The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (20 page)

Sam found Dr. Spiros outside another patient’s room. “Hey, can you order some Tylenol for Mr. Rhodes?” A fever could cause a high heart rate.

“I don’t think he can swallow anything,” Dr. Spiros replied.

Sam gave him a “don’t be dense” look. “No shit, Sherlock. I want it rectally.”

Dr. Spiros laughed and gave her the order.

William, the charge nurse that night, saw them laughing together and followed Sam to her next patient room. He typed the patient’s information into an EKG while Sam connected the leads. “So how was your date with Spiros?” he asked her.

“It was fine. No big deal. We just hung out.”

“What did you wear?”

“Jeans. A sweater. Boots. Why?”

William shrugged. “It makes a difference. Do you like him?”

“I don’t know. It’s too early to tell,” she said, dodging.

William looked at her for a long inscrutable moment before leaving to check on other patients.

At the eleven o’clock shift change, Grace, an older nurse, tried to transition her patient to another nurse. The younger nurse refused because she was overwhelmed. Grace explained the situation to Sam.

“Are you kidding me? Everyone’s overwhelmed!” Sam said. Sam had been overwhelmed plenty of times since her first day, but she kept her head down, focused on her sickest patients, and never once refused to take another. Sam took Grace’s patient without reservation. Grace had been working at least eight hours longer than Sam, and had every right to hand off her patients and go home. If Sam didn’t take the patient, he would be assigned to the inexperienced nurse with Mr. Rhodes, the sickest patient in the ER. Sam’s patient total was now at ten, the most of any nurse. “We have to work as a team,” Sam said. “On bad nights like this, teamwork is even more important than usual.”

Sam believed that nursing schools should instill the value of teamwork, but that hadn’t been her experience. The phrase “nurses eat their young” was, to Sam, “the understatement of the century.” While some of her nursing instructors had been friendly and helpful, many of her clinical instructors were not.

Early on in her schooling, when Sam hadn’t emptied a patient’s Foley, an instructor yelled at her about it in front of the other students and nurses. “You’re screwing up! How could you not empty the Foley bag? That’s gross!” the nurse yelled at Sam, her tone nastier than her words.

“Well, no, I didn’t empty the Foley. I didn’t know I was supposed to. We’re only a month into clinicals,” Sam had managed to say before dissolving into tears.

That instructor made other students cry and once screamed at a pregnant student so loudly that the woman left class early with chest pains. Sam stuck with the program. Other aspiring nurses did not.

Molly was assigned to a patient who had developed a 104-degree postoperative fever after a minor surgical procedure. Molly introduced herself, then started an IV to deliver fluids and medicines. An hour later, when she checked on the patient, the woman was feeling better. In a tired, crackly voice, she said, “Thank you, Molly.”

Molly couldn’t believe it. In ten years, no patient had taken the time to thank her by name. That small gesture made Molly feel important, “not in the world, but to that patient,” she said.

As Molly continued to work at South General, it happened again. But, for Molly, while the patients were preferable to Pines’, the nurses were not. The racial divide was pronounced: The white nurses worked together and the black nurses worked together. Except for Lara, whom the black nurses seemed to accept, South General nurses rarely crossed that line.

As much as Molly liked South General, her commute was ninety minutes each way, which meant her workday totaled fifteen hours. Knowing that South General was not the ideal hospital she sought, she decided to drop the hospital from her agency rotation and pick up more shifts at Citycenter and Academy.

One afternoon, a foreign-born woman came into the ER with abdominal pains and breast tenderness. Women of childbearing age with abdominal complaints automatically got a pregnancy test. Some of the women had no idea they could be pregnant. Others came to the ER because they would rather Medicaid pay hundreds of dollars for a hospital visit than spend $10 themselves for a home pregnancy test. Molly took the urine sample to the lab room and placed four drops onto a pregnancy test kit.

