Even more, some are aware that I am in their rooms doing things for their patients while they drink coffee or grab a snack. I was peeved. I guess I just need some advice on how to tactfully say ‘No’?

I often help people and they help me, but I feel like I was being taken advantage of that day. I don’t want to be rude, because I don’t want to piss anyone off. Help?

Leah Paul

I remember one of my clinical instructors praising me for a care plan I had written; it received the highest grade that particular week.  Her caveat: listen and learn during clinical so I could improve.

Laziness prevailed.

The next week, I wrote essentially the same care plan. This time I earned the lowest grade of all the care plans.

I didn’t learn, I didn’t listen, and I paid for it.

And, if I embraced that “know enough” attitude, I think in the long run the patient would have paid for it, too.

Florence Nightingale pioneered the art that is nursing today, but she was never a “true” nurse.  As my current nursing education instructor says, Ms. Nightingale, one of the first nursing administrators, adhered to the policy that nurses could never stop learning.  If a nurse thought they had learned all there was to know, she frowned upon them.

To stop learning was to stop caring-and to stop being the best patient advocate.

As a nurse, you have the unique opportunity to daily learn something new. Some days you may simply rethink a concept you already thought you mastered-and apply it in a completely new way.

In this way, learning is cyclical.  The things that are taught in school never go away; they just take on a new form.

As a student, I remember fussing about clinical instructors teaching me how to chart the way they did back in the 1800s. I wondered, How can this possibly relate to my current job, now that charting is electronic? Yet, I learned, after some foibles, that I should’ve heeded the advice. Charting follows many of the same guidelines as centuries ago-just in a different medium.

Change doesn’t necessarily mean different, it just means a different way of doing the exact same thing.

And as you put forth effort to learn-as well as allow yourself to be taught by some of those seasoned nurses who you swore you’d never talk to-you’ll grow, you’ll thrive, and you’ll care for your patients better.

But what do you believe?

Here’s the thing about seasons. They come and they go. That’s important to remember. Especially the going part. Some feel like the new birth of Spring, and some feel like the death of Winter. Either way, you have to remember to enjoy the good, and keep hoping through the bad. Both will turn into a new season in time.

If you’re a student, it may feel like the studying will never end. If you’re a new grad, it may feel like you’ll never get the hang of this new career. If you’ve been working for 30 years, it may feel like retirement will never come. Stop waiting. Enjoy what you’ve got. It will be gone before you know it.

As I remember it, college was the most fun of all the difficult things I’ve done. Lots of friends, lots of entertainment, lots of ….

Those first hospital jobs scared the crap out of me, but I had more free time and spending money than I’ve ever had since.

Now I’m 20 some years into a Family Practice career. I can do it with my eyes closed, but every time I go to work, something good happens. A great conversation with a patient or colleague, holding a baby, chatting with an old man who doesn’t have anyone to listen to him. I leave loving my job every day. Mostly.

When my first child was born, I was ecstatic but exhausted. I never slept. I thought he would spontaneously combust if I let him cry. He was also a terrible nurser, so he didn’t gain weight. That only added to the stress.

When he was about two weeks old, a friend said, “Don’t worry, he’ll turn a corner when he’s six weeks, and it will get much easier.” She thought that would encourage me. Instead it made me cry. I was SURE I would not live to see six weeks.

Twelve and a half years out, I can tell you I did survive. I even occasionally tell new moms that their little screamer will turn the corner at six weeks. But I always add how that statement made me feel.

What season of nursing are you in? What do you love about it? What do you not love about it? What advice are you giving about the last season you were in? That’s the other thing about seasons. There is always someone else in the last one and the next one.

I was never one of those people who kept one eye on the want ads. Maybe you’re one of those who do. I’ve always been content with where I am; I’m not fond of change. I’m very fond of the status quo. It’s a known entity.

Lots of nurses quit a job because it’s terrible. I get that. The staff and/or docs are terrible. The pay is awful. The politics are unbearable. The hours are killing you. You feel like you’re drowning in all the stuff you don’t know. You feel like throwing up when you wake up and have to go to work. I’ve quit jobs for those reasons.

I’m faced with a different dilemma now. I have a job I love, but another opportunity has presented itself. It sounds great. I’d work with people I like. It’s an opportunity to grow professionally. And it’s close to home. But did I mention that I hate change? And I do my current job well. It’s one I’ve been doing for nine years and could probably do until retirement. Change that is thrust upon you is one thing…but choosing it?

