Any nurse who’s been around for more than a minute has heard the intimidating phrase, nurses eat their young. It’s hard to imagine how this phrase could become so popular within a profession that’s known for being caring and selfless. Yet, many nurses both new and experienced report a significant lack of support and even bullying in their places of employment. This toxicity is often referred to as lateral violence, meaning aggressive behaviors happening internally between colleagues. These behaviors may be seen nurse to nurse or between nurses and supervisors. There may be several explanations as to what is behind lateral violence in nursing. What is most important is knowing what you can do if you are personally affected by workplace violence.
Nurse as Wounded Healer
In a study done in the Online Journal of Issues in Nursing, researchers applied the Theory of the Nurse as Wounded Healer to lateral violence in nursing. The theory, developed by Marion Conti O’Hare, states that individuals are drawn to specific professions, such as nursing, by a desire to relieve individual suffering after experiencing or witnessing traumatic events in their own lives. When the individual’s coping with trauma is effective, the pain is transformed into healing. When coping is ineffective and remains unresolved, that individual functions as a “walking wounded” and experiences problems in their social and work relationships. Applied to lateral violence in nursing, these wounds may be caused by work-related stressors such as witnessing or experiencing lateral violence in the workplace. If this is a regular and unresolved occurrence, soon the nursing staff may become inundated with the walking wounded. According to O’Hare, in order to effectively resolve this trauma, the nurse must first recognize and examine the trauma and transform the pain into a manageable state. The final step, transcendence, allows for insight and learning from past trauma that can be used to help others with individual pain and suffering. Only then, can the nurse become a wounded healer.
High Stress Work
An article in Nursing Times reported stress and burnout levels among nursing staff in the UK were higher than members serving in the armed forces. A survey sent to participants in UK’s health care system revealed nurses scored 1.5 times higher in stress levels than the average for soldiers after war zone trauma and twice as high as individuals working in emergency services. It was thought that nurses had higher stress scores because their line of work did not have the same degree of stress recognition as other stressful occupations, therefore the support for nurses to process their emotional reactions to their work was considered an abnormal response. What this translated to among participants in the study was low morale and high burnout rates in the workplace.
An Oppressed Group
A study in the Journal of Clinical Nursing suggested nurses working in hospital settings are an oppressed group, influenced by medical hierarchies in which nurses lack power and control. This can lead to a high level of vulnerability among nurses to workplace aggression as well as a pervasive individual level of negative self-concept. Oppressed group behaviors may occur when the powerless are fearful and silent when encountering authority, resulting in anger and aggression toward members of one’s own group. Low levels of social support can exacerbate this internal emotional abuse, leading to further low self-esteem and social isolation.
What You Can Do
Calling out workplace violence when it occurs is important in order to help resolve inappropriate and potentially harmful behaviors. Having an honest discussion with a colleague about aggressive behavior can help bring awareness to the issue while also communicating that this type of behavior will not be tolerated at work. It can be a little trickier when unprofessional behavior is coming from a nurse manager or someone you may report to on a daily basis. Some nurses may feel comfortable addressing the issue directly with their manager. If this seems intimidating, there are other ways to go about resolving a conflict such as reporting the behavior to your manager’s supervisor or finding out about your institution’s policies for reporting workplace violence. Everyone should be held accountable for unprofessional behavior, especially when that behavior causes others emotional distress. Addressing workplace violence is the first step to helping create a healthy environment for working nurses.
In light of Florence Nightingale’s recent 200th birthday, it’s hard not to wonder—how would our founder of modern nursing be responding to the Coronavirus pandemic? Known as the “Lady With The Lamp,” Nightingale was noted for wandering the wards of the hospital at night carrying a lamp, providing support to soldiers during the Crimean War. Advocating for basic standards of care, Nightingale believed in the importance of good hygiene and adequate nutrition but also helped improve the emotional health of soldiers by writing letters home for them. It’s easy to imagine her at the bedsides of dying COVID-19 patients, charged with the painful work of helping family members say goodbye to their loved ones over FaceTime. A natural problem-solver, we can venture to guess that Nightingale would be a leader in transforming today’s trends in how to manage the well-being of American citizens and guiding our decisions on economic closures. Nightingale faced many odds during her lifetime, but ultimately became known as a social reformer, statistician, and founder of what we know of as modern nursing today.
“God spoke to me and called me to His service. What form this service was to take, the voice did not say.”
