To those outside the nursing profession, it may be a bit frightening to hear the phrase, "nurses eat their young," but to any nurse, this is just a standard expression meaning the bullying or harassment of a fellow colleague.
"Nurses eating their young has been around since I started in nursing 25 years ago as a nurse's aide," says Frances Hodgkins, RN, PMHN-BC, from Michael E. Debakey Department of Veterans Affairs in Houston. Hodgkins acknowledges this issue continues today.
"I have decided that I will not eat my young and I will be a role model for the future. On my unit, we do not allow 'nurses to eat their young.' We welcome students and want to teach them the skills necessary to be good, solid nurses. I am interested in helping the younger nurses understand the dynamics of professional nursing. Not the childish behaviors that I was exposed to as a young nurse," says Hodgkins.
In a recent post on the Well Blog on The New York Times, Theresa Brown, RN, delves deeper into the issue of why nurses bully one another, reminiscing about when she first started out as a nurse and experienced senior nurses lying about whether Brown had completed her work.
"It's the dirty little secret of nursing, and it needs to be publicly acknowledged, and just as publicly discussed, because it's keeping us down," she wrote.
Other nurses in the field are aware of the situation.
"This lateral hostility is still alive and festering," says Tonya J. Barrere. "It seems more prevalent in the critical care areas [maybe because these nurses are many times aggressive by nature]. Many critical care nurses feel their knowledge level is above 'floor' nurses and they look down on them and consider them inferior. These same nurses are often rude and unprofessional when a bed in their unit is requested."
Brown references Kathleen Bartholomew, RN, MN, a nurse and consultant who literally wrote the book on the topic. In Ending Nurse-to-Nurse Hostility, Bartholomew addresses how and why back-stabbing, intimidation, and sabotage are all too common on some nursing floors, and provides strategies for how to stop these behaviors.
In her book, Bartholomew argues that "research shows verbal abuse significantly affects the work environment by decreasing morale, increasing job dissatisfaction, and creating hostility. Bullied staff report a decreased sense of relaxation and well-being at work, increased mistrust, low self-esteem, and lack of support from both staff and superiors."
To help prevent against the common issue, Bartholomew suggests the way to break out of the cycle of oppression is "to illuminate the behaviors and raise our self-esteem." Bartholomew continues saying "when self-esteem is low, individuals are powerless to change their situation, thus the very act of taking back our power raises our self-esteem."
Debra Savage, RN, MSN, BSN, CNO, at Sacred Heart Hospital in Chicago, IL suggests some ways of her own to help address the issue of nurse-to-nurse hostility, and "nurses eating their young."
"Selecting preceptors with the best attitudes and training them to understand generational differences as well as how to be an effective preceptor are crucial to preventing this problem," says Savage. "Nurse managers and educators need to keep an eye on new staff and meet with them regularly to make sure they are experiencing support and teamwork throughout their first year,"
All the women agree this is a common issue in today's healthcare settings, and that nurses need to do something to change this.
"We, as nurses, must be there for one another whether we are just starting or nearing retirement not only for the best interest of our patients, but also for increasing our own satisfaction and effectiveness in the workplace. We cannot afford to turn new nurses off to our profession or cause them excess stress from lack of camaraderie to want to leave the bedside early," says Savage.
"I am an advocate for my patients when I promote good collegiality and teach good nursing practice," says Hodgkins. "It is the responsibility of the older nurses to stop eating the young and change the culture of nursing today."
AMN Healthcare recently conducted its 2010 Survey of Registered Nurses to address the issues of job satisfaction levels and if the recession is affecting nursing career plans. The survey was sent to registered nurses via e-mail and 1,399 nurses completed the survey.
The survey found that almost half (44%) of all nurses plan to make a career change over the next three years, and that more than one-third of the respondents experience job dissatisfaction. Almost 50% of the respondents were nurses between the ages of 40-49, and 59% of the nurses currently hold a position on their hospital's permanent staff.
AMN Healthcare's survey also found:
15% of nurses plan to seek a new place of employment should the economy improve a year from now.
28% of nurses agree with the statement, "I will not be working in this job a year from now."
46% of nurses agree with the statement “I worry this job is affecting my health.”
29% of nurses plan to take steps in the next one to three years that would take them out of nursing altogether (by retiring or seeking non-nursing jobs) or reduce the volume of clinical work they do (by switching to part-time or less demanding roles).
8% of nurses returned to the nursing workforce over the last two years, 3% for economic reasons.
Only 6% of nurses are very confident that healthcare reform will provide a mechanism for ensuring an adequate supply of nurses
The majority of nurses (55%) believe that the quality of care that nurses provide today has declined compared to when they started in nursing.