I can just hear you now. “Grow up, Jana! Grow, move, change. It will be good for you.” Oh wait. Maybe that’s my mom talking. She didn’t raise me to be a coward. It just comes naturally.

I don’t mean for this to be all about me. It’s just that many of you, though younger and newer in the field, are really smart and still in the searching phase of life. I need a little pep talk. A reminder that adventure (if you can call a job change that) is a good thing.

And there is the possibility that I’m not the only nurse in the world who needs a little kick in the pants.

Enjoy a hearty chuckle at the fun poked at the not-so-glamorous parts of nursing. The list has been around for a while—and you probably have your own to add to it.

You know you’re a nurse if…

• You would like to meet the inventor of the call light some night in a dark alley.
• Almost everything can seem humorous…eventually.
• You can identify different diarrhea scents.
• You wash your hands BEFORE you use the bathroom.
• You check the caller ID on your day off to see if anyone from the hospital is trying to call and ask you to work.
• Discussing bodily fluids over a gourmet meal seems perfectly normal to you.
• You think that caffeine should be available in IV form.
• You get an almost irresistible urge to stand and wolf your food even in the nicest restaurants.
• You believe that unspeakable evils will befall you if you say, “It’s unusually quiet around here today.”
• You have had a patient look you straight in the eye and say, “I have no idea how that got stuck in there!”
• You notice that you are using more four-letter words than you even knew before you started nursing.
• When someone asks you for a pen you can find at least four of them on you.
• You live by the motto “To be right is only half the battle; to convince the doctor is more difficult.”
• You’ve told a confused patient that your name was that of your coworker and to holler if they need help.
• Your bladder can expand to the size of a Winnebago’s water tank.
• You find yourself checking out other customer’s veins in grocery waiting lines.
• You avoid unhealthy looking shoppers in the mall for fear that they will drop near you and you’ll have to do CPR on your day off.
• Your finger has gone places you never thought possible.
• You have seen more penises than any prostitute.

Take a Hard Look at Yourself

When your relationship with your preceptor is a flop, be mature and take a hard look at yourself first. Don’t run and complain to your manager without considering how you are contributing to the negativity in the relationship. After a little soul-searching, you may realize that there are some things you can do to improve the relationship.

Maybe you need to communicate your questions more intelligently and clearly. Maybe you never fully understood your preceptor’s expectations, and you need to ask for clarification. Maybe you’re too beholden to the “this is how we did it in school” attitude and need to embrace your preceptor’s recommendations. Or maybe you need to stop interpreting your preceptor’s critique as a personal attack—and receive it as it is intended: to help you become a better nurse.

The bottom line: You may be part of the problem, and it’s a lot easier to take responsibility for your actions than to harbor expectations that someone else should and will change theirs.

Go Directly To Your Preceptor…with an Open Mind

If you continue to have problems with your preceptor—even after you take an honest look at your behavior and make appropriate adjustments—then take the next brave step of communicating your issues directly to your preceptor.  So you don’t make sweeping generalizations at your meeting with your preceptor, consider documenting specific instances when you experienced negative feedback. And when you do launch your complaints, make sure they are presented in a non-accusatory way. Say, “Can you help me understand so-and-so situation?” or “I feel like I’m not learning when such-and-such happens…”

Your preceptor may not even know that she has offended you or created a bad working environment. And a good preceptor will want to explain her actions and, if necessary, rectify the situation. But go in with an open mind—your preceptor may point out some of your blind spots.  While it might be painful to hear, the critique might help you understand your preceptor’s expectations and help you mature as a professional. It could be one of your greatest learning opportunities.

Accept That Your Preceptor Isn’t Going to Be Your Best Friend

In the professional world, you’re not always going to work with people whom you’d choose to be friends with outside of work. Nevertheless, some new nurses look for a warm-fuzzy friendship with their preceptor. And when there is a personality clash, they immediately want to request a change.

The fact is you and your preceptor might be opposites. You might be vivacious; she might be insipid. You might be intuitive; she might be imperceptive. You might be passive; she might be confrontational. You might like routine; she might like variety. You might be cautious in your speech; she might be blunt.

The case may be that you and your preceptor won’t ever be BFFs (best friends forever), but you can still maintain a professional rapport. And you can improve the relationship simply by being receptive to your preceptor’s strengths. Sure, she might be blunt, but she is a fount of knowledge.  As your focus shifts from your preceptor’s shortcomings to strengths, your first weeks on the job won’t be completely unbearable. In fact, by the end of the precepting experience, you may even come to understand—and respect—your preceptor, despite your differences.