Nightingale’s parents initially disproved of her decision to become a nurse, expecting her to marry and raise a family at a young age. In fact, she had many marriage proposals but refused them all. Nightingale had other plans and, as a teenager, believed she received a calling from God to help the poor and the sick. Nursing was not a respected profession during her time and when Nightingale arrived at the British camp during the Crimean War, doctors did not initially welcome her. However, under her leadership, Nightingale’s group of nurses transformed the conditions of the hospital and brought the death rate down from 40 to 2 percent. Like many nurses today who are rapidly becoming infected with COVID-19 from working conditions, Nightingale fell ill shortly after arriving to Crimea with brucellosis, otherwise known as “Crimean fever.” With no active treatment for the disease, Nightingale suffered its persisting effects for almost 25 years, which frequently confined her to bed due to chronic pain.
After returning home from the war, Nightingale knew there needed to be health reform for the British Army. Having kept meticulous notes on the causes of illness and death during her time at Barrack Hospital, a commission was established based on Nightingale’s statistical findings to reform military medical systems. Nightingale had a knack for analyzing data and with the help of Dr. William Farr developed the first pie charts, calling them coxcombes. These charts helped illustrate her statistical findings in an accessible way and in 1860, Nightingale became the first woman elected Fellow to the Statistical Society. As a token of gratitude for her war efforts, a fund was set up that Nightingale used to institute the Nightingale Training School in London, which opened in 1860. The school offered a formal nursing education and made nursing a respectable option for women who desired work outside of the home. Although ill and bedridden for much of her later life, Nightingale wrote almost 200 books, pamphlets, and reports over the course of her career on hospital, sanitation, and statistics and provided advice on health care issues to colleagues across the globe.
“I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results.”
Florence Nightingale was a pioneer of nursing, leadership, and education and someone who certainly would not sit around and wait for things to blow over without taking action herself. In today’s times, one can easily imagine her as anyone from the charge nurse of an intensive care unit to an ANA president consulting with the White House team. One thing we know for certain is Nightingale would first and foremost be a patient advocate. She would not stand for a shortage of ventilators or medication for patients. If we learn nothing else from Florence Nightingale, we must remember that it is not enough just to care for our patients. We must be their voice when they cannot be heard and use actions to bring results.
Nurses have the opportunity to take on new and advanced roles through certifications and degree programs. For nurses working in maternal/child health, a lactation consultant is one such role to pursue. A lactation consultant, formerly titled IBCLC (International Board Certified Lactation Consultant), is a health care professional who may work in a variety of health care settings and specializes in the clinical management of breastfeeding. IBCLCs have been proven to improve breastfeeding rates, lower health costs, and improve consumer satisfaction and trust.
Many nurses and the general public may not know exactly what a lactation consultant does on a daily basis. Daily Nurse interviewed Robin Franzoni, a lactation consultant at a teaching hospital in central New Jersey. Robin worked as a NICU nurse for many years before she became an IBCLC. Here is what she had to say.
What first sparked your interest in becoming a lactation consultant?
When were you first exposed to an IBCLC?
My passion reaches back to when I was a new mom and getting ready to nurse my first child. My mother nor my aunt ever breastfed. I was one of the first one of my friends to have any children. My exposure to breast milk and pumping while working in the NICU was what really spurred my own decision to breastfeed. There were no lactation consultants at that time, but I saw how much better the babies did on their own mothers’s milk. I had horrible pregnancies and preterm labor with all three of my kids but I felt like the one thing I was successful at was nursing my own kids. So my success at breastfeeding and exposure in the NICU is what kind of gave me the interest.
What would you say your typical
day is like? What are your day-to-day responsibilities?
I see my discharge patients first and make sure they’re going home with all their questions answered and information for follow up after discharge, especially the ones who have had some difficulty latching or feeding or are losing too much weight. Then I see all the first time moms and assess the latch and get them motivated to start positioning the baby themselves. A large part of it is preparing them for what’s expected at home because they have such a short time in the hospital. Then after I’ve gotten through most of the first time moms, I see any other mothers having difficulty or who have asked for a consultation. But really my first priority is seeing, stabilizing, and supporting the first time mother.
What’s your favorite part of
I think being the person who has gotten a baby on for the first time or seeing a baby who’s been struggling and all of a sudden it clicks and they start eating. And the look of mom’s wonder on her face like, “Oh my gosh, it’s kind of happening.” I’ve been to hundreds of deliveries over my career and it used to be so exciting to watch a baby being born and they take that first breath. Seeing that baby eating for the first time is just as thrilling as watching the baby being born. It’s the culmination of many different things that are finally in perfect sequence and everything clicks and to me it’s really wonderful. It’s establishing that connection with the baby by nursing that is not only for the nutrition but the connection with the baby.
