“Yes, but not for long. He’ll be within eyesight of triage. He’s vomiting, so we have to give him Zofran, and then he’ll go to a room as soon as it’s ready.”

Lucy shrugged. “I can’t put an IV in him because he’s not going straight back to a room.” She turned to walk away.

“Lucy, the patient needs your help now! He’ll go back to a room within five minutes, but I have to assist with another patient,” Juliette said.

“No, I can’t do it.”

“You can!” Juliette insisted. “You can put an IV in him because he desperately needs it.”

Lucy ignored her, as if she didn’t understand; she seemed to have selective comprehension of the English language. She did this frequently to Juliette, even though techs were supposed to follow charge nurses’ instructions.

Juliette exploded, upset about Lucy’s treatment of the patient. “Oh, will someone just say it to her in a language she understands?” She regretted the words as she said them.

Gabriel, the secretary, whirled around in his chair and stared at Juliette. Lucy stomped out to triage. Erica, the senior charge nurse, hurried after Lucy to calm her down. “Bad move. That was the wrong thing to say,” Gabriel said.

“I know, I’m sorry. It was so wrong,” Juliette said. “I messed up. Should I go out there now?”

“No, just leave it alone.”

For the rest of the day, Lucy ignored Juliette even more blatantly than usual. “Where’d the patient go?” Juliette asked. “What room is that patient in?” Lucy wouldn’t look at her. If Lucy had a question, she asked another nurse, even though Juliette was charge.

The next day, Juliette went to Priscilla’s office to tell her what happened.

“She’s already been in here and she was crying,” Priscilla said.

“Oh, give me a break,” Juliette sighed. “Lucy was insubordinate before this escalated. Could the three of us please meet?”

“Sure,” Priscilla said. She never arranged the meeting.

Juliette bought an apology card and a box of chocolates from the gift shop. When she tried to apologize, Lucy refused to accept them.

“I don’t need a card,” Lucy said.

“I’m trying to say I’m sorry,” Juliette said, genuinely trying to make amends.

“What you did was wrong.”

“Yes it was. I’m trying to apologize,” Juliette repeated, still conciliatory.

Lucy stood up and walked away. Juliette left the card and the chocolates on her computer.

Weeks later, Juliette shared this scenario during a continuing education workshop. She felt awful about her mistake, but she worried that Lucy’s refusal to interact would affect patient care. “Lucy hasn’t spoken to me since,” she said.

“What Lucy was doing, before the incident and after you apologized, is a form of bullying that is common in nursing today,” the facilitator said. “Ignoring is a form of bullying because you’re blocking that person out. It doesn’t matter if you don’t like somebody. That’s fine. You don’t have to. But you need to be cordial to and communicate with that person at work.”

Juliette felt helpless, but Priscilla wouldn’t do anything about it. Priscilla was too afraid of confrontation to act like a manager and diffuse the situation. In Priscilla’s realm, bullies and slackers went unpunished, and staffers who did go beyond the call of duty weren’t recognized. Priscilla didn’t reprimand Juliette; in fact, she told Juliette that she had been right about the patient and encouraged Juliette to be charge nurse more often.

Shortly after that incident, Erica, the senior charge nurse Juliette genuinely admired, resigned from the ER to take an administrative position at another medical center. “I’m so tired of the bullshit at this hospital,” she told Juliette. Assignments and rule enforcement were too subjective, she said, and the gossipy atmosphere was poisonous.

“You should apply for my job, Juliette,” Erica said. “You do a good job when you’re charge.”

Some of the nurses thought Juliette would apply for Erica’s position, but Juliette didn’t want it. The job was too stressful. Besides, Juliette didn’t care about prestige or hierarchy; she preferred to help patients as a bedside nurse. Rumors spread that Charlene was lobbying for the position to be renamed “head charge nurse” to emphasize that Charlene, as nurse supervisor, had seniority. Juliette had heard that Bethany, a talented nurse relatively new to Pines, was applying. Juliette liked Bethany. If Bethany was sitting at the nurses station and saw another nurse walk by, she would automatically ask, “Do you need help with anything?” Bethany was a thorough nurse, as well. Juliette had passed by patient rooms multiple times and seen Bethany conducting a careful full head-to-toe assessment. Juliette associated Bethany with the clique, but she was upbeat and nice to Juliette.

One day, Juliette checked Facebook while sitting at the nurses station. “Let’s take the kids on the ferry this weekend!” a clique member had posted on several nurses’ walls.

“That clique is so mean,” she muttered.

“Don’t feel badly, Juliette.” Juliette looked up. She hadn’t noticed Bethany sitting nearby.

“When I started working here, I had never, ever seen cliques like the nurses in this ER,” Bethany said. “I was amazed.”

Because Bethany lived in the same neighborhood as the others, and because she was the most beautiful person in the ER, Juliette had assumed that the clique had embraced her.

“Aren’t you in it?” Juliette asked.

“Not at all,” Bethany replied. She had heard other nurses talking about her behind her back. “It feels like no one is on my side,” she said. “I don’t have work friends, so I just go home after work and that’s it.”

Last month, several members of the clique were standing around the nurses station talking about a party. Bethany couldn’t believe they unabashedly discussed the event in front of her. “So,” she said, “are you inviting anyone else?”

“Oh, no,” Anastasia answered. “It’s a thirtysomething party.” Bethany was 29.

“I see it all the time,” Bethany said now. “They’ll make their plans and purposefully discuss them in front of me, while excluding me.”

Juliette felt a rush of camaraderie. “Same with me! I have a seven-year-old daughter and you’d think they’d include me in the kids’ group playdates, but they don’t,” she said. “I can’t believe they exclude you, too.”

Juliette thought about this conversation for days. At least they seemed to like her better than Charlene, who still believed she was a part of the group. One nurse had admitted to Juliette that she was nice to Charlene only so that she would get good evaluations.

Juliette didn’t go out of her way to help Charlene anymore. On a busy day when Charlene was supervising the unit, Juliette deliberately focused on assisting other nurses instead. Charlene’s power-tripping, disrespectful treatment had worn Juliette down to the point of vindictive inaction. “On a day when the ER was crazy, I enjoyed watching her run around and be completely scattered,” Juliette admitted to a friend. “I didn’t triage more ambulances when I could have. There was a patient she could’ve moved out of my zone into the psych pod. That would have given her another bed. She didn’t catch on to it and I didn’t volunteer the advice. It’s not to the point where any patients would suffer; I would never do that. But she has destroyed any sense of loyalty I would have had to anybody else.”

It was common at Pines for nurses to plainly avoid helping coworkers they didn’t like. For example, when an ambulance arrived, usually one nurse would triage and others would help the assigned nurse move the patient to the bed, get him on the heart monitor, take vitals, and start an IV. But if the assigned nurse was disliked or lazy, nobody would help her unless the patient was in danger.

During Juliette’s evaluation, Priscilla told her that on the scale of 1 to 3, Juliette had scored several 2s and a few 3s, averaging about 2.6. “You’re doing an excellent job. I’m very happy with you,” Priscilla said. “You showed a lot of growth over the year, you help out your team members, you’re always available. You anticipate patients’ needs, you talk to the doctors about what’s needed, and you advocate for patients. The only thing is, you have to be on time more often.”