Burn Out and Bullying

Did you know the term burnout was first used to describe exhausted an disillusioned health care workers in the 60's, it certainly was a very relevant term.  As nurses it is not uncommon for us to suffer from burn out at some point, this condition is especially prevalent in high acuity areas such as the ER, ICU and Oncology but I think you can suffer it in every speciality, certainly more so if you have one of more bullies in your team!  At a time in nursing when nursing informatics is changing the face of clinical care so much (really when I walk on the floor now often nurses are glued to computer monitors and smart phones and not walking the halls and talking to each other!), and we are being asked to do more with less, who would not get burned out.

For me it is cyclical, I can have peace and harmony for a while then juggling all the different roles I have, clinician, nurse educator, consultant suddenly tumbles like a good game of Jenga and I have to step back and breath a little.  For me that means slowing down, making sure I get to that kickboxing and yoga class (really, it helps sooo much), get a good nights sleep and take care of my diet.  Small changes somehow make me feel a little more in control of the chaos that surrounds me, let's face it, it surrounds us all.  My family always knows when I am super stressed as I am in the kitchen making a dinner that Julia Child would be proud of.  Somehow creating something nutritious centers me, not surprisingly the family are not too upset when I get stressed......they know they are going to get fed.

Taking a step back and taking care of myself also helps me put those bullies and the control I am allowing them to have in my life into some perspective.  As I hinted in my last post a bully usually lashes out because they are operating from a place of pain, insecurity, surely someone who is that nasty must be in personal pain of some kind.  It allows me to think compassionately about that toxic person in my life without condoning their behavior and reestablish good boundaries, so I do not let the bully bother me so much and let them know how little they may get away with at my emotional expense.

The last couple of weeks have been that crazy for me and this week even though I perceived I had no time I walked the dog around the reservoir and just took in the colors and the great weather, went that extra mile at kickboxing (boy does it make me sleep better) and determined to make that yoga class tonight before my 4.30am start tomorrow for pediatric clinicals, which is going really well.  Heck I love students.

I promise this is the last post on bullying for a while but probably not the last word on taking care of ourselves as nurses.  We have to give ourselves permission to put ourselves first for at least 5 minutes a day and have/be a great day!!!!

Bullying In Nursing Culture Part 2

There is a point when you get way into your 40's (like me!) that you hope all the bullying and passive aggressive remarks in nursing will 1. Disappear or 2. Float off your back without sustaining the sting they intended.  Sadly I have more luck of the sun not rising in the morning.  Let's face it, we are a female dominated, dysfunction relationship, sad example of girlfriends gone toxic.   

My husband who is very successful in business can have a heated discussion with a co-worker and then go out with him for a beer.  I can interpret the most innocent of remarks as an attack on my performance, intentions, work ethic and character and not sleep for a week!!  This is because men are able to compartmentalize professional and personal and women cannot and therein lies part of the issue.

I was once a part of such a dysfunctional team that management forced us to do group therapy....yep that was about as much fun as cleaning up an over full exploding colostomy bag!!  But I do remember one this the therapist told us.

"Think the best of me and I will think the best of you!"

I have tried (not always successful) to apply that to my work relationships.  Maybe if that colleague called out she really is sick, maybe when your co-worker gave you the stink eye she was thinking about other things like troubles at home, maybe when your team mate snapped your head off it was because her to-do list is so long and she has not slept in 2 nights as she was up with her baby who is teething.  Who knows what the reason is, but the point is peoples bad moods and reactions to us is not always about us and so we should try and take the high road and focus on what we are doing right and not on that one thing we may have done wrong or that one thing that your co-worker wants the whole team to know you did wrong!!

We cannot change the psychosis of bullying within our profession over night but we can start with us.  Chose to be kind, chose not to participate in the gossip, in fact flee from it and make it known you will not participate.  Set an example for the novice nurse and the nurse who is unable to defend herself.  Be a champion of kindness and let's start caring for each other the way we care for our patients.

Bullying Within Nursing Culture Part 1

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Nurses are often called “Angels”.  This term has made me feel uncomfortable when directed at me.  If that patient and their family only knew all my foibles and judgmental thoughts that go through my head in the course of a day.  However, sometimes we are not very angelic towards our colleagues.   

This phenomenon has many terms these days, nurses eating their young, nurse bullying, horizontal violence.  The good thing is, it is being documented and written about more and more in nurse literature, but is it decreasing the incidence of horizontal violence.

