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Nursing and NCLEX Mastery
Friends of Flo - Nurses and Lateral Violence
June 29, 2017 Friends of Flo - Dr. Rebecca Porter PHD, RN, Dr. Tess Judge-Ellis DNP, ARNP, FAANP and Dr. Andrew Whitters DNP, ARNP
Join in the conversation about bullying and other negative situations that happen in a nurse's daily life. Dr. Rebecca Porter PHD, RN Dr. Tess Judge-Ellis DNP, ARNP, FAANP Dr. Andrew Whitters DNP, ARNP What should you do? Thanks for listening! If you enjoyed this episode, please share it with your nursing friends.

Episode Transcript

Speaker 1:0:00I had a really bad annual review. It was terrible. Sure I wrote an 11 page rebuttal. To classic Rebeccah right there.

Speaker 2:0:14This episode of Friends of flow is brought to you by an CLECs mastery. If you're a nursing student and you're about to take your CLECs you need to go to the App Store right now. All right welcome legs.

Speaker 3:0:26Folks this is friends of flow and you're talking to Dr. Tess Judge Ellis and I have with me Dr. Andrew Widders DNP and Rebecca Porter.

Speaker 1:0:37Now you got to go. Keep going. OK gotcha. Rebecca porphyry.

Speaker 4:0:41And we actually brought on so weird the Friends of Flo which means that we are nurses and nurse practitioners researchers and clinicians who like to get together and talk about nursing subjects correct. And we're like today we brought on Rachel Hedren with us today. So go ahead and say hello.

Speaker 5:1:00Hi my name is Rachel Hunter and I'm a medical psychiatry nurse at the University of Iowa hospitals and clinics.

Speaker 4:1:06All right.

Speaker 6:1:07So the big question today is nursing violence. Why do nurses either young do the nurses eat their young.

Speaker 4:1:16And so to do that. REBECCA Actually Dr. Rebecca is an expert in this content. So give your background just a little bit.

Speaker 1:1:23Rebecca We know I've known her Bekka for 20 years cashiering I go back a long time when I used to be a nurse practitioner and we've spent a lot of time talking about why why didn't nurses some nurses behave the way they do. And some people historically it's been called Nurses eating or young right. And I just I'm looking back in the literature Keshet what I do and I want to know when did this show start. And actually the term was coined in the early 1970s and it really began because nursing started over 120 years ago in the United States in a very patriarchal society and people called 10 years saying. Were asked to be demure. Quiet well reserved well-behaved women.

Speaker 3:2:21Oh my gosh we should not be in the profession.

Speaker 6:2:25Mean I really don't think no three of them knew that specific part of you know American history.

Speaker 1:2:32Yeah so I have my piece she's an ethics and I of course love the history of nursing ethics. And there was a book I found written in 1995 buying or self-assessed poo poo again the requirements to entry requirements to nursing school. And so you bring those Victorian moral support we're getting to the early 20th century and things like that die hard. And the role of women began to really change probably in the 1970s after the sexual revolution of the 60s that. Nursing is primarily a women's profession. There are many there now but nurses have never been empowered to do what they do. And I think sidebar that when you ask people what does a nurse do. My answer is you know when they don't do it right.

Speaker 7:3:34Oh yeah that's for sure. So you look at the patriarchy and you look at the power grid the power which the word gradient in a hospital. And in society it's men sliding down to women.

Speaker 4:3:55Or sliding down to young sure what's valued versus not valued in society right.

Speaker 1:4:01Targeted identity Souray right. So you put women a group of women intergenerational women people who are late baby boomers who have held onto the role of women that they grew up with of not question of doing what you're talk of working with older Boomer men physicians who are used to telling people what to do.

Speaker 6:4:29Do you think that's still prevalent in today's society that same gradient in society. Well I guess I guess we can see fashion of nursing excuse me within within the profession of nursing do you think that there's still that that gradient of of.

Speaker 8:4:46I think that there's oppression. I think that people. Power people in positions of power unless they are very self aware unless they're practicing moral leadership with kindness and generosity. Leaders are not aware of what they're doing to people who are following them. And so I think that power gradients sets up a place of oppression and to take that a step further in in my in my head.