What’s the most challenging part
of what you do?
It’s the preconceptions people have that negatively impacts nursing. It’s unrealistic expectations and misinformation the mother has received from family members or friends. It can be like trying to knock down a barrier that’s been erected around themselves. But I think it’s mostly the lack of good education about breastfeeding.
How do you work together with
nurses when giving care to a patient?
Well, I feel that I’ve been really fortunate. I developed this routine that after I’ve seen the mother and the baby I usually go to the bedside nurse. And I think it’s just evolved into what I do because I’m counting on the bedside nurse to carry the ball after I’ve left. The reality is I’m probably only going to see that patient once on day 1 postpartum and at discharge. So the rest of it falls onto the bedside nurse. Teamwork gets it done. I want every nurse to feel that she is part of the breastfeeding support and that I’m depending on them and trusting them.
Do you have any advice for
nurses who may want to become an IBCLC?
I think they need some really good mother/baby or NICU experience first. I think you need a base and then after building that base then think about doing it. It’s something I really think you have to have a passion for because it’s one of the toughest things I’ve done to date. I thought it would be less stressful than the NICU, but it’s just a different kind of stress. You’re shouldering not only the baby and assisting them, but you’re also responsible for the emotional well-being of the mother and part of the physical well-being.
If you are interested in learning
more about the professional role of a lactation consultant you can visit www.uslca.org or www.ilca.org.
Information about obtaining certification can be found at www.iblce.org.
investment in knowledge pays the best interest.”
Benjamin Franklin had the right idea when he talked about using the knowledge you’ve earned and putting it to good use. As nurses, we have a desire for continual learning, especially with the ever-changing new practices and research in the health care profession. If you’re new to nursing and have been working for only a year or two, you may be wondering, “What path should I be taking?” or “How can I broaden my knowledge and skills?”
There are many ways you can develop your career as a new nurse with opportunities that are often within your area of employment.
1. Obtain a certification.
For as many different nursing specialties that exist, there are virtually as many certifications for each and every one of them. Many hospitals offer additional compensation for nurses who are “board-certified,” meaning you are recognized by a specialty association of nursing as an expert in that specific area of nursing. There are other specific roles within your field of nursing that you may choose to be certified in such as becoming a Certified Diabetes Educator or a Certified Childbirth Educator.
2. Join a committee.
Many hospitals have committees for nurses called Shared Governance. Shared Governance is a group of nurses working together to implement best practices on a hospital unit. These practices can range from work-related issues such as scheduling to practice-related issues such as updating a policy on the best way to monitor patients’ blood sugar. These unit-based councils may also collaborate with other hospital units within a specific department to address how to best work together and keep patients safe.
3. Find a nurse-residency program.
This is particularly for brand new nurses who are looking for their first job after nursing school. Many teaching hospitals offer a residency program for nurses to participate in for one year after the beginning of their employment. These programs meet monthly and are a way for new nurses to discuss struggles they may be having or learning issues they might be facing. Often there is a research project nurse residents complete specific to their area of practice. These programs are a great way to meet other new nurses and can often help ease the transition from being in school into working in nursing practice.
4. Participate in continuing education.
Many states require a certain number of CEU or continuing education unit hours to re-register as a licensed nurse. There are many local and national conferences nurses can go to for the latest topics in the nursing profession and within different specialty areas. Most hospitals, upon employment, allot nurses with a certain number of education hours they may use at their discretion and may reimburse for class or conference costs.
5. Go back to school.
Making the choice to go back to school is a huge decision. While some nurses may already know, specifically, what area they want to focus on during their time in nursing school, others may need a few working years under their belt to get a feel for different kinds of nursing practice. Masters programs range from specializing as a nurse practitioner or nurse educator to forensic nursing or public health. Getting an advanced degree may broaden your career options and opportunities. Many nurses continue to work full-time while getting their degree with the great advantage of tuition reimbursement from their employer.
Advancing your existing nursing knowledge is a great way to become an expert in your nursing specialty or to explore other paths in nursing you may want to take. It’s well known that nursing is one of the most trusted professions and patients appreciate the knowledge and skills you bring to their care. Take the time to find out what career opportunities exist within your place of employment and in your community.