGED

Don’t take things sitting down. Learn to stand up for yourself!

The Solution

Dear NEW & DISCOURAGED,

I can certainly understand your frustration and want to thank you for sharing your experience; I wouldn’t be surprised that many nurses would relate to it. Let’s look at your situation from two angles – your confidence and the horizontal abuse; both seem to be active issues here.

Your confidence

First, I want to congratulate you on becoming an RN; you’ve worked hard to get here and deserve – as we all do – to be supported with your continued learning needs and appropriate work assignments.

It sounds like you may be having some issues maintaining confidence in your abilities. I urge you to try to think of this in terms of what you need to be successful rather than focusing on the things that are making you feel inadequate.

  • Some practical solutions might be to:
  • Request a designated preceptor on each shift
  • Work the day shift for a while where more help might be available
  • Ask for more orientation in the areas that you are concerned about 
  • Consider a less acute setting/department

 An important question to ask yourself before pursuing any of these solutions is what would help you to feel more confident.

Nursing is a stressful profession, and finding the right niche for yourself may take some time and experience. Talk to colleagues you feel comfortable with; you’ll soon realize there are many career paths for nurses! Perhaps you will find that another profession suits you better, but I hope that you get the support you deserve to succeed in this one!

In this particular situation, it would have been perfectly reasonable for you to page the charge nurse, especially after checking with nurses on the floor who seemed to be available. While it is fine to be concerned about the charge nurse’s stress level, it isn’t your job to set limits for requesting help from her.

If you needed help from your charge nurse and she wasn’t able to assist you, it is her job to delegate support from her staff or seek help from her supervisors. She probably had a sense of the other nurses’ workload. If they did indeed have time to help you, then she could have talked  with them about why they didn’t. If they didn’t have time, then she could have found other resources to advocate for them and their relative workload.  

Tired of a toxic workplace or all the politics? Find a better nursing job today!

The horizontal abuse

The two nurses in your story are exhibiting signs of horizontal abuse, also known as lateral abuse or lateral violence. 

Smirking, eye-rolling, irritated tone, and condescending questions, like, “Aren’t you checked off on that?” are disrespectful. Though there may be other explanations for this kind of behavior, I can’t think of any. This behavior should be identified and stopped. Several levels of intervention could be considered:

1. Offer some direct feedback. If you feel safe to talk with these nurses individually, you can invite each one to meet with you privately to share your concerns about recent interactions, and then formulate a statement that shows ownership and requests different behavior. You could say the following:

Yesterday, I asked you to help me with a stat blood transfusion. It was a difficult conversation for me. I was already nervous about the procedure and your comment and tone about me being checked off didn’t feel helpful at all.

In fact, I got the impression that you thought I shouldn’t need help. I would appreciate it if you would honor my request next time. If you can’t help me directly, maybe you could have gone over it verbally or directed me to someone who was available. Do you have any ideas?

2. Consider talking with your Nurse Manager. S/he may or may not be aware of abusive behaviors on the unit, or may not realize that behaviors like these would be considered incidents of workplace violence. As such, it is a leadership responsibility to address it; this may involve unit training and feedback for offending individuals. 

It is important that the unit begin the process of setting clear standards for interpersonal behavior; this would include creating or recreating norms, and considering any training required to ensure that ALL staff have the skills to practice them.

This could involve a variety of communication workshops. A plan for enforcing and monitoring new behaviors must be part of the process as well; it is helpful if the organization has consistent norms to fall back on.  

In addition, having a conversation about your reluctance to page the charge nurse is important for you both. It would be an opportunity for her to reassure you and provide clear expectations around contacting her.

This would also give her information about how her perceived stress level impacts others.  It is also an opportunity for you to reflect more about why you didn’t call her. Be wary of hesitating in future situations requiring assertiveness, and make a commitment to utilize her in the future. 

3. Self-care is extremely important in our profession and can be especially challenging in a toxic culture. If your nurse manager doesn’t feel comfortable addressing the horizontal violence, I would recommend that both of you seek support from the leadership in the Nursing Department and Human Resources. 

 

As you can see, these dynamics are complicated; sorting them out will help you develop confidence and skill in a supportive environment, ensure a mutually satisfying career match, and have a positive impact on patient safety. 

Good luck, and I hope this is helpful. As we move forward in healthcare to improve workplace dynamics, stories like yours provides very important examples for learning. 

Next Up: Day Nurse Left My Patient In Pain!

Beth Boynton, RN, MS is a Medical Improv Practitioner and author of Confident Voices (CreateSpace 2009) and Successful Nurse Communication (F.A. Davis 2015).  Her third book,  Medical Improv: A New Way to Improve Communication is scheduled for release in 2017.

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