The Nursing Lens

Author: Lesliann

  • What We Teach New Nurses About Speaking Up

    Cliques, favoritism, and bullying can shape a nurse’s first year as much as any clinical lesson.

    When in Doubt, Ask

    By Lesline Rostick, RN, BSN

    She answered my question about an IV line. A few moments later, I overheard her telling another nurse that I had asked it.

    I was a new medical-surgical nurse, just off orientation. I needed help, and she had helped me. But hearing my question become a conversation with someone else stayed with me. I told her I was still learning and would keep asking questions, even if people talked. My priority was keeping my patients safe.

    Years later, I still wonder how many new nurses have a question they need to ask—and hesitate because they fear what will be said after they do.

    New nurses have enough to learn without also having to learn which coworkers are safe to approach. A question might catch a medication concern, clarify an order, or help someone recognize that a patient is getting worse. We should want nurses to ask it.

    I want to be fair here. Nursing is demanding, and none of us gets our tone right every time. A stressful interaction does not automatically mean someone is a bully. New nurses also need honest correction. If something was missed, say so. Explain why it matters and what needs to happen next.

    But there is a difference between helping someone learn and making them afraid to ask again.

    When Belonging Changes How People Are Treated

    Friendships at work are normal. We spend long shifts together, rely on one another, and sometimes become close. The concern is when a group’s friendships start affecting the work.

    Who gets help when the unit is busy? Who receives important information without having to chase it down? Whose assignment concern is considered, and whose is dismissed? Is one nurse’s mistake handled privately while another nurse’s becomes a conversation at the desk?

    These questions matter even when favoritism is hard to prove. A nurse may not know why they are being treated differently. They do know when the rules seem to change depending on who is asking.

    For a new nurse, that can be deeply unsettling. They are still finding their footing. They need to trust that the information they receive is complete, that feedback is fair, and that asking for help will not make them an outsider.

    A review of 41 studies found that workplace incivility was associated with poorer teamwork, less open communication, and lower ratings of patient safety reporting. That does not mean every unkind remark leads to an error. It does remind us that the way we treat one another affects the conversations care depends on.

    Correction Should Leave Someone Better Prepared

    I would rather have a colleague tell me directly that I missed something than let me continue without knowing. That is part of professional respect.

    What helps is being specific: “This information needed to be included in handoff because the next nurse must watch for this change.” Now I understand the concern and what to do differently.

    What does a new nurse learn from sarcasm, public embarrassment, or being told, “You should know this already”? Perhaps they learn to hide uncertainty. That is the last lesson we should want to teach.

    The American Nurses Association distinguishes incivility from bullying, which involves repeated hostile behavior. We do not have to use the same label for every interaction to recognize when something needs to change. If a conversation goes badly, we can address it. If the behavior keeps happening, we need to look at the pattern.

    “When in Doubt, Ask”

    Years ago, during my orientation, an HR guest speaker said something I have never forgotten: “When in doubt, ask.”

    I carried those words with me when I asked about that IV line, and I still believe them. If you are unsure about a medication, an order, or a change in a patient’s condition, ask. I would rather ask again than guess and risk harming a patient. The stakes can include someone’s life and your nursing license.

    This matters especially when a new group of residents rotates onto a unit. They are learning the patients and the unit’s routines while managing many requests and responsibilities. Nurses are managing demanding assignments too. Everyone is human, and mistakes can happen at any point in the process.

    A provider writes an order, but the nurse caring for the patient brings a bedside assessment to that plan. When an order does not fit what you know about the patient, questioning it is part of your responsibility. It is not an accusation that the doctor is careless. It is a chance for the team to check the order together before it reaches the patient.

    I cannot emphasize this enough: if something does not look right, pause and ask. Clarify the concern through the appropriate clinical channels before proceeding. You may be catching a simple misunderstanding—or something with far more serious consequences.

    If you do not feel comfortable approaching one person, find another appropriate resource. Speak with your educator, shift director, an experienced nurse, the ordering provider, or the clinical response team suited to the situation. Keep going until you have the information or help you need. A dismissive response from one person should never be the reason a safety concern goes unanswered.

    I know that is easier to say than to do when you are new and worried about how others see you. But asking for help is part of practicing safely. The people teaching new nurses should make that easier, not harder.

    The Rest of Us Have a Responsibility

    Advice to new nurses can only go so far. We cannot tell someone to “speak up” and then leave them alone to deal with what happens afterward.

