VOICES BEYOND THE BEDSIDE

Tag: nursing

  • When Encouraging Patient Independence Leads to a Formal Complaint: Who Supports the Nurse?

    When Encouraging Patient Independence Leads to a Formal Complaint: Who Supports the Nurse?

    VOICES BEYOND THE BEDSIDE · NURSING PERSPECTIVES

    Patient advocacy · Functional independence · Nursing leadership

    Patient-centered care does not mean doing everything a patient requests. Sometimes, the most compassionate nursing intervention is helping patients maintain the independence they still have.

    As nurses, our instinct is to help. We respond to call lights, assist with personal care, provide comfort, and support patients through some of their most vulnerable moments.

    But there is an important distinction between helping a patient who cannot perform a task and automatically performing a task for someone who may still be capable of doing it independently.

    This distinction can become complicated when patients expect assistance with activities they previously performed on their own. Encouraging independence may sometimes be misunderstood as unwillingness to help, leading to frustration, dissatisfaction, or even formal complaints.

    It raises an important question: How do we balance compassion, patient expectations, and our professional responsibility to preserve functional independence?

    When Hospitalization Changes More Than a Patient’s Health

    Throughout my nursing career, I have witnessed patients enter the hospital who were previously independent with their activities of daily living (ADLs), only to experience significant functional decline during their hospitalization.

    Some patients arrive walking independently, feeding themselves, dressing, and managing their personal hygiene. As their hospital stay progresses, they may become increasingly reliant on nursing staff for activities they previously performed without assistance.

    I have seen patients who were living independently before admission become so physically deconditioned that returning directly home was no longer considered safe. Instead, they required discharge to short-term rehabilitation facilities to regain strength, mobility, and the ability to perform basic daily activities.

    This is one of the realities of bedside nursing that deserves greater attention.

    Hospital-associated deconditioning is not simply a matter of patients becoming accustomed to receiving assistance. Acute illness, prolonged bed rest, reduced mobility, pain, fatigue, medication effects, and other medical factors can contribute to a decline in physical function.

    For some patients, even a relatively short hospitalization can result in a meaningful loss of strength and independence.

    Not every decline is preventable. However, preserving mobility and encouraging appropriate participation in daily activities should be part of the recovery process from the beginning of hospitalization.

    Are we doing enough to help patients maintain their independence while treating the conditions that brought them to the hospital?

    Our goal should not be to make patients dependent on our care, but to help them recover enough independence that they no longer need it.

    Helping Versus Creating Unnecessary Dependence

    Nursing care involves much more than completing tasks.

    It involves assessing patients, recognizing changes in their condition, identifying what they can safely accomplish, and supporting them in maintaining or regaining their functional abilities.

    Consider everyday activities such as holding a cup, feeding oneself, washing one’s face, repositioning in bed, or participating in personal hygiene.

    For patients who are physically and cognitively capable, encouraging participation in these activities can help preserve confidence, coordination, and functional ability.

    Of course, a patient’s previous independence does not guarantee that they remain capable of performing the same activities during an acute illness.

    A patient may be experiencing weakness, pain, dizziness, anxiety, confusion, or another limitation that is not immediately obvious.

    This is why assessment must always come before assumptions.

    Rather than simply refusing a request or automatically completing the task, nurses can explore what the patient needs and determine the appropriate level of assistance.

    Sometimes that means providing full assistance. Other times, it means offering support, supervision, encouragement, or adaptive strategies that allow the patient to participate safely.

    The goal is not to make patients feel that they must prove their independence.

    The goal is to preserve their abilities without compromising safety, comfort, or dignity.

    Compassion is not measured by how many tasks we perform for patients, but by how thoughtfully we respond to their individual needs.

    The Hidden Consequences of Functional Decline

    When patients lose the ability to perform basic activities during hospitalization, the consequences can extend far beyond the hospital room.

    A patient who previously lived independently may now require assistance with bathing, dressing, toileting, transfers, or walking.