Speaker 9:5:26I look at a lot of nurses and I've been practicing for over ten years as a nurse and a nurse practitioner and I think that oftentimes nurses will make sacrifice professional sacrifices and that's almost an expectation at the sort of the corporate level the business level within hospitals and perhaps even in private practice. It's expected that you stay past a certain time past your your regular shift time to get down with your chart and you're expected to do X Y Z for your patience because that's what good nurses do. And I think that that's that can be problematic because nurses give so much of themselves and so much of their time that once that becomes this expectation it almost becomes self demoralising if that if that makes some sense. So go ahead and comment on that.

Speaker 3:6:24I mean I mean I mean how does it fit in with that.

Speaker 8:6:28OK I mean you've really political here. I think that's a caller that's a very pink collar blue collar attitude if you look at white collar workers if you look at corporate executives if you look at physicians if you look at attorneys they're not saying oh my shift is over. I got to get out of here.

Speaker 1:6:52They're saying here's a job could you. This is my client this is my patient. I'm going to stay here because it's my responsibility. That's just a. Counter argument. So I think it's how get him. I think it's how we are socialized into a war. I think it's an environment that we work in and I think it's a product of our society as well. Just because it's three thirty in the afternoon. And if your patient is still having chest pain or a psychotic episode or is in a cold are ethically morally.

Speaker 8:7:37Are you going to walk out the door. Are you going to feel that that you've sacrificed something. You know what is sacrificing a face or somebody suffering. What does it mean to suffer and what can we sacrifice to meet that person. That patient got their moment of suffering up at street 30 got to get out of here of course.

Speaker 6:7:56Yeah right. So let's talk about that. That translation from that sort of model and a historical model that you just mentioned. How does that translate then into what we see within it or some profess and this this idea that we quote eat our young unquote.

Speaker 1:8:14I think if we put this disrespectful behavior or lateral violence we never where you want to put onto it into a theory. And if we use that theory of human behavior we can begin to separate that there are three different components to to this kind of behavior and we look at.

Speaker 10:8:45People their own psyche their own psychology their own behavior. And if somebody is already has a propensity towards violence or towards being rude and that's normative behavior or they are a narcissist we can see that in our world today what happens with a narcissist. And the bullying that that creates then a second component of that is the organization. What does the organization value. What does it what's the social isolation that we're putting into that organization where we're working and are pressuring allowed is that hierarchy protected. Are people in power protected and everybody else is kind of just get your job done and be quiet. And it doesn't matter how you're being treated.

Speaker 11:9:35The third component of that human behavior is I am the values of the organization.

Speaker 10:9:46So it's the human psyche. Values and socialization of how we're how we're treating what we expect.

Speaker 9:9:55So how does a new nurse come into a situation. Perhaps a nurse is being interviewed coming to an organization and find out about those types of variables and organization.

Speaker 1:10:08I think it's hard to get to that question. Let me just pop out a statistic. Q Eighty five percent of nurses are bullied. In a hospital. And that's been going on for decades. A huge proportion of bringing nurses are going to leave within the first year because of bullying.

Speaker 6:10:34And doesn't that doesn't that drive you guys nuts. Because I mean the first podcast that we did you alluded to the idea that we're the most trusted profession. What were the most troubling. Thank you Sam. And then and then I hear stuff like this and this is embarrassing for me as a as a as a provider and as a nurse because we were we had this caring desire to do what's right for people but we can't seem to take care of ourselves. It really it really makes me really.

Speaker 12:11:03It really is really frustrating. But I think if you add up all of those issues of gender issues intergenerational issues funding cutbacks Rachel can talk about the high pressures that work of acuity increasing. It's normal now.

Speaker 8:11:23So you're working in a pressure cooker and then you add on top of all these other issues. And when we're talking about it's OK to have an angry outbursts. We all have those. It's you know exactly. You know we all have moments of anger but I think what we need to get at is where does the definition of bullying where does the definition of abusive behavior show open. I'd like to know what your thoughts are about where you guys think Rachel hasn't had a chance to talk yet.

Speaker 5:11:57I would say the biggest thing that I've noticed is that the gossip goes on and when you come into a new environment and you don't know anyone there's not really anything to say. And if you don't say anything. People sometimes can ostracize you for that for not really having an opinion about someone or something whether it's systematic and whether it's management whether it's just some kind of procedure that's protocol to unit.