    Experienced nurses can answer a question without belittling the person who asked it. We can share information consistently, offer help outside our closest circle, and correct gossip when we hear it. Leaders can make assignment decisions and expectations clearer, take concerns seriously, and follow up after a report instead of treating the conversation as the end of the matter.

    This is a leadership issue as well as a peer issue. In a survey of hospital nurses, a better work environment was associated with less coworker incivility, and nurse manager qualities were an important part of that relationship. Culture is shaped by what leaders address, what they overlook, and whether the same standards apply to everyone.

    I do not expect a unit where every shift is smooth or every conversation is comfortable. I do expect us to remember what our words and actions teach the nurses who come after us.

    A new nurse who asks for help is trying to do the right thing. The way we answer may determine whether they feel able to ask the next time.

  • Before We Call a Patient “Difficult”: Bridging the Patient Communication Gap

    What one conversation taught me about fear, understanding, and the power of being heard.

    By Lesline Rostick, RN, BSN

    “It feels like I’m drowning.”

    That is how a patient with heart failure described his shortness of breath when I asked how he was feeling. During handoff, I had been told he was declining his telemetry monitor and oxygen. He was described as “very difficult.”

    I needed to know he had declined care. But that description reflected someone else’s experience of him, not the whole person. I wanted to understand his perspective before drawing my own conclusions.

    When I entered his room, I introduced myself and listened. He was visibly anxious. I asked what he understood about his reduced ejection fraction. He told me he did not know what it meant.

    I explained in plain language that the heart works like a pump and that his was not pumping as effectively as it should. We talked about how his condition could contribute to his breathlessness and why the care team wanted to monitor his heart rhythm and oxygen needs. I also advocated for help with his anxiety.

    After our conversation, he agreed to wear the monitor and keep his oxygen on.

    I cannot say that one explanation was the only reason he changed his mind. What I do know is that listening revealed concerns I would not have understood from the label “difficult.”

    Handoff Is a Starting Point

    Handoff tells us what happened and what needs our attention. It cannot tell us everything a patient is feeling or understands. When a patient declines care, we need to assess the risks, but we should also ask questions without assuming the answer.

    Was the equipment uncomfortable? Was the patient afraid? Did he understand its purpose? Was there another concern we had not heard? In this case, I learned that he was anxious, struggling to breathe, and unsure what his diagnosis meant.

    The handoff was right to tell me he had declined care. But the word “difficult” did not tell me that he felt like he was drowning or that he did not understand what a low ejection fraction meant.

    A label can travel from shift to shift. If we are not careful, it can shape how we approach someone before they have had the chance to speak for themselves. We may see the refusal and miss the fear behind it.

    An unbiased approach does not mean dismissing a colleague’s report. It means taking the information seriously while allowing the patient to tell us their side.

    Understanding Is Part of Care

    Medical language can create a gap between what clinicians explain and what patients take away. Terms such as ejection fraction and telemetry are familiar to us, but they may be unfamiliar to someone who is sick and frightened. An explanation given is not always an explanation understood.

    A patient may hear the words without knowing what they mean for the symptoms they feel or the care we are asking them to accept. They may be too overwhelmed to ask a question. If we ask only, “Do you understand?” it can be easy for someone to say yes while still feeling lost.

    We can begin with, “What have you been told about your condition?” Then we can explain one idea at a time, connect it to the patient’s concerns, and invite them to tell us what they understand in their own words. If our explanation has not been clear, we can try another way.

    Doctors and nurses share responsibility for that work. We can also advocate when breathlessness, pain, fear, or anxiety makes it harder for someone to take in information and participate in care.

    Health literacy is not a judgment about a patient’s intelligence. It asks whether we have communicated in a way that helps the patient understand what is happening and make informed choices. Education is not simply a way to obtain agreement. It is part of respecting the person receiving care.

    Listening and education will not resolve every refusal or prevent every escalation. But they can reveal something a report alone cannot give us: the patient’s point of view.

    Let Handoff Inform Your Care

    Let your own assessment shape how you approach the patient. Listen without judgment and ask what may be behind a refusal before deciding what it means. A patient’s choices may involve fear, discomfort, confusion, or a need they have not yet been able to express.

    When we give patients the chance to tell us their experience, we gain information that a report alone cannot provide. We may not always change the outcome, but we can make sure the person receiving care is heard, understood, and treated with dignity.