    Families may suddenly face difficult decisions about whether their loved one can safely return home.

    Discharge plans may change. Additional rehabilitation services, mobility equipment, or caregiver support may become necessary.

    For some patients, a hospitalization that was expected to end with a return home instead results in a transfer to a short-term rehabilitation facility.

    As bedside nurses, we see these transitions firsthand.

    We witness the frustration of patients who struggle to regain their strength and the disappointment of those who discover that they can no longer perform activities that once seemed effortless.

    This is why maintaining functional independence should not be treated as an afterthought.

    Early mobilization when medically appropriate, collaboration with physical and occupational therapy, individualized care planning, and encouraging participation in daily activities can all contribute to better functional outcomes.

    Nursing assistants are especially important partners in this effort because they spend considerable time helping patients with everyday activities and often recognize subtle changes in functional ability.

    Preserving independence requires teamwork, adequate staffing, appropriate resources, and consistent communication.

    It cannot rest on encouragement alone.

    When Encouraging Independence Is Perceived as Refusing Care

    Despite the clinical importance of promoting independence, these interactions can sometimes create tension between patients and healthcare professionals.

    A patient may interpret encouragement to perform a task independently as a refusal to provide assistance.

    From the patient’s perspective, hospitalization is a time of vulnerability. They may feel frightened, exhausted, uncomfortable, or uncertain about what they can safely do.

    From the nurse’s perspective, encouraging participation in care may be an intentional intervention to maintain function and prevent unnecessary decline.

    Neither perspective should automatically be dismissed.

    Communication becomes essential.

    Explaining why participation matters can help patients understand that the intention is not to deny assistance but to support recovery.

    For example, a nurse might say:

    I want to help you maintain as much of your independence as possible while you’re here. Let’s see what you feel comfortable doing, and I’ll help you with anything you cannot safely manage.”
    This approach promotes partnership rather than confrontation.

    However, even thoughtful communication does not guarantee that every patient will be satisfied.

    And this is where another challenge emerges.

    When Patient Satisfaction Conflicts With Clinical Judgment

    Healthcare organizations place considerable emphasis on patient satisfaction and experience.

    Rightfully so. Patients deserve dignity, respect, timely assistance, and compassionate communication.

    But patient satisfaction and clinically appropriate care are not always the same thing.

    A patient may be dissatisfied when a nurse reinforces fall precautions, encourages safe mobility, explains a treatment limitation, or promotes participation in activities of daily living.

    These interventions may be clinically appropriate even when they do not align with a patient’s immediate preferences.

    This does not mean patients should be ignored or that every nursing decision is automatically correct.

    It means patient dissatisfaction must be evaluated within the full context of care.

    A complaint can identify a genuine care concern, a communication breakdown, an unmet need, or a difference between patient expectations and clinical recommendations.

    Determining which occurred requires an objective review.

    When complaints are evaluated without considering clinical circumstances, there is a risk that nurses may feel pressured to prioritize avoiding dissatisfaction over exercising professional judgment.

    That is a troubling possibility for a profession built on patient advocacy, clinical reasoning, and safety.

    The Emotional Impact of Patient Complaints on Nurses

    Nurses and nursing assistants work in environments where their decisions, communication, and actions are constantly observed and evaluated.

    A patient complaint can be emotionally difficult, particularly when staff believe they acted in the patient’s best interest.

    Questions naturally arise.

    Will leadership listen to the staff’s perspective? Will the clinical reasoning behind the intervention be considered? Will the complaint affect the employee’s professional reputation?

    Healthcare professionals should always be accountable for their actions.

    However, accountability must be grounded in fairness.

    A patient’s right to report concerns is essential, but filing a complaint should not automatically establish that misconduct or neglect occurred.

    Similarly, a nurse’s belief that an intervention was appropriate does not eliminate the need for review.

    Both perspectives matter.

