"You don't want to be a nurse in that unit" my instructor said to me during one of my clinical rotations, "those nurses eat their young." "Eat their young?" I thought. "What the hell does that mean?" It was a phrase I had never heard before, yet I knew instinctively what she was talking about.
I walked into a room during one practicum shift and saw a middle-aged woman in tears. She was hunched over and weeping. "What's wrong?" I asked. I had assumed the worst: burst stitches, back spasms or a spill on the hospital floor. She sniffed and turned to me, "That nurse was so mean to me." She wasn't in any physical pain, she was crumbling from spitting words and harsh treatment.
Mean nurses aren't just mean to patients, as I had myself experienced, they were also mean to other nurses, managers, students and seemingly everyone in their vicinity. They slapped on gauze, rolled their eyes and back talked. They were overly critical. In fact, some nurses were so consistently harsh it seemed to me that they must be unsatisfied with their lives, their work and everything else in the universe. Nurse Ratched from One Flew Over the Cuckoo's Nest isn't just a character in a movie; she is a real live entity -- and she works on every unit.
How does this happen? I can vouch that, for the most part, nursing students are compassionate. The concept of caring is so rigorously stressed in the classroom it almost warrants a class in itself. In fact, it is in almost every class. No other health profession explicitly identifies caring as a mandate for its practice. Apparently we don't care if your doctor, pharmacist, physiotherapist, psychiatrist, radiologist or dentist is uncaring. Nope. Nurses must be understanding, compassionate and, darn it, very, very nice.
Yet once the student nurse hits the hospital floor, learning is swift and steady. You learn who to trust and who to avoid in a heartbeat. But this still didn't explain how some nurses came to "eat their young." I asked people what their theories were and was told "some nurses are just bitches."
What is most unsettling about the "bitch theory" is that it seems to apply to women more often than not, given that nursing is a profession made up largely of women. In fact, other professions similarly dominated by women also had a reputation for having mean female bosses. In accounting, where I used to work, I often heard employees, both men and women alike, stating that they would prefer to work for a man, again citing the meanness as a reason.
The feminist in me couldn't stop at that as an answer either, so I went where all good scholars go to find the holy grail of answers: Google. The answer came in a book by Kathleen Bartholomew, clearly titled Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other.
The answer came in a simple and eloquent two-word phrase: horizontal hostility. It turns out back-stabbing, fault-finding and criticism aren't nursing interventions. It's a real problem. One explanation that Bartholomew presents is the oppression theory -- the notion that subordinate group often act out at each other instead of at the higher powers.
It makes sense. Women, as an oppressed goup, face some unique challenges -- especially those that go into nursing. We tend to be perfectionists, we want to never make mistakes and we tend to be Type A personalities. The challenges of the field end up stressing us out, making us feel overworked, undervalued and burned out. No wonder 60 per cent of nurses quit in the first five years of practice. We are also oppressed by a system that puts doctors in a superior group. We tip-toe around physicians, we say "sorry" for calling them and we get comfortably miserable at the bottom of the totem pole. We downplay our own importance in the system, despite the fact that nurses statistically and empirically increase the health outcomes of patients.
In the current health care aura, times are tough for nurses. I shadowed one particular nurse who had seven patients during her shift. Between giving medications, doing assessments, taking vital signs and hanging bags of fluids, it is a wonder she never checked herself in. On another shift, I approached a resident with a concern for a patient and he didn't even turn to acknowledge me. I talked at him, but he didn't even blink in my direction. I was dumbstruck and eventually walked away.
How can we expect nurses to take care of patients when they are in a hostile environment? Tip-toeing around certain people does not create warmth and openness. Add to the mix heavier patient loads, quick turnovers and the continued expecation of high productivity and horizontal hostility is understood much more clearly. The Alberta government promised that the recent nursing cuts, hiring freeze, and closing of 350 beds would not lead to a decrease in patient care. But how could it not? By further stressing an already stressed system, it seems inevitable.
I am not saying that it is excusable, or that individual nurses shouldn't be held accountable. Let's face it, some nurses are abusive. But calling nurses "bitches" does nothing to end the problem. The first step in ending it is understanding why it happens. Before we simply chalk it up to mean, emotionally unstable nurses, let's be honest about where it all stems from. Only then can we stop nurses from eating their young.