Speaker 4:12:27They're looking to see whether or not you're part of the club. Can you join in on that gossip because it's interesting it's a lot of. That's a lot of pressure.

Speaker 6:12:36I mean there's just in general that seems like a lot of social pressure to fit in.

Speaker 7:12:40I just watched the movie Mean Girls. I had to watch that. Is that the one with the dog you see is what you see as his passion.

Speaker 3:12:50Yes. The one with Rachel McAdams and Laura Lenzi let him go. OK.

Speaker 1:12:55OK. So it is really hard to be in your person. It's really hard because you brought up to Andrew. You asked How do you how did you find out about. Where did you like. And I think wait a couple weeks ago we talked about how how do you interview for your first job. Where did the questions you ask about your first job did it your market you know you can get a job pretty much wherever you want. And so where do you want to work and you should have your criteria shut down. You want to work in a place where scholarship is valued higher like higher education going on to school that needs to be supported.

Speaker 5:13:43I was told before I interviewed not to talk about potentially going to grad school because it could limit my potential on the unit. They would not see me as management material because they knew I was going to leave. Wow. But I didn't really take that advice to heart. And luckily I was that was well received by my assistant nurse managers.

Speaker 6:14:05But it's something that's out there that a lot of new nurses here I think is but that alone seems like there's a desire to press you into a have the peg fit its whole right.

Speaker 9:14:18Really go ahead. That's it. And I think that that just sounds that just sounds very forward and it sounds it doesn't sound like an environment that is that would be made attractive to you especially a new person coming out of school.

Speaker 4:14:32Did you have something else to say about that Rachel.

Speaker 5:14:35No not really I'm just glad at least where I interviewed that I didn't have feelings that I couldn't express my own educational goals. I thought that made me more marketable and if they didn't see it that way I knew it wasn't going to be the place for me.

Speaker 1:14:48Right. So another question that you could ask is How confident can gold in your unit.

Speaker 4:14:56You know before we go onto that and the new thing I wanted to get back to something that you said early that resonated with me. Bekkers said that that was when you said something about well behaved well-behaved nurses. You know you had to be a well-behaved woman. And so consequently I think when like when I run up against resistance that I would it's easy for me to fall back and say I'm being such a B.I you know a bitch. Can we cuss on the podcast Muggsy. He says yes we can. You know you get this as a person who was raised and I'm I'm not quite a baby boomer I'm at the tail end of the baby boomers.

Speaker 7:15:40So yeah. Cash I was born in 65 which means your last day of 1965.

Speaker 4:15:47Yeah yeah. But I guess my my my thought is that you come up the assume of course I'm a nice person and I was raised a nice Iowa and I'm moving forward and and then I come up against a like I want to be like say my mind about something and I sound to myself kind of bitchy and I have an internal conflict about this and how it's accepted. And maybe this is just revealing myself a little too much. But I think it resonated with me when the culture out there is we're still supposed to be nice. And where does the point of being assertive and in ownership of that it's just simply that's me and I'm being assertive versus oh my gosh they're going to think maybe I will see girls up Stuckey's the saying we're off to a break.

Speaker 2:16:40Period and CLECs mastery we love nurses and especially nursing students but we need your feedback about this podcast. If you have ideas on topics or you have questions you want us to answer. Shoot us a message leave a comment go to our Facebook page and just tell us what you think because we want to help you in the most specific way that you need that help. Thank you so much.

Speaker 7:17:09Okay so don't I like this is Macduff. I oh I wish it McBeath last night it was lovely to be. But it was hot outside. Yeah I was thinking and thunder.

Speaker 13:17:22Anyway Rachel you brought up the thing about gossiping and gossiping is so much fun. It really is. Yeah it really isn't fine. Until. Somebody gets hurt and so you have to be able to exercise some street smarts and and be able to discern whether this is just gossip about something fun or is it destructive or is it whining. And what's it accomplishing when you get into a kind of gossip that is mean or divisive or mean girls are trying to split a group splitting or there's a Plec being formed and you're not part of it. It takes a lot of courage. I was going to show moral courage that is the same thing to say. I don't know all the facts about this and I am I don't think we should be talking about this and when you have all the facts I'd love to have a conversation about it. There aren't any facts here. We're just speculating and I'm not going to be part of this and walk away. But that's being done at this predication that that yes it's it's courageous to say that but then the person who says that is also putting themselves out there to be destroyed socially by gossip and by showing you where does it feel like Rachel. Psychiatry where does it feel like. To know that you're sitting and listening and laughing right when you know you shouldn't be but you're going trying to get along.

