For the 18th year in a row, Americans have rated the honesty and ethics of nurses highest among a list of professions that Gallup asks U.S. adults to assess annually.
In 2019 nursing once again topped the poll, with nurses ranking
19% ahead of engineers and 20% ahead of doctors. The results—85% of responses display
regard for nurses’ honesty and ethical standards as “very high” or “high”—show that
over four out of five Americans still regard nursing as the most trustworthy
among the major professions.
Compared to other professions, the trust ranking for nurses is
now 31% above police officers, 45% above clergy, and 57% above journalists in
this year’s poll. Among the other professions included in the poll, there is finally
some good news for members of Congress—who from last year’s 8% trust rating have
leapt ahead to 12%. As a result, congressional representatives have been nudged
out of last place for 2019 by car salespeople, who are now trusted by only 9%
of Americans polled. For more details, visit
the Gallup site.
As a resolution for the new year, prepare to take a stand against bullying. Sadly, new nurses are often lost to the profession for the most disturbing of reasons: workplace bullying. Even the greenest nursing student soon hears the phrase, “nurses eat their young,” which was first used by nursing professor Judith Meissner in 1986. As Katherine Colduvell, RN, BSN, BA, CBC notes on Nurse.org, “[the saying] refers to the bullying and harassment of new nurses, and those four simple words can cause a great deal of anxiety for new graduates. In fact, researchers propose that at least 85% of nurses have been bullied at some point in their nursing career.”
Why Nursing is a Fertile Ground for Bullying
Even before entering the workplace, nurses face bullying as students. After they enter the profession, new nurses have to confront the stresses involved in dealing with patients, being slighted by doctors, exhausting shifts, and even the miseries of sore feet. However, instead of banding together and enjoying a network of support from more experienced nurses, they often find themselves belittled, whispered about, harshly blamed even when not at fault, and subjected to openly abusive language.
Why is bullying so common among nurses? One frequently cited reason is based in oppression theory. In this theory, nurses are oppressed by their lack of empowerment within the healthcare system. Subject to being treated as inferiors by doctors, management, and even some patients, nurses often feel powerless against their oppressors and are likelier to take out their sense of oppression on members of their own group. Bystanders, meanwhile, are afraid to speak out for fear that they, too, will become the objects of bullying. In addition, nurses may have already encountered bullying in school from faculty and classmates who view one another as competitors rather than as colleagues.
Riding the Bullying Cycle
In Fast Facts on Combating Nurse Bullying, Incivility,
and Workplace Violence, author Maggie Ciocco, MS, RN, BC shows that
oppression leads to a vicious cycle, and “Not only are student nurses victims
of bullying, but they themselves become bullies as well. This impact must be
addressed, because they are our future in the health care system, and the lives
of patients depend on the student nurse becoming a just and moral citizen.”
According to Renee Thompson, RN, who frequently speaks and writes on nurse bullying, patient care suffers as a result of the bullying cycle: “If I withhold information from you and it causes you to make a mistake with a patient, or if I yell at you or criticize you in front of a patient, it’s potentially harmful to patient care,” she said. “When you’re being treated in a way that is making you feel badly, it stops the flow of information. When we’re not freely communicating with members of the healthcare team, it ultimately affects outcomes.”
Protecting Yourself from Bullying
The question is, how can a nurse avoid being drawn into a bullying situation in the first place?
An ounce of prevention: research healthcare organizations before you apply (after all, nurses are in demand; an organization is applying for your acceptance as much as you are for theirs). Do they have strong official policies governing bullying in the workplace? A caring, respectful culture? What do other nurses say about the environment there?
Bear yourself with confidence. Bullies tend to pick on easy
targets. If you have faith in yourself and take pride in your work, you will
make a much less attractive object to those seeking vulnerabilities.
Be more than just a bystander. Even if you are not the object of bullying, being around it can affect the way you feel about yourself and your work. Being a bystander—simply witnessing acts of bullying—can create feelings of guilt, depression, disillusionment, and even trauma. Calmly stand up for the dignity of other nurses who are being maltreated. You will like yourself a lot better than you would if you instead pretended to ignore the bullying or merely stood in silence. Have a sense of humor, be positive, and try not to allow your emotions to rule your response. Like a grounded self-confidence, these are traits that can prevent you from becoming a target and can contribute to your ability to defend others who are being harassed.
