One morning, Wendy, an older part-time nurse, came sauntering through the ER, flashing a large diamond ring. “I’m engaged!” she told an ER volunteer. “Guess what? I got engaged!” she announced to the secretaries. She navigated the department throughout the day, telling everyone except for Juliette. She kept walking by her, pretending Juliette wasn’t there.

Wendy hadn’t spoken to Juliette for about a year now, ever since a disagreement over a patient. A woman had come into the ER with a dislocated ankle. When Dr. Hughes, a resident who picked up ER shifts only occasionally, went into the patient’s room, Juliette was across the ER, in the bathroom. At the sound of a bloodcurdling scream, Juliette raced to her patient’s room to find that the resident had pulled her ankle into place without offering any pain medication.

Juliette gasped and rushed to the patient’s side.

“It’s okay,” the doctor said to Juliette as he turned to leave the room.

“He just relocated the ankle,” another nurse said.

“Without pain meds?” Juliette said. She turned to the patient, who was incontinent because of the agony. “I am so sorry he did that to you without any pain medication.”

“What are we giving her?” Juliette called out to the doctor.

“Dilaudid.”

Juliette rushed to the medication dispenser, pulled the medication from the machine, then ran back to the patient.

“Thank you,” the patient whispered, and reached for Juliette’s hand. Juliette sat with her for a few minutes, then changed the patient’s gown.

As the patient settled in to rest, Juliette took the other nurse aside. “Why wasn’t she medicated?” she asked.

“We asked for pain meds and the doctor said it was fine, she didn’t need it.”

“Juliette, hallway please,” the doctor said from outside the room.

“We had the pain meds to give her,” Juliette told him.

“I had to do it right away,” Dr. Hughes said. “There wasn’t time.”

“No, we could have medicated her,” Juliette said.

The doctor shook his head. “Next time that happens, you need to call me out of the room and tell me you have a problem with what I’m doing.”

“Fine, but I believe what you did was wrong,” Juliette said.

From the nurses station desk, Wendy, openmouthed, watched the conversation like a Ping-Pong match. “I can’t believe you said that to the patient and were disrespectful to Dr. Hughes!”

“My first responsibility is to the patient, Wendy, not the doctor,” Juliette said. “The patient deserves care.”

At 65, Wendy was a nurse from a time when nurses stood up to give their seats to the doctors. “The doctor deserves respect and you shouldn’t speak to him that way,” Wendy scolded.

“Doctors aren’t God,” Juliette told her. “They need to be called out when they’re wrong.”

Wendy hadn’t spoken to her since. Meanwhile, Dr. Hughes and Juliette, who had a good professional relationship, easily resumed working together with no problems at all.

•   •   •

Juliette was eating lunch with Molly on their day off when Molly mentioned that she had seen Bethany at a nursing conference. “She said something that you’re not going to like,” Molly added. Juliette looked at her, puzzled.

“This is going to hurt your feelings,” Molly said. “This is going to upset you. But I have to tell you.”

“Okay,” Juliette said. She figured she had angered somebody at work. It wouldn’t be the first time.

Molly paused. “Well, Bethany said that in her interview for senior charge nurse, Priscilla told her, ‘I heard the only reason you were applying for the job was so Juliette wouldn’t get it.’”

“But I didn’t even apply!” Juliette said.

“I know. Bethany said you two were friends and she never thought that, much less said that,” Molly said. “But then Priscilla said, ‘Between you and me, I would never hire Juliette for senior charge nurse.’ ”

Juliette sat back hard in her chair. “Wow” was all she could say. Her eyes welled. She hadn’t applied for the job because she had no interest in it. She liked being charge nurse on occasion, and coworkers had told her she was great at it, but she didn’t want a full-time supervisory job. Her heart was bedside, with the patients, doing the job she loved.

Molly continued, “I wanted you to know what she said because Priscilla is not the same person to your face as she is behind your back. I know that you’ve trusted her and that you’ve been confiding in her. I thought you should know what she is saying to your colleagues about you because I’m worried she’ll tell people about your private stuff, too.”

Juliette was dumbfounded. She had believed that Priscilla liked and respected her. Priscilla had never written Juliette up, never called her into her office, never told her she was performing poorly at any aspect of her job; rather, she had frequently encouraged Juliette to be charge nurse. How was Juliette supposed to become a better nurse if her supervisor wouldn’t tell her what she was doing right or wrong? “Why would she do that to me? If Priscilla really felt that way, why wouldn’t she have told me during my evaluation? Why would she tell someone else?” Juliette wondered. “Priscilla was totally unprofessional, and it makes me angry and upset. The number of times I have been in Priscilla’s office and shared various confidences, felt that she was on my side, believed in me, thought I was a good nurse. To find out she said this to another employee is hurtful and a betrayal. And I didn’t even want the job! All I wanted was clin 4. She’s gossiping and trying to create fights. It’s staff-splitting. It’s wrong, it’s damaging, and I can’t possibly respect her after this.”

Priscilla’s slight was not only a personal betrayal from the one person left at Pines who Juliette had considered a confidante, but also a reflection of a toxic environment where cliques, gossip, and vendettas affected both staff morale and patient care. Good nurses were underappreciated and Juliette was a good nurse. “Priscilla is an ineffectual manager on so many levels. Her duplicity is too glaring to ignore, and Charlene’s poor managerial skills combine to make a miserable work environment. The emotional drain isn’t worth it anymore,” Juliette said.

During her next shift at Pines, Juliette found Bethany in the med room looking for supplies. “Bethany,” Juliette said, “I heard from Molly that Priscilla told you she would never give me the senior charge nurse job.”

“She did!” said Bethany, looking relieved. “I told Molly because I knew she’d tell you and I didn’t feel comfortable telling you that directly. Priscilla said she wanted to make sure I knew she’d never give you the job. But you didn’t even apply!”

“I’m just astonished she would say something like that,” Juliette said, disappointed that the gossip was true.

“It’s so completely unprofessional,” Bethany said, shaking her head. “What are you going to do?”

“I don’t know. I’ve been done with this place for so long anyway.” Juliette thanked Bethany and went on with her workday.

That evening, Juliette called Erica, the senior charge nurse who had resigned in November. She explained what had happened. “Can you believe she said that?” Juliette asked.

“I can absolutely believe she said that,” Erica replied. “I heard things that she said about me in that office. There’s an endless cesspool of information flowing from that back office to the ER. She fosters a sorority girl atmosphere with the gossip and the backstabbing, which is why I couldn’t wait to leave.”

“If I go agency, would you write me a letter so that I can update my recommendations?” Juliette asked.

“Of course I will.”

The next day, Juliette came to a decision. Molly had been trying to persuade her for months that she would be happier if she went back to the agency they had worked for previously. It was finally time to give up on Pines. Like many talented nurses continually defeated by poor working conditions, Juliette quit.