There is a pervasive problem within the nursing profession. It’s been called nurse-to-nurse hostility, lateral violence, intergroup conflict, and eating our young. There are a lot of different names for it but whatever you chose to call the problem, it’s responsible for ruining a lot of nursing careers.

A Bully In Scrubs

There are many reasons why a nurse turns into a bully. Nurses have little autonomy in the workplace while being held accountable for everything that happens on our unit. We are also low man on the hospital hierarchy structure totem pole. Doctors and hospital administrators outrank us, and we work in a very intense environment. Throw in a few hostile patients and family members and you get the recipe for a bully in scrubs. Nurses who feel overwhelmed and oppressed at the bottom of the health care ladder engage in passive aggressive acts. Unfortunately, this type of behavior only perpetuates the cycle of lateral violence on the unit.

Lateral violence comes in all shapes and sizes. It can be verbal or non-verbal and either overt or covert. The most common forms of lateral violence include undermining, withholding information, sabotage, infighting, backstabbing, scapegoating, and undermining nursing colleagues. Bullying is a type of lateral violence that is generally associated with individuals at different levels of power and authority, but can also occur nurse to nurse. This type of behavior includes humiliation, intimidation, victimization, and verbal abuse.

It doesn’t take long before new nurses experience these types of destructive behaviors in the workplace. According to research conducted by Martha Griffin, RN, PhD, clinical specialist and program coordinator of nursing professional development at Brigham and Women’s Hospital in Boston, 60% of nurse new to practice leave their first positions within six months because of some form of lateral violence being perpetrated against them. Griffin’s research also shows that 20% of new RNs leave the nursing profession within three years due to lateral violence in the workplace. Even seasoned nurses can run into lateral violence when they chance jobs.

Bringing Down the Bully

It isn’t easy facing a bully, especially if you’ve been bullied in the past. However, you can transcend your fears and establish a healthier relationship with your coworkers by using a few simple techniques.

Improving the work environment starts with open, honest, and respectful communication. People must hold themselves and each other accountable for unacceptable behavior on the unit. Confront and address inappropriate behavior immediately as it occurs with the perpetrator. This is important because it shows that you will not tolerate the behavior. It is also helpful in some cases because the other person is not aware of their own behavior. Make “I” statements when you talk about your feelings. “I feel… when you.” Keep repeating yourself if the other person makes excuses, denies, or dismisses the incident. Keep records of incidents and communications if all else fails, and show them to your supervisor.

Patient care suffers when nurses can’t get along with each other. It’s time for the infighting to stop. Do you have stories about lateral violence in the workplace? Come to Nursing Voices and tell us about it. We’re waiting to hear from you.

Every nurse thinks about quitting their nursing job from time to time when they are having a horrendous day at work. Wanting to run for your life when you’re facing a stressful situation is normal, but it brings up a question posed to me by one of my readers. Super LPN wants to know when is it time to quit your nursing job. She writes:

I am thinking hard about quitting my present job, am attached to my resident patients, and some of my aides, and the Monday through Friday shift. But I have no unit supervisor. The whole operation is very “manage by crisis” oriented. I often work 10-12 hours a day, and I only want 8 hours a day. I have a life outside of work, and it has suffered badly. I am so sick that I cannot handle doctors over the telephone, and I forget things. I am staying home from work today. I have even lost my voice. I am afraid for my license. I was promised a very good nurse as my unit supervisor, but she was in a car wreck on her first day of work and we haven’t seen her yet. I am still all alone. I am responsible for narcotics that other nurses give, and I’m not a supervisor! Morale is very low, mine included, I have no control, and all the responsibility for people’s lives. I’m about over it. But, I get along fine with the DON. Any suggestions?

Dear Super LPN:

You are asking a very important question that every nurse faces during his or her nursing career. The nursing field is filled with nursing jobs like the one you are describing to me. I can’t tell anyone what to do, but I’m going to give you some things to think about to help you make your final decision about quitting your nursing job.

Can I Afford to Quit My Job?

