Ep 58: An ED RN Talks To Nurses
Preamble:
Welcome to It’s An ED RN, on today’s episode we’re going to talk about talking to our fellow nurses. Whether you have found yourself on the receiving end of a more experienced nurse looking to make a meal out of you, or you’ve maybe even been that hungry hungry RN yourself, it’s time to squash this beef once and for all.
I’m your host, an ED RN and I hope you’ll stick around to listen;
Intro Song
Episode 58: An ED RN Talks to Nurses
Welcome:
Welcome to my podcast, It’s An ED RN
I am your host, an ED RN and today we are talking about:
Mostly lateral violence;
If you’re new to the show:
Introductions:
Nurse x13yrs
5yrs Admin
Back to bedside in ED
Nurses who need nurses
The arbitrary nursing hierarchy:
Hospital nursing
ICU
ED
PACU/OR/Cath lab/IR
MedSurg
Not hospital
Freestanding ER
Urgent care
MD office
LTAC
SNF
Home Health
Nursing Instructor
We all know on some level this exists because we’ve run into situations where this has been brought up
Think about talking to your fellow nursing students when you were getting ready to graduate who among you was like oh I just can’t wait to be a MedSurg nurse
Have you ever heard another nurse make a comment like PACU is where nurses go to die?
Have you ever fully judged and unseen SNF Nurse after you get their trainwreck patient in your ED
Then there’s the issue of Pay on the whole MedSurg nurses make less than their critical care or emergency counterparts
Then there’s the prestige how often a doctor makes eye contact with you as a MedSurg nurse as opposed to when you’re in the ICU or the emergency department
We know these hierarchy exist in nursing because we know they exist culturally; people who are paid more have more social prestige, seem to be more valuable to society are treated better and therefore higher on the social hierarchy
Basically think about who has access to parking adjacent to where they work, and you will find out who is valued in your hospital and who is not
Lateral violence (type III violence) among nurses is on the rise
This study
The emergency department has the highest rate of violence
lateral violence may be used as a form of informal power as a result of organization-related feelings of oppression, meaning that those who feel oppressed (or undervalued) may try to regain power by hurting their colleagues
The origins of this violence have been related to the patriarchal historical background of nursing, with its internalized sexism, due to the oppression that it generates, both individually and collectively
Lateral violence can be verbal or physical aggression, but it also can be things like being rude to someone gossiping about them spreading rumors about them, refusing to help them with their patient care when they’re in need making fun of them when they ask questions acting like they’re stupid telling other people that they’re stupid
As a woman Nurse in her 40s who has greater than 10 years’ nursing experience, I am a part of the demographic most likely to be the perpetrator of lateral violence
And it makes sense; think about the early days of the feminist movement. They align themselves mostly white women aligned themselves with patriarchal, misogynist ideals, and the Nazi party. They were hardened, racist, and sexist, and this was very intentional because it gave them a group with which could fast track them to a position of power, they aligned themselves with who was in power, they took what they could get and in this way nurses who are more experienced yet have not been advanced in their nursing career into established positions of power or maybe they have but those positions of power because they’re a nurse don’t really mean that much they exert that power on who they canas a way to fast track take a shortcut to that feeling of being someone important
It’s super messed up
Interesting study:
The study basically looked at different silos of the healthcare team, so doctors nurses Allied health professionals and found that they had minimal interaction between the silos when nurses needed help figuring something out. They often went to other nurses and doctors needed help figuring something out and went to other doctors. They took all these members of the different silos and put them in the slab controlled study mixed them up and separated them into groups and then set them on task something that had to do with what they normally do and they found that those attitudes that they previously had in their silo kind of fell away, and they became very good at collaborating with each other
All this to say that whether you are a MedSurg ICU emergency PACU, OR nurse it’s very likely that your contribution in any given situation is valuable
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Talking to Nurses (e.g. each other)
Study showing correlation between good and poor communication associated with safe and unsafe medication outcomes, respectively;
What can we do about it?