    Organizations that encourage professional judgment must also create environments where staff feel safe explaining and defending their clinical decisions without fear of automatic blame.

    What Nursing Leadership Should Consider

    When patient complaints involve assistance with daily activities, mobility, or independence, leadership should look beyond the immediate expression of dissatisfaction.

    A thorough review should consider whether the patient’s current abilities were appropriately assessed, whether assistance was offered according to clinical needs, whether safety precautions were followed, and how the interaction was communicated.

    The patient’s concerns should be explored respectfully, and staff should have an opportunity to provide their account.

    Documentation, care plans, therapy recommendations, and changes in the patient’s clinical condition may all be relevant.

    Leadership should also consider whether staffing limitations, inconsistent care approaches, or unclear expectations contributed to the interaction.

    A complaint may reveal an opportunity for education, improved communication, or better coordination among team members.

    But it should not automatically become a disciplinary matter simply because a patient was dissatisfied.

    Supporting nurses does not mean dismissing patients. It means ensuring that fairness, clinical evidence, and professional accountability guide the review process.

    Strong leadership protects patients’ rights while respecting the professional judgment of the healthcare team.

    “A patient complaint deserves investigation. It should not automatically become a verdict against the nurse.”

    Are We Measuring Satisfaction or Supporting Recovery?

    Patient experience is an important measure of healthcare quality, but it does not tell the entire story.

    A patient may be satisfied because every request was accommodated, yet still experience preventable functional decline.

    Another patient may initially feel frustrated by encouragement to participate in mobility or self-care, yet benefit from interventions that support recovery.

    Neither satisfaction nor dissatisfaction alone establishes the quality of nursing care.

    Meaningful evaluation must consider patient safety, functional outcomes, communication, individual preferences, and the clinical circumstances surrounding care.

    We should also recognize that nurses cannot independently prevent hospital-associated deconditioning without organizational support.

    When nurses manage high-acuity assignments, inadequate staffing, and competing clinical priorities, opportunities to assist patients with mobility and self-care may be limited.

    It is often faster to complete a task for a patient than to provide the time, supervision, and encouragement necessary for that patient to participate.

    But efficiency and recovery are not always the same thing.

    If healthcare organizations want to preserve patient independence, they must provide the staffing, rehabilitation resources, equipment, and interdisciplinary support necessary to do so.

    Promoting independence should be an organizational priority, not simply another expectation placed on already overextended bedside nurses.

    Final Reflection: Compassion Should Promote Independence, Not Replace It

    After years at the bedside, one lesson continues to stand out to me: helping patients recover requires more than treating their immediate medical conditions.

    It also means recognizing the importance of the abilities they had before hospitalization and doing what we reasonably can to help them preserve those abilities.

    I have seen how quickly independence can be lost and how difficult it can be to regain.

    I have also seen the value of encouragement, patience, appropriate assistance, and teamwork in helping patients participate in their recovery.

    We must never assume that a patient is unwilling to perform a task simply because they request help. Their physical condition, emotional state, and individual needs deserve careful consideration.

    But we should also recognize that routinely performing tasks patients can safely accomplish themselves may unintentionally reduce opportunities to maintain function.

    The answer is not to withhold assistance.

    It is to provide the right level of assistance, at the right time, for the right clinical reasons.

    And when that approach results in dissatisfaction or a complaint, nurses deserve leadership that considers the complete clinical picture.

    Patient-centered care is not about doing everything for patients. It is about doing what is best for patients, with their safety, dignity, preferences, and long-term independence at the center of every decision.

    Sometimes that means stepping in.

    Sometimes it means standing beside a patient and encouraging them to try.

    And sometimes, the greatest measure of our care is not what we did for a patient, but what we helped that patient regain the ability to do for themselves.

    Let’s Continue the Conversation

    As healthcare professionals, how do we balance encouraging patient independence with meeting patient expectations?