After Molly’s second post-IUI pregnancy test had been negative, she had kept her chin up. But when a third IUI was again unsuccessful, she started to get discouraged. Her follicles weren’t responding well to the fertility medication. The IUIs, lab tests, and drugs already had whittled most of her insurance coverage. If Molly’s next IUI was unsuccessful, her doctor had told her they would have to move on to IVF, an even more expensive process that she would have to pay for entirely out of pocket.

Molly had never been the sort of person to “What if?” but even she wasn’t immune to these creeping doubts. What if the next IUI didn’t work? What if her money ran out? And, worse, what if she couldn’t get pregnant at all?

When Molly returned to the patient’s room, she asked the woman if she could discuss the test in front of her husband. The woman nodded.

“The results were positive. Y’all are pregnant,” Molly said.

The couple immediately burst into joyful tears and hugged, ecstatic. “We have been trying for a while,” the woman said through misty eyes. “I have lost a baby in the past.”

Molly wiped her eyes and, smiling, left the room. She couldn’t decide whether her tears were “sweet tears, happy tears, or jealous tears.” Whichever they were, Molly couldn’t remember ever feeling that way before.

In late November, Molly wore Thanksgiving scrubs for an Academy shift. “Oh, would you look at that,” Molly overheard the baby nurses titter, hyperaware that she didn’t bother to follow their trends. Molly didn’t mind the comments; the young nurses probably considered her cheerful animal-printed scrubs the equivalent of, in her words, “the grandma sweater with the embroidered flowers.” The Academy girls wouldn’t be caught dead in printed scrubs. But patients often commented on Molly’s with a smile.

Nurse divisions were particularly stark at Academy. Academy nurses had a “look,” a uniform within the uniform. Most of the nurses were new grads who wore designer scrubs (such as Urbane), North Face zip-up tops, and $120 Dansko nurse clogs. Molly wore her old running shoes for comfort.

The divisions went beyond the clothes, though. The major clique consisted of what Molly called “the cute little trendy girls” who had graduated from Academy’s prestigious nursing school. The Academy graduates were talented, prepared nurses who would not leave any coworker in the lurch professionally. But socially, they distanced themselves from nonalumni.

One of Molly’s favorite nurses was Claire, who had spent two years as a medical/surgical nurse before coming to the ER. Claire was friendly, helpful, and overweight. She had told Molly quietly that clique members weren’t nice to her and made her feel inferior, even though she was more experienced. Two months later, Claire quit. “It makes me sad,” Molly said. “She was big, and being a cute nurse at Academy really equals being part of the ‘in crowd.’ For some nurses, being included like that makes them happier workers and better able to focus on their job, so when they’re blatantly left out, their days are much more difficult. The profession has that reputation of older nurses eating their young, but I feel like the younger nurses were eating their fat.”

At Pines, Molly did not believe that Juliette’s size was the reason the clique excluded her. Juliette was the type of person whom you had to get to know in order to love, and some people didn’t look past their first impression. Juliette could say something completely benign, but her tone of voice could make it sound negative, and her blunt mannerisms could seem abrasive. Molly tried to persuade her to leave Pines and work for the agency instead; the agency would hire her back without question. She thought Juliette would be happier outside of Pines’ strange social bubble.

Molly had befriended Juliette when they were both new nurses. She came to know her as funny, outgoing, loving, kind, and generous. Juliette had a handful of close friends for whom she would do anything, and she often let them know how much she cared for them. She was much softer than people realized. If Molly were to play armchair psychologist, she would guess that Juliette was the way she was because she had a difficult childhood with an alcoholic mother who chose booze over her daughter. Molly believed Juliette had constructed a tough exterior to protect her feelings but at the same time was desperate for approval. It was a combination that unintentionally could come across as simultaneously harsh and needy.

The traits that nettled Juliette’s colleagues were some of the same characteristics that made her an excellent nurse. Juliette was fiercely loyal to her patients, standing up for them no matter the cost. Patients also appreciated that she was straightforward; she told them the real scoop and then did everything in her power to help make them better. It was a mistake to dismiss Juliette without giving her a chance.