I totally understand why you want to quit your job. You are working under tremendous pressure, and I’m sure that the stress that you are under is impacting your health. If you decide to quit your job, ask yourself if you can afford to be without a job while you are looking for a new one. If you need a steady income—and who doesn’t—don’t quit your job until you have a new job waiting for you when you walk out the door. Start looking for a new job now if you’re thinking about quitting your old job. You might get a better job offer somewhere else.

Can I Afford Not to Quit My Job?

I am really concerned about how your unit is being managed. Good facilities strive to provide excellent patient care. They will do anything to prevent a crisis from occurring on their units. It sounds like your unit is just one incident report away from a major lawsuit. Can you really afford to stay in a situation where you can lose your license? I understand how the people we work with become our extended family. Just remember that you can still visit your former patients and hang out with your friends when you leave your old job for a new one. Don’t let guilt and fear of the unknown hold you back. Personally, I’ve never kept a job that has made me miserable. Life is too short and I refuse to lose my sanity, or my nursing license, over a job.

Do you have questions or comments about working as a nurse? Come to Nursing Voices and tell us about it. We’re waiting to hear from you.

I’m sure that what I’m about to say will shock a lot of young people in the nursing profession. Nurses use to hold the same job for a lifetime. I’ve known many nurses who have worked their entire career where they attended nursing school. Now unit secretaries have to update their unit staffing roster every month because of the turnover. According to a recent report by the US Bureau of Labor Statistics, “baby boomers” held on average 10.2 jobs between the ages of 18 and 38, so that means that it’s time to prepare for your next exit interview. There’s a right way and a wrong way to say your goodbyes to your former employer. Here are some tips on how to make a graceful exit from your nursing job.

The Truth About Exit Interviews

Exit interviews seem harmless enough, but nothing can be further from the truth.
Responsible employers might use the information to improve their nurse recruitment and retention activities, but disreputable employers solely use exit interviews to gather information that they can use against former employees in case of future litigation. Be careful how you answer open-ended questions, and be especially careful if you are leaving because you can’t stand your old boss. Ranting during your exit interview can come back to haunt you. The notes from your exit interview are kept in your employee file, and your former employer will think twice about rehiring you at a later date if you burn your bridges as you are walking out the door. Remember that nothing you say is confidential. What you say during your exit interview can also be used against you in a court of law if you ever decide to sue your former employer.

How to Answer Exit Interview Questions

There is no rule that states that you must participate in an exit interview, however it could hurt you later on when you ask for a reference. Also be aware that you are not required to answer any questions during an exit interview. Keep your answers short, or just say, “No comment,” if you don’t want to answer a question. At the end of the meeting the HR rep may ask you to sign the notes that he or she has taken during your interview. Don’t sign anything! You will be signing away your rights if you end up in court.

Here are some commonly asked questions:

What is your primary reason for leaving you nursing job?
What was most satisfying about your job?
What would you change about your job?
Were you happy with your pay, benefits, and other incentives?
Would you consider working again for this company in the future?

The best way to say goodbye to your nursing job is to walk out the door calmly. Don’t make a noise at your exit interview. Shake hands, collect your last check, and look forward to the rewards and challenges of your next nursing job.

If you have any advice about exit interviews, come to Nursing Voices and tell us about it. We’d love to know what you think, and we’re waiting to hear from you!

Everyone occasionally has a bad day at work. Something goes wrong and we take our anger and frustration out on our coworkers. It happens to the best of us, but what are nurses supposed to do when intimidating doctors act out against nursing staff day after day? Here are some tips that will help you deal with doctors who have nasty dispositions.

Don’t Hide, Get Wise.

I’ve seen this scenario play out countless times during my nursing career. The nursing station is full of playful chatter that comes to an abrupt halt when a certain physician walks onto the unit. Nurses scatter and take cover as the doctor starts yelling and slamming charts down at the desk. The best thing to do is to show no fear. Some doctors enjoy making nurses sweat, so don’t feed into their negative behavior by giving it positive reinforcement. Give them direct eye contact. Don’t allow them to hover over you. Stand up, don’t sit as you speak to them. Speak in a low, quiet tone. The physician will have to lower his or her own voice to hear what you are saying. It’s also appropriate to tell an abusive doctor that you will not tolerate their behavior. And if all else fails, walk away. Tell them that you will speak to them when they can act in a professional manner.

