Kindness

It has been while since I blogged.  With the end of semester and Christmas festivities, I simply could not do everything.  Please forgive me for being away for too long!!!

I love educating students to become nurses who will practice safely and provide optimum care to those they serve.  How then, could I feel a little twinge of guilt doing what I love? There are those in nursing who are ugly and set out to destroy their peers, both novice and seasoned nurses. Some revel in seeing their colleagues (and at times, the student nurse) break down, become overwhelmed, and cry. So, what am I doing? I am encouraging, watering, building self esteem, and attempting to "grow" a nurse while creating a positive working environment for practicing nurses to criticize, tear down, and destroy what I and my colleagues have attempted to instill in the nursing students.   We want the novice nurse to practice safely, holistically, therapeutically, compassionately, and be kind to their client and colleagues. If we provide this education during nursing school, maybe we can stomp out horizontal violence (HV) in nursing.  We no longer tolerate harassment in the workplace so why is nursing administration and management still tolerating HV?

I know without a doubt, there are nursing educators who feel the dark secret in nursing should not be let out of the bag.  Let the nursing student find out on their own how evil nursing administrators allow their team of nurses to treat one another.  Nursing administration is as guilty of HV as the staff nurse. Need to be off for surgery or for an illness and the gates of hell hath no fury.  We all hear how awful nurses have been treated by management when they need to be off for illness.  Yes, even I thought this was a myth until the day (years ago) I felt the wrath of those in the Ivory Tower.  Had it not happened to me, I would have probably still thought the other nurses who shared their stories, had surely misunderstood what management had said to them.  I am still in awe of what happened so many years ago when I needed to be off for surgery. Forgiveness was given but the situation will never be forgotten.

I have watched how well nurses are treated as long as they give excellent care, work crazy hours when a shift cannot be covered, and do everything else management ask of the nurse...unless the nurse gets sick.   All of the sudden the golden child, who could do no wrong, is no longer the golden child.  Unbelievable isn't it?

Nursing educators feel the sting of HV also.  When a colleague ask, "Is there anything else I can do for you? Do you need help with anything?" and the answer is "No", do not complain that the colleague did not do their share of the load.  Spreading false rumors about colleagues is not conducive to a healthy and positive environment. If as much effort were put towards building one another up as is put towards tearing them down, what a wonderful environment would be created.  Lord knows, one gets more with sugar than with vinegar.  Sad that some have still not learned this life lesson!

I must be honest with the students in my care.  I attempt to guide the students to practice safely while instilling positive leadership and management skills.  My advice is to stay out of the cliques, learn to walk away from negativity in a positive manner, and to be kind to everyone!  One person can make a difference and that person is you!

Constructive Criticism

Recently, I was involved in a conversation about  "coddling" students.  To coddle means to be indulgent or act sweat, squirm, cry, and become so stressed the student cannot think.  While I do want to grow nurses who practice safely and in a holistic and therapeutic manner, I do not want to and will not participate in any way, to provide a hostile environment where the student feels they are bullied and or humiliated.

 

 I am not even sure why this negativity is present in nursing schools and the environment many nurse's work in.  Nurse educators are not exempt from participating or being the victim in horizontal violence (HV) in nursing.  The National League of Nursing (NLN) (2008), the American Nurses Association (ANA) (2006), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2008) all concur there should be ZERO tolerance.  Heavens to Betsy, JCAHO (2008) issued a sentinel event in 2008 to stop HV in nursing and stated there should be ZERO, yes, I said ZERO tolerance. So, why are we continuing to allow and tolerating HV.  We continue to sweep it under the rug.  Is it because there is a shortage of nurse educators and nurses to staff the floor? Businesses are so concerned that their facility does not present or tolerate a hostile work environment but yet organizations that employ nurses and nursing schools are allowing this behavior.  When we watch this happen and do not voice a concern we are as guilty as the mean nurse

 I refuse to participate in HV.  I refuse to mean to my peers and colleagues. I refuse to be mean to nursing students.  If a student is having a bad day, has done poorly on a test, or just needs some positive reinforcement, I am your go to person. I give out hugs, I give out chocolate, I give out smiles, and positive constructive criticism.  My office is very cozy and open to the student who just needs to voice their feelings. I would never say anything negative to the student in regard to another faculty member, but I will listen.