    Have you witnessed patients lose functional independence during hospitalization and subsequently require short-term rehabilitation?

    And when clinically appropriate nursing interventions lead to patient dissatisfaction, how can leadership better support both patients and staff?

    I would love to hear your experiences and perspectives.

    Voices Beyond the Bedside

    Where Nursing Experience Meets Honest Conversation.

  • When the Survey Becomes the Scorecard: What Press Ganey Can—and Cannot—Tell Us About Nursing Care

    A patient can receive excellent nursing care and still leave the hospital dissatisfied.

    A nurse may have prevented a fall by refusing to allow an unsafe, unassisted walk. An ordered medication may have been delayed because a patient next door was deteriorating. A call light may have gone unanswered for several minutes because the nurse was managing an emergency. A patient may have wanted something that was clinically unsafe or simply outside the nurse’s control.

    Then comes the survey.

    Did the nurses respond quickly?
    Did staff listen carefully?
    Would you recommend this hospital?

    Patient experience matters deeply. We should listen when patients tell us they felt ignored, disrespected, uninformed, or unheard. Their experiences can expose real problems in healthcare.

    But there is another question worth asking:

    What exactly are we measuring when we measure patient satisfaction?

    The Architecture of the Score

    To understand the tension between clinical reality and patient feedback, we must first understand how patient-experience scores are collected and used.

    The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized national survey overseen by the Centers for Medicare & Medicaid Services (CMS). It measures patients’ perceptions of their hospital experiences and allows comparisons across participating hospitals.

    Press Ganey is one of the organizations that administer patient-experience surveys for healthcare facilities. However, Press Ganey and HCAHPS are not interchangeable. Press Ganey offers broader patient-experience measurement services, while HCAHPS is a federally standardized survey.

    HCAHPS examines several aspects of hospitalization, including communication with nurses and physicians, staff responsiveness, care coordination, and the overall hospital experience.

    These results carry financial implications.

    Through the Hospital Value-Based Purchasing (VBP) Program, CMS adjusts a portion of participating hospitals’ Medicare payments based on performance across several domains, including patient experience, clinical outcomes, safety, and efficiency. Patient-experience scores therefore contribute to reimbursement, although they are not the sole determining factor. CMS

    Understandably, healthcare organizations pay close attention to these measures.

    The challenge arises when the numbers are interpreted without examining the conditions under which care was delivered.

    Consider nursing communication and staff responsiveness.

    Patients reasonably expect nurses to listen, explain their care, and respond when they need assistance. These expectations are fundamental to compassionate nursing practice.

    But what happens when a nurse is responsible for several patients with competing needs?

    What happens when one patient requires an urgent assessment, another needs pain medication, a third is confused and attempting to climb out of bed, and a fourth is waiting for assistance?

    The survey captures the patient’s experience. It does not necessarily capture everything happening around the nurse at that moment.

    A score alone cannot distinguish between a nurse who was inattentive and a nurse who was managing multiple urgent clinical priorities.

    That distinction matters.

    Scripted Caring vs. Clinical Reality

    In response to patient-experience concerns, healthcare organizations may introduce structured communication approaches such as AIDET: Acknowledge, Introduce, Duration, Explanation, and Thank You.

    These frameworks can be useful. Patients benefit when nurses introduce themselves, explain what to expect, communicate delays, and acknowledge concerns.

    Clear communication can reduce uncertainty and help patients feel respected.

    However, communication tools have limitations.

    When patient-experience scores decline, organizations may respond with additional training, scripting, rounding expectations, or compliance audits.

    Those interventions may be appropriate when communication itself is the problem.

    But what if the underlying issue is insufficient staffing?

    What if nurses understand the importance of responding promptly but are physically unable to meet several competing demands at once?

    A communication framework cannot create additional nursing hours.

    A scripted explanation cannot eliminate the clinical needs of another deteriorating patient.

    And no amount of customer-service training can make one nurse available in two rooms simultaneously.