Calling in the Middle of the Night

Here’s a common occurrence that happens on a nursing unit during the night shift. A nurse has to call a doctor for telephone orders for a patient who is in pain or who has spiked a fever in the middle of the night. The night nurses start haggling with each other over who is going to make the call because the doctor has a monstrous reputation when it comes to being called in the middle of the night. The unlucky nurse who ends up having to make the call dials the phone. The doctor answers the phone call, and after a few moments of silence, says words that would make a sailor blush. If you’re that unlucky nurse, stop and remember theses things before you respond to Doctor Temper Tantrum:

1) Don’t apologize for doing your job. You aren’t making social call. You are making a phone call to a physician on behalf of your patient.
2) Don’t take anything the physician says personally. Pull the phone away from your ear while the doctor screams, curses, and vent. Then calmly, yes, calmly, continue your conversation by stating the facts and asking for orders. Speak with absolutely no emotion in your voice. This technique is useful in calming down irrational patients. It will work on irrational doctors in the middle of the night, too.
3) If the physician continues to be abusive, or refuses to give you orders, have another nurse listen in on your conversation on another phone line. You’ll need a witness. Then call the nursing supervisor. Write up the incident and file a compliant with hospital administration in the morning. In the meantime, your nursing supervisor can immediately take the issue up the chain of command. No matter what happens, keep focusing on your patient because they are your first priority.

Do you have any tips on how to deal with rude doctors? Come to Nursing Voices and tell us about it. We’re waiting to hear from you.

All bad nursing jobs must come to an end, and even the good nursing jobs must come to an end, too. There is a right way and a wrong way to leave a job. The best exit strategy involves planning ahead. Here are some tips that will help you end your nursing job with style and grace.

Give Your Resume an Extreme Makeover Before You Hit the Road.

It’s always a good idea to update your resume every year, but it’s the essential first step when you want to quit your nursing job. I have a very good friend who works as a human resource specialist for a large metropolitan. She told me once that most nurses don’t know how to write a clear and concise resume. Keep your resume simple. It’s supposed to be a snapshot of who you are, not a novel about your life. Every resume has a section that includes a heading. The heading includes your name, address, email address, phone number, and any other contact information that you want the nurse recruiter to have. Next, state you objective. Write something like, “ To use my nursing skills to provide quality bedside patient care at hospital X.” This is a great way to personalize your resume. Then make a list of all the jobs you’ve had and the dates. Tailor your list to the position that you’re applying for. Show how your prior jobs have helped you prepare for the job that you want. And don’t forget to use spell check. It’s there for a reason. Go online and find a few examples of what good resumes look like before you sit down and write one up.

Step Out of One Job Into Another

Some people are sad to leave their job while others can’t wait to get out the door. No matter what category you fit into, it’s best to have another job lined up before you make your exit. Start scouting around for a new job just as soon as you feel the need to roam and don’t be afraid to use contacts you have made at your old job to find a new place of employment. Remember, it’s not always about what you know, but who you know when you’re looking for a new job.

Write Two Resignation Letters

No, that’s not a typo. You should write two resignation letters, especially if you are leaving your job under duress. The first resignation letter should be just for you. Fill it with all the hateful things you want to say to your scrum-sucking boss, and then burn it, shred it, or throw it away. This exercise might sound crazy, but it will keep you from burning your bridges as you are walking out your employer’s door. The second resignation letter is for your boss. Keep it simple. Just state that you are resigning your position. If possible, always give the customary two weeks notice for your resignation.

Do you have any words of advice about leaving a job? Come on over to Nursing Voices and tell us about it. We’re waiting to hear from you.

You walk into the room, you introduce yourself, and everything you do from that point on is wrong. Every nurse has taken care of an angry patient. It isn’t pleasant, and many nurses are leaving the profession because they just can’t take it anymore. Here’s some advice. Use these tips the next time you run into a patient that makes you want to quit your nursing job.