Nurse-to-nurse bullying has been called “a silent epidemic,” “professional terrorism,” “insidious cannibalism,” and “the dirty little secret of nursing.” And it is crucial that the public learns about it—and hospitals eradicate it—because it affects patient care.

Workplace bullying can happen in any profession. It may come as more of a surprise from nurses, who are expected to be nurturing, empathetic, and caring. But the numbers are staggering. In the United States, a
Journal of Nursing Management
study found that 75 percent of nurses had been verbally abused by another nurse. It is so pervasive that even the American Nurses Association observed, in literature for its members, “Most of us could probably recount at least one story in which we as nurses encountered or witnessed workplace bullying.”

Nurse bullying is a significant problem in many corners of the world, in countries as diverse as England, Japan, Portugal, Finland, Australia, New Zealand, Ireland, Taiwan, Poland, Canada, and, a country with particularly high rates, Turkey. Worldwide, experts have estimated that one in three nurses quits her job because of it, and that bullying—not wages—is the major cause of a global critical nursing shortage. “We are not ‘angels in white,’” a Japanese nurse told me.

One of the most sobering statistics comes from Boston Medical Center’s director of nursing education and research, Martha Griffin, who found that nurse bullying is responsible for 60 percent of new nurses leaving their first jobs within six months and 20 percent leaving the profession entirely within three years. “It is destroying new nurses,” a Kansas nursing instructor told me. “I have five students who graduated less than a year ago who quit the nursing profession because of this behavior. It makes me very sad.”

It is tempting to attribute nurses’ hostility to their high-stakes work environment. But studies show that more nurses experience bullying from peers than do doctors or other healthcare staff. And nurses are verbally abused more frequently by each other than by patients, patients’ families, and physicians.

As distressing as it is for a nurse to be bullied by a physician, disruptive-behavior expert Alan Rosenstein reported that nurses are more upset by nurse-on-nurse “backbiting and unnecessary scrutiny.” As one nurse wrote him, “I expect that behavior from the surgeons,
not
the nurses, because I rely on them as my peers.”

In 1986, nursing professor Judith Meissner coined the phrase “nurses eat their young” as a call to action for nurses to stop ripping apart inexperienced coworkers. Nearly thirty years later, the practice festers, and while younger nurses may more often be targeted, no nurse is immune. As a Washington State Post-Anesthesia Care Unit nurse said, “There is a culture of treating other nurses like dirt.” The mystery is why this behavior continues.

Bullying among nurses goes by several names, including nurse-on-nurse hostility and lateral aggression. Rosenstein noted that nurse bullying is usually less direct than doctor bullying; it is more frequently behind-the-back “undermining, clique formation, and other types of passive-aggressive behaviors.” Indeed, a
Research in Nursing & Health
survey found that the most common bullying methods are, as Juliette experienced, “being given an unmanageable workload (71 percent) and being ignored or excluded (58 percent).” Nurse bullies have admitted to other researchers that their most frequent weapon was “to stop talking when others entered the room.”

According to Griffin, the five most frequent forms of lateral aggression among nurses, in order of frequency, are: “Nonverbal innuendo (raising of eyebrows, face-making), verbal affront (covert or overt, snide remarks, lack of openness, abrupt responses), undermining activities (turning away, not available), withholding information . . . , [and] sabotage (deliberately setting up a negative situation).”

Several other behaviors fall under the bullying umbrella, including when nurses gossip; ignore; condescend; belittle; humiliate; in-fight; unjustly criticize; fail to support a coworker because of dislike; give the silent treatment; make slurs or jokes about race, religion, appearance, demeanor, gender, or sexual orientation; or exclude a nurse from socializing. Bullying includes giving hints that a coworker should quit his or her job and excessively monitoring a peer’s work. Pennsylvania State professor Cheryl Dellasega has written that other common relationally aggressive behaviors include “manipulating or intimidating another nurse into doing something . . ., teasing another nurse about lack of skill or knowledge, running a smear campaign, or otherwise trying to get others to turn against a nurse.”