    We cannot expect communication strategies alone to correct problems rooted in inadequate resources.

    The purpose of these tools should be to support meaningful communication, not replace it with a checklist that overlooks the realities of bedside care.

    Are We Measuring the Nurse or the System?

    This is where patient-experience measurement becomes particularly complicated.

    Patients experience the hospital through the people caring for them. Nurses are often the most visible representatives of an organization.

    When meals arrive late, equipment malfunctions, medications are unavailable, or staffing is insufficient, the nurse is often the one expected to explain the delay.

    The patient may not know which department is responsible.

    They only know that something they needed did not happen when they expected it.

    Their frustration is understandable.

    But the nurse may have little control over the circumstances that caused it.

    When a patient selects “Sometimes” instead of “Always,” that response deserves attention. It may indicate poor communication, delayed care, inadequate resources, or several problems occurring together.

    It should not automatically become evidence of poor nursing performance.

    Are we measuring the performance of the nurse, or are we measuring the constraints of the system through the nurse?

    This is not an argument that nurses should be exempt from accountability.

    Professional nursing requires effective communication, timely assessment, clinical judgment, compassion, and respect.

    Patients deserve those standards regardless of how busy a unit becomes.

    But accountability must be fair.

    We cannot evaluate individual nursing performance without considering the environment in which that performance occurs.

    A nurse who repeatedly fails to communicate with patients may need coaching and support.

    A nurse who cannot respond promptly because the unit is consistently understaffed may need something entirely different.

    Both situations can produce similar survey responses. They require different solutions.

    When organizations fail to recognize that distinction, they risk directing corrective action toward the wrong problem.

    The Leader’s Responsibility: Looking Beyond the Numbers

    Patient-experience surveys are valuable.

    They can reveal patterns, identify communication gaps, highlight patient concerns, and guide quality improvement.

    The problem is not collecting the data.

    The problem begins when the score becomes more important than understanding what produced it.

    Imagine a unit experiencing declining staff-responsiveness scores.

    Before concluding that nurses need additional communication training, leadership should examine the broader picture.

    What were the staffing levels during the reporting period?

    How did patient acuity compare with available nursing resources?

    Were nurses routinely carrying additional assignments?

    Were nursing assistants available?

    Were there frequent admissions, transfers, or emergencies?

    Were nurses reporting difficulty completing care within their scheduled shifts?

    Were patients experiencing delays because of individual practice issues, operational barriers, or both?

    These questions should be part of a meaningful quality-improvement process.

    Survey results are generally reported in aggregate, so they may not identify the circumstances of an individual shift. However, examining trends alongside staffing, acuity, operational data, and frontline feedback can help leaders investigate potential contributing factors.

    Nurses should also have a voice in interpreting the results.

    They are uniquely positioned to explain the operational realities that may not appear in a patient-experience report.

    Their observations should not be dismissed as excuses or resistance to accountability.

    They are an important source of information.

    When leadership combines patient feedback with frontline clinical insight, the data become more useful.

    Instead of simply asking nurses to improve their scores, organizations can begin identifying the changes necessary to improve the actual patient experience.

    That might mean improving communication practices.

    It might mean revising workflows.

    It might mean addressing equipment problems, staffing shortages, or delays involving other departments.

    Most importantly, it means choosing interventions based on the problem identified rather than assuming every unfavorable score reflects an individual failure.

    The Score Tells Only Part of the Story

    Patient-experience surveys tell us how patients experienced their care.

    They do not always tell us why that experience occurred.

    A delayed response may reflect poor communication, inadequate staffing, competing clinical priorities, or a combination of factors.

    Understanding the difference requires leadership to look beyond the score.

    Patients deserve to feel heard, respected, informed, and cared for.

    Nurses deserve to have their performance evaluated fairly, with recognition of both their professional responsibilities and the operational realities of their practice.

    These expectations are not in conflict.

    In fact, they should strengthen one another.