Tip #1: Put Yourself in Your Patient’s Shoes (or in their patient gown).

The first thing that I do when I’m confronted with a beastly patient is try to remember that fear and loss of control are the two biggest factors that turn nice people into jerks. I ask myself how I might act if I were in my patient’s place. Patients come to the hospital out of necessity, not by choice, and many people respond to this kind of stress by lashing out at everyone around them.

Tip #2: Don’t Tune Out Your Patient When They Are Angry

I know that this is easier said than done. It’s not easy listening to a patient’s verbal abuse. Patients and their families want to feel empowered, not patronized when they are talking to you about a problem. Give your patient your undivided attention. Turn off your cell phone. Sit down at his or her bedside and really listen. Acknowledge the problem, ask about it, and listen to what the patient has to say. It’s not easy listening to angry words, but it’s an important skill to learn. Also, try to understand what the patient is really dealing with. Is the patient angry about something concrete, or are they dealing with grief? We can’t fix sadness. Sometimes the only thing that we can do is be empathic and validate the patient’s feelings.

Tip #3: Turn Down the Volume When Patients Start Yelling

I learned this tip from one of my early mentors. I was fresh out of nursing school when one of my patients went ballistic when I started giving her a bed bath. My mentor heard the metal bedpan hit the wall as it shot past my head and hit the hall. My mentor came running into the room and started talking to my patient. My patient screamed obscenities. My mentor responded in a very quiet voice. The patient’s voice grew louder. My mentor became quieter when responding to the patient. Within a few moments, the patient started lowering the tone of her voice so she could hear what my mentor was saying. The patient was then able to calm herself and she became less irrational. I’ve never forgotten this technique. It really works.

Tip #4: Don’t Make Promises You Can’t Keep

Your patient is demanding everything under the sun. They are yelling, and they are threatening to call their lawyer. What do you do? It’s really tempting to tell a patient that they can have whatever they want just to make them happy, but prepare for the fallout if you can’t deliver on your word. Keeping patients happy involves trust, and nothing will blow trust out of the water faster than a big fat lie. It’s all right to tell a patient that you don’t know the answer to a question, but it’s not OK to make things up as you go. If all else fails, tell your patient that you will ask your nursing supervisor to come talk to them.

Do you have a story that you would like to share about appeasing an angry patient? Drop by Nursing Voices and tell us about it. We’re waiting to hear from you.

It’s a Catch 22: You can’t get a job as a specialty nurse without experience, but how are you supposed to get nursing experience without a job. Sound familiar? Here are three tips that will help you find your dream job.

Tip One: Start Building Your Resume When You Are In Nursing School.

Hospitals traditionally like growing their own nurses to fill spots in their nursing rosters. Three year diploma schools started that trend years ago, and it continues in today’s workplace. Older, more experienced nurses aren’t leaving their jobs because of the economy, so there are fewer jobs for nurses coming up the ranks. That means that nursing students who know what unit they want to work on when they graduate need to go and talk to the unit’s head nurse now. Let them know that you want to work for them when you graduate and ask them what you need to do right now to start preparing for a position on the unit. They might help you get a job as a nurse’s aid on their unit, and make sure that you get some work hours that don’t conflict with your school schedule. Get to know people on the unit, and choose a mentor that can teach you things that you’ll never learn out of a book.

Tip Two: Work PRN Until a Full Time Position Opens Up

Older nurses approaching retirement age are staying in the workforce longer because of the of the faltering economy, which means there are fewer fulltime jobs available for new nurses entering the job market. The best thing to do is sign up to work PRN in a lot of different places. This will help you get the number of work hours you need each week in order to survive in addition to opening a lot of doors for you later on down the line. Fulltime positions are usually offered to part timers first when those positions become available. Working PRN in many different areas also gives you extra job experience, which translates into a richer and fuller resume.