Speaker 12:19:18And then you go home and you just think what the heck have I been hanging out. Who the heck am I become here. That's difficult. You're which like to be new which like to have that happen. How hard is it to just walk away.

Speaker 5:19:34I think for me my role is a little bit different because I had been a student there before so I knew people. But I'm hearing from other new nurses that are very good friends of mine. It has really destroyed them psychologically. They they can't really handle it and they don't feel like they can talk to people above them like their assistant or managers or nurse managers so chosen to either move on to different roles or move to different institutions.

Speaker 4:20:07But this gets into your second part of your theory. I mean it's the moral you know your own sense of self and and your own courage I suppose. And then and knowing yourself but then the organizational supports around you and then what's and what's supported in the organization.

Speaker 12:20:24Exactly. So part of being able to take a stand and a healthy response is to say I can't do this anymore but then having a courage to say to a human resources I am leaving because of the Intrepid gossip. I'm being bullied for the last six months. And that's one of the definitions of bullying is that there's a target. It's purpose is to isolate and separate and humiliate another person or group of people. And it has to be a pattern that has to go on usually for about six months before it's really called bullying.

Speaker 6:21:06So let's expand over a little bit. What else can be done besides going to H.R. or going to management or even the people the people that are conducting the bullying. Because this could be this could be a a lone rider situation where a nurse might feel completely on his or her own and that right there takes a tremendous amount of energy and courage.

Speaker 1:21:37So let me tell you a story. My very first job I was bullied by my nurse manager this is a long time ago but I was I was isolated. In retrospect I realize after I many years did I realized what had happened to me. And this nurse manager had bullied me. She started off my first day of work saying I hate nurses from two two year and four year program. She was at a time when there used to be three year hospital based programs. And I was from her quote for your program and I think he's going to go well from there. And she kept giving me really horrible assignments and I.

Speaker 10:22:21I told her on the first day for instance I've never I've never had any training and emergency room care and out of Calgary. We didn't do emergency room or critical care that was considered. You had to have a separate education certification to work in those areas. And it was considered post graduate education first day on a job where did I get assigned.

Speaker 1:22:45It was a small rural hospital that your first case in the morning multiple vehicle accident and there I was. And I asked for help. And I was told that I was weak and stupid and inept. And so I told the physicians that I've never done this before. Tell me what you need and I will do my best. There is another gaters code. And I started to do CPR and she bumped me out of the way and she said Get the hell out of the way you're of no use here. And next time you're shackled. It was just awful. And just like you find in the literature. That kind of bullying can be covert. Like getting really bad assignments repeatedly. It can be people targeting you without warning signs reading notes about you. Or it can be very overt like she knew she was brushing me aside. But no matter where it is we have our responses are so breaking. Rachel you talked about friends who have left her unit and they're doing that to protect her own health. And we know that this kind of behavior affects us physically that people got pinning chest pain chronic illness flare. So as a nurse practitioner is when you see nurses coming into your practice with an explicable symptom that you could say tell me what's going on at work.

Speaker 1:24:21And mentally depression political expression needs psychiatric intervention. Loss of face loss of friends getting into bad coping strategies like drinking too much. It has. So what do you do when your manager is a bully. I had a really bad annual review. It was terrible.

Speaker 7:24:46So I wrote an 11 page rebuttal on the classic classic Rebecca right there.

Speaker 12:24:53And I sent that letter to the chief of medicine and the director of nursing and then I quit and and she followed me into my next job. She wrote a really horrible evaluation but at my next job saved my life. Shaped my professional life. So this has been going on for decades. And what do you do. We can talk about things that you can say towards different things and tests well have lots of perspective lots of things to add from her psychiatry training but ultimately we have to look after ourselves as we look after ourselves and after regain some seniority where we are we have to spread our kindness and generosity to one another. You have to stand up. You have to walk in here UMich on that first day with your shoulders back and your head held high. And look people in the eye and let them know. That you're not going to be one of their targets. You're here to work. We're not here to be best friends. We're not here to be in a click. We're here to care for patients what we hold in common may not be our personal values but what we do hold in common our are our professional values are clear.

