Within the first week of my job as a medical assistant in a busy OB/GYN practice, it happened to me. Walking back to the “nurse triage” room, I asked what I thought was a reasonable question about a newly pregnant patient I had just brought back to a room. Based on her menstrual cycle the patient’s estimated due date (EDD) was out of congruence with her latest scan—should I change the date in the computer based on the new information?

The seasoned nurses—who just an hour earlier had been congratulating me on my admission to nursing school that coming Fall—both rolled their eyes. One heaved a sigh, not even trying to hide her exasperation at my inquiry. 

“Just leave it alone, we’ll take care of it,” she responded.

I was stunned. I quickly turned from them, squeaking out a hurried, “Ok, great, thanks!” I didn’t understand why I deserved such a response, and what’s worse—I hadn’t received any clear answer to my question in exchange for the micro-humiliation I now felt. 

Later, in the break room, I confided in one of the front desk staff. “Oh, honey,” she said knowingly, “don’t take it personally—nurses eat their young!”

Horizontal Violence

Call it bullying, call it hazing, call it abuse; the qualifiers for the generally accepted (and long-acknowledged) practice of harassment passed on from old to new nurses don’t particularly take the sting out of it. Especially when it seems to happen to every new nurse as they come up. Indeed, when I started as a GN in my first official nursing job a few years later, I saw it happen over and over again.

But why?

The dirty little secret of nurses eating their young is a problem recognized by anyone in the profession. In fact, numerous studies have been done on it—a quick search on Pubmed for “nursing and horizontal violence” (the academic term for such behavior) turns up over 500 hits. 

When you can’t be in 5 places at once (someone will dare to insinuate you’re slacking)

One reason posed for this lack of empathy towards newcomers is that of burnout. Nursing is a tough job, and the pace often moves too quickly to resolve any type of interpersonal conflict on the spot. In short, managing unpredictable shifts in a fast-paced environment leaks stress. And that stress is often redirected  to the lowest members of the totem pole—new nurses.  It’s almost as if seasoned nurses need a reflection of all that is put upon them in any given work day. 

But it’s not just the newbies who take it. Conflict between nurses of different departments is well-documented. Watch any patient report call between an ED nurse and the ICU nurse she is attempting to hand a patient off to, and undoubtedly they will both hang up the phone complaining of the other’s incompetence. Strained conversations held over an alert and oriented patient about their (perceived lack of) care in the originating department are not uncommon. Ill-disguised inquiries—why didn’t you hang this drip or begin any of the admission orders—translate into accusations of mismanaged time and the perception of one department slacking off over the other. 

For one of the most trusted professions, this kind of behavior is confusing. It can be said that nurses pour any available compassion into their patients and into their trusted inner work circle, saving any scraps for their personal life. With everyone working against the clock— especially at for-profit institutions—time is money, patient turnaround is paramount, and oh yeah: don’t forget to document all those tasks you barely had time to implement, or else. 

Do(n’t) kill the messenger 

Nurses take a lot of abuse from everyone in the healthcare channel. Doctors, patients (and their families), ancillary staff, management…untoward behavior can spring up from all of these sources, and more. And since nurses are usually too busy to respond in the moment, that frustration goes one of four places.  Nurses either find ways to manage stress healthfully with diligent self-care; transfer departments in search of the utopian “work-life balance;” or burnout completely and entirely leave the profession.  And the last group? They lace on their gloves and fight back—or in this case, down. 

Fighting within members of an oppressed group is a natural byproduct of pressure-cooking stress. By definition, nurses serve as the middle (wo)men for so many interactions between patients and the healthcare they are actively receiving. Healthcare, that for those patients, is often hard to navigate and endure. Predictably, a handful of nurses caring for them will take on the burden of their complaints personally. Add that to the “go, go, go” pace expected from their employers and coworkers, and it’s no wonder that hostility erupts in the fox hole.

But’s that’s not all (nurses)

It’s important to note that the majority of nurses do not behave in this way. As the adage goes, however, “one bad apple will spoil the bunch.” What’s more, many nurses actively work to flip the cultural nursing norm of bullying. Especially now that bullying has become a topic of nationwide concern, the language needed to discuss such sensitive subject matter is widening and becoming more mainstream. 

To tackle Big Problems, many (administrators) incorrectly assume we need Big Solutions. But daylong workshops and in-services are not the answer here. And that’s because influence is spread more effectively through the relationships we create. 

In nursing, we often like to say of our patients, “They won’t remember what you said, they won’t remember what you did, but they’ll always remember how you made them feel.” For myself, I was lucky enough to have incredibly patient and caring preceptors throughout all my department transitions. Ones that encouraged the more dumb questions the better, didn’t cruelly critique me in front of patients or staff, and permitted just the right amount of “watch one, do one, teach one,” methodology to build my confidence over time.  They had realistic exceptions of my abilities and naive knowledge base. And they also actively modeled how to handle interpersonal conflict; or better yet—how to prevent it. 

During one such transfer of a particularly complex patient—a young mother of three who had suffered a devastating intracranial  hemorrhage—my favorite preceptor imparted a lesson I will never forget. During every interaction—from the moment she called report, to every conversation with the patient’s understandably anxious family, to summoning the extra transport staff needed to move this critically ill patient between floors—she always followed the same script. Which was this: addressing people by their name, asking how they were and pausing to listen to their response, explicitly obtaining permission to relay information, and then finishing by asking if there was anything else she could do to make their day a little bit better. 

This technique always worked on the even the most dedicated curmudgeons. I was always in awe of this—her superpower of empathy. I’ll never forget the transformative effect that bearing witness to anyone’s pain had on them—whether it was the oxygen-sucking pain of a traumatized family member, or a janitor mumbling about how he was called off his lunch break for a stat room clean. Or, the effect that it had on me, and how I would aspire to conduct myself in all the nurse-on-nurse arenas I would go on to work in, paying it duly forward.