Counteracting a Bullying Situation
As Maggie Ciocco advises, if you do find yourself or a co-worker on the wrong end of a bully, don’t fly off the handle. Your best options are to direct collegiality and pro-social responses to the behavior you are encountering:
Ignore the behavior—If the behavior is
completely out of character for the person, you could just ask him or her a
friendly question unrelated to what he or she just said. Polite, respectful
conversation disarms a co-worker who has given way to stress and temper as much
as it does a bona fide bully.
Be calm, confident and in-control when contradicting
a bully (you don’t want to get dragged into a fight). Without being overly
defensive, simply express disagreement—such as saying “That’s not the way it
happened”—and introduce your side of the story.
You can also use what Ciocco describes as “therapeutic communication for bullies”:
Speak to how you will address the situation or help him or her to deal with the situation. “I’m going to ____. Is that okay with you?” or “Would you rather that I ______?”
If what you are saying is ignored, repeat what you will do to assist the bully, indicating that the bully needs to choose how the assistance will take place.
If the bully does not respond appropriately, this conversation at least puts him/her on notice that you will not tolerate being bullied. End the conversation by saying something like “why don’t we talk about this at/after such and such, when we have more time”—and leave the area.
Utilize Calm and Self-Respect to Gain a Position of Control
suggests, “A good trick for enhancing your effectiveness is to choose the time
and place for your confrontation with the bully. When you are attacked, calmly
ask to meet with him later to discuss the matter. That will give you time to
think through your response.” In the National Student Nurses’ Association’s study
Nurse to Nurse Horizontal Violence, Recognizing it and preventing it, J.E.
Hurley notes that “Five nurses in one study who spoke out against horizontal
violence reported positive outcomes from ‘standing up for myself’”
In the end, it is likely that one of the most important qualities that should govern your actions is respect. Showing respect for yourself and your colleagues can help you to avoid bullies, to counteract bullying against yourself and others, and help prevent you from becoming a bully yourself.
Fast Facts on Combatting Nurse Bullying, Incivility and Workplace Violence
This pocket-sized, quick-access guide gives nurses crucial information they need to know to understand, identify, and effectively counter incivility, bullying, and violence in all nursing settings.
Awarded Second Place in the 2017 AJN Book of the Year Awards, Professional Issues category!
Did you get
a good night’s rest? Nurses, like many other health care providers, frequently
work shifts that lead to sleepiness and fatigue. In fact, 55% of nurses work
more than 40 hours a week, and one in five nurses works at more than one job.
This can have effects that you need to take seriously when you consider your
sleeping habits and sleep hygiene.
Going Without Rest: A Risky Business
from NASA and the U.S. military has established that there is a significant
impairment in cognitive function following 15 to 17 hours of sustained
wakefulness. Here are some examples of the impairment you risk due to lack of
After 24 hours of uninterrupted
wakefulness, your impairment is comparable to that of someone who has had 2-3
When you’ve been awake for 17 hours, your
cognitive and psychomotor performance becomes roughly equal to that of someone who
has consumed 1-2 alcoholic drinks. Staying awake for 24 hours creates a
condition comparable to having a blood alcohol level of roughly .10 percent,
which is over the legal limit for driving in all 50 states.
Individuals who work night shifts are
six times more likely to be involved in a sleep-related auto crash, and can be
prone to “drowsy driving,” which is every bit as dangerous as driving while
Nurses who work rotating shifts,
according to one study, are nearly two times more likely to make medication
errors than nurses who primarily work day shifts.
While there is still limited research into the effects of sleep deprivation on nursing errors, there has been a substantial body of work that studies the effects on rest-deprived people in other occupations, such as police officers, pilots, and air traffic controllers, and the findings are alarming. There certainly are parallels, and as NurseChoice.com remarks, “Experts note that lack of sleep in nurses is dangerous for patients and the RNs themselves.”
always change your work schedule to accommodate your rest schedule, so what can
you do? For starters, the American Nurses Association wants to dislodge such
thinking. The risk to both nurses and patients is serious enough that ANA has
position on the issue of nurses and proper rest: “both registered nurses
and employers have an ethical responsibility to carefully consider the need for
adequate rest and sleep when deciding whether to offer or accept work
assignments, including on-call, voluntary, or mandatory overtime.”
To ensure that you are getting the most restful sleep possible, the Centers for Disease Control and the National Sleep Foundation offer some basics. Check their recommendations to make sure you are not overlooking the obvious:
Go to bed at the same time each night
and rise at the same time each morning.