Tip Three: Have a Friend Introduce You To Their Boss

My father was a smart man. He always said, “It’s not always what you know that will get you ahead in life. It’s who you know that counts.” No truer words were ever spoken when it comes to the nursing profession. My last three jobs came to me by word of mouth. The jobs weren’t posted. I just put some feelers out and my friends came back with some leads. They talked to a few people who set me up with a couple of interviews. Nursing is a small world, especially in the area where I grew up. Use your resources and start networking. There isn’t anything wrong with using a few connections when you’re looking for a job.

Do you have any job-hunting stories you want to share? Come to Nursing Voices and tell us about it. We’re waiting to hear from you.

It’s cold and flu season and many of my non-nursing friends are shocked when I tell them that hospitals have unwritten rules about nurses calling into work when they are sick. Sure, nurse recruiters tell new hirers that they can call in sick, but in reality, nothing could be farther from the truth. I’ve actually heard a nursing supervisor refuse to accept a nurse’s callout because there was no one that could take her place on the unit. There are consequences for calling in sick. Nurses that choose to take care of themselves when they are ill face the wrath of their employer when they return to work. Most nurses choose to work when they are sick. This scenario plays out everyday in hospitals and it’s called presenteeism.

How many times have you gone into work feeling like you had to die first before you could start feeling better? I know I have. Why? I’ve had to save my sick time for when my children got sick or for when I was really dying. And then there is the threat of being written up for an unexcused absence. Those come back to haunt nurses at their end of the year evaluation. Annual raises are affected by how many times a nurse calls out sick during the year.

The concept of presenteeism has been around for a long time, but it’s relatively new to the health care arena. According to an article written by Donna J. Middaugh, PhD, RN and published in Dermatology Nursing, April 2007, Presenteeism is the opposite of absenteeism. Nurses report to the nurses station but are functionally absent. Researchers have equated presenteeism to two different employee behaviors. The first group goes to work when they are sick or tired. These employees are not productive because they are suffering from stress, depression, illness, headaches, or other disorders. The second group of employees put in excessive work hours as an expression of commitment or ways of coping with job insecurity. Even though both groups of employees are at work, neither group is working at their peak capacity. This puts them, their co-workers, and patients at risk for illness. In addition, these nurses are at an increase risk of making a medical error.

There are solutions to presenteeism, but it requires cooperation between management and labor. Hospital administrators need to understand how a sick nurse can impact patient care and ultimately the hospital’s bottom line. Nurses need to stand together and tell administrators, “We’re mad as hell and we’re not going to take it anymore.” Yes, I know that sounds like a line out of a movie—because it is—but nurses must understand that they are risking their patients’ health as well as their nursing license when they come into work sick. Remember, one small mistake in calculating a medication dose can kill a patient. Nurses must be alert and at their peak performance when they are work.

Middaugh suggests that nursing managers conduct anonymous job satisfaction and stress surveys of staff, and allow staff members to include details of specific stressors or dissatisfiers and also offer suggestions for improvement. She also suggests that they confer with other mangers, and review human resource policies and benefits that support work/life balance.

Annie was always a good nurse, but things started slowly changing after she met Don. Her coworker, Gloria, was worried. Patient care on the unit was suffering and by the look on Annie’s face every morning during report, so was she. Gloria had grave concerns for Annie’s safety at home because of Annie’s attempt to conceal her bruises with thick makeup. Once a bright and happy woman, Annie was fading away. When Annie started going out with Don, she couldn’t talk about anything else. But now when someone asked how things were going, she’d abruptly change the subject. Quiet and more sullen, Annie started isolating herself from her coworkers. When the nurses went out together after work, she didn’t join them anymore saying, “I really need to get home. Don doesn’t want me out at night.” Gloria wanted to help Annie, but how?

Does this scenario sound familiar to you? You’re not alone if it does. Domestic violence is a social problem with its consequences reaching into every corner of the workplace. It reaches even into the nurses station. A woman is beaten every 15 seconds in America. According to the Bureau of National Affairs, domestic violence costs employers 3 to 5 billion dollars annually due to work absenteeism, increased health care costs, higher turnover, and lower productivity. Moreover, harassment at work as well as the time spent awaiting court, reduces a victim’s ability to maintain or secure employment. Also, the National Institute for Occupational Safety and Health shows that murder is the third leading cause of death in the workplace, and the first among female employees. Of the 1,071 workplace deaths nationwide in 1994, 17% of the female victims were killed by a spouse or former spouse. Domestic violence affects women in all walks of life: housewives, executives, and yes - even nurses. Nurses need to educate themselves about the signs of domestic violence.

