Phases of Nursing and Bad Behavior

There are several phases of nursing:


The Honeymoon Phase -  It is wonderful to be out of nursing school, just passed boards, giddy with excitement to make a difference and be practicing as a nurse.  The novice nurse feels EUPHORIC!  Advice for this phase is to find a nurse at the facility you are working that is positive, open, and you want to model your nursing practice after.  Steer clear of negativity.  Be positive and don't allow anyone to steal your joy! If a nurse is negative, chances are the clients she serves will not have optimum patient outcomes! If your preceptor is not positive, let the manager know NOW and request another!! (A nurse must command the room....remember when we told you this in nursing school?)


The Shock Phase - Realizes that nursing IS not what they expected and is far from perfect. The preceptor they are learning from does not follow protocol or do anything like they were taught in nursing school.  They don't know EVERYTHING.  Communication is unclear, bullying is vividly present among other nurses and professional behavior is very poor. The novice nurse may have experienced humiliation by other health care professionals and their colleagues because nurse bullying is allowed to go on.  Advice for this phase is to know it is NORMAL to feel dismayed and overwhelmed in your new profession.  It is okay to talk about this with the Nurse Manager, your preceptor, or the director of the floor you are working on.  Give yourself credit for all the things you DO know:  how to perform a thorough head to toe assessment and check for skin integrity, how to electronically chart that assessment, how to pull and administer the medications, knowing what the medications are, developing a patient specific care plan that will promote your patient to their highest level of wellness on the health continuum AND an assortment of other things.  YOU KNOW MORE than you GIVE YOURSELF CREDIT FOR!!!!  So go ahead and give yourself a high five for being a communicator, collaborator, educator, and advocate for the patients.  Observe the nurses you value and copy skills from them.  Make them your own and ignore the bad behavior!


The Recovery Phase - Finally understands the only person responsible for their nursing practice is "YOU".  By observing, you begin to see that each nurse has their own description of their nursing practice and each nurse is responsible to be the nurse they want to be....no one else is responsible for this.....turn around and LOOK IN THE MIRROR....and  "get it". How can you understand, be respectful, provide dignity and integrity to the patients AND all you work with?  Journal!  Write what is working and what you need to improve on.  ALWAYS keep a sense of humor and treat everyone you come in contact with the way you want to be treated! Everyone deserves to be treated with dignity, integrity, and respect.


The Resolution Phase - The novice nurse is beginning to set goals, define their mission and values.  Hopefully you have not started to picking up bad habits (we tell you about this in nursing school) just so you feel that you "fit in" with the rest of your peers.  This phase can be celebrated by knowing your successes and rejoicing in them.  ASK questions and if someone says anything to you, remind them that nursing is life long learning and when a nurse no longer ask questions, the nurse is a danger to herself, her peers, and the patient she cares for.


Where am I going with this?  I spent the afternoon with a novice nurse who is in the "shock phase" of nursing.  She has passed the "honeymoon phase" and is no longer elated.  She shared with me that she and several of the other 2014 grads are already burnt out and ready to find a new career.  This saddens me because these nurses are amazing! Very well educated, smart, compassionate, therapeutic, and holistic!


She experienced nine preceptors during the orientation period, one of whom was the poster model for a "nurse bully".  This particular preceptor wanted to know why there were so many things she didn't know.  (I only wish I could jump in her body for a few minutes to let this preceptor know a couple of things!) To begin with nursing school does not teach the student all there is to know.  Nursing school is to provide the student with quality, safe, and effective education.  This education forms a solid foundation for the student who passes boards to build upon.  The novice nurse really learns when she gets her first job as a board certified nurse.


Nursing is LIFE LONG education.  Whenever a nurse thinks they know it all, they are a danger to themselves, their peers, and the patients they serve.  To humiliate another human being, embarrass or  bully them should be grounds for termination.  Zero tolerance!! 


As I spoke with this novice nurse attempting to tell her she is normal, a good nurse, to believe in herself and continue to make a difference,  I knew from the look in her eyes, she has her mind pretty much made up.  There are two nurses she works with that she feels "safe" enough with to ask questions of.   I told her she can transfer to another department or she may want to go work for an insurance company, look into becoming an employee health nurse, care coordination, etc.  There are so many avenues for nursing besides floor nursing.


I hope that by listening to her and providing some attention and "tender loving care" (TLC), this novice nurse will see what a blessing and gift she is to the world of nursing!  There is a nursing shortage and we truly cannot afford to lose any of the gems!

An amazing thing happened during practicum........

A wonderful thing happened at practicum with the students last week.  On Wednesday they commented how wonderful the nurses were on the med surge floor we were on.  The nurses were helpful with each other, the students, and me.  How wonderful for the students to see this and bring it to my attention!


Guess what?  It happened again on Thursday during the OB practicum!  MUAH!  I love it when a plan comes together.  I hope we are teaching them to comment on the positive and stay away from the negative!!!!

Sharing the journey

I was invited to share,  with freshmen college students a little bit about nursing and my journey in nursing.  It was very nice and informative evening.  I shared the stage with a clinical psychologist and a state social worker.  We had not met before this evening but it seemed like we had known one another our entire lives. We each work in a different profession and provide the client served with hope, integrity, dignity, and humility to those who cross our path.  What a wonderful evening sharing our journey with young students! 

Civil Educator?

