VOICES BEYOND THE BEDSIDE

Tag: writing

  • The Power of a Pause: What Nursing Taught Me About Burnout and Gratitude

    You do not have to finish every task before you allow yourself a moment of peace.

    For a long time, I lived as though rest had to be earned. There was always another task at work, another bill to pay, another person who needed me, or something at home that could not wait. Even when I sat down, my mind kept moving. I was planning tomorrow instead of living today.

    I am learning to slow down. Sometimes that means stepping outside to tend my garden and water my plants. Sometimes it means watching a movie without mentally going through my to-do list or listening to music without fear and worry taking over the moment. I want to feel safe enough to simply enjoy where I am.

    Nursing has taught me how much can change in a person’s life when an ordinary ability becomes difficult. I have cared for people who wished they could take one step without pain, lift an arm, reach an itch, swallow a meal safely, or sleep through the night.

    Those experiences stay with me. They remind me to notice what I can do today. I can wake up and see the daylight. I can hear a familiar voice, taste my food, drink clean water, and feed myself. I can turn on a hot shower. I can read, write, study, learn, and make choices for myself. I have a place to rest and a job to go to.

    I do not always remember to be thankful for these things. Most days, I simply do them and move on. That is why taking a moment to reflect matters to me.

    Gratitude also needs to make room for honesty. I can be thankful for my work and still be exhausted by a shift. I can appreciate my home while worrying about a bill. I can enjoy a quiet moment and still have problems waiting for me when it ends. Gratitude does not require me to deny any of that.

    And when someone is living with pain, illness, or disability, they should never have to hear that they simply need to be more grateful. The people I have cared for have taught me to pay attention, to listen, and to recognize how much effort an ordinary task may take.

    A pause cannot fix every source of stress or burnout. But it can help me ask myself a question I often forget: How am I doing, and what do I need right now? Maybe I need sleep. Maybe I need help. Maybe I need to sit in my garden for ten minutes and let myself breathe.

    Today, I am grateful for the small things I can do and the moments of peace I can find. I am giving myself permission to enjoy them before every task is finished.

    What is one ordinary thing you are grateful for today?

    #TheNursingLens #Gratitude #Nursing #Wellbeing

  • 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.

  • Silence Protects the Culture, Not the Nurse: Why Policy Alone Will Not End Nurse Bullying

    Calling it bullying is only the beginning. What are we going to do about it?

    My recent post about new nurses speaking up opened an important conversation. Nurses shared stories of being humiliated, criticized, excluded, and made afraid to ask questions.

    One nurse remembered discussing this same problem as far back as 1988. Another shared that she spent five years studying why nurse-to-nurse bullying persists. Their perspectives reinforced a difficult truth: This is not a new problem, and awareness alone has not ended it.

    Silence allows harmful behavior to become normalized. When nurses fear retaliation, embarrassment, or damage to their careers, they may stop reporting what is happening.

    Awareness matters—but awareness without action will not change the culture.

    Zero Tolerance Must Be More Than a Policy

    Healthcare organizations need genuine zero-tolerance policies addressing bullying, intimidation, retaliation, verbal abuse, and deliberate exclusion. However, a policy cannot live only inside an employee handbook. It must be consistently reflected in everyday practice.

    That means:

    • Defining bullying clearly: Provide specific examples so employees understand the difference between constructive feedback, workplace conflict, incivility, and repeated harmful behavior.
    • Creating safe reporting channels: Give employees confidential and impartial ways to report concerns.
    • Protecting against retaliation: Safeguard nurses who raise concerns in good faith.
    • Reviewing complaints promptly: Investigate concerns fairly, consistently, and without favoritism.
    • Documenting behavioral patterns: Track repeated conduct instead of treating every complaint as an unrelated event.
    • Enforcing accountability: Apply expectations regardless of seniority, popularity, experience, or position.
    • Using appropriate interventions: Offer coaching and education when appropriate, with meaningful and proportionate consequences when harmful behavior continues.
    • Closing the feedback loop: Follow up with the person who reported the concern rather than leaving them wondering whether anyone listened.

    A zero-tolerance statement has little value when employees see that certain people are repeatedly excused because they are experienced, popular, difficult to replace, or closely connected to leadership.

    Breaking the Silence: Structural Solutions

    Policy establishes expectations, but changing a culture requires deliberate structural action.

