MSN, RN, NPD-BC
One of the main fears new nurses must overcome is communicating with providers (nurse practitioners, physician assistants, physicians, etc.).
Some new nurses perceive providers to be above them in importance because of their title (and even pay grade). Some fear retaliation if they question orders or call out unprofessional behavior. Some cite bullying as the reason they find it difficult to communicate with providers. I want to empower you as a new nurse to find your voice, speak up for yourself, and help you deliver quality patient care.
Bullying in healthcare settings is prevalent, particularly between nurses and providers. The Joint Commission has standards that guide our response to workplace incivility and particularly takes a stand against bullying. It defines workplace bullying as repeated, health-harming mistreatment of one or more persons by one or more perpetrators. Bullying, the Joint Commission states, can take various forms, including verbal abuse, threatening behaviors, and work interference.
In 2020, the American Medical Association (AMA) adopted a policy that provided a formal definition of workplace bullying and guidelines for prevention:
“Repeated, emotionally or physically abusive, disrespectful, disruptive, inappropriate, insulting, intimidating, and/or threatening behavior targeted at a specific individual or a group of individuals that manifests from a real or perceived power imbalance and is often, but not always, intended to control, embarrass, undermine, threaten, or otherwise harm the target.”
Bullying not only affects the one who is being bullied, but also can affect patient outcomes and create a culture of accepting unprofessional behavior. The American Nurses Association Position Statement on Incivility, Bullying, and Workplace Violence takes a similar stance.
Have you experienced anything like this in your current position or prior to graduating from nursing school?
Many years ago, I was assisting a new nurse with an admission on the medical intensive care unit. The individual was a fresh postoperative patient who was supposed to be admitted to the surgical intensive care unit. Due to a shortage of beds, the patient came to our unit for care.
The surgery was a result of an infectious disease process that affected the patient’s gastrointestinal system. The patient was on precautions that required caregivers to don personal protective equipment (PPE) before entering the room.
The new nurse first observed that the dressings surrounding the abdominal drains needed reinforcement, as there was a fair amount of leakage. As she had not seen an order yet, the nurse applied gauze to absorb the leakage and waited until the physician came in so she could ask how he wanted her to care for the wound.
When the physician entered the room, he did not perform hand hygiene. He also did not don gloves. The physician began to palpate the abdomen around the leaking wound. Assuming good intentions, the nurse professionally reminded the physician to perform hand hygiene and don gloves.
As she realized the gloves were not easily visible behind the curtain, the nurse kindly showed him their location. The physician then began to raise his voice and use offensive language. Before I could say a word in her defense, the nurse calmly asked the physician to lower his voice and suggested the conversation take place away from the patient. The situation escalated further, resulting in the charge nurse being called to the room. After this event, the nurse submitted an incident report. With subsequent visits to our unit, we noticed changed behavior in this physician in which he was much more respectful.
I want to be clear that the boldness of this nurse is not something we always see. If you don’t feel quite as courageous as this nurse, do not feel ashamed. I do, however, want to emphasize what could have happened if she hadn’t said anything. The physician would have continued to touch the affected areas, which would have increased the risk of the spread of infection. The physician also could have continued to speak to other nurses unprofessionally. The impact of the nurse’s voice was significant.
Let’s discuss one more example of how not taking a stand against bullying can affect patient outcomes. Medication errors can occur for several reasons. As we all learned in nursing school, a nurse should not follow provider orders unless there has been a thorough review of the appropriateness of that order.
Some medication errors have occurred because a nurse feared questioning an order. Let me provide a reminder and some encouragement. You know more than you think you know. Asking a question is not a sign of incompetence.
The safety of your patient far outweighs the fear of backlash or being perceived as incompetent. If there is a poor patient outcome, the onus does not just fall on the person who wrote the order. It falls on the one who carried out that order.
Questioning the safety of an order can build trust and respect within your healthcare team because your “good catch” shows your level of knowledge and attentiveness.
Still feeling a little fearful? Here are a few tips to respond to bullying:
Nobody deserves to be bullied. You are NOT “just a nurse.” You will spend eight to 12 hours per shift caring for a patient. This makes you the most important source of information that will guide decision-making for the patient’s plan of care. Effective communication between nurses and providers is vital for quality patient care. Your voice matters. Starting today, I encourage you to find your resources and find your voice! I wish you all the best in your career!
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