AACN News—November 2002—Opinions

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Vol. 19, No. 11, NOVEMBER 2002

President's Note: Bold Voices-Stop the Abuse and Disrespect

By Connie Barden, RN, MSN, CCNS, CCRN

What makes a nurse want to stay in one workplace, but run away from another? Who makes it that way? How does a bold voice help to create an environment where a nurse wants not only to work, but also to contribute to its growth and outcomes?

For decades, nursing leaders have called for healthcare cultures that attract and retain nurses. During the nursing shortage of the late �80s, the Department of Health and Human Services made nurse retention a healthcare priority. Just last month, JCAHO singled out �creating organizational cultures of retention� as a key recommendation in addressing the effects of the current shortage. (See related article, page 1.) The fact is that everyone from government officials to administrators, researchers, scholars and nurses is discussing the shortage, trembling as the frightening prospect of too few nurses becomes real.

As leading organizations put forth their bold positions, nurses seem to be waiting for something to change. When nothing does, front line nurses are again disappointed and frustrated.

Traveling around the country I meet dozens of nurses. They tell me about toxic workplaces. Places where abusive and disrespectful interactions between colleagues are the norm. Whether nurse to nurse, experienced nurse to new nurse, physician to nurse or even when a nurse isn�t involved, the stories I hear are more disturbing than the shortage itself.

Disrespectful and noncollaborative behavior creates negative, even unsafe, conditions. The negative impact on job satisfaction and morale can directly and adversely jeopardize patient outcomes. Studies show that when nurses are intimidated about communicating with other team members, quality care is endangered. Serious mistakes can happen when intimidation leads to incomplete communication. This must change. It is unethical. It demoralizes nurses. It drives us out of nursing faster than anything else in healthcare.

How can we create change in an atmosphere of abuse and disrespect? First, we can�t wait for someone else to tackle the problem. Authoritative statements from regulatory agencies and leading associations offer third-party support, but the change needs to happen in the day-to-day environment where we work.

It is imperative that a �no tolerance� standard for abusive behavior become the new norm. Staff members are the ones who must boldly create and maintain a respectful, collaborative environment. Administrators and managers may set the tone for acceptable behavior and participate in developing policies and mechanisms to address disrespectful and abusive situations. But staff members are the ones who will hold themselves and each other accountable for unacceptable behavior. They will recognize these as untoward incidents, investigating them, analyzing them and seeking solutions just like they do with medication errors and similar events.

Finally, we must all share our best practices and successes. Is collaboration and support the standard where you work? Are negative behaviors just not tolerated? How does that happen? Tell us what works. Share your challenges and successes in creating a collaborative, supportive environment. Outline the strategies and skills used to make a new standard of respectful behavior the norm. Describe how you nurture a respectful environment and what you do to preserve that environment when it is challenged. Write to AACN News, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail, aacnnews@aacn.org.

Many factors contribute to creating an environment that supports and retains nurses. Unwillingness to tolerate the status quo. Willingness to challenge the negative impact of abusive behavior in the workplace. Most of all, accepting that waiting for someone else to find a solution is never a real solution. Use your voice boldly to make a difference. Individually and as part of a team dedicated to improving the care environment for our patients, their families, our colleagues and ourselves. Your voice will begin to set the new standards.


JCAHO Regulations Are Stifling
AACN News recently published an article about solutions a JCAHO panel proposed with respect to the nursing shortage (Public Policy Update, AACN News, September 2002). The first strategy was to �transform the workplace to give nurses the independence and support they need to do their work well, thereby creating a culture of professional satisfaction and encouraging retention.� I almost laughed out loud.

After more than 20 years in critical care, JCAHO�s ridiculous and tedious regulations lead me to consider a career outside of nursing. Not only do I have to repeatedly prove my competency, but I also have to prove we adhere to standards that are basic to every student nurse�s education. Although JCAHO has its place in protecting the healthcare consumer, its mountain of regulations is becoming so burdensome that I actually feel sorry for my administrators.

It�s time for the hospitals and professional nursing associations like AACN to come forward in defense of nurses who are trying to maintain our independence and culture of professional satisfaction.
Cheryl Keser Peterson, RN, BSN, CCRN
Stockton, Calif.

Speaking Out Can Make a Difference
I found Connie Barden�s �President�s Note� column in the September 2002 issue of AACN News (�Bold Voices: Doctors Cure; Nurses Care ... Oh, My!�) very informative and true.

I believe that nurses need to speak about what it is that they do on a daily basis. We can all use our voice to speak out intelligently and professionally.
Dianna Nikolai, RN
Salem, Wis

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