I repeatedly have said I will not be surprised at the actions of those who have power over others BUT I recently had ANOTHER eye opening discussion.  This individual is a LPN and has gone back to school to pursue her dream of becoming a RN.  She is a long time friend who I had told to call if she needed help (does not attend the university I work at).  She asked if I had any suggestion for success in one of the classes she is currently taking. She advised the first day of class, the instructor stated "I am not here to teach you".  The instructor went on to let the class know they did not know "crap".  Less than five students passed the first test and the highest score was in the lower eighties.  The instructor told the class this score was too high to earn on her test.  I am appalled at this story and even though I do not teach where this student attends classes, I am embarrassed this person is a faculty member who is to facilitate education for future nurses.  This instructor's behavior is a form of bullying and a perfect text book definition of horizontal violence in nursing.  What SHOULD happen?   The entire class should file a formal grievance and after an investigation, this educator should be turned out to the community for more opportunities.  End of story.  I cannot comprehend why nursing instructor(s) are allowed to treat students in any manner that does not provide integrity, dignity, and respect.




In order to stop bullying and horizontal violence in nursing we must all stand tall and against this type of behavior.  This is unacceptable....what will you do when you see this behavior?  Keep quiet and allow it to go on or speak out against it?  By keeping quiet, we are saying it is acceptable.

REALLY????????????????????

ALL nursing educators must "resemble" kindness in nursing and promote ending horizontal violence in nursing.  Horizontal violence in nursing is the maltreatment of other colleagues which will also end in poor patient outcomes.   As sad as this story is, I hear it over and over:  A loved one is ill and has been in the hospital for several days and cannot get a bath.  Bathing is part of nursing. Documentation is done daily about client bathing and if it is done unassisted or assisted.  Why would the nurse caring for the client not realize the client needs to be bathed or help with bathing?  A nurse is to perform a head to toe assessment during their tour of duty,  how could the nurse NOT make sure the client is clean???  What is the nurse charting?  Poor hygiene does not promote skin integrity or help to restore the client to wellness.  I am so furious right now.  Oh my, my.  I am sick and ill at my stomach that there are nurses who are not providing EXCELLENT care to those they serve.  How has this nurse made the client feel...as they do not matter or worthy of living.  They would not even bring her a brush.  We must teach novice nurses to NEVER treat ANYONE this way. Florence Nightingale has rolled over in her grave!

Breaking point

With the announcement of Robin Williams death, a few thoughts come to mind.  We cannot see into someone's heart and soul.  While an individual appears strong, funny, responsible, kind and compassionate on the outside, we never know what is really going on inside.

• To nurse educators:  Do not teach by intimidation.  Do not look at a student and say, "Why are you here, you will never be a nurse!" 
• To administrators, directors, managers: Why would you belittle another nurse?  Why would you say, "you are a poor representation of a head nurse" or "you are incompetent, what is wrong with you?" or "I don't care if it is your vacation time, it is your weekend and you must work, no, a prn nurse cannot work for you!" 
• To staff nurses who work side by side: Why would you sit on your tail while another is running around attempting to care for patients and laugh because your co worker is near tears? 

What happened to smiling and saying, "we can work through this, yes, take your vacation and enjoy time with your family."  "Let's work together to build you up and see how we can you a better head nurse." "Tell me what you are struggling with, we can work on it." "What can I do to make things better for you?"


We are to provide dignity and integrity to those we serve and that does not only mean the patient and their family.  As a nurse educator, I must provide dignity and integrity to my students.  I must find a way to build them up for success instead of attempting to set them up for failure.  This holds true to administration, directors, managers, and co workers.  We MUST provide integrity and dignity with human compassion to all we serve!


We never know what straw will be the one to break the camel's back.  We must learn to be kind, even when we need to deliver constructive criticism.  We must provide kindness, compassion, dignity, integrity, and respect.  Until we stand up and say, "I am not going to take your maltreatment anymore!", horizontal violence in nursing will continue.  Will you push someone over the edge with your comments or will your comments prevent them from going over the edge?


Education, role play, being a servant leader, providing respect, and refusing to participate in HV in nursing are all ways to nip it in the bud!!  Heaven help us all, it may help make us better people outside of work as well.  Do not be the one to push someone to the brink, be the one who will catch them as they fall and help them stand up again.


One person can make a difference and that person is you!


On the journey with you,
Jodi

STOP the HV in nursing!!!!!

One of my students in the RN-BSN class asked me if I had any guidance for her after she earns BSN.  She said the horizontal violence on the floor has gotten worse.  She was not sure she wanted to stay on the floor.  How sad is this?  Administration at facilities have got to get a grip on this behavior and STOP it!!!  If they would start with zero tolerance and get rid of the nurses who continue to practice in this manner, I am sure we would see a decline in HV in nursing.  Bullying is not allowed in the workplace and HV in nursing is a form of bullying!!!!  Nursing is a profession that prides itself in caring for clients in a therapeutic and holistic manner.  We provide integrity and dignity with respect to those we serve.   Why would nurses not do this for their colleagues?   Facilities are losing good nurses because Administration allows HV in nursing to continue.  They know it is going on but do nothing to stop it. Even when it is staring them in the face, nurses are resigning and telling them why, they do nothing.  Heavens, sometimes Administration is the problem.  How many staff nurses are intimidated when  they need to be off work for a medical procedure?  How many co workers do not take their turn to be pulled to another floor, refuse to go, and are allowed to get by with this?  How many directors and managers belittle the staff nurses? When is someone going to stand up and say, "I am mad and I am not going to take it anymore?"  One person can make a difference and that person is you!