If All Else Fails…

If you make every possible attempt to rectify the relationship but still find it is not conducive to learning, then take your complaints to your nurse manager/educator. Let him/her know the steps you’ve taken to improve the relationship, demonstrating you’re professionalism and commitment. Then be prepared to give specific examples of what you need in a preceptor and why your current precepting relationship is failing you. Ultimately, the hospital needs you to gain confidence and knowledge during this period so that you will be an effective member of the team—and with a “bad” preceptor, you certainly won’t. With the right information, your nurse manger/educator can get you the coach you need to be a success your first year.

The expression “nurses eat their young” comes from this story, and it isn’t all that far from the truth. It might sound like your unit—where you feel constantly pulled down by your peers’ cutting remarks, backstabbing, and eyebrow-raising. Kathleen Bartholomew, RN, MN, author of Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other, speaks on why nurses can’t seem to help each other rise to the top.

RealityRN: What is the theory behind nurse-to-nurse hostility?
Kathleen Bartholomew: It’s called horizontal hostility, which is aggressive behavior (bullying, verbal abuse, and violence) directed at co-workers who are on the same power level. And it’s born out of a sense of powerlessness.

Studies show that nurses are typically seen as unequal in power to doctors—they are “oppressed,” so to speak. It’s called Oppression Theory. Nursing has never been considered an empowering profession. Since its inception, nurses have been considered handmaidens to the physicians in a male-dominated society. As a result, nurses assume the label and become unprofessional–cliquey, catty, mean-spirited, and intimidating, especially toward new nurses.

Why do nurses work against each other, rather than work together to improve their position?
Nurses remain silent because they are a powerless group without a voice, and they don’t feel safe. Ironically, this is why nurses eat their young. Seasoned nurses stick close together, and they keep everyone who’s different outside of the group. So new nurses show up, and the group doesn’t want to let them in. It’s a way for seasoned nurses to find power in a powerless position.

Also, when a nurse does speak up, she’s pushed out. I’m standing outside organizations because according to the theory, any oppressed group is going to kick out the person who draws attention to the group, even if their motives are good.

Why isn’t nursing recognized as an empowering profession?
Intellectuals and professionals don’t gossip. Smart people don’t sit around and talk about who did what. Doctors think that nurses are gossipy—and that reinforces that nurses are substandard.

Do the institutions where nurses work add to the problem?
Yes. In institutional situations, the voices that matter are usually from the top. This leaves nurses with very little power. Sure, there is the illusion of a union for many; however, the unions don’t have the same goals that we do. Their goal is power, and our goal is quality care.

If a union empowered nurses, educated the public about what nurses do, and did all those things that raise the self-esteem of individual nurses in the profession, unions would go out of business. So it becomes counterproductive for the unions to empower their nurses. Yet, here and now, unions still serve a purpose because nurses do not have the time or energy to come together, and even when nurses try to speak up (and few actually do), they are not being heard.

Where’s the hope?
The good news is that out of the chaos, there’s a chance to form something new. That’s what my work is about. Let’s look at the chaos, sift out what we want, choose our role and how we want our relationships to be, and next time we walk on the floor, let’s become that.

And if people on your unit refuse to change, you can refuse to work there. You don’t ever have to put yourself in a position where you don’t feel valued, recognized, or appreciated for all the gifts and talents you bring everyday to the floor.

Okay, maybe I complained.

I guess I felt justified. Just out of nursing school, I suddenly was working nights, weekends, holidays–all the hard shifts. I wasn’t used to not being able to spend “normal” time with my friends and family; it was a difficult transition.

When I expressed my frustration–said something like, “I’m tired,” or “I wish I didn’t have to work this weekend”—or even asked one of them to fill in when I had a wedding to attend, all the seasoned nurses rebuffed me. “It’s your turn. You have to do it. Suck it up. We did it. This is nothing compared to how we had it,” they said with a scowl.

There was no support in building up to those horrible shifts. What I needed to hear—and what would’ve helped me stop complaining–was, “You know what? It stinks, but eventually you’ll make it through. This is just a phase. Hang in there.”

All I needed was a little support; it would’ve gone a long way in helping me not be discouraged. It makes me wonder how I’m going to be once I have 10+ years under my belt: an adversary or ally?