We are nurses: Stop the bullying in health care

Originally published on KevinMD

The surgeon is doing a tonsillectomy on a 4-year-old boy. Dr. Jones drops an instrument on the floor of the OR. The instrument is now contaminated and has to be sterilized by a special machine called an autoclave. This was a small hospital, so they did not have a large inventory of duplicate surgical instruments. So the circulating nurse put the instrument into the autoclave. As this machine locked in with a special timer, they had to wait for the sterilization process to be completed.

It was 2 minutes, then 3 minutes. The surgeon screamed at the nurse saying it was taking too long. Dr. Jones stood up, having his sterile surgical gown and sterile gloves on, and he picked up the steel stool he was sitting on and threw the stool across the room, and it crashed against the wall, as he screamed obscenities. No one was hurt physically, but it was a verbal and a physical threat. This violent act or gesture was reported to administration. All of the nurses knew the surgeon would get away with it. He would never be reprimanded or put on probation. It all was swept under that proverbial rug. Like nothing happened.


The circulating nurse placed an incorrect instrument onto the surgeon’s sterile table during surgery. The surgeon was so angry, that he picked up his scalpel and threw it at the male circulating nurse. This scalpel, this razor, missed the nurse’s face by 1/2 of an inch. The nurse pressed charges. Eventually, the charges were dropped for insufficient evidence.

The administration did not blink an eye.


Cathy was a timid nurse, but was the kindest nurse you’d ever want to take care of you. She was very busy, as is the case in intensive care units. She was new to this hospital. Her other hospital did not have many patients on ventilators. This night was a heavy assignment. She had many IV drips running. Levophed, vasopressin, Ativan, fentanyl and a Pavulon drip. The patient had to be chemically paralyzed due to his asynchronous breathing with the ventilator. Cathy could have looked up this drug: Pavulon, but she saw three experienced nurses, and so she asked them what were the indications of Pavulon.

First, they ignored her as the three nurses “huddled” together laughing. They didn’t answer her.

So Cathy asked her question again. And outside of her patient’s room, the three nurses started to laugh and talk about her. She heard them say out loud that she was stupid and how ridiculous it was for her to ask that question. That maybe she should take remedial nursing 101.

Cathy stayed in her patient’s room, looked up the info on the computer, as a few tears slowly trickled down her face. She now knew that working in this most strategic, dynamic ICU, that she was on her own. Dangerously on her own.

A month passed, where she was shunned and ignored. She heard the nurses talk about upcoming weddings and baby showers and birthday parties of fellow staff members. She knew she wasn’t invited. They basically treated her like she was invisible.

Cathy felt degraded, isolated, lonely and depressed. She felt that the group of nurses were so negative and aggressive, that she didn’t have a chance to change the lateral violence in that unit.

Cathy transferred out of the ICU hoping she could find a place that was friendly and kind and encouraged teamwork.


Patty was a traveler nurse. And she loved it. She was able to travel to different cities and states and practice her emergency department Nursing specialty.

This ER was gigantic, and everything came through this door. Gun shot wounds, near suicides, heart attacks, any trauma, it was a smorgasbord for all ailments throughout this big city and beyond.
But Patty noticed that this ER lacked teamwork. The nurses basically shunned her and immediately she felt like an outsider instead of being an experienced nurse here to help them out.

She started to receive the worst assignments. The nurse-patient ratio was one nurse to four patients. Patty was given six patients at a time. All of the time.

When she called out for help, no one was there. When she needed help to pull up a 400-pound patient, no one was there. When she needed an RN to witness her mixing a vasopressin drip stat, no one was there. Patty could normally handle any situation, but now she felt overwhelmed.

She overheard a staff nurse say to the charge nurse: “Well she makes all of that money. She can do it herself. Give her the worst.”


So where are the bullies?

They are everywhere. In the nursing workforce, in the OR, in the emergency department, in ICUs, in floor nursing, in nursing homes and assisted living centers.

Who are bullies?

Bullies are older nurses who can be cruel to the younger nurses.
They are managers and directors that turn their backs on the nurses that plead for help.

They are physicians that belittle the nurses and put them down and are condescending to them.

They are younger nurses who feel like they have a special entitlement granted unto them, who have minimal experience but dictate to the older nurses that they are now old and “in the way.”

