VOICES BEYOND THE BEDSIDE

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  • The Hidden Cost of Caring: How Modern Healthcare Desensitizes Nurses

    When nurses have no time to grieve or recover, what happens to the people who care for everyone else?

    By Lesline Rostick, RN, BSN

    We often call nurses heroes, angels, and the backbone of healthcare. We praise their empathy and resilience. But there is a quieter reality behind that praise: many nurses feel they must set their emotions aside to get through a shift.

    A patient dies. We support the family, complete the care that follows, and prepare the room. Once it is cleaned, another admission may be waiting. The next patient deserves our attention, so we steady ourselves and walk in.

    The grief does not disappear when the room is ready. We may remember the family’s faces on the drive home or find ourselves thinking about the patient days later. Yet there is often no time on the unit to acknowledge the loss before the work moves forward.

    Are nurses becoming desensitized? Or are we learning to hide what we feel because we have so little opportunity to process it?

    What a Nurse Carries

    Patient loss is one part of the strain. Alarms sound, medications are due, call lights ring, documentation needs to be completed, and admissions arrive. When every task feels urgent, it can be difficult to give patients the time and attention we wanted to give them.

    Nurses may also face hostility from patients or visitors, bullying from coworkers, and concerns that leaders leave unanswered. The CDC has identified harassment from patients and coworkers as a working condition associated with symptoms of poor mental health among health workers.

    The shift ends, but our responsibilities do not. Some nurses are raising children alone. Some care for children with special needs or aging parents. Others are managing their own health, relationship difficulties, or financial pressure. A nurse can leave a difficult shift and go straight home to people who need them, with little time to rest before returning to work.

    These pressures build together. During a difficult period in my career, my anxiety began before my shifts. My stomach hurt when I arrived on the unit. I called out more often than I wanted to, and eventually I took a leave of absence to care for my mental health.

    I had worked hard to become an RN. I cared deeply about nursing and my patients. I needed care myself.

    Give Nurses Time to Recover

    Checking on a colleague after a patient death matters. So does having a manager who listens when a nurse says an assignment is unsafe or reports bullying. Hospitals need to provide support after difficult events and address the working conditions that add to nurses’ distress.

    They should also provide paid mental health days as a required benefit for nurses. These days should be separate from time needed for physical illness, available without disciplinary attendance points, and usable without disclosing a diagnosis to coworkers. Hospitals must plan coverage so that taking a mental health day does not leave other nurses with unsafe assignments.

    A day away will not resolve every problem. A nurse returning to bullying or an unsafe workload needs more than permission to rest. Leaders must respond to those concerns directly.

    A U.S. study published in JAMA Psychiatry found that, in 2017–2018, female nurses died by suicide at nearly twice the rate of women in the general population. The study cannot explain any individual death. It does underscore the importance of making it easier for nurses to seek help before a crisis.

    Reclaiming the Heart of Healthcare

    Expecting nurses to remain deeply empathetic without fixing the structural issues that exhaust them is unrealistic. Empathy is a renewable resource, but only if the person giving it is allowed the environment, time, and safety to recharge.

    If we want nurses to keep caring for us, we have to build a healthcare system that cares for them, too. It’s time to dismantle the forces that cause desensitization and bring humanity back to both sides of the hospital bed.

    To my fellow nurses and healthcare professionals: What happens on your unit after a difficult patient loss? Are staff given time and support to process it, or are they expected to move straight to the next admission? Have you ever felt you had to set your feelings aside just to get through a shift? I’d welcome your perspective in the comments.

  • When Bullying Creates a Hostile Work Environment in Nursing

    Rumors, unequal scrutiny, and unanswered concerns can make nurses feel unsafe in the place where they are expected to care for others.

    I worked hard to become a nurse. Earning my RN was one of my proudest accomplishments, and I entered the profession ready to learn and care for people. I never imagined that I would begin to dread walking onto my unit.

    The anxiety did not always wait for my shift to start. Some days, my stomach hurt as I arrived at work. I wondered what I would be accused of, whether my report would be accepted, and who might already have heard a story about me that was not true.

    Nursing is demanding. Patients can deteriorate quickly. Assignments can change. We depend on one another to communicate clearly and respond when someone needs help. When a nurse cannot count on fair treatment from coworkers and leaders, the strain reaches into every part of the shift.

