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The Mean Girls Club, or What’s Wrong in Nursing
I always knew I wanted to be a Nurse Practitioner (NP), even before starting nursing school, but I didn’t realize at the time one of the major benefits of being an NP: You’re not really considered a nurse anymore.
During my undergraduate clinicals, I started seeing the ugly underside of nursing, the side that students only hear about if they have nurses in their family: Nurses eat their young. At times it’s said almost jokingly, like a girl describing the awful band her boyfriend likes with a tone of, “I hate it, but that’s just the way it is, and I love him in spite of it.” As a student nurse, I would talk to any NP that would give me the time of day, and one of questions was about the interpersonal dynamics at the provider level: Are NPs catty to each other the way staff nurses can be? Everyone I spoke with said that the environment among providers was overwhelmingly better than being a floor nurse. So y’all can imagine how disheartened I was after spending the majority of my clinical hours this semester on a unit where the NPs are just as much a part of the Mean Girls culture as the nurses. One of the reasons I wanted to become a mid-level provider was to get above the fray, away from the backstabbing and snideness.
The real problem here isn’t my recent morale-crushing experience in the ICU, but rather the general Mean Girls culture in nursing, and the way little seems to be done to combat it. Channeling Regina and Gretchen might be okay in high school (if you haven’t seen the movie, go watch it now), but that kind of behavior is not only unacceptable for nurses, it’s dangerous. And it’s unfortunately all too common. When I typed in “bullying among” the first thing Google autofills to is “bullying among nurses.” That says a lot. There have even been articles written for the American Association for Critical-Care Nurses, American Nurses Association, and the Academy of Medical-Surgical Nurses about bullying in the nursing profession. New grad RNs tend to get targeted the most, and much like the Greek system, there is a strong tradition of hazing in nursing that ultimately puts the patient at risk.
Bullying contributes to the high turnover rate in nursing, and it’s not uncommon for nurses to work on a unit for six to twelve months before transferring to another unit or an entirely new hospital. High turnover rates affect health care costs more than you might think. Anytime a new RN is hired, there’s often a six- to eight-week orientation period, regardless of previous work experience, during which the new RN is paired with an experienced nurse on that unit. For those two months of orientation, the hospital is paying two nurses to do the job of one. Since nursing salaries are covered under the fee of the facility that’s billed, patients ultimately end up literally paying the price for nurses not being able to play nice.
But it can get even worse than just an increase in your hospital bill. Sometimes patient lives are literally put in jeopardy because of the Mean Girls culture. While I’ve never had a nurse refuse to help during a patient emergency, I’ve read stories of nurses who were left to fend for themselves while a patient was crashing. And I’ve chosen to handle a patient emergency by myself instead of asking for help from the other nurses (well, one particular nurse) who had created an adversarial work environment. It’s hard to bring yourself to ask for help when you feel you can’t trust the other person.
I’ve experienced the backstabbing, manipulation, and cattiness in almost every clinical and work setting I’ve been in as an RN and NP student. Fortunately, until this semester, I’ve been above the fray by virtue of functioning as an NP. But all of this makes me ask: Why is it that many times, when women are together in a group, they sabotage and tear each other down? Why are women often more critical of each other than we are of men?
I was reading something on Facebook about the division within my church over women’s ordination, and as someone pointed out, the most vocal critics of having women on the platform came from other women. I’m not convinced that it comes down to biology, as some would have us believe, or women wanting to gain the attention of the best potential mate. Women who are married with children can be just as mean as the single gals.
So what drives women to such lengths, even to the point of putting someone’s life in danger? Is it an innate desire for control? Respect? Status? Or are we perpetually stuck in high school, looking for the approval of the popular girls?
Published in General, Healthcare
Ooh! Links to this research would be super-interesting.
Outstanding neologism of the year. I plan to put this one to work. But the only quote I could think of was, “Let us now parage famous men.” Not appropriate for this discussion. How about, “I do not come to parage Caesar, but to bury him.” Or “damned with faint paragement.”
Glop, yoohoo, Glop! We need Mr. Goldberg on this!
