Christina Purpora, PhD, RN, is an assistant professor at the University of San Francisco School of Nursing and Health Professions. She has 30 years of hospital nursing experience.
by Steve Robbins/Flickr Creative Commons
I wonder whether any of my nurse colleagues can recall having said or done something less than kind to a peer at work. Looking back over 30 years of nursing, I am aware of times that I could have been kinder. Not too long ago, the way that Emily—a less experienced nurse who was new to our unit—conducted herself in response to my reaction to her request for help taught me that I ought to consider a better way to act.
Request for Help
I was walking out of a patient’s room when Emily greeted me by name, then said, “Ms. S has one of the new IV pumps and the alarm keeps going off. I can’t figure out what’s wrong. Can you please help me?”
I felt annoyed at her for making one more demand on my time when I could barely keep up with my current assignment. Rolling my eyes, I curtly replied, “Emily, I think you can handle it. You had the in-service like everybody else.”
Seemingly unrattled by my terse retort, Emily stood her ground. “Yes,” she told me, “I used the troubleshooting tips I learned. But there’s still a problem. I’m concerned about Ms. S. and I’m uncomfortable that I’ve missed something. I think this is a safety issue.”
I recognized Emily’s use of the Agency for Healthcare Research and Quality TeamSTEPPS “CUS” words: Concern, Uncomfortable, and Safety, a tool designed to clearly communicate that a patient is at risk for harm when a first attempt to get a safety threat across to a member of the health care team doesn’t work.
The initial irritation I’d felt turned to embarrassment, and I answered Emily’s explanation with, “Okay, let’s go see Ms. S.” I followed Emily to her patient’s room where, together, we figured out the problem. Ms. S. was unharmed. Outside of the patient’s room, Emily thanked me and asked what she could do for me in exchange for the time I’d spent helping her. When nothing came to mind, she reiterated, “Please let me know if something comes up, because I’d happy to help you.”
My embarrassment grew in the presence of Emily’s team approach. With the potential safety threat averted, we carried on with our respective patient care responsibilities.
Reflect and Amend
For the rest of the shift, I couldn’t stop thinking about my outburst, which stood in glaring contrast to Emily’s professionalism. When I realized that a patient could have been harmed while I was resisting my peer’s call for help, I was horrified. I wanted to apologize to Emily.
At shift’s end, I found Emily in our locker room getting ready to leave. I asked her whether she’d be willing to walk and talk with me on our way out to the garage. She agreed. As we walked, I said, “Emily, I’m sorry for snapping at you when you asked for help. I feel ashamed about the way I acted. I was wrong to treat you like that.”
She answered frankly. “When you rolled your eyes and snapped at me, I was taken aback. But I decided to stay focused on my patient’s safety rather than call you out. I planned to talk with you later about how what you did and said affected me. I was working on what to say to you, so I’m glad we’re having this talk.”
In response, I told her that I was glad too, and that she’d done a phenomenal job advocating for the safety of Ms. S. Then I added: “You were professional when I wasn’t. I get stressed sometimes, but that’s not an excuse for acting the way I did. From now on, I’m going to manage my stress better so that I don’t snap at you or anyone else.”
As we parted ways, Emily smiled and said, “Okay, Christina, I’m going to hold you to that!”
A Better Way
On my way home, I thought about how I might respond in a better way to a peer’s request for help when I feel stressed. I put together several ideas and decided to collectively call them my “Check My Conduct Plan.” In situations such as the one between Emily and me, I’ll use my plan to:
- (1) pause
- (2) recognize my stress level
- (3) take a deep breath
- (4) proceed with kindness
- (5) recognize and acknowledge my peer’s request for help
- (6) determine whether I can help, based on the immediate needs of the patients in my care (if I can’t go with my peer to help, I’ll tell my peer why and refer him or her to alternate resources. If able, I’ll help)
- (7) be open to ask for and accept help in return
I remembered that Emily asked whether she could help me with anything that morning. I realized that she already had. She challenged me to think about my misconduct, which led to my making a plan to keep my conduct in check when stressed. Emily said she’d hold me to a better way to act. My sense is, she will.
However, that’s not her responsibility. It’s mine. I’m committed to being kind and helpful to my peers and working together with them to keep our patients safe.
Super. Simple…to the point…doable, usable. Thanks you…This is ho bullying stops. drlg
Great article, I’m definitely going to use this. You’ve hit the key problems that lead to unprofessional behavior: stress, time pressure, patient safety issues and education on how to better deal with all of the above.
We also have to start holding the ones who create and allow the stress, time and safety pressures to get out of hand accountable.
I represent nurses who are put in situations of no remedy. Nurses are being tracked on cameras and GPS locators, timed to the last cc of a piggyback medication, grossly understaffed, and disciplined for trying to get their patients what they need in the time they need it, while maintaining complete control and professionalism.
Despite the IOM and ANA endorsement of non-punitive responses to errors involving system problems, nurses continue to be disciplined for being human and making errors in complex systems. Just getting through the shift without a manager criticizing or God-forbid a patient or family complaint, is a major milestone.
Nurses definitely need the tools to deal with stress, but nursing as patient advocates for safety and quality care cannot survive the way hospital nursing is trending.
The ideal would be the educating everyone about author’s conduct plan, with a daily debrief of how many times the plan needed to be used and the stressors that caused the need for the plan. The debrief could be then used to identify and decrease the occurrence of those situations.