 

 How do we give out constructive criticism, sandwich, sandwich, sandwich the comment!!!! How do you do that?  Here is an example:  “Your bedside manner with the patient was therapeutic and your knowledge of the medications administered went very well.  The sterile dressing change was going well, until you broke the sterile field.  You did realize your mistake and started over again.  The education you provided the patient and care giver was very good.  This was a learning lesson for you today and you did well correcting the error, and keeping the patient out of harm’s way.”  How difficult is this?  I guess I am worn out with hatefulness and we all can stop HV if we band together.  Remember, one person can make a difference and that person is YOU!

 Those who participate in HV in nursing must be so miserable with their inner self.  Truly, they need to find another profession because we all are miserable with the negativity they project.  I feel sorry for them, will continue to be nice and smile in hopes that someday, they get the picture that you get more with honey than you do with vinegar....and the patients will have better outcomes and their colleagues will appreciate them!  Stand up for ZERO tolerance!!!!!! Be kind to all!

 

References

American Nurses Association. (2006). Background report: Workplace abuse and harassment of
 nurses. Retrieved from www.nursingworld.com 

 Joint Commission (2008). Sentinel event alert: Behaviors that undermine a culture of safety.      

 Retrieved from www.jointcommission.org/SentnelEvents/SentinelEventsAlert/sea_40.htm   

 

 National League of Nursing. (2008). Nurse bullying. Retrieved from www.nln.org

I love teaching and seeing the "ahha" moment.  As a nursing educator, we do realize that many procedures can be performed in a different way. A brand new student may only see black and white, no gray area.  As a student progresses in the program, they begin to see the whole picture AND the gray areas. A staff nurse at a clinical site may not perform a sterile dressing change the way it was taught in school.  Guess what?  This may be okay, as long as sterile technique is not broken.  So nursing students, be careful and do not offend the staff nurse with "that is not the way we learned to do it in school".  We do attempt to teach the procedure a specific way in school so you may understand the technique, concept, and rationale.   In reality, there may be eight different ways to perform a procedure, but remember... as long you do not compromise the patient, have practiced safely, and finish with the same ending, all is well!

Don't forget to be kind and SMILE!  You may be the only bit of sunshine the patient sees today!

I had an amazing experience on the floor this week.  It was the first week for the students and we passed many medications, performed dressing changes, bed changes, and bathes.  The students performed so well and the staff nurses were welcoming, nurturing, and helpful to me.  When we have more than five or six students on the floor it makes it almost impossible to give each student a positive experience that is filled with learning.  I want to give a shout out to the nurses on 2SE at Clark Memorial Hospital in Jeffersonville, Indiana.  Cindy, Carol, Diane, and Del.  Thank you for being positive role models, mentors, and advocates for the student nurses!  Many nurses could learn a few a things from you! 

What are YOU doing when you witness HV among your colleagues?

 

        Is the manager or the director of your unit degrading to the staff nurses?  Have you witnessed maltreatment of a colleague and not done anything about it?  If we stand by and witness HV in nursing and do nothing about it, we are as guilty as the perpetrator.   What type of care do you think the patient who the targeted nurse was caring for, received after the verbal abuse?   HV in nursing is the same type of behavior as bullying.  We do not accept or encourage bullying so why are allowing HV in nursing to go on and on and on?

       Be an advocate for your colleagues and for the patients you serve.   If this type of behavior is occurring in the facility you work at, follow the chain of command, and help stop this behavior among nurses.  Make sure you have all of the facts.  Document the date, time, who was present, exactly what was said, and how it made you feel.  We must rally together to stop this type of behavior among nurses.   When we have zero tolerance for HV in nursing, we will have better outcomes for the nursing staff and the patient's served. This is a win - win colleagues! 

      Have you been in this position?  What are your thoughts?

