As a new grad, Stacie was prepared to face nurse bullying by the older, senior nurses. She learned about it in school, experienced it as a student during her clinical rotations, and even did her own search on the web to help “bully-proof” herself. She was prepared and confident that she could recognize AND address any attempts at “eating” her.
What Stacie wasn’t prepared for was being bullied by the nursing assistant.
Sandra was older, had been working as a nursing assistant on that unit for 35 years, and extremely competent in her role. Stacie introduced herself to Sandra the first day she worked with her but Sandra just glared up and down at her with her arms crossed. She didn’t even say hello – she just mumbled, “Um hm.” At first Stacie just blew it off but she started noticing that Sandra would help the other nurses but not her. Sandra always seemed to “forget” to check Stacie’s patients’ blood sugars but not the other nurses and when Stacie asked her about it, she replied, “Listen here missy. Don’t think you’re going to come in here and start ordering ME around. Check it yourself.”
Bullying and incivility are problems.
According to Christine Porath, an associate professor at Georgetown University, 98% of the employees she surveyed experienced incivility while 99% witnessed incivility in the workplace (note: not just healthcare).
In nursing, studies show that up to 99% of us have either experienced or witnessed bullying and/or incivility in the workplace.
However, there aren’t any studies that look specifically at bullying BY support staff.
HOW DOES SUPPORT STAFF BULLYING SHOW UP?
The CNA who has been working on the same unit for decades isn’t about to let “some young whippersnapper” tell her what to do! So, she cares for the other nurses’ patients but somehow “forgets” to answer call lights, change the linens, or provide the hygiene on the new nurses’ patients.
She may smile when the new nurse asks for help and may even agree, but then doesn’t complete the task.
Some may be up front and warn the new nurse that they’re not going to take orders from them, like Sandra did. However, many use a covert tactic – sabotage, back stabbing, favoritism, etc.
In the end, it’s the patients who suffer most when the nursing assistant is trying to make a point with the new staff.
UNDERSTANDING THEIR PERSPECTIVE
We all know that nurses can be condescending to nursing assistants. A nurse will walk out of a patient’s room, walk down 3 hallways, 12 flights of stairs, just to find the nursing assistant to ask her to put her patient on a bedpan!
If you get beat up long enough and made to feel less important, you start to get resentful and than generalize all nurses as condescending, lazy, and disrespectful. So, when the new nurses start working, these nursing assistants aren’t about to let them take advantage of them so they go on the offense – they squash the new nurses before they get squashed.
What to do?
SET CLEAR EXPECTATIONS FOR THE WORK
Even though the nursing assistant might try to intimidate you, YOU are the one with the license and ultimate responsibility for patient care. Therefore, your goal is to set the expectations for the work, communicate honestly with the support staff AND respectfully.
- Never say, “Can you do me a favor”?
Why? Because they will think they are doing YOU a favor. Instead, say, “Mrs. Rossi needs her blood sugar (BGM) checked at 11am because I need to give her insulin before lunch.” And then make sure you follow up to ensure it was done.
- Focus your conversations on what’s best for the patients.
Let’s say the nursing assistant didn’t check Mrs. Rossi’s BGM, you can then say, “I’m concerned about Mrs. Rossi. By not having her BGM checked at the right time, it puts her at risk for hypoglycemia because the timing of the BGM is critically important.”
- Don’t blow it off.
We teach people how to treat us. If we constantly blow off someone’s rude behavior or in this case, not doing the job, we teach him or her that they can behave that way. Stacie should then say, “Help me to understand why you didn’t check Mrs. Rossi’s BGM at 11am (there might be a good reason or their might NOT be). If you’re ever in that situation again, please let me know right away because the priority is knowing the BGM results so that I can care for her.”
The key here is to remember to set the expectations for the work you will both do together. You have a role and they have a role.
If you are the nurse, focus on building a relationship with all support staff. You can do this by including them as valuable members of the healthcare team. Here are a few suggestions:
- Include your nursing assistants in report
Discuss the plan of care, share any concerns you have and ask them if THEY have any concerns.
- Offer to pitch in and help
When you see the nursing assistant changing linens, cleaning a patient, or assisting a patient to a chair, stop and help even if the patient isn’t yours!
- Show gratitude
Always thank the support staff for their help, be specific (thank you so much for helping me with Mrs. Rossi. She has such complex needs and such fragile skin. Your help today to keep her clean made all the difference), and be kind.
After Stacie’s shock wore off when she was blind sided by the nursing assistant bully, she started applying the same principles she learned about addressing NURSE bullying to Sandra. It was rough at first, but over time, she was able to show Sandra that they were both on the same team and that just because Stacie was new and young, they were both there for the same reason – to care for patients.
Thanks so much for reading.
Take care. Be kind. Stay connected.
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Dr. Renee Thompson works with healthcare organizations that want to overcome the leadership and clinical challenges their people face every day.
If you’d like to find out more about her programs, please visit her website www.reneethompsonspeaks.com.
Contact Renee today at firstname.lastname@example.org to bring her to your organization to talk about ending the cycle of nurse bullying.