    Nurses should be accountable for the care they provide. Healthcare organizations must be equally accountable for the conditions under which that care is delivered.

    When we measure the patient experience without examining the nursing environment, we risk holding nurses accountable for problems they cannot solve alone.

    The goal should never be to improve a number while leaving the underlying problem unchanged.

    The goal should be to improve the care patients actually receive.

    The score tells part of the story. Leadership has a responsibility to investigate the rest.

    References

    1. Centers for Medicare & Medicaid Services (CMS). Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).
    CMS – HCAHPS Overview

    2. Centers for Medicare & Medicaid Services (CMS). Hospital Value-Based Purchasing Program.
    CMS – Hospital Value-Based Purchasing

    3. Press Ganey. Patient Experience Measurement and Improvement.
    Press Ganey Official Website


    Voices Beyond the Bedside
    Where bedside experience becomes a voice for change.

  • Emotional Intelligence in Nursing: What It Looks Like on a Difficult Shift

    By Lesline Rostick, RN, BSN

    A nurse can master complex medication protocols, recognize subtle changes in a patient’s condition, and manage a heavy assignment and still face a difficult interaction with a patient, family member, or colleague. Clinical knowledge is essential. So is the ability to recognize emotions, respond thoughtfully, and communicate under pressure.

    Daniel Goleman’s five domains of emotional intelligence—self-awareness, self-regulation, motivation, empathy, and social skills—offer a practical framework for those moments.

    Self-Awareness: Knowing What You Bring into the Room

    You are managing several high-acuity patients, an unexpected admission, and calls from a family waiting for an update. You feel rushed and frustrated. Self-awareness means recognizing those feelings before entering your next patient’s room.

    The patient did not create the staffing shortage or the demands of the shift. Taking a breath, deciding what needs attention first, and asking for help when needed can keep your stress from shaping the interaction.

    Self-awareness also challenges our assumptions. If we have already labeled a patient “difficult,” are we still listening to what they are trying to communicate?

    Self-Regulation: Choosing a Response Under Pressure

    Patients and families sometimes express fear or frustration as anger. An exhausted colleague may speak sharply during handoff. Self-regulation does not mean suppressing your feelings or tolerating abusive behavior. It means pausing long enough to address the issue clearly.

    A response might be, “I can see you’re upset. Tell me what you’re most concerned about so I can understand what happened.” If the behavior becomes abusive or threatening, the nurse can set a firm boundary and seek support.

    Knowing when to de-escalate—and when to call for help—protects both patients and staff.

    Motivation: Staying Connected to Clinical Purpose

    Many nurses enter the profession because they want to help people. On a chronically understaffed unit, that sense of purpose can feel distant. Motivation may look less like inspiration and more like following up on a concerning assessment, clarifying a medication order, or speaking up about an unsafe assignment.

    Professional purpose must never be weaponized by organizations to demand endless sacrifice from frontline staff. Commitment to patient care and advocacy for safer working conditions belong together.

    Empathy: Looking Beneath the Behavior

    A patient repeatedly removes their telemetry leads or declines treatment. The behavior may disrupt the plan of care, but it does not explain why it is happening. The patient may be frightened, uncomfortable, confused, or unsure what the treatment is for.

    Empathy asks us to get curious before making assumptions. We can ask what concerns the patient, explain the treatment in plain language, and listen to the answer. The patient may still decline care. Our responsibility is to address their concerns and respect their decision.

    The same approach matters with colleagues. Before assuming someone is careless or uncooperative, we can ask what happened. Their answer may reveal a workload or communication problem the team needs to address.

    Social Skills: Turning Understanding into Teamwork

    Nursing depends on brief conversations with real consequences. During handoff, active listening helps the oncoming nurse identify immediate priorities. When paging a provider, the nurse must clearly communicate what has changed, why it is concerning, and how urgently a response is needed.