    Prepare Nurses to Respond

    Nurses—especially students, new graduates, and newly hired staff—should receive communication and de-escalation training. Cognitive rehearsal can help nurses practice calm, professional responses before a difficult interaction occurs.

    Examples include:

    “I am open to constructive feedback, but I would like us to speak respectfully.”

    “Can you clarify what you mean?”

    “I am asking this question because I want to provide safe patient care.”

    Practicing these responses can help nurses find their voices when they might otherwise freeze or remain silent.

    Create an Objective Review Process

    A bullying complaint should not depend entirely on the judgment of one manager, particularly when personal relationships or staffing pressures may influence the response.

    Organizations should consider a consistent review process involving appropriate representatives from nursing leadership, human resources, professional practice, and employee relations. The purpose should be to examine facts, identify patterns, protect confidentiality, and ensure fairness to everyone involved.

    Hold Leaders Accountable for Unit Culture

    Leaders are frequently evaluated on budgets, staffing metrics, productivity, and patient outcomes. Psychological safety should also matter.

    Anonymous employee feedback, turnover patterns, exit interviews, repeated transfers, absenteeism, and reports of incivility may reveal problems that operational numbers alone cannot show.

    A unit with persistent fear, silence, and turnover should not automatically be described as having “difficult staff.” Leadership practices and organizational conditions must also be examined.

    Make Precepting an Earned Responsibility

    Precepting should not be assigned simply because someone is available or clinically experienced. Strong clinical skills do not automatically make someone a supportive teacher.

    Preceptors should demonstrate patience, emotional intelligence, respectful communication, and a genuine willingness to teach. They should also receive preparation, support, and feedback.

    New nurses deserve structured mentorship—not “preceptor roulette.”

    Clarification Before Assumption

    Accountability does not mean labeling every disagreement or uncomfortable interaction as bullying.

    Nurses come from different cultures, backgrounds, generations, and communication styles. These differences can affect how we express ourselves, interpret tone, and understand one another’s intentions.

    That is why open communication and clarification are essential. Before assuming disrespect or harmful intent, we should pause and ask:

    “Can you help me understand what you meant?”

    A respectful conversation may uncover a cultural difference, unclear wording, high stress, or a genuine misunderstanding. Clarification gives people an opportunity to explain themselves, repair the interaction, and learn from one another.

    However, clarification must never become an excuse for repeated humiliation, intimidation, gossip, exclusion, sabotage, retaliation, or verbal abuse.

    Cultural differences deserve understanding. Persistent harmful behavior requires accountability.

    Silence Protects the Culture

    Leaders must create opportunities to discuss bullying during orientation, staff meetings, huddles, preceptor development, and leadership training. Nurses must know what behavior is unacceptable, how to report it, and what will happen after they speak up.

    New nurses must feel safe asking questions. Experienced nurses must feel safe raising concerns. Leaders must be willing to listen, investigate, clarify, and act.

    A policy means little when the nurse reporting bullying becomes the problem.

    Silence may protect the reputation of a unit or organization temporarily, but it does not protect nurses. It does not strengthen teamwork, improve retention, or keep patients safe.

    Zero tolerance must mean zero excuses, consistent accountability, protection from retaliation, open communication, and a commitment to cultural change—not merely protection of the organization’s image.

    Silence protects the culture.

    Speaking openly, listening carefully, and acting consistently protect the nurse.

    What practical steps has your workplace taken to prevent nurse-to-nurse bullying while encouraging respectful communication?

    #NurseBullying #NursingCulture #PsychologicalSafety #HealthcareLeadership #PatientSafety #NurseMentorship #TheNursingLens

  • The Wrong Blueprint: Why We Teach Our Boys Survival Instead of Wealth

    Financial knowledge, trusted mentors, and visible opportunities can help young people imagine a future they can work toward.

    In nursing, we often meet people after something has gone wrong. We treat an injury, respond to a crisis, or help a family through a loss. Those moments have made me think about what support might have helped long before anyone reached a hospital.

    I think especially about our boys. We tell them to make good choices and stay away from gangs, drugs, and violence. Those warnings matter. But a warning is not a plan for the future. A young person also needs someone who will listen, teach them what they do not know, and help them see opportunities within reach. Some are born into it, and that’s all they know.

    As a mother, I want my sons to know that their lives are worth more than the dangers I worry about. I want them to understand money, recognize people who may be using them, and know where to turn when they need guidance. I want that for other boys in our communities, too.

