May. 28, 2015

ER Nurses: The Cycle of Violence

I often say that ER nursing mirrors an abusive relationship. It's a predictable cycle of violence. 
In previous blogs I have mentioned that in my opinion the enemy we as ER nurses face shouldn't be each other. Our enemies are injuries and illnesses. Don't you agree?   I know you do. It is counter-productive to attempt to add each other to our list of enemies...but we do it and for the life of me I cannot figure out why.  I do have a few theories but haven't made a true conclusion to explain the inexcusable passive-aggressive violence that ER nurses  project upon each other. 
 
1. Treating each other badly is a way to control something, ANYTHING, in a chaotic environment. 
2. Tearing others down makes some people feel better about themselves. 
3. Some people have a constant hunger for power and degrading others feeds this hunger. 
4. Keeping the spotlight on someone else means that the spotlight isn't on them. 
5. Some people are just jerks. 
 
I'm sure that there are multiple other explanations for lateral violence in emergency medicine. These are all reasons that there is a constant need to walk on eggshells while at work. Most ER nurses have Type-A personalities. It is excruciating and exhausting for a Type-A personality to continually walk on egg shells.  Type-A people are assertive, sometimes overly so. Type-A people have a tendency to speak their minds and feel that their way of doing things is the absolute BEST way of doing things. Unfortunately, if Type-A people are true to themselves at all times in the ER, they will end up in the supervisor's office on a regular basis. (Hence the walking on egg shells approach.) This creates a bit of a pressure cooker situation. 
 
Sometimes it only takes a few shifts, other times it takes months or even years but it is inevitable...every ER nurse explodes.  It's not pretty and there are usually victims involved. I have seen it time and time again. That sweet nurse that always smiles, is always grateful, always positive...they are a ticking time bomb just waiting to explode. Trust me. That sweet nurse is one tiny incident away from making a complete ass out of themselves. It might be a loud explosion with multiple witnesses, complete with tears, snot, and drool. OR it might be a slow-leaking explosion manifested in poor attitude, decreased participation, and feelings of helplessness. Either way, it happens and then the fall-out begins. 
 
It only takes a moment or two for the ER nurse to think, "Oh shit. Whyyyy did I dooooooo that?!?"
They immediately know that their explosion has instantaneously placed them in the spotlight. They also know that this is not where they want to be. Being in the spotlight means every move you make will be scrutinized. Every patient complaint, any tiny detail that was missed in charting, any possible misunderstanding between you and another staff member...these are all excuses for management to write you up which gives them ammunition to support the fact that they are going to FIRE you. Yep. Fire you. Or worse. Burn you at the stake after shoving bamboo shoots under your fingernails. It's petrifying. There are a few clues you can look for to know whether or not you are on the current hit list:
 
1. Your manager or supervisor won't look you in the eye, uses forced smiles when glancing in your direction, or they just avoid you like the plague. 
2. You hear whispers that your charts are being reviewed. 
3. You are being called into the office for petty reasons. 
 
Trust me. If this is what you are experiencing at work you have hit the part of the cycle where you need to start showing the love through hearts and flowers. Your option of laying low is completely out the window. You must now become involved in a committee, mentor someone, and pick up extra shifts when the department is short. You have got to prove to them that you are still on board and drinking gallons of departmental Kool aid daily.  This leads to walking on egg shells which leads to another explosion which leads to hearts, flowers and remorse which leads to walking on egg shells which leads to another explosion which leads to....you get the picture. 
 
It all seems a bit silly, doesn't it? One big game. I guess my question now is whether or not this is present in other areas of nursing or just in the ER? Either way I would like to see this cycle banished from ERs across the nation. I'm so sick and tired of this work place drama adding to the stack of tasks we must complete every 12 hour shift that we work.   Seriously. STOP THE MADNESS!!!!!! In the words of Michael Jackson, just start with the man in the mirror. Support your fellow staff member. Be honest with those around you. Give excellent patient care and treat your patients like you would want to be treated.  I just can't figure out why we continue to make this job harder than it actually is. Harder than it needs to be.  Let's work together from this point forward the break this cycle of violence. Everyone. Seriously. Staff, management, and administration joining hands to break the cycle. Is that too much to ask?