They are the “know-it-all” nurses who know everything, and everyone else is stupid or “special.” The list goes on and on. The situations and circumstances, unfortunately, are endless. And in the land of nurses being loving, caring. saving lives and being unselfish in all that they do, there is a percentage nationwide, universally that is destroying the core of what good nursing is all about.

What is the make-up of a bully?

Someone who may have low self-esteem, that it subconsciously makes them feel better to tear someone else down.

Someone who has narcissistic tendencies. They consider themselves infallible, above all others, including physicians.

Someone who has lived in a home environment and has learned to mimic negativities such as harassment, shunning, ignoring, and laughing at others.

This behavior affects the entire unit. It reduces morale, and the chain of comradery is broken.

60 to 80 percent of nurses nationwide have reported that at some time in their nursing career, they have been bullied. Many leave that workplace; some nurses leave their profession.

Nurses that are victims become detached; they second-guess their skills; they become depressed and withdrawn.

Who can help?

Besides confronting that person, management would be the next in command. If management is ineffective, human resources would be next. But there is always a fear of retaliation.

Some institutions have zero tolerance. This behavior is not accepted. The EAP (employee assistance program) is recommended for the victim and for the bully. EAP is a counseling service offered by many hospitals to their employees. A probation period may be recommended for the bully.

Hospitals that implemented zero tolerance, have seen a 50 percent change in the climate of the unit, for the better.

If more institutions would implement zero tolerance, we could all get back to caring and practicing what we love. And that is nursing.

Let’s put a flashlight on the bullies. Make this end. Turn your units around, nationwide and get back to empowering each other, educating each other, coming together and learning from each other and helping one another with physical tasks, and emotional tasks. We are only good if we work together. For the sake of the unit, the nurses, the physicians, the technicians and most important: for the sake of the patients. Let’s come together and make nursing the greatest profession nationwide.

Educate, teamwork, empower: That’s what makes a good nursing unit.

On behalf of the majority of positive nurses, managers, physicians, EMTs paramedics and technicians, I salute you all for relentlessly doing some of the hardest tasks a job could have. This medical profession is emotionally and physically challenging. We have to constantly stay updated on medical terminology and protocols. Every day, every minute is a new challenge. Saving lives is not an easy job. All due respect for these medical professionals.

Let’s stamp out bullying forever and go back to what we know and love.

Let’s work together. And come up with some solutions!

Empower, engage, educate, and work together as a team.

We. Are. Nurses.

A miracle in the intensive care unit

Originally published on KevinMD

She fit into the palm of his hand. That long nine months. Waiting desperately for that baby they thought they could never have.

Jeff, football player from his high school days, met the love of his life, Bridget, at the school party. She was smart and beautiful; Jeff was big and burley, but as kind and gentle as a kitten. They hung out through their college days.. And finally said their “I do’s.”

Within a few years, they tried and tried to have a baby. Year after year, MD after MD. And finally, Bridget was pregnant.

Her water ruptured, a little too early, and Jeff drove her frantically to the hospital. Two months too early, little Samatha was born. Fragile and delicate, 3.5 pounds. And they had to rush her to the neonatal ICU. Jeff stared at this small creature they had made together.

As he held her in his hand, her tiny fingers grasped his finger. And they were smitten with each other. This little girl would be his baby princess. He would do anything forever to make this baby Sam happy. She was so tiny, everything was delayed, her speech, her fine motor skills, her walking. But with great love and diligence, Jeff and Bridget finally got to see baby Sam lift herself off the floor and started slowly hobbling over to her mom and dad. Those first steps were a triumph. Baby steps. They were so grateful for those baby steps.

Jeff was a hard worker and a good provider for his family. Almost to perfection. After he received his law degree, he went to work and rarely knew what a weekend was. But they always had a family vacation, and he taught his little princess how to canoe, ride a bike, climb a mountain, go camping, toast marshmallows on an open fire, shoot a basketball and attend those very special father-daughter dances at the elementary school.

Sam was so proud of her dad; she wanted to be just like him. And so off to college she went, to obtain that law degree, just like Dad.

Bridget noticed that her husband would get short of breath after a brisk walk through the neighborhood, sometimes his rosy cheeks turned gray, sometimes he would sweat profusely without any exertion. Jeff would never complain. And he never knew when to quit: He always had an excuse, “I pulled a muscle,” “It’s indigestion, it’s really hot outside.” Jaw pain was maybe the hard candy he had eaten.