Make sure your bedroom is a quiet,
dark, and relaxing environment, which is neither too hot nor too cold.
Make sure your bed is comfortable and
use it only for sleeping and not for other activities, such as reading,
watching TV, or listening to music.
Remove all TV’s, computers, and other
‘gadgets’ from the bedroom.
Avoid large meals before bedtime.
Clean Sheets and Lavender: Other Ways to Get a Good Night’s (or Morning’s) Rest
hygiene can also help—for example, make sure you are sleeping on fresh, clean
sheets. In a National
Sleep Foundation (NSF) Bedroom Poll, some three-quarters of respondents
said they get a more comfortable night’s sleep on clean sheets with fresh
scent. The NSF suggests that you “wash sheets and pillow-cases at least once
weekly, so they always smell fresh,” and regularly wash your pillows. And, while
morning showers are more energizing, if you are a night-time shower person,
timing is everything. Showering too close to bedtime can make it difficult to
fall asleep, but if you shower no sooner than 90 minutes before going to bed,
it can help you fall asleep an average of 10 minutes earlier than usual.
The NSF adds that “lavender has been shown to decrease heart rate and blood pressure, potentially putting you in a more relaxed state. In one study, researchers monitored the brain waves of subjects at night and found that those who sniffed lavender before bed had more deep sleep and felt more vigorous in the morning.”
For nurses, therapeutic inhaled essential oils (TIEO) provide a welcome solution; there is no need to get a doctor’s order, administer a pill, insert an IV or monitor for drug interactions. Because it is a designated nursing intervention and not a drug, essential oil inhalers can be stocked as a regular supply item that doesn’t need to be dispensed from the pharmacy. In addition, patients can administer it themselves whenever needed, decreasing the amount of time nurses are required at the bedside. TIEO has an outstanding safety profile that allows its use with patients of any age or medical condition. In fact, multiple studies have shown that therapeutic inhaled essential oils not only improve patient outcomes, they also significantly increase patients’ satisfaction with their care.
Born in an Operating Room…
New wellness brands are rarely conceived within a busy operating room. Soothing Scents was officially launched in 2004, but really started a few years before, when a nurse anesthetist from Maine was trying to figure out a way to lessen the discomfort of post-op nausea experienced by her hospital patients. That nurse anesthetist was Wendy Nichols (BSN, APRN, CRNA), founder of Soothing Scents Inc. DailyNurse had questions for Wendy about Soothing Scents’ flagship product, QueaseEASE, and how she developed it within her cottage industry, whether essential oils are gaining acceptance in hospitals, and the safety of essential oils.
DailyNurse: What causes nausea in the operating room?
WN: Nausea is a pretty big
problem in anesthesia. So many things cause it in the perioperative
environment, and it’s our job—along with the nursing staff—to relieve it. An
age-old technique for nausea is inhaling the vapor of isopropyl alcohol.
Unfortunately, patients have negative associations with the smell.
One night while using the alcohol vapor with a nauseated c-section patient, I had a sudden thought about essential oils. I knew they contained high amounts of natural alcohols, and obviously smelled significantly better than alcohol prep pads, so I figured they may be a more effective option.
DN: So that gave you the idea to create an alternative to the alcohol pads?
WN: So that night I went home to get a product that I was sure someone had, but couldn’t find anything. There were essential oil companies that bottled oils, and there were studies on the efficacy of essential oils in reducing nausea, but no one had combined the two, and no one had provided a delivery method that would pass the safety test of the medical sector. So, it became an obsession, something I researched extensively for months, after which I felt bold enough to start blending.
DN: How did you go about finding the right delivery and storage system?
WN: The original homemade
QueaseEASE was made in round tins I bought from Amazon. I fashioned a round
screen over a cotton pad that held the oil blend, separating the user from
contacting the oils even in the early prototype days.
To make the product suitable for use in a healthcare environment, we did the following:
Spent many months sourcing the purest, highest grade essential oils that provided gas chromatography and mass spectroscopy testing (GC/MS) to verify the constituent levels.
Worked with container material specialists to design inhalers that were made from appropriate materials to prevent the essential oil vapor from diffusing through the walls of the container.
Designed a variety of single-use containers that were leak-proof, provided low ambient aroma for the users’ immediate vicinity only, and prevented the user’s skin and eyes from contacting the essential oil at any time.
Had the blends/inhalers tested by a microbiology lab to see if they supported any microbial growth; bacterial, fungal or viral. (They don’t). The hospital I worked at gave me the green light to use [QueaseEASE and other blends] with my patients.