I am sure every nurse reading this can remember a time when they were the victim of bullying in the workplace.  The discomfort of being victimized by this never leaves us.  It can be especially bad for new nurses; at a time when they need to be mentored and supported they are wondering if they made the biggest mistake of their lives by joining this angelic vocation called Nursing?!

I once left a job when the bullying got so bad.  I loved the job, but a few burned out cynical nurses who decided to put a target on my back made life at work so toxic I did something I am not proud of.  I handed in my notice and walked out the same day!  This is not something I would recommend, but the situation had become so bad and once I handed in my notice I actually was in fear of the consequences so I just left and never went back.  Not cool, really not cool but I also have to say it was a vote for my emotional safety and I do not entirely regret it. 

The job started well enough, it was a new area for me but I was eager to learn.  The team were supportive, wanted to get to know me but it was obvious that a few nurses who had been there several years were burned out in the high stress area of pediatric oncology and had become victims to their situation, claiming their victim hood as a source of self-soothing for the daily grind.  It started with the usual gossip of other team members; with things as trivial as a perceived bad hair style to accusations of work ethic (really sometimes junior high never ends for some people).  I tried hard not to participate in these conversations; maybe that was my first mistake and the beginning of the target on my back.  I soon was avoiding coffee and lunch with certain nurses because then the trash talking would get really bad.  It set me apart; maybe they thought I was better than them.  Nothing could be further from the truth, not a novice nurse, but one in a new area, I felt I was drowning in information I did not completely understand and had nowhere to turn.  Physicians were too busy to entertain my frequent questions and certain nurses looked at me as if I was asking yet another stupid question.

Then started the withholding information, a power play that made me feel even more isolated.  Sometimes it was just that almost insignificant team stuff that makes you feel a part of the team, so and so if pregnant, isn’t that great?  Drinks after work, would you like to come?  Then this escalated to the team emails, highlighting that one small error I had made in a very public way. Often they came on a Friday afternoon so I would be in agony about the issue all weekend and dreading going back to work by Monday morning.  

Reasonable conversation helped in the short term but then the abusive behavior would start again.  When I took it to my supervisor I was told I needed to deal with this myself, it was the best way.  I had always prided myself as having good communication skills and not lacking in personal confidence in the workplace and a team player.  But I recognized I too was turning into a victim.  I seconded guessed what I was doing.  Once after I addressed the passive aggressive behavior face to face no one talked to me for two weeks!!! Well, clearly that did not work.  Soon I was crying every day on the way home from work and then I was waking at 2am dreading going to work.  My husband begged me to find a solution. I left but for a long time felt like I had failed in that position, when in reality the organization failed me.  It can be a silent lonely experience to be victimized in the workplace.  Bullies have a perceived power that is hard to come up against, it takes a fair amount of courage and emotional energy to make the daily attack that will enable long term change.

This was my story, everyone has one, and sadly I know this is true.  As I start this series on nurse on nurse conflict I would love to hear your story.  Please email me at angiemiller1966@yahoo.com and I will publish your story, anonymously if you prefer.

·        
        What is your experience?

·       How would you have handled it differently?

·       What tools and support do you think would have made the situation better

·       How can we finally stop this happening to novice and expert nurses alike

Nursing Informatics - Curse or Crucial

As the title of this post may suggest I am having a love hate relationship with technology this week.  However, I learned long ago I better get with the program or I would be left far far behind in every aspect of nursing.  Technology is a fast growing, rapidly essential part of everyone's nursing practice.  From learning to take a blood pressure with the touchscreen monitor at the bedside (first you have to set the right profile, know the right buttons to press, being able to trouble shoot - you get the idea!) to the ipad applications that are just there for those in the health care profession.  Yes, yes I know these tools are there to make my job easier and promote high quality of nursing care, but instead of getting a BSN there are some days I wish I had a degree in computer science!

The online class I teach has just changed it learning environment from EPIC to Blackboard.  Now I had just come to terms with EPIC, me and EPIC had recently become friends, I was able to join the discussion board, use the grade book, send and receive emails all without too much stress.  Now my new love is Blackboard but we are like a dysfunctional couple from the "Bachelor", we desperately want to make it work but we do not really know each other yet, and we are in love with the thought of being together but the reality.....well it leaves me wanting.  Learning a whole new system has seriously slowed down my productivity and increased my stress this week.