There are some things that you can do if you suspect that someone you know is a victim of domestic violence. Find a private place to talk and have the conversation when you’re less likely to be interrupted. Clearly identify the problems that you are seeing. This opens the door for the other person to bring up the subject of abuse. Express your concern and make a statement of support. If the nurse doesn’t self disclose, no further questioning or speculation should be made. However, end the conversation by giving her the telephone number to the hospital’s EAP coordinator. If she does open up, you should encourage the individual to seek help. Help her find ways to increase her safety at work, and let her know that she can get counseling services through the hospital’s EAP program.

Creating a plan of action is the first step in providing a safer workplace for the victim of domestic violence. If you are a victim of domestic violence, ask for temporary changes in your work schedule or workstation if you are being harassed at work. Have someone screen your calls or ask to have your phone number or email addresses changed. Get an order of protection and take a copy of it to the security office with a picture of your abuser. With hospital security alerted, the facility’s security officers can be on the lookout and remove the offender if he comes to the workplace. Also ask security to escort you to your car at the end of your shift. Taking these steps can keep the workplace safer for everyone. Putting an end to domestic violence in this country won’t happen over night. But with motivation, education and compassion, nurses can make a difference in the workplace.

Come join the discussion about domestic violence in the workplace at Nursing Voices. Tell us your story. We want to hear from you.

Their eyes met across a crowded room. They knew in an instant they were kindred spirits. The problem? The crowded room is the nurses’ station, and the kindred spirits are coworkers. During the last few years, there has been a lot embarrassing stories circulating out on the Internet about hospital employees who have become romantically entangled with each other. Personally, I’ve never dated a coworker. It just struck me as being kind of incestuous. I always thought dating someone I worked closely with would be like dating my brother. Eeewww!

Workplace romances are nightmares for human resource managers, and they have been around in hospitals since the days of Florence Nightingale. In fact many studies reveal that almost 80 percent of employees are involved in or know someone who is involved in a workplace romance. It’s not surprising when you think about how much time we spend at work. Where else are couples going to meet?

Love around the nurses station creates a problem for everyone, especially for the couple involved in the relationship. I personally find it embarrassing to watch coworkers making goo-goo eyes at each other. Staff members start feeling like intruders when the happy couple is chatting away, engaging in pillow talk at the nurses station. People love to gossip. The rumormongers are in their glory as stories about the couple start circulating throughout the hospital, and no one gets any work done. In fact, according to research, the happy couple’s productivity goes down by 24%, their coworker’s productivity goes down by 11%, and unit morale goes down by 16%.

And then there is the issue of breaking up. That’s always complicated no matter whom you are dating, but it’s especially awkward when you’re breaking up with someone you have to see everyday at work.

He said, “Excuse me, please pass the scalpel.” She said, “My pleasure. Where would you like it? In your back, or through your heart,”

Yeah, things can get messy. Human resource managers also warn that stalking and acts of retaliation can occur when a workplace romance ends badly. Unfortunately, when things get too dysfunctional on the unit, the boss has to fire someone. Who gets canned depends on the situation. If it’s a doctor-nurse relationship, guess what, the nurse gets fired. Rank has its privileges and nurses are more expendable. If a nurse is seeing another nurse, it’s a tossup. Sometimes they both get a pink slip. In the end, someone has to start looking for work somewhere else.

It’s hard having a social life when you work forty hours a week plus mandatory overtime, but finding love in the workplace is not a smart thing to do. I’d like to suggest stopping at Starbucks on your way home from work. Life may be a party, but don’t bring your love life to work. It can really hurt your career.

Have you been in a workplace romance, or have you seen one blossom or fizzle at work? Come tell us about it a Nursing Voices. We’re waiting to hear from you.