Speaker 3:26:25Bravo. Yes brother Roback.

Speaker 12:26:28So part of that part of that code of ethics is that we care for ourselves as we care for our patients we care for one another as we care for our patients.

Speaker 4:26:41This is why we're trust a profession right.

Speaker 14:26:46That's so.

Speaker 13:26:50What do you say when they're gossiping. Well we can say we I spoke about that what do you say when they are rolling your eyes. I didn't get that done today. Rachel I'm sorry I have to leave that bath for you. And you roll your eyes at me or I'm Will I roll my eyes at your check. I've got to start my shift already. Ten minutes late. And because I could do a bath and I roll my eyes. What can you think. I don't get a lot of first things I. Know.

Speaker 7:27:31This is all we have to keep cash. Exactly. We do have to be professional.

Speaker 12:27:37So I think for a second. What would you say to somebody who wants her eyes at you.

Speaker 5:27:45I think a lot of it comes back to education before we even step on the floor at our first job. I think it comes from this is the reason we have nurse presidency Bertram's. I think they need a lot of work. And these are the things they should be helping us learn how to handle ourselves.

Speaker 12:28:00So were you ever caught where you were to say no this is don't you think it just gets that leadership individual leadership.

Speaker 4:28:10And I think when you're the what you when you think you're the lowest man on the totem pole as a new nurse and or whatever your new job is then you don't think you're a leader but maybe Leadership to me leadership it's personal leadership not just like taking a position to be a leader. Right. So I don't and I do think that going through vocabulary I think and some of those. I mean Rebecca gave us three or four articles that we were to read in preparation for this.

Speaker 7:28:37I wish we could put up those citations on the Facebook site of people are really interested and hear some ideas when you get when you when somebody is rolling your eyes at you. You can say.

Speaker 15:28:50I see from your facial expressions or I saw your eyes roll and that indicates to me that you have something to say to me and it's OK to talk to me.

Speaker 13:29:00I'm I'm safe to talk to and and when somebody says oh you're just a newbie no wonder you didn't get everything done.

Speaker 12:29:10You guys are all the same as you can say. You know I I know I have a lot to learn. I'm in my first year but I learn best from people who respect me. I learn best from people who treat me with respect. And how could you reframe rephrase that would help me learn and it's a great question because what you also have to remember is that sometimes people who are mentoring or projecting appear to be really critical. And it can be your personality be they've got standards but she may want to be sure that you know what you're doing and you can perceive Guiche as overbearing but they're also saying I'm responsible for what you're doing right now. So I'm going to be on your case.

Speaker 6:30:05Well this is getting so kind of a little thicker skin.

Speaker 5:30:08Yeah I think that's something I got a lot of on my unit and it was the best thing for me. And I always forget that I got all that constructive feedback that made me made me strong from the beginning of time of need. Do you have an example. Rachel I think the biggest thing was being a medical and psychiatry unit. Some of the medical stuff really we just didn't have a lot of experience in a nursing school. However I learned quickly but they would you know even if they saw me struggling they let me struggle through it. And they were you know constructively criticizing like OK next time do it this way next time do it that way or if you think you have a better way let's come up with something together. I think that feedback is what what made me better. And if somebody was just like OK I do it however you want I I wouldn't be a good nurse.

Speaker 6:30:58And I think the key word there is being constructive with with great nurses and with new people. I think to your point I think that when you're calling someone names that that just punctures their their competence. And it's demoralizing. And so I think there is a big difference between being constructive and then just being angry to say well it was just dumb you know because that way is can be construed as well I guess I was just called stupid right there.

Speaker 7:31:34So one of the ways we got to we have to quit actually we need to quit. I'm sorry we have to end this we maybe need to have another session at some point. I'm going to be really interested to see what kind of comments people have. Please send them in Twitter. I'll be hearing your story and and give us some examples that we can pick up next time. Keep your eye on the patient. Be the change you. Be kind to to them over. I'll watch you if you watch me.

Speaker 2:32:03Friends of Flo was brought to you by an CLECs mastery. Go to the App Store right now. Downloading CLECs mastery. And before you leave if you could just share this with your Nurhasyim friends. Tell them about us leave us feedback go to our Facebook page. Tell us what you liked. Tell us why you didn't love so much. Be nice but thank you so much. We really appreciate you.

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