Your wish: my command. The current technical term is “lateral violence,” and ANA has come out with a position and a few references:
http://www.nursingworld.org/Mobile/Nursing-Factsheets/lateral-violence-and-bullying-in-nursing.html
And a second edition of the book: http://www.amazon.com/Ending-Nurse—Nurse-Hostility-Second/dp/1615692819/ref=sr_1_1?s=books&ie=UTF8&qid=1455645018&sr=1-1&keywords=why+nurses+eat+their+young
All of that said, I stand by the idea that referring to anything but battery as “violence” is unnecessarily dramatic and sacrifices accuracy.
Thanks!
As the only dude RN in the room, my experience is that we men are treated worse because we are a direct threat to the matriarchy. You just won’t find us complain about it because as men we are conditioned to suck it up and Soldier on.
On a personal note, I find the phrase “male nurse” to be a little demeaning; I don’t think you would ever use the phrase “Filipino/African American/Indian nurse”.
No offense meant. In this case, I wanted the phrase to mean “nurses who are male as distinguished from female,” not the old, disparaging connotation of “male nurse (singular).” I haven’t encountered the latter for some years.
I don’t know about research on this issue, but it sounds right to me for any organization.
Vicryl Contessa,
As a male physician I would say your description is accurate in some hospitals. It all depends on the culture and leadership. I worked as a resident in a hospital where the OB manager was a real witch. Other floors at the same hospital didn’t seem that way. Some of the worst cattiness that I’ve seen is from female nurses to female physicians and vice versa. The same nurses that treat male physicians respectfully can be quite a handful for a female physician and I’ve seen and heard nurses talk about female physicians really tearing them apart.
This has been a real eye-opener to me.
It reminds me of how many of life’s problems do not have actual solutions.
This makes more sense to me as an explanation of the culture than, “women are just so catty,” because otherwise I’d expect the Google autofill to list a bunch of other female-dominated groups after “bullying among … ” It makes sense in terms of medical culture, which is pretty fanatical among doctors, too, and for obvious reasons: mistakes kill people.
The way I’ve heard it expressed among doctors is a bit different, but certainly has some elements of this. For example, I’ve asked friends or relatives who are doctors about the sleep-deprivation that seems to be part of a medical education, and wondered out loud whether patients might be safer and doctors might suffer from less burnout if doctors doing their residencies were allowed to sleep more. I’ve always got a huge pushback — “No! I was never allowed to sleep! You can’t possibly learn what you need to learn if you sleep! The residents must go through the same torture I did.” The attitude seems to be that there’s no way to make a good doctor save by depriving him or her of sleep and any kind of personal life for years. Whether this is true, or whether it’s a form of hazing culture, I don’t know, because I’m not a doctor, but I suspect there’s something about the profession that puts a premium on being, as you put it, a fanatic.
What does everyone else think? Doctors?
Claire,
That’s crap. The idea that docs need to have that trail-by-fire, sleep deprivation nonsense is garbage. It’s more of a “I had to do it, so you have to also.” ritual. I learned nothing in my 22nd hour of call that I couldn’t learn in the 2nd hour of a normal work day. Do we ask the same of pilots or truck drivers? Patients are put at risk with that kind of stupidity. Ask yourself, would you want your dad to be under the knife of a doctor who had been up for 18 hours?
That’s what I always say. I’m reporting what I’ve heard in response, from people more qualified to talk about what makes a good doctor. Glad to hear you agree with me.
An important aspect of the “hazing” aspect of this issue is that it prevents improvement to processes. A nurse or doctor who anticipates being slammed for an error may conceal it, when there’s a process that could’ve been made better. For example, handing someone a sharp instrument will stick them X/100 times. Instead of lambasting the person, we could get a standard procedure to put the object down on a sterile surface and let the other person pick it up. Fewer people get stuck that way. But that kind of performance improvement, as vital as it is, gets stalled by an environment where an error reported is taken as a license to abuse the staff member.
