The Invisible Wall in Nursing
Ask a nursing student what specialty they want to go into in freshman year, and most of them will say, “I don’t know yet”. Ask a nursing student what specialty they want to go into senior year, and they will tell you, “ICU, Pediatrics, L&D, Oncology” and it is fascinating to watch them stand taller when uttering this and say all they reasons that the area they are going into is better than the next and how they could never go into the others. Proud, yes! Segregating, also yes.
Almost all of them are going to start in a hospital setting, whether they want to or not. Yet, many new graduate nurses, there is a shared perception that “med surg” is a holding cell, a period at work frozen, a stepping stone for a higher rung in the ladder of where they are “meant to be”.
Pause.
Let me tell you about medical surgical nursing. I have worked with some of the most well rounded nurses in knowledge, skills and critical thinking. Their work flow isn’t heavily flooded with technology, their patient ratios are higher and they often work with many sub specialties. Consequently, these nurses form some super sweet skills in communication, coordination, time management and creativity. So, nursing students all around, please don’t turn a blind eye to medical surgical nursing, because it isn’t the “sexy” specialty to work in.
At the same time, I get it. ICU is cool. There is so much technology, and often it is enticing because it is a different type of nursing where you dive in to pathophysiology, where every little change in rate can plummet a BP faster than you know, where patients are in this in-between of life and death, and your efforts and knowledge as a nurse are lassoing them back to our realm on earth. The ICU can be stressful, humbling and devastating. ICU nurses, are so knowledgeable, fast to respond, and have a unique outlook on life, and cherish their time here on earth even more.
Other specialties like Pediatrics, Labor & Delivery, OR nursing, Oncology, Home Care, Rehab, Long Term Care & the ED can have their own strengths and weaknesses as well. Ask any nurse who works there.
I also urge nursing students to think outside of the box. Personally, I did. When I went to nursing school, I worked to get my LNA and worked in home care – I absolutely loved it. I applied for my LPN, and then started working at a camp for children and adults with disabilities. And when I graduated with my BSN, I didn’t beam over to a hospital job, I continued to earn my MSN, while completing a graduate certificate program – LEND , teaching me leadership, clinical and advocacy for children with disabilities, at the same time I worked in a group home for adults with disabilities. This makes me unique in my story, and when anyone asks my journey to how I arrived at where I am today, it is not a cookie cutter comeback. Take that social norms! At the same time, when I did wind myself towards the hospital setting, I was nervous because I was starting in the hospital later than others, and I had home care experience, and to fit in I will self-admit that I chirped the pediatric nursing pride.
Pride is great, but when it leads to elitism and degrading others’ specialty and purpose, that is problematic to our nursing profession and culture.
With early separation, each new graduate nurse takes an invisible brick and builds a wall. After passing the NCLEX and orienting to the unit, statistically the first year as new graduate nurses, we are more focused on socializing and fitting in than clinical content. If they don’t continue to take the invisible bricks and complain about the ED for not documenting an IV insertion, or the sister unit taking the float again when all they do is obviously “sit around and do nothing” …they are alienated from the group.
If they don’t join in the blame game, or voice frustrations with the other units, the new nurse will have a great fall from the invisible wall. You can bet without being accepted into the social circle for refusing to complain, they will look to leave that unit as soon as that 1 year finish line is in sight.
My hands are up, waving for your attention, because I am talking about a concrete, foundational solution to nursing retention.
Demolish the invisible wall. Take down the silos, the towers of service lines. What’s our purpose? To make our community a healthier one. That purpose takes pediatrics, cardiology, emergency medicine, rehabilitation, long term care, ambulatory clinics, home care and more.
We are all important, and part of the healthcare puzzle, and when a piece of the puzzle is missing, our purpose is incomplete. Is anything but a completed purpose, worthwhile?
Over my years, I heard the literature on horizontal or lateral bullying amongst nursing and it is alarming. Yet, this subtle tribal segregation, potentiates the undercurrent of this phenomenon. If we accept that it is okay to degrade another area of care, or the work that happens there, it creeps towards the line of making it okay to do the same for a co-worker on your unit, and that co-worker could do the same to you.
I refuse to work in an environment that is anything but supportive. Constructive, yes…with difficult conversations, yes. But, with the assumption that everyone is trying to do the best that they can to contribute to a larger purpose.
When our physician colleagues have a question with a patient about a specialty outside of their expertise, what do they do?
The get a specialty consult. They don’t try to solve the issue on their own, they don’t puff out their chest in elitism within their own specialty and assume that they are all knowingly almighty, and that all other specialties are subpar. Most of the time. Nursing needs to change. Get an informal nursing consult when you have a question. Change your work environment.
There are so many things as a nurse you don’t have control over. One thing I assure you we all have, is control over your work environment. If you don’t like something, work to change it not to complain it.
So, I challenge you. I challenge you at the conclusion of Nurses Week 2017.
- When you are tempted to comment on another area in nursing, ask yourself if you are complimenting or complaining.
- When you have a patient on your floor or area, and their diagnosis is more common in another area – initiate a nursing consult, give that area a ring. This shows that you respect their expertise, and by asking for their help you open the door for them to reciprocate.
- Give a shout out to the care area your patient came from when they have done something exceptionally well.
Foster this collaboration and collegiality in the new nurses. Foster this in ourselves.
Together, we are stronger than apart. Together we unite in purpose. Our individualized strengths and passions make us unique to innovate, advocate and change healthcare.
Think about it. Nurses are in the ICU, Schools, Medical Surgical floors, Forensics, OR, Pediatrics, Clinics, Legislature, Labor & Delivery, Universities, Public health offices, Law firms, Oncology, Infusion Suits, Homes, Cardiology, Quality Improvement, Courtrooms, Boardrooms, Psychiatry, Addiction Centers, Information Technology, Care Management, Wound Care, Nurse Practitioner Clinics, Business, Radiology, Cruise Ships, Long term care, Rehabilitation, and so much more. We are pervasive in all aspects of human interaction. We influence so many people, by virtue of just having the honor to connect.
Think about how loud a voice of 3 million strong would be? Nurses in all areas of healthcare make a difference. Yet, it will take us all to crumble the bricks of the invisible walls, and instead weave a network of respect, consultation and advocacy.
~ Keep on Caring ♥
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