    Sometimes a page goes unanswered, or a new resident may need guidance before making a decision. Social skills do not mean waiting quietly while care is delayed. They mean following up clearly, using the chain of command when necessary, and keeping the focus on the patient’s needs rather than turning the exchange into a personal conflict.

    When assignments change, respectful discussion gives nurses a chance to raise safety concerns before frustration turns into conflict. These skills matter in leadership, too. A charge nurse or manager who listens to concerns, helps remove barriers to timely care, and addresses conflict fairly helps create a unit where staff feel able to speak up.

    Emotional Intelligence Needs a Supportive Workplace

    Emotional intelligence can help nurses respond thoughtfully to stress. It cannot fix chronic understaffing, missed breaks, or a culture where concerns are dismissed. Research has found an association between nurse burnout and lower patient safety, quality of care, and patient satisfaction. Working conditions belong in any serious discussion of how nurses care for patients and one another.

    We can practice emotional intelligence in small ways: notice our stress before it affects an interaction, ask what may be behind a patient’s decision to decline care, listen closely during handoff, and raise concerns clearly. Leaders must do their part by listening to those concerns and acting on them.

    A shift will rarely end perfectly. There may be medications, labs, or other tasks to finish or hand over. The work continues from one nurse to the next. Emotional intelligence does not demand perfection. It asks us to stay aware of how we affect one another and use that awareness to make care safer and more humane.

  • Stop Saying “Nurses Eat Their Young.” Call It Bullying.

    Early in my nursing career, I began to dread walking onto my unit. I experienced scrutiny, rumors, and unequal treatment that left me anxious before shifts. As a new nurse and a nurse of color, I felt that my work was examined more closely while the conduct of established colleagues went largely unquestioned. I raised concerns, but the lack of a meaningful response left me feeling increasingly isolated. The stress followed me home and ultimately contributed to my taking a leave of absence.

    This is my experience. It is why I cannot hear “nurses eat their young” as a harmless expression.

    We repeat the phrase to students as a warning and to new nurses after painful shifts, as though mistreatment were a passage into the profession. But when a nurse is repeatedly ridiculed, excluded, or targeted, it is bullying in its truest form. Giving it a familiar nickname does not make it acceptable.

    Who Made This a Rite of Passage?

    I have never seen “nurses eat their young” in the Nightingale Pledge. So where did the idea come from that a nurse must endure hostility to become a good nurse? At what point did we begin treating another nurse’s distress as evidence that they simply need to toughen up?

    Bedside nursing faces a serious retention problem. Heavy workloads, burnout, and unsafe staffing all matter. But we must also ask what happens when a new nurse enters an already demanding environment and is met with ridicule instead of support. Why would we expect nurses to remain at the bedside if asking for help comes at a personal cost? We cannot address retention while treating bullying as a rite of passage. Research has found an association between workplace incivility and nurses’ intentions to leave.

    When Asking Questions Has a Cost

    Nursing depends on recognizing uncertainty and asking for help. We tell new nurses to speak up for patient safety, but our response to their questions teaches them whether speaking up is truly welcome.

    A nurse should be able to say, “I haven’t done this before,” or “Can you check this with me?” without fearing embarrassment or gossip. That remains true for experienced nurses moving into an unfamiliar specialty. None of us stops learning.

    When asking for help carries a social cost, we undermine the behavior we expect of safe clinicians.

    It Is Time for Action

    Leaders must take reports of mistreatment seriously, examine patterns of unequal treatment, and apply expectations fairly. Silence is a response, too—and it tells the person who spoke up that nothing will change.

    As colleagues, we can answer questions without belittling the person who asked. We can correct practice respectfully, refuse to participate in gossip, and step in when someone is being targeted.

    New nurses should not have to prove their resilience by enduring bullying. It is time to stop calling hostility a nursing tradition. Name the behavior, address it, and build a workplace where nurses can learn and patients can be cared for safely.

    Lesline Rostick, RN, BSN

  • 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.