Uh it’s not crap. Some of it serves a very real purpose. The military trains troops and especially special forces to operate under the most extreme conditions of physical exhaustion, hunger, sleep deprivation etc. Is that because they just want to haze the trainees? No, it’s because they need to learn how to operate under those conditions. “Train how you fight“.
Doctors frequently need to be able to do their jobs, under less then ideal conditions. Many doctors need to be able to be awoken in the middle of the night and be able to function. Or work long stretches without a break. Or miss a meal. Maybe it’s my bias from working in the ER my entire career. But I’m sure it’s not much different for Surgeons, or Hospitalists, or Obstetricians or Anesthesiologists. Even just being awoken from sleep and being able to access what you are told and to give orders is something that needs to be learned. What’s learned in that 22nd hour of call is how to deliver care when you are dead tired and want nothing more then to be off, but you can’t because you need to take care of that patient. “Train how you fight“.
In the past it was carried to ridiculous extremes. For example the Surgical ICU rotation at Ben Taub Hospital in Houston under Dr Debakey was 1 month in the ICU of constant call. Residents were not allowed to leave the unit at any time during that month.
Just like in most areas of life there needs to be a balance between pushing the students and not exceeding what they can safely do.
Yeah, but he’s a doctor, not a Green Beret. I want him to heal me, not drag me through the jungle for twenty miles so we can get to the choppa! Appropriate training for the job.
I know a lot of attending physicians feel like the residents and fellows nowadays aren’t as competent and committed to their work as docs of days past. They say that during the interview process the young docs are more concerned about how much vacation time and money they get. And with the new restrictions on hours, surgical residents are literally forced to leave the OR in the middle of a case at times in order to not get in trouble for going over their allotted hours.
There should be some kind of balance, but trial by fire is a great teacher. Unless it becomes dangerous by virtue of not having support available if needed.
Why?
Why is this a necessity for doctors who are not in combat or a disaster zone? Are hospitals not hiring enough doctors? Why doctors as opposed to other jobs?
Douglas
“Yeah, but he’s a doctor, not a Green Beret. I want him to heal me, not drag me through the jungle for twenty miles so we can get to the choppa! Appropriate training”
That’s my point the training is appropriate. You want your surgeon to be able to get up in the middle of the night with 2 hours sleep and be able to go in and take out that appendix, then get the rotten gall bladder out of the next patient. Ditto the OB who has a delivery then the emergency C section.
Exactly. I once did a 10 hour microvascular case on 2 hours of sleep- I wouldn’t recommend it. Still, I did it.
Omega Paladin
“Why is this a necessity for doctors who are not in combat or a disaster zone? Are hospitals not hiring enough doctors? Why doctors as opposed to other professions”
generally at most places there’s one surgeon, one anesthesiologist, one Ob etc etc on call. In there’s more the demand is that much higher. The surgeon on call may sleep the night through, or he may be up all night doing emergencies it’s not predictable. In the ER we are chronically short staffed, and demand routinely exceeds the ability we have to care for them, not just doctors and nurses but room to see people, lab, X-ray etc. That’s why it was not uncommon for all the staff to work like dogs, and still have patient waits to be seen of 8 hours.
It’s not war. It’s a job. Schedule doctors to work shifts. There is no need to force educated professionals to work 24 or 36 hours just to see if they can. And the military does do the training in part to weed out the ones who can’t handle it. Is that how you want medicine to work? To break residents to wash out the bottom 20%? Physical and mental faculties deteriorate with sleep deprivation. When is it ethical to put real human patients at risk just to push the limits of a trainee? Is there any evidence that such training improves patient outcomes in the post training years? Do you continue to train yourself in that manner? Would you stay up 24 hours on purpose then go to work just to see if you can do it? You mentioned doctors and military. What other jobs do you think should be trained like that?
That sounds like an opportunity for someone to build an urgent care clinic or something to meet all that demand. It just seems to be a bad system from my perspective in occupational safety. I don’t even think nuclear reactor operators have that kind of approach, and they are mostly ex-military people who do an extremely demanding job – it’s about the blue collar equivalent to being a physician.