While “kids-these-days” gripes are predictable and inescapable in any profession, they are louder in nursing because the workforce skews older. Widening the generational divide, nursing degree programs have changed since older nurses began working. Until the late 1970s, nurses attended school in the hospital setting, where they learned both in classes and in the wards, explained Canadian nurse and author Donna Yates-Adelman. “Today, baccalaureate degree nurses graduate with very little hands-on clinical experience and are left to catch up after they graduate,” she said. “This has created a rift between the new graduates and the working nurses (many who are hospital-trained), who see it as having to help finish the new nurses’ education.”
Indeed, a Florida Atlantic University study revealed that the young nurses most affected by nurses eating their young “were those with university education; they felt they were resented for learning too much theory and not enough practical training.” Canadian researchers found that “older, diploma-prepared nurses expressed resentment for new baccalaureate degree graduate nurses. These older nurses would relax at the desk and watch their new colleagues flounder. Young baccalaureate nurses . . . concealed their educational background to prevent ridicule and resistance.”
The quandary leaves new nurses feeling stuck. To earn respect from their coworkers, they need the experience gained from what amounts to on-the-job training. But some coworkers aren’t necessarily willing to give them that training because they don’t respect the new nurses. When a Kansas nurse’s colleague grumbled, “I hate nursing students,” the nurse said, “I told her, ‘This from someone who was once a nursing student.’ How quickly we forget where we came from.”
Younger nurses say they feel like they can’t win: If they are too timid, coworkers push them to toughen them up; if they are too confident, coworkers try to take them down a notch. “In my ER, new nurses are lumped into the same boat: know-it-alls who know nothing who are trying to steal the thunder of the older nurses around them. Which is hysterical,” said a Texas nurse who has been at her job for less than a year. “These experienced nurses have years of wisdom they could share to help a younger nurse. But when they do, it’s to assert dominance. They hold it over your head: ‘Remember that time I saved your ass?’ And they use it and use it and use it against you.”
No matter the cause, lateral aggression, like doctor–nurse bullying, is a problem that goes beyond hurt feelings. It can be just as psychologically damaging as physical abuse, and the effects can last for years. Nurse victims can suffer from symptoms of depression, anxiety, fear, shame, self-blame, guilt, post-traumatic stress disorder, and eroded self-esteem.
Furthermore, multiple studies have found that bullying can have substantial economic consequences for healthcare institutions. Researchers found that higher rates of workplace bullying are associated with higher rates of nurses quitting or intending to quit. This turnover can cost workplaces between $40,000 and $100,000 per nurse, and the sick days nurses take to cope with or avoid incidents can cost additional hundreds of thousands of dollars.
Nurse bullying also has been proven to increase medical errors and accidents and decrease productivity. Besides the distraction of dealing with the behavior and the effects of the emotional fallout, Griffin observed that “lateral violence stops newly licensed nurses from asking questions, seeking validation of known knowledge, and feeling like they fit in, and stops them from acquiring the tacit knowledge-build necessary in clinical practice.” When nurses are afraid to ask questions, they are less likely to be able to provide safe care.
From sorority to sisterhood
Nurses are a sisterhood, a sisterhood that can be empowering, invigorating, edifying, spirit-raising, the stuff of the “secret club” about which a nurse rhapsodized in the introduction to this book. But this sisterhood (males included) could be so much stronger if nurses weren’t divided by perceived hostilities, misdirected anger, and vast generational rifts.
Beginning in nursing school, nurses learn to be advocates for patients, but not necessarily to be advocates for each other. As new graduates during a time of vulnerability, some nurses are trampled by the same coworkers they need to support them through their transition to practice. Strong mentors can dramatically help both to change this atmosphere and to help new nurses thrive despite it. A New Jersey nurse practitioner who said it’s her “goal to change the attitude of ‘nurses eat their young’ ” advised mentors to “engage in teachable moments, put your ego away, learn something from the mentored, and take pride in the work you do. If you love your work, you will impart that passion to others.”
That impression during a nurse’s formative years can last for an entire career. Several nurses told me that they chose their specialty because of a particularly impassioned instructor or that they have returned to a cherished mentor for guidance repeatedly throughout their careers. More than a decade after working with her, an Arkansas CRNA is still in contact with a mentor who was “like a big sister to me. She taught me to be a patient advocate, to stand up to doctors, and voice my opinion if I felt like something would affect the patient negatively or if I had an idea that might benefit the patient. She also taught me to say no if asked to do something I wasn’t comfortable with. She gave me a confidence in my professional abilities that has allowed me to achieve my ultimate career goal.”
The mentor/mentored relationship can benefit both parties. A Washington State PACU nurse precepted two new graduate nurses who remained at her hospital and now work as her peers. “I love the feeling of supporting them and knowing that I provide a safe space for asking questions and sharing stories. And I got a couple of great friends out of it!” the nurse said.
Nurses representing all generations want to strengthen the sisterhood. “We may be fat, old, and wrinkled, but we pitch in and help each other even when it is not our patient. If the youngsters would just lay low and learn instead of being competitive, then they would flourish,” said an Ohio NICU nurse. “When something cool is going on, I try and snatch a new nurse to share with her. We have had the occasional nurse who is excited about learning but also cautious. She is easy to tuck under your wing and share everything you know with her, [while] often learning from her newer views at the same time.”
Young nurses said they want the same thing. Experienced nurses “are the foundation of hospital care, and their strength and giving nature inspires me to want to learn more and succeed as a nursing student,” said a Massachusetts first-year student. “One nurse I work with has a great skill of being able to explain complex body functions in ways students are able to understand. After becoming a nurse, I hope I can be as influential to students as the nurses are to me.”
When a nursing team is able to build an ideal sisterhood, the result is glorious. A Florida high-risk OB nurse said that the camaraderie among her nursing team is “unparalleled.” At and outside of work, these nurses grew to know and to respect each other. “When we finish our individual nursing assignments, we check on one another to see that everyone has completed their nursing responsibilities and assist them if they haven’t. Working holidays is part of the deal, so we plan dinners to celebrate at work since we can’t celebrate with our families. Our job creates a place of comfort, happiness, support, and sisterly love. I know I could depend on these nurse sisters for anything I may need. It’s just the way it is with nurses.”