Mar. 18, 2015

ER Nurses: Why can't we all just get along?

In the past few years we have seen a trend across the nation where states are passing laws making violence against emergency room nurses and other emergency department workers a felony offense.  It is true.  Emergency medicine is dangerous.  We deal with drug abusers, violent criminals, gangs, and grieving family members who lash out physically and emotionally towards us.  These incidents are unfathomable to those who do not live and breathe emergency medicine.   Health care professionals can literally be divided into two groups in regards to the ER: they either LOVE it or they HATE it.

 

I happen to be one who loves it.  I love the excitement, the adrenaline, and the ability to rise to the occasion during the most stressful of times.  I love the human connection that I make with mothers and fathers and the homeless and the chronically ill.  I love every wretched part of ER medicine except for one: The violence, both physical and emotional, that we project onto each other.  This type of violence is far worse than the violence that has been making headlines.

 

When I was in nursing school two decades ago, I became familiar with the phrase of “nurses eat their young.”  I really didn’t believe it until I became a new graduate in a Level I Trauma Center.  What I found is that this phenomenon truly does exist but not in the way I imagined.  Experienced nurses expect so much from those who are new to the field.  They generally do not coddle.  They generally don’t mince words.  Experienced ER nurses approach new nurses in the same way they approach emergencies.  They are there to get the job done.  They weren’t EATING me, they were teaching me how to thrive in an unforgiving environment.  They treated me like my great grandmother treated her tomato plants.  She always swore that her tomatoes grew so brilliantly because she would go out and literally beat them with a broom.  Her rationale was that they would pollinate better and thrive if you abused them a little.  I was a tomato plant in the ER.  I can honestly say that although at first I did not appreciate this, I grew to understand that by pushing me and not letting me slide, my mentors made me into the nurse I am today.  For this, I am grateful.  For this, my patients are grateful. 

 

ER medicine has become very metric driven.  How many patients can we see in a day?  How many sepsis patients get their treatment in less than a few hours? How many patients get their CT scan in less than 15 minutes?  I support metrics.  Metrics are measurable and produce better patient outcomes.  Metrics allow for the monitoring of professional practice.  Metrics are good.  Unfortunately, it is impossible to apply metrics to an area in ER nursing that needs SEVERE and timely intervention.

 

Over the past decade or so I have witnessed a truer phrase than “nurses eat their young.”  What I have seen is that ER nurses actually eat each other.  (Now don’t start getting defensive…I am not saying that ALL ER nurses are cannibalistic but there are many who are and they are calculated and loud…oh so very loud) Something has gone awry in my profession.  I do not like it.  I do not support it.  I do not participate in it.  Unfortunately, there are many who do.  It happens in emergency departments everywhere and is not limited to large ERs or small ones.  It does not discriminate based on race or gender. It has nothing to do with level or years of experience.  It is not old nurses against new nurses or vice versa.  Gone are the days of professional courtesy.  Gone are the days of interpersonal communication.  I remember a time in nursing when if you offended a fellow employee there would be actual real-time communication regarding the incident.  I remember when patient care errors were discussed and remediated at the time in which they were committed.  I remember a time in nursing where part of professionalism included being upfront and honest.  I remember a more family-style environment where people didn’t always get along but you knew that no matter what they had your back.  I hear stories from my ER friends all over the country regarding the Guerrilla warfare that is now being used to hurt each other, both professionally and personally.  Lists that are kept in secret notebooks, incidents that are discussed in secret meetings in which the accused is not allowed to be present…all of these things being piled against a fellow nurse simply to use against them in HR when the time is right.  These offenses are committed by all levels of ER nurses and are not limited to management teams.  It is a disease that is spreading.  I hear of employees operating with these covert tactics.  Emergency medicine is stressful enough without adding the necessary wound care needed after pulling all of the knives out of the backs of its nurses.  Allowing this type of annihilation to the morale of the people who dedicate their lives to saving the lives of others is a travesty.  It creates a climate of paranoia and distrust. It directly affects retention and job satisfaction.  And whether you believe it or not, it also has a profound impact on PATIENT satisfaction.  Even the concept of the capability of ER nurses doing this to each other is incomprehensible to me.  I thought that nurses were innately programmed to help and support the people around them.  Am I truly that naïve?

 

WHY ARE SO MANY OF US OUT TO GET EACH OTHER?  This lateral violence has got to stop.  There is not room for anything like this in emergency medicine. For those of us who do not support the direction in which ER nursing is going, let’s band together and promote a positive change in our culture. In ERs across the country let’s make a pledge to each other to offer an environment of support and growth; a climate of trust and clarity.  ER nurses, for the most part, are impeccable human beings.  They are meticulous.  They are intelligent.  They are loving.  They are absolutely, without a doubt, the-cream-of-the-crop type of human beings.  They are there to get the job done.  Let’s stop tearing each other down, trying to create reasons to prove incompetence where there is none.  Let’s observe another nurse’s weakness and then support them so that they might improve.  Let’s give grace where it is needed.  Let’s focus on our patients and saving their lives.  Let’s push each other to know more and to BE more.  In the ER we DO have an enemy.  Our enemy is illness and death.  Our enemy is not our fellow employee.  We are a family of nurses around the country and around the world.  Let us begin again to act like one.   Let us say it together, “I am an ER nurse…HEAR ME ROAR!”