So on a hot sunny day, Jeff was cutting the grass, the neighbors saw Jeff fall to the ground as the lawn mower ran down the yard by itself.

A neighbor ran over and looked at Jeff.

He was lifeless, lips were blue, cyanotic, he was barely breathing, slow gasping breaths, his radial pulse was thready. And the neighbor reached out of his pocket, and called 911 on his cell phone. Jeff stopped breathing; his heart stopped. His neighbor started CPR immediately, fast and hard compressions on Jeff’s chest. Hoping that this was just a temporary nightmare.

But Jeff never came to.. And he was rushed by the ambulance to the closest emergency department.

CPR still in progress, a code blue was called overhead.

CPR, shocking with the defibrillator, nurses pushing drugs into his veins to start his heart up again, the MD and respiratory therapists putting a tube down his throat into his lungs for airway, that life-saving endotracheal tube. It was a good team of ER doctors and nurses. They worked well together, especially in a crisis. And after that golden hour in the ER, CPR, shocking, epinephrine, shocking, intubation, vasopressors for the low blood pressure. They finally had Jeff with a cardiac rhythm and a blood pressure, but he never woke up.

The MD stated they would do a “code cool” on this patient. Jeff had had significant heart damage, a major heart attack, and the medical group would perform a procedure whereby this ER and this ICU team would induce hypothermia on Jeff.

Code cool is a treatment that puts the body into a hypothermic state, with pads that cool down the body to 32 to 34 degrees Celsius.

Since Jeff didn’t regain consciousness after his cardiac arrest, there was concern that Jeff had anoxic injury to his brain, easily caused during a cardiac arrest. Jeff, if he survived this, could end up in a vegetative state.
Bridget and Sam, shuffled in the waiting room, came to visit Jeff in the ICU during visiting hours. As they walked through that ICU, they saw patient after patient, lifeless, on ventilators, hooked up, IVs, millions of IV drips, chest tubes, nasal NG tubes, wrist restraints, nurses running in and out of rooms. Never a dull moment in this ICU, the word “quiet” was taboo, because quiet meant that the ICU at any given time, could erupt into pure chaos. Those lifeless bodies could drop their blood pressure down to nothing, or their EKG could go into a chaotic rhythm, or that patient coming out of his opioid overdose, could erupt into violence. Code blue, code gray (violence/attack), code stroke: We had them all.

He lay there lifeless. He didn’t move, didn’t open his eyes. Day after day, the ICU nurses and MDs proficiently kept this hypothermic machine going, preserving the heart, the brain, the kidneys, the liver, the lungs.
After a week of cooling Jeff, then rewarming and then a final 72 hours of being normothermic, the sedation and paralytic drugs were slowly being weaned. Jeff didn’t move for several days. The ICU doctors and nurses worried that there had been significant brain damage. An EEG showed some slowing of his brain waves. Bridget and her daughter almost abandoned all hope.

Sam proudly walked across that stage, law degree in her hand. Her mom smiling ear to ear. Their wonderful daughter, following her dad’s footsteps. Bittersweet, knowing that her dad was dying in an ICU.

Finally, Jeff improved, minute after minute, day after day. One sunny day, he was extubated, breathing on his own. He looked around wondering where he was, this strange place, these people coming in and out of his room. His wife and his little princess held his hand. And they told him how his heart stopped beating, how he stopped breathing, how he turned blue, how they almost had to pick out his coffin.

Sam told her dad, that she met her true love, and she was engaged. The wedding could wait until her daddy got better. Jeff was sent to rehab, and every day, he got better and stronger and more confident to where he finally graduated to his home. His own stomping grounds.

Sam was beautifully dressed in her white gown, a laced veil that covered her face. She could barely see as her eyes were filled with tears. She wrapped her arm around his arm. Her dad. Her hero. And together, Jeff proudly walked his baby princess daughter, down the aisle. One step at a time. Baby steps. They were so grateful for those baby steps.

With the persistence and expertise of the doctors and nurses and respiratory therapists, Jeff beat the odds.


Sometimes they really do happen.

This story is dedicated to the emergency departments, intensive care unit, and coronary care units who give their time and endless expertise in assisting critically ill patients who face high mortality outcomes.