After a few weeks, I couldn’t keep enough of the inhalers in the hospital, they had become so popular. So I asked my entrepreneur brother for advice, and he immediately got the product, and what I was trying to do. So, we met up in Idaho and agreed to start this little business together, and how we were going to go about it. And that’s how it all started.
DN: What’s been the response of the medical sector? Are they receptive to the idea of essential oil therapy?
WN: Surprisingly, the general
attitude has been overwhelmingly positive. In fact, the most prevalent question
we get is how quickly we can get it to the nurses.
Most nurses are familiar with positive attributes of essential oils for wellbeing, and that vapor inhalation is the safest and fastest route for the healthcare environment. But I have been surprised (and gratified) to see how easily and quickly QueaseEASE gained traction in venerable institutions like the Mayo Clinic. In fact, they were one of the earliest adopters of our product.
DN: You seem to feel a mission to educate people in the field of essential oil therapy…
WN: Essential oil therapy for the
healthcare environment requires competency, just like any other patient
intervention. For instance, nurses and other healthcare providers rely on
evidence-based practice standards to ensure their patients’ safety. A key mission
of ours is to promote and support studies and referenced educational material
for hospital-based essential oil use, which we have proudly done since our
Our latest initiative, in
collaboration with the American Nurses Credentialing Center (ANCC), is a certified nurse competency course that provides up to date
research and evidence-based practices for using therapeutic inhaled essential
oils (TIEO) for nausea and anxiety in the healthcare environment. We are
extremely proud of it and feel incredibly fortunate to be able to offer it free
to our nursing colleagues.
At the ANCC Magnet conference in Orlando, I heard time and again, how important this course has been in ensuring acceptance of essential oil therapy use in hospitals.
DN: Are there any contraindications for using QueaseEASE and the other therapeutic inhaled essential oils? For instance, should patients with allergies exercise caution?
WN: The composition of essential
oils, namely their lack of protein molecules, means there is very little chance
they could cause a true allergic reaction. It is not impossible, however. The
few allergic reactions that have been reported have almost all been
skin-related. People that have a true allergy to any of the essential oils in
Soothing Scents products should either exercise caution or refrain from using
For more details on Soothing
Scents and therapeutic inhaled essential oils, visit the Soothing Scents website. To sign up for
the Soothing Scents ANCC-accredited TIEO online training course, which is free
for all RNs, visit here.
Healthcare—a recruiting organization engaged in hospital staffing services and
workforce solutions—has released its biennial RN Survey of 19,967 nurses from
locations around the country. While the outlook is not overwhelmingly negative,
the findings depict a challenging road ahead for the healthcare industry.
Hard Times Ahead, but Educational Goals Remain Vital
to the challenges nurses face, hard times lie ahead. In addition to the
well-known shortage of labor, nurses are being stretched to the limit by overlong
working hours. Further, many are working two jobs, and a slew (80%) of Baby
Boomer generation RNs—who comprise the majority of all working nurses—plan to
retire within the next five years.
However, nurses—especially younger ones—are in accord with the Institute of Medicine declaration that they “should receive higher levels of education and training.” While not quite meeting IOM’s call for doubling the number of nurses receiving Master of Science degrees by 2020, nurses are still very much invested in their further education.
For instance, 18% are currently enrolled in a higher education program. Most of that group is comprised of Millennials and Generation Xers, at 25% and 21% respectively. However, the number of nurses planning to embark upon a higher education program within the next three years has been steadily decreasing. This may be owing to the increasing number of hours the average nurse is working, and the growing number who have taken on second jobs.
Who’s Enrolled; Who’s Planning to Enroll
Unsurprisingly, Millennials are still at the forefront of those planning to enroll around 2022, with 34% saying they plan to pursue higher education within three years, joined by 22% of Gen X nurses. With Baby Boomer nurses preparing for retirement, the number of them making educational plans is understandably low.
The types of
educational programs nurses take can vary. 46% of nurses currently enrolled are
aiming at a master’s degree, while 33% of enrollees are working towards their
Baccalaureate. Millennials are showing the greatest movement toward advanced
practice and higher degrees, making up 46% of those enrolled in a master’s
degree program, and 47% of those working toward a doctorate. Still, young nurses
are very keen on professional development: 20% of all nurses say they intend to
become advanced practitioners, and the majority of that number, 39%, again consists