Nurses are leaders who delegate, make important decisions, devise policies, collaborate with an extensive care team, wear many hats, and save lives regularly. But those peering in from the outside may not have the insight into what else being a nurse can entail.
Sticks and stones may break our bones and words do hurt us. And we get a lot of words – from patients, their family members, doctors, and sometimes even our very own coworkers.
One of the biggest lessons that I have learned as a nurse is to be amenable. We must be flexible, agile, and comfortable being uncomfortable. But what’s just as important, if not more, is to know where we stand and to stand firmly and confidently.
I graduated nursing school nearly two years ago. I’ve experienced many emotions as a nurse since then but I will never forget feeling in my heart the desire to be the best. I aimed to be tough and smart but friendly and pliable. I had felt such a need to live up to my “title”, especially in front of the surgeons and physicians that I work alongside.
Initially, I perceived doctors as my superiors. I so naively assumed that they knew far more than I did and that their decisions, ideas, and perceptions trumped mine. I didn’t ever want to be wrong in front of them. But what I quickly realized was that that this was wrong. This type of mindset was wrong. It only did myself and my patients a disservice. Decisions and ideas from must be weighed and considered equally.
We are all professionals with the same vision. We are team players and there is no hierarchy of importance or priority of knowledge. Every interdisciplinary team member plays an equally important role when it comes to the care, responsibility, and outcomes for our patients. Nurses need doctors and doctors need nurses. It is “us”, not “I” nor “you”.
Words From Physicians
I’ve been called out many times by doctors for overlooking things. Not changing a dressing as soon as it’s striked through, not getting a patient out of bed soon enough, or not strictly adhering to a nonspecific order in my effort to advocate for a patient. These words have dug deep. Whether it be through the abrasiveness of the way the words are delivered or the actual words themselves, it’s painful.
I’ve learned that the best thing to is nothing. But only initially.
Our initial reactions are often not the most pragmatic ones. They are infiltrated with and clouded by emotions, defensiveness, and confusion. Diffusion of dissent has its time and place and is optimal only after emotions have dissipated. With that being said, the more real-time the feedback can be, the more relevant and opportunistic it is to be impactful. Discussion and feedback is absolutely necessary and an important aspect of learning, growth, and successful collaboration.
Communication skills are key but as we all know, can often vary. It is rare that healthcare facilities have truly established cultures of communication or proper training on conflict resolution. My own experiences have since shaped my thoughts and conclusions.
When a member of the care team lashes out, I’ve found it helpful to consider where it originates.
Physicians choose their profession for the same reasons that us nurses choose ours. They dedicate a great deal of time to prepare themselves to help others. Physicians, too, want what is best for their patients. Oftentimes, difficult words and actions stem from a perception of this want being threatened, questioned, or not shared. Benefit of the doubt allows us to realize that despite the word, action, or reaction being unjustified, the motive comes from a good place.
But even despite a good motive, it is not excusable. We are equal partners in care, are not subject to any less respect, and must expect that professionalism is maintained throughout. It is our responsibility to communicate any breaches of this and stand firmly and confidently in these expectations. When we let something slide or presume it is ‘not a big deal’, we are not setting anyone up for success. As partners in care, we must hold one another accountable.
Words From Co-workers
The nurse-physician relationship is much debated and discussed. What’s lesser understood and in the open is the relationship amongst nurses. We typically only hear about “nurses eating their young”, but what does that even mean? It’s vague and limited.
Hurtful words are both delivered and received by nurses. Stressful situations beget stressful situations. And we are almost always in stressful situations! We work at the speed of light to ensure patients’ needs are met (whether it be ice water or an Amiodarone drip). But we can often function so quickly and automatically that we don’t slow down to process our emotions, thoughts, and feelings that get translated into words. Words that come flying out and thrown at whoever is standing in their path. Words that can hurt.
We’ve all been there, on both sides of the fence. We make assumptions, can be quick to blame, communicate passive-aggressively, or be insensitively blunt. And oftentimes there are legitimate contributing factors: stress, exhaustion, desperation, burnout, a lack of resources. Whatever the cause may it, it’s ultimately inexcusable. We must recognize that it will inevitably occur but can be ameliorated.
What matters most is not what is said but what happens after the words are spoken. Professional relationships are intricate. And even more so when their success has a direct impact on the health and lives of others. There is little to no room in professional relationships amongst nurses for emotion, subjectivity, judgement, or politics. Our work requires that we are able to choose objectivity over subjectivity. During a code or other emergent situation, walls dissolve, opinions and differences cease to matter, grudges dissipate, and we see eye to eye . And we all walk away better for it. How can we apply the same capability and non-existence of the ego to non-emergent situations?
We must learn: to forgive, be candid, be objective, take ownership, let go, be aware, maintain respect, and move on. We can practice mindfulness to prepare ourselves for stressful and unanticipated situations. Words can hurt and words can destroy. But words can also be rendered powerless.
When it’s Constructive Criticism
Let’s be real for a minute. No one likes to be told what they don’t do well, how they can improve, or what they’re lacking.
Constructive criticism can be difficult to handle and the words communicated during a review or evaluation can sometimes stir up feelings of inadequacy, doubt, and disillusion. They can cause us to question our competence and abilities in a profession we profoundly care about.
The objective of reviews, evaluations, and constructive criticism is to provide an opportunity for growth. Not dissimilar to physical growth, it can be thought of like working out. Soreness is a result of and correlated to the intensity of the workout. Even though it hurts, you know you’re building strength that will better prepare you for the next workout. You will be able to see and feel the results of your effort and the endurance of pain. It’s important that we adopt a similar mindset when being mentally, emotionally, and professionally ‘worked out.’ We won’t always like what we hear and they may make us sore. But that isn’t always negative.
If we maintain the perspective that those providing feedback are doing so in our best interest, we will better able to respond to the constructive criticism. We need candor, transparency, perspective, honesty, and dissonance. Without, we cannot grow. We must be grateful for those that hold us accountable, challenge us, and push us out of our comfort zones.
Words from Patients and Families
Each and every nurse has been at the receiving end of rude and hurtful words from patients and families. I am the first to raise my hand here. I have been called “dumb, inadequate, too young to know.” But those words came from a sick confused patient. That does not mean that his words did not hurt me, they resonated in my mind all throughout my shift. I have also have family members that were also verbally aggressive and I had an instance where a family member grabbed my arm. It can be intimidating specially for a person of my size who is 5 ft tall.
How do you handle hurtful words from the people you care for?
Again, remind yourself to see the big picture and that their words do not indicate the kind of nurse that you are. Also, stand your ground. Know your rights and if someone puts their hands on you, oh baby that’s a code grey. Be respectful and assertive and continue to the amazing job that you already do, and if there needs to be a switch of assignment, speak with your charge nurse or nursing manager.
Nevertheless, do not doubt who you are.
When words hurt…
- Breathe. Step-away. Welcome the associated emotions and recognize that they will pass. We can’t control what others say or do but we have complete control over the way we react. Avoid being reactive. It’s almost always something we end up regretting.
- Be objective. Step back and take all subjectivity out of the equation. Analyze the situation from a third-party perspective. How could the situation have been handled differently? Where did it go wrong?
- Be confident. Remember who you are and what you’ve done to become that person.
- Resolve. Internally and externally. Resolve any associated feelings of doubt, anger, confusion, insecurity, hostility, or hurt. Resolve the conflict head-on in a professional manner. Allow things to remain in the past.