Nurse Questions Answered: Toxic Workplaces and Vaccine Tension

'Toxic' Bullying

Nurse: I have 2 years of experience in bedside nursing. I recently started a job on a busy med-surg unit, where the atmosphere is "toxic." Nurses on the unit hang together in cliques and their behavior seems bullying to me. I have difficulty finding help moving patients, plus I desperately need a mentor. The experienced nurses are not helpful. How do I deal with this? Should I resign?

Diane M. Goodman, BSN, MSN-C, APRN

Goodman: Unfortunately, your scenario is common in nursing. Statistics demonstrate that greater than 50% of nurses report bullying by colleagues, with career statistics reported even higher. This situation not only is scary for you, but bullying may lead to unfortunate consequences on the job: poor communication (as you have seen), diminished teamwork, and potentially unsafe situations for patients. Leaving this job is no guarantee that the next position will be better.

Techniques to deal with bullies are varied, but direct communication is a good start. I once asked a fellow nurse "if her bullying attitude was working for her," because it was not working for me. I was also in a new position at the time.

Bullies may define their behavior as assertive. They may not realize how aggressive they appear. If you do not feel comfortable talking to one of your peers (in a quiet location, such as a coffee break) then you need to speak with your direct supervisor. Avoid naming names and be nonconfrontational. Ask for a recommendation about a mentor and start with the person named. Have a few tasks written down that you would like to review with the mentor (auscultating heart sounds, lung sounds; or specific equipment, alarms) and continue from there.

Express gratitude for help. Praise works wonders. In a situation that is "toxic," change needs to develop slowly. You have identified a situation that is unhealthy for both workers and patients; a supervisor needs to know about this. Plus, you need support. Hang in there.

Do Not Disturb the Doc

Nurse: I am a newer nurse working on an orthopedic unit. One of my assigned patients has been readmitted for acute/chronic back pain. She is often a patient on our wing and is challenging for all nurses when the orthopedic surgeon admits her, as we are not able to meet her pain needs. She will utilize the call bell frequently, asking (actually, demanding) analgesics before they are "due."

The surgeon left instructions that we were not to call him to ask for additional medication doses, or to adapt her pain plan once he had written orders.

As a nurse providing care for this patient, what should I do? The patient has insisted that she needs more medication, but the doctor left verbal instructions not to call. Where do my responsibilities/obligations lie?

Goodman: Few issues prove more challenging to the nurse than trying to alleviate patient discomfort. One of the first suggestions I would make is to offer as many nonpharmacologic options as possible to reduce pain. Does she need repositioning? Distraction (music, TV, a family visit)? Would a hot or cold beverage assist in lowering her anxiety and stress? Would she approve a visit from her religious leader (if indicated)? Ask how she decreases pain at home when medication is not helping her discomfort.

If none of these therapies appeal and the patient continues to verbalize severe discomfort, nursing process obligates that you provide care for her discomfort. Sorry, but that would include calling the physician. If this makes you uncomfortable, access a supervisor for assistance. When an orthopedic surgeon admits a patient for pain control, the physician and nurse need to collaborate on what endeavors could control the patient's pain.

If more analgesics are not an option (for safety reasons), a medication for sleep or to decrease anxiety may be helpful.

With the supervisor's assistance, you might be able to compromise with both the doctor and patient, setting limits for how many reassessments/calls the unit may place during the night for refractory pain — for example, every 4 hours. This technique could backfire, so it is best to have reinforcements. Good luck!

Vaccine Divisiveness

Nurse: I am an experienced nurse employed by a small-town rural facility. We do not have a vaccine mandate at our facility, but senior leaders have encouraged vaccination. The subject of vaccination has become a source of continual tension with peers, and the disparate dialogue is beginning to affect teamwork on the unit.

Arguments are occurring daily, with each "side" becoming more vocal and defensive with their opinions. When I am in charge, I have been having an increasingly challenging time getting my team members to focus on the division of work rather than debate pros and cons of COVID vaccines.

Please help me defuse the tension while realigning our goal to deliver great patient care.

Goodman: Unfortunately for nurses working in healthcare, the divisiveness of our country can be reflected in arguments and hotly contested "values" at work. It is hard to leave opinions at home, especially when those ideas spill over into wondering whether an employee mandate is around the corner.

One of the more difficult lessons I learned in my career is that all opinions, no matter how unique, have value. Early on, I wanted peers to be more aligned with me instead of less so — type A instead of B. As I matured in clinical experience, I realized that the type Bs of the workforce are just as necessary as the As. Differing viewpoints make a better recipe for extraordinary teams.

To help defuse this overly tense situation, allow the group to exchange dialogue in a friendly, affirming pattern. You might consider adding the topic of vaccines to a staff meeting, where fears about COVID variants and vaccination could be a topic for discussion by nurses. Have peers establish ground rules for the conversation and enforce them. A meeting off-site (with pizza) might also encourage nurses to listen to opposing views.

Assure that nurses are not debating the topic where patients can hear what nurses are discussing, especially if voices sound tense and/or angry. And if the tension appears to be escalating, human resources is excellent at providing teambuilding tools to nurses.

You have demonstrated superb leadership in recognizing a problem that the unit needs to resolve.

Remain focused. Remember that all opinions represent "truth" to the nurse expressing them.

Stay safe out there!

Diane M. Goodman, BSN, MSN-C, APRN, is a semi-retired nurse practitioner who contributes to COVID-19 task force teams and dismantling vaccine disinformation, as well as publishing in various nursing venues. During decades at the bedside, Goodman worked in both private practice and critical care, carrying up to five nursing certifications simultaneously. She is equally passionate about her dogs and watching movies, enjoying both during time away from professional activities.

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