 

Banding together to "grow a nurse"

Nurses are taught by nurses.  Education is provided in the classroom and at a facility taking care of patients under the watchful eye of seasoned nursing faculty.  All nurses have been taught in this manner so how could nurses ever forget they were once a student?  While some nurses are welcoming and share their wealth of knowledge with nursing students, others…not so much…we hear “stay out of my way” or the student is completely ignored by the seasoned nurse.  Sometimes they make life very difficult for the nursing student.  Learning and comprehension do not occur when a student is stressed.  Students learn when their mentor is calm, welcomes questions, allows time for the student to think of the answer to hopefully have positive patient outcomes and for the student to have that “ahha moment”!

Why oh why would a nurse act like the student is not in their presence?  Why would they make the student feel like they were in the way?  When I facilitate clinical, I go in to the patient’s room and introduce myself, and ask, “Is it okay if we have a student come in and help take care of you today?”  (I have been facilitating clinical for seven years and have only had one patient decline a student.) When the patient advises it is okay, I will throw in, “Are you okay with a male student?” (Again, I have only had one tell me no males, so we assigned a female student.)

If I were the nurse in labor and  delivery, I would do exactly what a physician does when they have an intern with them…they bring them in.  They do not ask permission because this is how physicians AND nurses learn.  The student is observing only.  Many times we have heard the seasoned nurse walk into the patient’s room and say, “We have students today and you do not want a student do you?”  Presentation is everything!  Even if a student observing would have made no difference to the patient, it surely will after a question like that!  The students have advised many times during the clinical day, when they are paired up with a nurse, they are ignored.  Attention all directors, managers, and staff nurses….at one time, you were a student once, we must band together to “grow a nurse” and stop this form of horizontal violence in nursing.

What are your thoughts and comments?

Family Smooth Over!

We have all been through this:  Patient is fine, no complaints, pain is under control, and all is well.  The family arrives and suddenly everything is wrong!   How can a nurse handle this without causing more stress to the patient, the family, the rest of the staff, and other patients on the floor?  Learn to smile (ALWAYS), gently touch their hand or arm and say, "You know what, you may be right, but, what can I do FOR YOU, RIGHT now that would make things better?"  The family member is so shocked that you said they might be right.  In their mind they are thinking, "She/he said I might be right, she/he wants to do something for me".  It may as simple as a cup of coffee or a warm blanket.  Try it, it is hard to be mad at anyone that has a smile on their face.  Does this work EVERY time?  Of course not, but more times than not, it works.  Remember that you do get more with honey than you get with vinegar and it only takes one person to make a difference and that person is you!

Tip to start the day off right

When we get off the elevator in the morning and hear "Run, it has been a nightmare", this starts the day in negative manner.  Negativity breeds like wildfire.  Learn to smile and say, "Everyone must be taken care of, give me report so you can get out of here!"  Breath, get report, go on walking rounds, and smile at your patients.  Will make a difference in the outcome of their day and yours!  Try it, I would never steer you wrong!

"What the horrors of war are, no one can imagine. They are not wounds and blood and fever, spotted and low, or dysentery, chronic and acute, cold and heat and famine. They are intoxication, drunken brutality, demoralization and disorder on the part of the inferior... jealousies, meanness, indifference, selfish brutality on the part of the superior."  (Florence Nightingale, Mother of Nursing)

What does this quote say to you?  My perception is there has been a war within the culture of nursing for many years. Any thoughts?

 

Recently spoke with an individual who went to a very plush rehab center.  The nurses were not friendly, did not have knowledge of the medications they were administering, told the patient to "just take them, the doctor ordered it, I don't know what it is for."  The individual was intimidated and feared retaliation if she complained of the care she was receiving.  What type of patient outcome do you think this was?  The individual did not feel good about this experience and anyone she relays her experience to will not go to this facility.