More than one-third of nurses (36%) said they either would not recommend nursing as a career to young people or were not sure that they would.
Another topic the survey asked nurses to comment on was the nursing shortage and comparing it to five years ago. Thirty-three percent of nurses said the shortage has gotten worse, despite an economic downturn that has sent many RNs back to nursing from other areas of work.
An additional 28% said they have seen no change to the nursing shortage over the last five years, while a minority of nurses surveyed (39%) said the nursing shortage is not as bad as it was five years ago. The survey suggests that most nurses believe the heavy patient loads and demanding work assignments characteristic of nursing shortages have not changed.
Nurse satisfaction was also a topic on the survey, and even though 78% of nurses said they are satisfied with their career choice as a nurse, only 66% responded saying they were satisfied in their current job position. The survey also asked nurses if they "often feel like resigning from my position," and 29% agreed with the statement.
Finally, the survey reported almost half of the nurses (44%) will continue to hold their current position, and as the economy begins to turn around, they will seek out a different career opportunity. The nurses reported they would change their current role by switching to a less demanding nursing position, working as a travel nurse, switching to part-time, retiring, or taking other steps.
Smokers may not want to apply to work for Memorial Hospital in Chattanooga, TN. As part of a new hiring policy listed on the hospital's Web site, beginning February 1, the hospital will no longer hire employees who smoke or test positive for nicotine.
Prior to being hired, employees will undergo a drug test and the facility will add nicotine to the list of drugs. Even nicotine coming from a patch or gum would be detected in the screening. The new hiring process will not affect current smokers at Memorial Hospital. Instead, Memorial Hospital will offer smoking cessation help to those employees who smoke.
John Brady, an OR nurse, agrees the hospital's move is a step in the right direction.
"I think that it is about time that the healthcare industry takes a stand such as this," says Brady. "I am an ex-smoker. Instead of complaining about the negative effects of smoking and second-hand smoke, let us take responsibility for our actions and enforce what we believe is good for the people that work for hospitals and their patients."
Not everyone agrees with Memorial Hospital though; nurses from other facilities are speaking out.
"I would be interested in viewing the officials at Memorial Hospital and noting whether they have normal BMI's or not," says Tonya J. Barrere. “Let's go a step further, scrutinize their exercise regime, and evaluate their blood for elevated cholesterol/triglyceride levels. One could even argue that other moral choices could be challenged for review—such as how much alcohol is consumed weekly by the staff?"
Officials at Memorial Hospital believe hospitals need to set a healthy example for the community, and think not hiring smokers is a step in the right direction. Karen Chavez, RN, BSN, an infection control/quality assurance nurse for the Good-Samaritan Society of Socorro (NM), feels differently.
"Smokers take far more breaks then non-smokers. I have worked in smoke-free hospitals where the staff had to leave hospital property to smoke, which took even more time away from their patients," says Chavez. "Having said all that, I don't believe the hospital or any other company has a right to tell you what you can or cannot do on your own time."
Julie Mann, hypnotherapist, EFT practitioner and life-coach, from the United Kingdom, is not for or against hiring nurses who smoke, but believes smoking is one way nurses cope with the pressures and stress of work.
"Smoking, overeating or drinking too much are all ways of coping with the pressures of work and life," says Mann. "Working in a hospital is such a stressful environment.
Cigarettes and food provide temporary relief and serve as a kind of anesthetic, one that can distract and comfort the individual from their thoughts and emotions. If nurses are to change their habits, they need to want to, otherwise they may just adopt another coping strategy."
Although Memorial Hospital says its decision is not about saving money on healthcare costs, some people find that hard to believe.
"This is not about setting an example but about the almighty dollar—let's at least be truthful. This issue opens a huge can of worms and should not be left in the hands of a few 'officials' to decide," says Barrere.
When it comes to certain policies, it's all about the details.
In 2006, Pam Harmon, RN, legal nurse consultant and chief nursing officer at Fredonia (KS) Regional Hospital (FRH) took a closer look into her facility's employee code of conduct.
The Commitment to Coworkers policy, as the code of conduct was then known, only pertained to the nursing staff and did not deal with other staff members' attitudes. This went against a new facility policy because the code of conduct's new purpose was to include everyone—not just the nursing staff—and to change the attitude of every staff member in FRH.
Harmon took matters into her own hands, and with the help of an in-service committee, went about changing the information of FRH's employee code of conduct.
