Where to start? While I am glad that in Australia things seem to be looking up (or you are in an excellent health care setting–I suggest staying there), I don’t think that is true for American nursing.
Couple of caveats: I can only speak to my own experience and what I have observed over the years in several different acute care settings. Also, there are indeed hospitals and other settings where nursing staff is supportive of one another and a team mentality exists. I know this is true, but have not been fortunate enough to find one of these places. (that truly is not sarcastic–I haven’t found such a place).
I really don’t have a lot of time today–and fully exploring this issue could take years. I’ll do what little I can to shed some light (as best I can).
I’ve been an RN for 20+ years. When I graduated in 1984, IV pumps were just starting to be seen on specialty units. I had to learn the apothecary system of measurement as well as the metric, “to serve those older physicians who prefer this method”. I was to give up my seat at the nurse’s station for any MD who came on the unit. I wore white. No cap (I was not capped-an edgy thing for my nursing college to do). I still cannot call docs by their first names(even the ones 20 years younger than I)–not only do they not invite me (or the staff) to do so, it is frowned on by administration. Some things die slowly.
Couple of things: nursing is a conservative profession that changes slowly. Or rather, the culture of it changes slowly. The technology and practices change all too rapidly! Just like medicine, we are faced daily with new research, new “best practices”, new drugs and treatments. This can lead to not only anxiety but also stress when doing our job. (I have had it happen that something I did on Monday is against policy on Friday due to new findings. That is all to the good because it improves pt care, but it can leave you feeling somewhat battered and unsure of your knowledge base!)
Re the eating the young stuff. YES. It happens and on a spectrum no matter where you work. It is endemic and pervasive and can be toxic, IMO. Maybe if I tell you what happened to me, you can extrapolate some generalizations that may help you. Not all of this happened to me, but enough of it did where I feel I can write about it with confidence that it does occur often.
Me: Doctor and nurse’s daughter (mom was Director of an ED); graduated with BSN and passed Boards. Entered the job market during the last nursing “glut” in the mid 80s. Was offered a job of newborn nursery nights–I would not use any skills there (that I wanted to), so went to my mother’s old hospital(she had moved on to direct prison nursing), and was hired immediately for med/surg.
[the fact that I was related to a former administrator and personally knew a VP was an onus that naive me had no clue I would almost never overcome]
Med/surg: nurse/pt ratio in 1985 was one RN to 18 pts. yes, 18. HMOs were just hitting and there were still some people in the hospital for “tests” and things like “pelvic traction”. For those of medical background reading this, we were still doing Domborough soaks (sp?) and pouring Betadine into bedsores. You were castigated in nursing school for “demeaning the pt by touching him with gloved hands”. We’ve come a long way…
The ratio now for med/surg is 1:8-9. Still too high, but much better! I had 2 aides “working” under me. 3 RNs to a floor with 36 pts on it. I never so much as knew my pts’ names. I knew their treatments, meds, IVs and maybe their labs. There was no time for teaching, for comfort, for lunch. This was a hellish environment–truly chaos.
Given this, like foot soldiers on the front in battle, there was precious little comfort or support to be had. Any sign of weakness was a real threat to the precarious appearance of “care” being given. You learned quickly not to cry at work, not to ask for help–because those things showed weakness. Asking for help got you scathing commentary on your abilities as a nurse and your character as a person. I wish I were exaggerating. I was told that those were my call lights and I had to answer them, never mind whatever other emergency I had going on (or if I needed to go to the bathroom). It was sick. Taking concerns to the NM was a dead end, but here is where some of the “femaleness” of this comes into play:
Nurses tend to be people pleasers–they want to help. Some of us truly must help or suffer anxiety if we are not allowed to do so (not me). Nurses also tend to be young women–a demographic for which it is still overwhelmingly true that the disease to please is strong. And nurses also tend to come from dysfunctional home environments, where boundaries and limits are fuzzy at best. Not true for all nurses, certainly, but enough that I feel I need to mention it.
Couple that with the natural insecurities that lie in anyone just starting in a high stress profession and we have a crucible that can lead to dangerous situations. Let’s face it: if the new administrative assistant screws up a file, that’s bad. But nobody died. Nobody had an anaphylatic reaction or had a vital symptom missed. That is not to say that admin. ass’ts are necessary and their work unimportant, I’m just trying to communicate the underlying stress that all nurses work with (other health care professionals too).
So, we have (so far) an untried nurse, a young woman who needs to please, someone who may not be able to recognize or articulate healthy boundaries and a chaotic and stressful environment that has an entrenched culture that is suspicious of new people (who can you trust in the jungle?), desperate for support and afraid to show that need. This is not a good environment for learning or nursing.
Now let’s turn to the nursing hierarchy, which despite many, many changes in practice and staffing etc, still remains at heart a military, top-down one. There is little to no collaboration between hospitals or even units within a single hospital (at least not in the southern half of the city of Chicago and its surrounding suburbs).
Docs think nothing of attempting to get support (aka consultation) from another colleague on staff, and if that doesn’t pan out–they say things like, “Melanie is over at U of C. Her team has done some work with X treatment. I’ll give her a call” even though Dr Tom works for Northwestern and hasn’t seen Melanie since the last GU conference or whatever. That simply does not occur in nursing. It can and it should. (actually, it does occur–at the academic level and in some of the subspecialties like wound care. But it is not a regular thing).
back to the hierarchy–so essentially, you now have these little fiefdoms of power–in reverse order: CNA, student nurse, graduate nurse, LPN, RN, assistant nurse manager, nurse manager, director of unit(s), nursing supervisor(on par with unit directors), director of nursing or VP of nursing. Edicts come from on high and are handed down as such. Very little gets from CNA back to VPN. We are often asked to things with little to no explanation of why the changes are needed. Sure, you can ask–and get no real response except for one like, “Joint commission is coming”. or “the VP wants it done that way.” And if you have a suggestion for a change? You can tell your NM, and hope s/he finds it good, but it won’t come to anything until it’s gone through several committees and final approval of the VPN.
Is it any wonder that those in the trenches then look for stuff they can control? Power is power, no matter if it’s the power to shame a newbie. And there actually is some twisted logic in that–you better be tough out there or you will die–or kill someone. Like those cultures who let kids play with fire because “it’s the only way they learn to respect or fear it”–that’s nursing to new grads.
More later.