Nursing 101 and for the rest of your life:

• ALWAYS know what medication you are administering to your patient, along with the side effects why the patient is taking the medication, and how it will benefit them, both short and long term.
•  If you do not know the answer, find it.  You may have to excuse yourself and find the answer or you can simply look the info up on the computer you should ALWAYS have with you when administering the medication since we do have an electronic medical record (EMAR) in the majority of facilities now.  If your facility has not transitioned to an EMAR yet and is still using a paper MAR, know the info before you enter the room.
• NEVER intimidate the client, this does not promote positive patient outcomes.
• Nursing is life long learning, we never know everything and do have to look information up or ask questions of our colleagues.  The minute a nurse tells me she/he knows everything, I am afraid of  them.  They are a danger to the patient served and their colleagues.
• Smile....you may be the only bit of sunshine the patient sees all day.  One person can make a difference and that one person is you!

I want to let you know about the fantastic care I received at Clark Memorial Hosptial yesterday!  Amazing! We do have a wonderful community hospital.  Shout out to Aaron, Drake, Shannon, Angie, Brittany, Meghan, Ronnie, Dr. Garcia, Dr. Linder, Debbie (I think she was the other nurse in the OR with Ronnie), I am so sorry if I have left anyone out.  Awesome team in Preop, OR, and PACU!  This is what positive nurses and staff promote! WELLNESS and POSITIVE patient outcomes!

I am having surgery today.  I have a fractured humerous at the greater tuberosity.  The fracture is at the joint which is releasing fluid and keeping the bone moist so it has not healed.  I will update you on how my family and I are treated today.  Should be an interesting day!  Be kind!

Some of you reading may think, "Oh those nurses just make this stuff up, really, the morale and atmosphere cannot be that bad". Well, folks, I hate to tell you but it is TRUE!!!!! In 2009, the Joint Commission issued a sentinel event in regard to the attitude in nursing and implemented standards that required accredited health care organizations to develop rules and regulations and put them in place. These regulations should specify what types of behavior were acceptable and to create a formal process to manage unacceptable actions. The Joint Commission did advise the health care facilities that cruel, rude, and socially unacceptable behavior among health care professionals places the patients served in an unsafe position and the quality of care is not top notch. Not only does it place the patient at risk, the nurse who is being bullied is at risk .

What type of horizontal violence am I speaking of?

• Refusing to help the novice nurse, a supervisor advising their co-workers not to answer any of their questions, not to help them at all- let them sink or swim!
• Refusing to take part in duties of the floor.
• Setting others up for failure.
• Administration mistreating the staff nurses when they need to be off for illness, surgeries, etc.
• Old fashion bullying.
• Condescending attitudes (Where did you go to school? You don’t know how to do that?)
• Retaliation (nurse calls in and will be given the most difficult patients upon return)
• Nursing faculty mistreating one another.
• Hazing of novice nurses or seasoned nurses new to the facility.
• Staff nurses mistreating nursing students.
• Nursing faculty mistreating nursing students, weeding out.

This writer is convinced that EDUCATION and ZERO TOLERANCE are the keys to eradicating horizontal violence in nursing. We must be kind to one another and show compassion. We must all be accountable for self AND others. If we are witness to this behavior and do nothing to stop it, we are as guilty as the perpetrator. The protocol must be enforced, no exceptions to the rule, learn to apologize to all, including coworkers, families and patients who witness the behavior. Remember, one person can make a difference and that one person is YOU!

Horizontal Violence in Nursing

Many of us have heard the saying, “Nurses eat their young”. This is true. Nurses are mean spirited towards one another, bully one another and like alcohol, there are no boundaries: nurse educator to nurse educator, nurse educator to student, staff nurse to nursing student, staff nurse to staff nurse, management to staff nurse, and the list goes on and on. We must stop tearing one another down and start building one another up. A good place to start is nursing school. We need to provide education and prepare the students and provide the tools to eradicate this type of behavior. Seasoned nurses must role model positive behavior for the novice nurse. One person can make a difference and that person is YOU!

Negative behavior by the nurse will affect the patient, the patient outcomes will not be positive. Nursing management must learn to be kind to the nurses who work for them. This is a no brainer, happy employees are harder workers. Nurse management can send all the cards they want that say, “thanks for working the extra shift”, “thanks for all your hard work,” or “we are glad you are on our team”. It is their actions that speak louder than words. What are your thoughts? Do you have questions about handling a difficult situation?