The University I am a clinical instructor for recently changed their email server from Outlook to Google.....What!!!!  What was wrong with Outlook, it was an old friend, like sleeping in your favorite t-shirt.  This Google thing is for the millennials, how do I populate my address book,why am I now getting emails from the whole university not just the nursing department.  I am not really interested in who is running for freshman student government (although I am sure it is extremely valid), but now I am getting daily emails from Tiffany, Justin and Dave trying to persuade me why they need my vote!!!

Now don't get me wrong, I am a lover of technology.  In our house we have more computers than TVs, sad fact is you will often find my husband and myself in the evening working on our laptops and ipads spontaneously.  I pride myself on being a multi tasker, I can cook dinner and text my kids with one hand behind my back.  But sometimes technology goes so fast I feel stressed, marooned with nowhere to go.  Thank goodness I have very techy children who are also nocturnal so I can call them at anytime of the night.  Goodness knows how I would have got through grad school without Elliot showing me how to use PowerPoint.

And it got me thinking, nursing is one of those multi generational professions.  We have nurses in their 60's and their 20's who must both coexist with peace in the clinical environment.  And technology can make it hard for those who have not been exposed to it all their lives and fear looking stupid if they ask for help too many times.  In the converse, the older more mastered nurses often do not tolerate the millenials with the insane ability of opposable thumbs and the ability to listen to you while playing on their smart phone!  There must be tolerance both ways because I am afraid my friends that accelerated technology is here to stay.  

All I can say is HELP!!!!!

Nurse Leadership

I have just come to the end of teaching an online class on nurse leadership, it is a class I have done a few times now and its good to deal with a familiar syllabus and understand upcoming assignments better.  The course content has stirred in my thoughts about nurse leadership and a discussion with students that is new and energizing.

I look back at the nurse leaders I have been fortunate enough to work with and I learned something from all of them, the good ones as well as the bad!  I have had leaders who have had a transformational democratic style and those who were undoubtedly autocratic dictators!!  I remember one of my first student nurse clinical experiences on a surgical unit in a small mining town in Northern England.  The matron on the floor had trained in the military..enough said, you could eat off her floors.  She ran her floor like a D Day reenactment!  It was intimidating, we asked very few questions but somehow learning took place and the patients were cared for beautifully.  I do not remember one post op surgical infection, no-one went a day and a half without pooping! and those beds were made with crisp sharp angles on the corners!  But I also took from that experience I did not want to be an intimidating leader, I wanted relationship, to be a mentor, more of a coach and that is what I have based my hands on and teaching career on in nursing.  I also remember my first job as a graduate nurse on a busy Neuro Ward in Oxford, England.  The matron had an open door policy, wanted to know all her staff and their husbands, wives and children.  We socialized outside of work, it felt like family, community.  It was a gift as a new nurse to be able to make mistakes in a safe and supported place, I learned so much and still think back on that time with fondness.

The syllabus for this leadership class also presents the students with a survey of how politically savvy are they.  Very valuable tool, are they connected to the staff as a community or do they operate in an isolated way?  Is their voice influential and is their leadership style appropriate for the environment or do they need to consider changing it?   This survey led to much class room discussion on who we are, why we are the way we are, and what is the cost benefit/loss of all of it.  To be influential, powerful and effective as a leader I do not think you have to have the loudest voice, strongest personality or the most letters after your name, although I do think education gives you greater credibility.  But I do think you must be authentic, have incredibly high standards of nursing care, treat patients, colleagues of every color, rank and skill with respect and keep working on growing professionally and personally.

Yet Another Nursing Dilemma

Of course as nurses we often have daily dilemma's because caring for people can be messy, does not always fit into any ethically correct template, all those variables of people, family, diagnosis, living arrangements, emotional state, motivation or lack of it play into the outcomes of the nursing plan I devise at admission.

I have this patient, lets call her Alice, she lives with her mentally challenged brother who is high functioning but certainly not capable of making any of the household decisions.  Alice has COPD caused undoubtedly from her addiction to cigarettes.  She is admitted to the hospital on average once a month due to an exacerbation of COPD, is on 6 liters of O2, still smokes at least a pack a day.  Alice has type 2 diabetes caused undoubtedly from extended use of steroids for her COPD and an addiction to fast food, she is low income and so I have organized meals on wheels to be delivered every week, she is completely home bound so I also organized a food pantry to deliver to her every week.  She orders out fast food to be delivered daily.  The end of the money always comes way before the end of the month.  She cries and cries by the 20th of every month that she has no funds to feed her or her brother even though the fridge and freezer is full of donated food she does not want to eat.  She is estranged from most of her family due to her unhealthy lifestyle, they are all exhausted with trying to help her, so Alice is basically alone with her brother.

