Monday, February 20, 2017

Lions, Gazelles, and Nurses

Nursing has a hierarchy of power and experience just like any other profession; in fact, it also has a hierarchy that sometimes feels akin to the laws of survival on the savanna or in the jungle.

Have you ever observed that the less experienced and more vulnerable nurses frequently get left on the outside, often falling prey to bullies and "predators"? This is the herd mentality at its worst, and many novice nurses are taken down by bullies and power-hungry colleagues who eat them alive when they're demonstrating the slightest weakness.


Protection and Predation

Out on the African savanna, herds of gazelles keep watch for lions, one of their most fierce predators; the culling of the herd is a natural phenomenon, and lions need to eat just like anyone else. The thing is, some naturalists notice that the sicker, older gazelles are left on the outside of the herd, vulnerable to predation and outside of the safety of the circle. Young gazelles are naturally kept on the inside, their parents and elders protecting them and keeping them close, with the innate understanding that they are the carriers of the gene pool who need to survive into adulthood so that the species can  thrive into the future. 

In the healthcare environment, we often see a herd mentality, as well; in this scenario, the experienced nurses make up the bones of the innermost circle of safety, and survival of the fittest is frequently the name of the game. But what about the newer nurses? Where are they in the hierarchy?

A Med/Surg Herd

Let's consider a large Med/Surg unit where we find a mix of older, highly experienced nurses, some nurses who are two to five years into their careers, and a number of fresh-faced novice nurses who are in their first year in the profession.

Now let's imagine that there's a bully in the mix; she's a nurse with 25 years of experience, a toxic personality, and a stranglehold on the unit culture. The administration is afraid of her, the nurse manager turns a blind eye to her egregious behavior, and most nurses just keep their heads down and hope she doesn't pick on them or single them out.

The older, more experienced nurses may be relatively safe from the bully; they've known her a while, put up with her toxicity, humor her, or perhaps just ignore her as much as they can in order to not call attention to themselves. Their silence is essentially complicity, and some of them may actually play into the bullying and tacitly empower her aberrant behavior. A bully can sometimes be a younger nurse who bullies older nurses, as well; this power dynamic can work in both generational directions.


The New Nurse: Falling Prey to the Lion

Meanwhile, the newer nurses are fresh blood for the bully/lion/predator; they are unsure of themselves, need to ask questions, and are vulnerable to being singled out and stalked by the bully and her minions.

If the members of the nursing herd try to stay out of the bully's way -- or actually support her in being the bully -- what does that mean for the newer nurses? It generally means that they are kept on the outside of the circle of protection and safety, left to fend for themselves against the nurse predator.

If you think of the nurses on the unit as a herd, the young are left on the outside to fend for themselves, and the elders are, for the most part, held in the center, cushioned against the attacks of the predator/bully; however, an elder nurse can also be deemed weak by the "herd"and thus ostracized to the fringes.

The calculus of this situation is untenable and unhealthy, with certain nurses receiving the short end of the stick; vulnerable novice nurses need nurturing and support, not the feeling of being thrown to the lion(s).

Extending the Circle of Safety

In order to counteract a situation that lends itself to the burnout and attrition of newer nurses (as well as those seasoned nurses who are for some reason vulnerable to bullies), the circle of safety needs to extend its protection to everyone. Rather than leaving more vulnerable colleagues to be picked off the edge by predators and bullies, the circle closes around those who need its reassuring sanctuary, whether they be older, younger, or somewhere in between.

Dr. Renee Thompson, one of the world's foremost experts on nurse bullying, has documented and communicated the subtleties and vicissitudes of this scourge through books, blog posts, articles, podcasts, keynote speeches, videos, and her significant social media presence. As Dr. Thompson informs us, we must learn to speak up in the face of bullying, and to protect those members of our team who are susceptible to a form of professional predation that sends many a nurse running for the exit, often leaving the profession altogether.

We must reject the old adage that nurses eat our young; rather, we can choose to create and embrace a new paradigm where nurses nurture and empower their young instead.

This isn't rocket science, but we nurses need to learn the skills that will help us to bully-proof ourselves, speak up in the face of bullying, end nurse predation, and enclose our colleagues in a circle of safety that keeps the lions on the outside and the vulnerable protected from harm.

We can make different choices, and it's our daily decision regarding which path we will take. I implore you to extend the circle of safety, protect the vulnerable, and bring a sense of community and symbiotic togetherness to your corner of the nursing world.

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Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway.

Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses.

A widely published nurse writer, Keith is the author of "Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century," and has contributed chapters to a number of books related to the nursing profession. Keith has written for Nurse.com, Nurse.org,  MultiViews News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, Working Nurse Magazine, and other online publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, podcaster, holistic career coach, writer, and well-known successful nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives.

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