    Show Them How a Future Is Built

    Financial literacy is one practical place to begin. Young people can learn how to make a budget, use a bank account, understand interest, and recognize the long-term cost of debt. They can learn what a credit report records, why it matters, and how to correct mistakes on it.

    We should teach these skills without pretending that information alone removes every obstacle. A good credit score cannot replace affordable housing, a decent wage, or access to opportunity. Still, understanding how financial systems work gives a young person more tools to make decisions and ask informed questions.

    Those lessons become more meaningful when boys can see adults putting them into practice. A conversation with someone who owns a business, works in a trade, manages a household budget, or took an unexpected path through education can make an unfamiliar possibility feel real. Success has many forms. Our boys deserve to see more than one.

    Be Someone They Can Come To

    Information matters, but so does the relationship in which it is offered. A boy who makes a mistake needs an adult who can hold him accountable and still believe he has a future. He needs room to ask a question without being embarrassed for what he does not know.

    Families cannot do all of this alone. Coaches, teachers, neighbors, employers, faith communities, and local organizations can offer steady guidance and opportunities to learn. Mentorship should mean showing up consistently, helping a young person take a concrete next step, and staying interested in who he is becoming.

    That includes taking his concerns seriously. If a boy says he feels unsafe, pressured, or hopeless, he needs more than a lecture about better choices. We need to hear what is happening and help him find support.

    Start Before the Crisis

    Healthcare speaks often about prevention. We should bring that same commitment to the communities our patients return to. Teaching financial skills, connecting young people with mentors, and creating safe places to learn will not solve every hardship. They are worthwhile ways to stand beside our children before a crisis brings them through our doors.

    I want us to ask a different question of our boys. Alongside “What trouble should you avoid?” let us ask, “What future do you want, and who will help you build it?”

    The tragedy isn’t just that gangs and drugs are introduced early; it’s that they are introduced as the only visible pathway to wealth and status. When a young boy believes that financial freedom can only be achieved through systemic traps, his potential is hijacked before it can ever take root.

    He puts up an armor of composition and survival—very much like the forced emotional walls we see in overextended clinicians,j ust to manage the constant threat of fight-or-flight living.

    The Knowledge Gap: Finance vs. Survival

    Generational wealth doesn’t fail in our communities because of a lack of ambition; it fails because of an intentional systemic information gap.

    • The Street Economy is Accessible: The mechanics of the street are visible on almost every corner, marketed through media, and aggressively pushed by peers.
    • Financial Literacy is Gatekept: Concepts like debt-to-income ratios, compound interest, investment portfolios, and leveraging credit scores are treated like advanced secrets rather than foundational survival tools.

    When a young boy isn’t taught that a clean credit score can buy property more efficiently than cash from an illicit trade, he naturally defaults to what he can see. We have to make financial literacy louder, more attractive, and more accessible than the visual temptations of the street.

    Enlightening Our Children, Protecting Our Boys

    If we want to change what our boys choose, we have to expand what they can see. This isn’t about telling them to “work harder” within a broken framework—it is about arming them with the institutional tools required to beat the system legally.

    Introduce Financial Literacy Early

    We must treat credit education and budgeting as non-negotiable rites of passage. Teach our boys that true ownership isn’t a depreciating luxury vehicle; it is an appreciating asset. Show them how money works behind the screen of a bank app, not just how it looks in a hand.

    Decouple Success from the Street Blueprint

    We need to actively dismantle the myth that power and luxury require violence or illegal trades. We must flood our boys’ environments with visible, accessible examples of men from their own communities who built substantial, thriving lives through technology, real estate, finance, and trade ownership.

    Move from Survival to Legacy Building

    Just as we advocate for structural shifts inside hospital staffing to protect clinical sanity, we must advocate for structural mentorship networks in our neighborhoods. Our boys need spaces where they can let down their armor, ask questions, learn from mistakes, and see a future that extends past their twenties.

    Reclaiming the Narrative

    We cannot expect our children to navigate an economic system they have never been trained to understand. If we want our boys to stop stepping into the traps that lead straight to our hospital beds, we have to meet them long before the crisis begins.

    It is time to give our children a new blueprint. Let’s teach them to build, to invest, and to survive using the power of their minds, their credit, and their community.

  • 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.

  • 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.