Toxic Nursing: the stories, the solutions

Rude Docs

Hector, a nurse on the rehabilitation unit, graduated from school the week before he started work. He is well received by his nurse coworkers, but the physicians give him a hard time. “You new nurses are all the same. No common sense!” fumes Dr. Monroe when Hector doesn’t realize he is supposed to have his patient in bed when the physicians make rounds.

“If you had half a brain, you’d know that it’s your job to make sure these patients take in enough calories to help them get through rehab!” says another doctor, Dr. Carter. “It’s hard work to go through therapy all day.”

Hector feels totally incompetent, even when the other nurses reassure him and try to run interference with the physicians.

The Expert Weighs In:

In this example, at least two doctors are known on the unit for berating new nurses.

Stopping this disruptive behavior is crucial for collaboration, safe care and for rewarding long-term careers. Ideally, the nurse manager would have spoken with these physicians before Hector started on the unit. A quick chat in private about the expectation of respectful behavior, sentinel event data related to poor communication, the cost of recruiting and retaining qualified staff, and an invitation to look at teaching opportunities may be all that is needed. Because that didn’t happen, the nurse manager will have to speak with Hector privately and explain that he or she is working on addressing this behavior with the physicians and that Hector should try not to take it personally.

In addition, he or she should role-play with Hector to help him be assertive with these doctors the next time an incident occurs.

Finally, the nurse manager should be aware that staff might be contributing to an unhealthy alignment of “us versus them” with the physicians.

–Beth Boynton, RN, MS, Organizational development consultant, speaker and author, Beth Boynton Consulting Services

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