Alice has pulse ox consistently in the high 80's on O2 and her blood sugars are regularly over 250 in the morning if she takes them at all.  There are many other diagnosis including colitis, depression, fibromyalgia, cataracts to name but a few.  She sees her physician monthly (when she is not in hospital) but he has all but given up on her because she never follows instructions.

For the past 18 months I have been seeing Alice, twice sometimes three times a week to monitor her physical status and teach/encourage her on smoking cessation strategies, compliance with a diabetic diet, and most of all O2 safety in the home (I am so afraid she will blow up her and her brother when smoking during O2 use).  Nothing has changed, if anything her physical condition gets progressively worse.  And in the midst of all this, we became friends, I like Alice, she likes me.  We start and end our visits with a hug.  She has my cell phone number memorized (not always a good thing!).  And so I continued to go and attend to her needs, and I know her physical therapist was working as hard as I was to help Alice reach her potential, all to no avail.  This week I realized I had become another one of her enablers.  It would have been easier if Alice were obnoxious, verbally aggressive but she is not, she is sweet and grateful and has no interest in participating in her plan of care.  I am no longer helping her in anyway.  So after a case conference with the team and her family doctor this will be the last week I will see Alice.

She cried when I told her, she scowled when I honestly told her why, she does not want to change but she does not want to lose her team.  Unfortunately when Medicare is paying all the bills you cannot have it both ways.  Above all that I realized Alice needs a new team, fresh eyes and she also needs to see accountability in her poor sick addicted life.  I am torn about this decision as I am certain it is the right direction to go but I also struggle with Alice's perception that I am abandoning her.  I continue to explore the benefits of keeping a nurse patient relationship therapeutic, sometimes its not as easy as the text book says it is!

Summer.....what Summer

So great plans and all that.  My summer was supposed to be quiet and serene, lots of time for getting through that pile of books in my study and do some writing, including updating this blog on a weekly basis.  What happened?  Life happened.  We spent the beginning and the end of the summer travelling to Barcelona, London, and later South Carolina and Colorado and thoroughly enjoyed all of it, especially Colorado, there is something about being in the mountains that speaks to my soul, restores me a little, we all need that every now and again, especially in a high burnout profession like Nursing.

I continued with community nursing which had its very busy weeks covering for staff who were gone on vacation.  I had both interesting, sweet and challenging patients and some very hostile relatives.  I continually tell myself, their aggression is not really about me, its more about the frustration of their situation.  For an elderly patient who is facing end of life issues, a helpless relative can feel powerless and this can come across as dissatisfaction of care to the health professional in the line of fire (literally!).  Even though I know all this after several "not so nice" rels this summer I admit to it all getting a little old, being shouted at and second guessed several times a week.  But we soldier on, the hands on care is still the most magical part of nursing for me.

I also continued with my online teaching commitments.  This summer I have been coaching a leadership class and thoroughly enjoying it.  These young BSN students see themselves as novices even though many of them have years of clinical experience.  But the online education experience is a wonderful medium to exchange powerful ideas, lively discussions, solve issues hypothetically through PowerPoint presentations and develop a base knowledge that will hopefully lead them onto successful leadership positions.  All I really have to do is facilitate and grade 60 papers every weekend (groan!), all done at home by the power of my laptop, my perfect kind of job.

Just when things got to August and looked like I may have a month of breathing space before my semester starts again for my traditional teaching job at a Philadelphia University we met this guy....

I really was uncertain about doing the dog thing after losing our beloved Golden Retriever in April.  However one particular weekend when I was missing him so acutely my husband put me in the car and took me to a pet adoption at a local pet store....and there we met Toby.  It was love at first sight.  An adorable choc lab/pointer mix.  Loves to snuggle, chew cell phones and TV remotes.  He is especially fond of the 3am pee followed by a snuggle in bed.  And so I am now walking the neighborhood at 7am/pm every day, chasing him around the house with my carpet shampooer (forgot how much work potty training is), trying to persuade him not to eat the cat daily ( I secretly think the cat quite enjoys it!).  Exhausted and enjoying every minute of him

Faculty meetings have begun, planning and organizing a new semester is ongoing, I am ready to roll with whatever fall brings me and looking forward to it.

How was your summer?