Senior doctors and nurses bully newbies through gossip
(This is part 2 in a series on bullying in hospitals by The FilAm, a content partner of Rappler. Read part 1 here)
NEW YORK CITY, USA – They continue to walk the corridors of every hospital and nursing facility, these doctors with a huge ego and a ‘God Complex.’ Some senior nurses walk in their shadow.
“These are doctors who think just because they have many years of education they know everything, and no one can tell them what to do. They have what is known as the God Complex,” said nurse educator and legal consultant Nemcy Cavite Duran in an interview with The FilAm. “Some of them look down on young graduates and foreign-born nurses. They do not have confidence that these nurses will be able to assist them competently.”
As an entry-level nurse some 20 years ago, Duran witnessed how some nurses would offer their seats at the nursing station to physicians and cater to their every whim. She was surprised to see such attitude of submissiveness in US. hospitals.
Nurse-to-nurse bullying, she noted, continues to this day, usually a result of unmet expectations. A new nurse, for example, expects guidance from a superior, while the seasoned nurse expects a fresh graduate to hit the ground running because she just came out of nursing school and all duties of a nurse are still fresh in her mind.
“The senior nurses expect the young to function independently, and yet the young nurses expect mentorship and guidance because they want to avoid medication errors,” she said. “I still see this from time to time.”
The American Nurses Association (ANA) recognizes that nurse-to-nurse interactions and physician-to-nurse interactions are the “top two sources of conflict” in the health care work place. The ANA developed an anti-harassment manual where bullied nurses will find the resources to get help, and also to foster an environment of team work.
Gossip as form of bullying
Bullying is not all cursing and barking orders. It can be an act as subtle as gossip, according to a study in the American Journal of Nursing (AJN).
“Relational aggression is a type of bullying typified by various forms of psychological (rather than physical) abuse. It includes such behaviors as gossiping, withholding information, and ostracism,” said the AJN study entitled “Bullying Among Nurses” authored by Penn State University Prof. Cheryl Dellasega. She has conducted extensive research on bullying among women.
Some doctors with the ‘God Complex’ look down on the new and foreign-born nurses.
The introduction of Cultural Competence Training in many facilities sought to address diversity-related conflicts, said registered nurse Rank Nur, who works in a hospital in Queens. Nur has participated in training workshops where the staff is taught to be respectful of their colleagues’ ethnic background. Part of the training uses the "TeamSTEPPS" approach, a form of workplace interaction that promotes teamwork.
“It originated from NASA following an accident involving one Apollo mission. Investigation showed that some lower level staff saw something amiss but did not speak up because they were afraid to rock the boat or be blamed,” explained Nur.
“In such workshops,” she continued, “Health workers learn to speak up, but to speak up using TeamSTEPPS language.”
For example, a nurse who may want to call a doctor’s attention about her concerns can say: “Excuse me, doctor, I’m using TeamSTEPPS here. I am uncomfortable about patient safety when I see that…” The doctor is likely to acknowledge the nurse’s comment and act appropriately.
Language is a big part of misunderstanding in a multicultural setting, said Duran, who is also a speaker on ‘overcoming language barriers,’ one of the components of diversity training. She remembered asking a Filipino nurse why she refused to speak to a particular doctor. “After he cursed me out?” the nurse said. The two had a common patient, and needed to work together.
In conducting training, Duran would emphasize communication that is respectful of other cultures and articulated in a moderate volume.
“There are many problems caused by miscommunication,” she said. Sometimes, even if two people speak the same language, there may be different interpretations of a common procedure or concept. Such barrier may lead to a delay or confusion in providing care to the patient.
“It’s all about the patient,” she said.
Both Duran and Nur believe diversity training has paved the way in creating a culture of courtesy among health care professionals and workers. “I’ve seen some changes,” said Duran.
In some cases, Filipino nurses are left to deal with bullying using their own survival tactics, especially when the supervisors – the people who are supposed to protect them – are the perpetrators. Some would report and suffer the consequences. Others ignore the problem hoping it will go away.
Speak up, fight back
Many take the easiest way out and just quit, Filipino nurses being in high demand anyway. Very few would seek counseling. There was a time, according to some of the nurses interviewed, bullying was seen as one of the reasons – together with immigration restrictions — health care had a scarcity in nurses. The retention rate was dismal.
There is no coordinated approach Filipinos nurses react to bullying, especially when the enforcer is a ‘kababayan.’ The FilAm reached out the Philippine Nurses Association of New York for comments but did not receive a reply.
RN Menchu de Luna Sanchez said being friendly has helped her through her early years as a nurse.
“I just did my job, and when I had some food for lunch I’d offer them,” she said. In time, they came to accept her and her amiable ways.
While there remains a large population of Philippine-born nurses who are non-confrontational, that may be changing with the entry of U.S.-born nurses who are more assertive and articulate.
“These are the nurses who are likely to tell doctors, look we are supposed to be partners. You care for the patients, so do we. In fact, we spend more hours with them than you do,” said Duran.
And without any ambiguity, the nurses who would “speak up and fight back,” said Nur. – Rappler.com