Because most nurses are kind, sympathetic, and understanding with their patients but abhorrent toward other nurses, there is a perplexing paradox in the world of nurses and nursing that is challenging to reconcile. It's difficult to believe that a profession rooted in healing could be rife with a scourge of unkindness and incivility given how frequently backbiting, bullying, and other forms of mistreatment occur. Nevertheless, here we are.
Nurses and the Ethos of Kindness and Compassion
Healing and empathy will always come up when someone is asked about breastfeeding. Numerous times, the Gallup survey affirms our reliability and sincerity, and many nurses receive congratulations for their career decisions from strangers.
However, the majority of patients probably have a tale to share of a nurse who went above and beyond. Of course, we also occasionally hear stories of patients feeling abused by a crusty, burned-out battle-axe of a nurse.
Dr. Renee Thompson, CEO and founder of the Healthy Workforce Institute, an organization that works with healthcare facilities that have troubled workplace cultures and ingrained problem behaviors among their staff, says that nurses can be kind and compassionate to their patients but cruel to one another.
Given these facts, what in the nursing profession causes its members to treat one another so harshly when an ethos of kindness and compassion underpins the bulk of the care that nurses provide and how others perceive nurses?
Nurses and Internalized Oppression
There are various hypotheses as to why nurses engage in bullying and abuse (also known as horizontal or lateral violence). Internalized oppression is a psychological phenomenon that happens when group members feel as though they are being oppressed by outside forces and turn their resentment toward other group members.
The University of San Francisco School of Nursing and Health Professions issued a report in 2012 that paints a picture of the causes of nursing's perception of oppression:
"Nurses are among the groups perceived as being oppressed. The historical basis of this theory is that forces outside of the profession with greater rank and power control their practice. Women provided patient care at hospitals in the late 1800s and early 1900s in exchange for nurses' education. The male doctors and administrators who oversaw those hospitals looked out for their interests by paying for the nursing care that the women provided while paying the women little to nothing in return. Additionally, nursing was seen as a woman's profession, and the care that nurses provided in the course of their work was regarded as lower than that of services provided by male doctors.
If internalized oppression is perhaps at the core, this suggests that nursing education, the workplace, and nursing literature all need to address these concerns more forcefully.
A Culture of Safety is Possible
Dr. Thompson recently stated that there is an "epidemic of bullying and incivility in healthcare that not only affects morale and turnover but also affects patient outcomes."
The issue is that healthcare organizations don't do a good enough job of ensuring that their personnel have the knowledge and resources necessary to deal with disruptive behaviors, and frequently fail to establish behavioral standards from the start.
Various domains of intervention are required, according to a recent study from the National Library of Medicine, including:
1. preventing new bullying behaviors.
2. putting a stop to crimes as they happen.
3. Encourage people to take action against bullying based on developing relationships, a positive work environment, and more administrative backing.
According to the AMA Journal of Ethics, everyone must deal with these problems. Additionally, they stipulate that healthcare organizations must "outline steps for individuals to take when they feel they are victims of workplace bullying; provide contact information for a confidential means of documenting and reporting incidents; and establish procedures and conduct interventions within the context of the organizational commitment to the health and well-being of all staff."
The AMA comes to the following conclusion: "A culture of safety is possible when well-functioning professional teams are partnered with health systems that share your goals and values—and when leaders are committed to creating systems that make it simple for team members to do the right thing."
Regardless of the interventions we select, dealing with these behaviors promotes employee retention, a more positive workplace environment, effective and safe patient care, and even fewer medical errors.
A Broad-Spectrum Problem
It is a perplexing irony that nurses treat one another differently than they treat their patients. We could be confused, irritated, furious, or sad, but apathy and inaction are not acceptable responses.
An all-encompassing issue, disruptive nurse behavior, and the resulting toxic working atmosphere require a diversified approach to solve. Everyone bears responsibility, as the AMA so eloquently stated, and it is essential to uphold that obligation.
These unhealthy and toxic workplace behaviors can be recognized, documented, bravely addressed, and eliminated like so many weeds in an otherwise healthy garden just waiting to bloom happily. This can be done by bringing more members of the nursing profession on board and by increasing the proactive responses by healthcare leaders and executives.
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