Most of these studies on lateral violence, have some recommendations as to what organizations can do to limit this behavior, but what can we as individuals do?
Well…
Tips and Tricks:
Instead of tips and tricks, we’re going to do actionable items because this is a very serious problem. We can’t afford to lose nurses over such stupid bullshit so here we go here are actionable items for you, regardless of where you are at on the arbitrary nursing hierarchy.
Action Item #1: do a personal inventory of words and actions think about your last six shifts if you can remember that far back in your life, think about the interactions that you had with each nurse the nurses you work next to the nurse you gave report to on the floor the nurse you gave report to and the other area of the ED the nurse that called for report from PACU. How did you treat them? How did you talk to them? How did you talk about them to other nurses? Was there that you think you could modify next time so that you spoke only with respect about this person and I’m not talking about sugarcoating when a nurse is bad at their job that’s not what we’re talking about here, our number one priority in nursing is the safety of the patient. This includes keeping them safe from providers who are bad at their job. I’m just talking about when you’re stressed and that PACU nurse is giving you some shit report on your patient who is coming and you’re frustrated because it’s not all the information that you need. How do you respond to them? How do you talk about them? Are you making assumptions about them in that moment are you essentially making up stories about them in your head and then broadcasting it as fact it’s very nuanced and that’s why it takes a lot of attention to certain behaviors
Action Item #2: set your intentions. I don’t mean to sound like the 20-something fully ripped instructor in a hot yoga class right now, but you are going to set intentions for your shift work and those intentions are going to be words and actions that proactively cultivate a culture of support guidance meaningful specific feedback and better practice for everyone. It doesn’t matter how far into your nursing journey you are, you can take this on. You can do this. If you’re not someone who feels adept enough to educate other nurses, you still have things that you know and at least a couple nurses who will give you good feedback and guidance so seek them out, but generally as you’re talking to other people, other nurses, clerks housekeeping staff, the guy who comes in empties the bio bins you’re going to speak to these people with respect you’re going to be courteous, and some of that courtesy might be that you throw things in the trash instead of around the trash, speaking to myself mostly about this, but you’re going to be very intentional about creating an environment where your thoughtful of other people's rules in that environment and supportive of them. Plan for what you’re gonna do and say when you see it happening to someone else.
Action Item #3: build your tribe. You’re going to pull around you like-minded people who are also on this journey to be professional and courteous and build others up. You are not gonna give this level of attention to people who continue to be dismissive and hyper critical of other nurses, especially newer nurses I am not talking about bullying the bully but what I am talking about is building a team of people with a shared goal of trying to make your work environment less fucked up.
Actional Item #4: fuck serenity. This idea that you should just accept things you can’t control is for me some very high-level bullshit and I’m all right if other people engage in it but I’m not going to. I see something I can’t control or that I’m told I can’t control and I figure out how to control it, sometimes that breaking a few rules that are arbitrary and poorly constructed sometimes it takes a lot more effort and really all you need to do is look at the thing that you want to control which is mostly something you want to change on and consider what would you need to be in a position where you could make that different at least in your immediate work environment? What would that look like? What position would you need to be in the hospital? What education would you need to get in order to meet the requirements for that position what kind of experience would you need to have; don’t think about it. Don’t think about how you’re gonna get from where you are now to that place just think about what it would look like for you to be in that place then reverse it all the things you would need to do between now and then to make it happen and then just get further and further and further into the details, mapping it out, unrelated to the intention actually do it just for fuzzies and maybe it’s doable maybe you have 2 to 4 years to go back to school and get your PhD so that the next time law-enforcement tells you no I’m skipping ahead now
Closing:
I hope you’ve enjoyed this episode; if so, leave a review, find me on socials and tell your nurse friends to listen;
Nurses shouldn’t eat other nurses. It’s bad for business. It’s not Hart healthy and it creates an environment very high in cortisol. It. And when you see it being done step in and stop it.
Thank you for listening and have a safe shift.