Harmon searched the Web to find a variety of examples from other facilities to get a broader perspective on her facility's options. Using key words, such as "standards of performance" and "code of conduct," Harmon gathered a few examples that she brought to an in-service committee meeting.
Harmon was also careful not to layer another facility's policy onto FRH, but rather selected items that were actually applicable to her facility.
"We took a lot of information from other facilities' examples, only taking what we felt necessary for Fredonia," says Harmon.
From these examples, Harmon and the in-service committee blended information to fit the FRH's needs, and came up with the standards of performance to include all the staff members.
"Throughout the development of the standards of performance, the in-service team and I decided which information would be important enough to feature in the document," says Harmon.
Improving the attitudes and the quality of patient care, along with the attitudes of the staff members, was the focus in Harmon and her committee's mind when reviewing all the information.
Eventually, Harmon and the committee determined what to focus on for the new standards of performance. These areas include:
Attitude
Personal appearance
Communication
Culture of safety
Commitment to patients
Commitment to co-workers
Customer waiting
Hallway etiquette
Privacy
Safety awareness
Sense of ownership
"The old code of conduct was not as specific and did not pertain to every staff member in the facility," says Harmon.
The previous code of conduct was a one-page document that only addressed patient care staff, and there was no requirement to sign any documentation regarding the code.
Now, the standards of performance is a two-page document that everyone in the facility—from the CEO all the way down to new hires— has to sign.
"We have been talking about focusing on positive thinking, positive ways to approach people, and we as a committee feel if we could get something everyone could read, sign, and commit to, then we would have a better outcome and performance from all staff members," says Harmon.
The new standards of performance document is not only signed by everyone in the facility, but is also reissued annually, so that staff members are reminded of the commitment they have to themselves, the patients, and other FRH staff members.
The policy is also an important part of the hiring process and is one of the main points of information that FRH discusses with each potential employee. During the interview process, the expectations derived from the standards of performance are discussed in great length.
"We ask the potential candidate questions regarding the policy and handling particular situations so they are thinking about these things before they sign in to be a part of our facility," says Harmon.
No tolerance for negativism
With any new policy, there are staff members who do not take things seriously, and with FRH's new standards of performance, there were a few teaching moments.
"Over the three years, there have only been a few instances where employees did not abide by the standards of performance policy," says Harmon.
For a first offense, employees receive a verbal warning if they were not living up to the areas stated in the new policy. A second offense earns a written warning, and if the behavior continues, the staff member might even be put on suspension and eventually terminated from FRH.
"We developed a policy that has no tolerance for negativism and a goal of improving customer service by improving the attitude of all our staff," says Harmon.
The amount of care required by hospitalized patients seems to grow every year, and many nurses in the field question whether recently-graduated nurses are sufficiently prepared to take on the demanding task.
Josephine Nappi, MA, RN, director, nursing professional development for nursing education at Memorial Sloan-Kettering Cancer Center, in New York, NY, agrees there is an added amount of care needed for those who are hospitalized.
"Our patient acuity rises daily, our aged population presents additional challenges, and at the same time knowledge and technology increase exponentially. Individuals new to our profession must translate what they have learned in their basic nursing programs into practice rapidly," says Nappi.
The National Council of State Boards of Nursing (NCSBN) considers this a major issue and recently raised the passing standard on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to ensure new nurses are sufficiently ready to take on the growing needs of sicker patients.
The higher passing standard was voted on in December 2009 and will go into effect on April 1, 2010. Nurses will be granted a passing grade with a -0.16 as opposed to a -0.21.
Joanie Alston Lovelace, MBA, RN, NHA, resident services administrator at Barclay Friends in West Chester, PA., believes that "a test score does not always reflect the knowledge level of an individual."
"The new nurses coming out of school today are very 'book' smart, however they lack the hands-on experience of the 'old' school nurses," says Lovelace. "There needs to be more clinical time incorporated into the learning process. The new nurses also are not truly prepared for what they will face in a new position. In school, they have maybe three patients to take care of in their last year of school and when they are in the work setting they could have as many as 15."
Judy Dodge of the Indiana Heart Hospital has mixed feelings about raising the passing standard of the NCLEX. "I do feel that 75 questions doesn't seem like enough to cover all the processes and diseases that one learns over the course of their education. I realize one cannot cover everything, but it just seems like such a very small sample," she says.
The higher standard is the result of NCSBN's regular plans to reevaluate the test and passing standard every three years to ensure both stay current and reflect the care nurses will give their patients.
Lovelace, Nappi, and Dodge believe that changing the passing standard is only part of the solution, and is one of the many steps the nursing profession should take to safeguard the patients.