    When a Rumor Becomes the Story

    One morning, I was giving handoff before I had finished all my documentation. I explained that I had the clinical information needed for the report and would complete the charting. The oncoming nurse refused to take the report. Later, I learned that she had told the shift director I had not given it.

    I wrote out the report and left it at the charge station. Before leaving, I returned to photograph what I had written because I wanted a record that I had provided the information. When a coworker asked why, I said that, as a person of color, I felt a need to protect myself. A rumor then circulated that I had called the nurse racist. I had not.

    That rumor stayed with me for months. I felt people watching me, whispering, and drawing conclusions before speaking to me. It was isolating to come to work knowing that my own explanation might carry less weight than something I had never said.

    My handoffs also seemed to receive more scrutiny than those of other nurses. I was aware of how readily new nurses could become targets of criticism, and I was especially troubled by what I observed as unequal treatment of nurses of color. I had already emailed my manager about workplace concerns. When she finally called me to a meeting, the focus was the rumor. I left feeling that the concerns I had raised still had not been addressed.

    I cannot tell another person what they intended. I can say what I experienced: my account was harder to believe, while the rumor was treated as grounds to question me.

    The Harm Does Not Stay at Work

    The longer it continued, the harder it became to walk onto the unit. I called out more often. At times I arrived and felt so anxious and physically unwell that I struggled to stay. Eventually, I took a leave of absence because my mental health was suffering.

    An absence appears on a schedule. It does not show the dread that came before it or how painful it was to wonder whether the career I had dreamed about was the wrong choice for me. I still wanted to be a nurse. I needed a workplace where I could do that work without feeling isolated and constantly on guard.

    My experience is personal, but the effects of bullying on nurses are documented. A 2025 study conducted across three hospitals identified gossip and rumors among the behaviors nurses reported. Participants also described strained working relationships and feelings of powerlessness. Those findings come from a specific group of hospitals and should be understood in that context. They give language to a harm that is easy to dismiss when it happens quietly, between shifts and conversations.

    Speaking Up Must Be Safe

    A hostile work environment can also change how a nurse approaches a clinical concern. As a newer nurse, I sometimes felt that admissions were assigned to me without enough attention to the patients already in my care. On one shift, I was caring for patients with significant needs, including confusion and fall risk. I raised a concern about taking another admission because I did not believe I could do so safely without more support. The shift director became involved, and I was directed to take the admission. A sitter was ultimately provided for one of my patients.

    I am glad that patient received additional support. I also remember the pressure of having to defend why I asked for it.

    In a 2023 survey of 867 hospital nurses in the United States, greater psychological safety was associated with more open communication, higher job satisfaction, lower intention to leave, and more favorable patient safety ratings. Because it was a survey conducted at one point in time, it cannot prove that psychological safety caused those outcomes. It does show why leaders should pay attention to what happens after a nurse asks a question or raises a concern.

    If nurses expect ridicule, unequal scrutiny, or retaliation, speaking up becomes harder. That matters during handoff. It matters when an assignment feels unsafe. It matters when a nurse needs to say, “I need help.”

    What Leadership Allows Becomes Unit Culture

    I heard people explain away a coworker’s conduct by saying, “That’s just how she is.” That answer leaves the next nurse to deal with the same behavior. It also tells everyone watching which concerns are likely to be taken seriously.

    I eventually brought my concerns to HR. I was told that the investigation supported my account and found that my manager had been unresponsive. I had hesitated to pursue it because I feared what might happen if I did. By then, the experience had already affected my health and my trust in the workplace.

    Managers have a responsibility to examine concerns without favoritism. That means looking at patterns: whose handoffs are questioned, whose assignments are reconsidered, who receives an answer after raising a concern, and whose account is believed. When a nurse reports bullying or unequal treatment, a leader’s response can either restore trust or deepen the harm.

    Nurses need to feel safe with the people beside them as well as with the patients in front of them. We cannot expect open communication while allowing rumors to define a colleague, dismissing harmful conduct as a personality trait, or making nurses fear the consequences of asking for help.

    I took leave to care for my health. I remain proud to have become a nurse. Both things are true. What happened should not be accepted as part of learning to survive in this profession. A nursing unit is safer when concerns are heard early, examined fairly, and acted on before a nurse has to leave to recover from the place where they work.

  • 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.