Autonomy in Nursing: How to Have it Stolen From You

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One of my favorite things about nursing is the autonomy we have in our care. It can be scary and overwhelming, especially as a new grad, but it is also extremely rewarding when  a decision you make facilitates the betterment of a patient.

Nursing is the first job I have ever had where a “boss” was not constantly breathing down my neck. I get to plan my day and do things as I see fit. I have the ability to use clinical judgment skills to decide to give and hold medications. I have the right, ability, and duty to question inaccuracies in care. I also have the right to be able to practice as a nurse without being placed under a microscope by others.

—Yes, another post about bullying, mobbing, horizontal violence, lateral violence,how nurses eat their young, or whatever term you want to phrase when a nurse is constantly targeted.

I’ve already talked about the lists they make. I’m sure they have one on me a mile long, quite honestly. In fact my boss, who mostly seems to ignore things people tell her, has actually approached me on a couple of occasions about some really absurd “opportunities” they have no doubt made lists about. You see, they literally comb the charts, the eMARs, the nurse’s notes, the kardexes, and even probe the patients to find faults in their fellow nurses. It’s not just me, unfortunately, but I fear I’ve likely given them a greater desire to find my faults. I have seen them gasp in disgust about a miniscule detail being over-looked on an order and proceeding to call said nurse any number of derogatory terms such as stupid, incompetent, lazy, ext.

But seriously guys, even though we hold peoples lives in our hands everyday, not everything is the end of the world. I thought I had left the drama club behind after high school. But alas, we have an independent group of crap-stirrers who are apparently planning a hospital showcase. These nurses are gonna prove to the world that the walls of this place would surely crumble if they weren’t there to let everyone else know how stupid, incompetent, or unwanted you are. That means you: nurses, doctors, techs, CNAs, secretaries, house supervisors, managers, housekeeping, dietary respiratory, lab, and especially pharmacy, because according to them, you guys are the president of the idiot club… but you may have to fight for that title with dietary, depending on their mood.

Who does this?

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I personally don’t have the time to go through every ounce of a patients medical information in an effort to get dirt on another nurse. I also have never had the desire. I believe what goes around comes around, and while I fully participate incident reports, and discussing errors that effect or have the potential to effect the patient, as a rule, if I find an error, I do my very best to know broadcast it in a derogatory fashion. I have never laughed about it. I have never called another nurse stupid, not to their face, not to a co-worker…. maybe to my husband…. but I gotta let it out somewhere.

Who has such audacity to do this? I mean truthfully, we work in the same hospital, on the same floor. How are you that much “better” that me, or anyone else you work with? If you are the nurse that invented nursing would you kindly find a better way to share your magnificent skills with the world. Because you are obviously so much better than everyone else that touches a chart. You obviously have all the answers and never make any mistakes. And I have never had to unclamp an antibiotic for you, clean up a Foley you left open, or insert an NG tube you choose not to. Nah… never.

The unfortunate circumstance that spawned this unneeded question of my judgment and competency involved home medication. If a patient is admitted at night, and they have pm medications that take routinely that they have not had, I do my best to give them to them. If you take a clonazepam everyday for sleep, and its 1am and you haven’t had it, you’d want it, right? You wouldn’t want me to hold it because the oncoming nurse might be annoyed by it. I mean surely, you want to sleep, and its hard enough to sleep inside hospital walls even with high doses of sedatives.

What annoys me the most is I was there late, off the clock, doing homework with a co-worker, also off the clock and I am interrupted because I happen to be there so she can question my judgment. What does it matter really what answer I give? They result is the same, they got the meds. What satisfaction is gained when I tell you that they needed it to help them rest? None, because you rolled your eyes, flipped your hair, huffed, and abruptly shut the door while I was in mid-sentence.

Seriously if there is a duty to act as a nurse, by all means question my judgment. If a patient could be injured, has the potential, or there is a better way to do something, an easier way, or just a way I’ve never thought of, please tell me. But please, in matters of pure clinical judgment, my ability to act and make decisions, unless it has cause someone harm, is obviously wrong, or has caused you a great inconvenience could you kindly just suck it up and be pissed off on your own accord. I understand you may not agree with me, but that doesn’t mean I am wrong, and I am really getting tired of you telling me what is the appropriate thing to do. You are no better than me. Once again, we work in the same hospital, on the same floor, and we wipe the same asses.

Grow up. Show up. Take care your patients. And leave me alone!

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12 thoughts on “Autonomy in Nursing: How to Have it Stolen From You”

  1. @Not Nurse Ratched It is utter BS. No better work for it.

    One day I was working and counted the times that a particular nurse found an error or another reason to complain about something someone else had done. It was 32. 32 times! 

    How miserable it must be to go around all day looking for things to complain about.

  2. @Nurse Jenn This appeared to be the case in the bullying I experienced. I don’t want to get into details, because I don’t want to offend anyone, but they basically though their years of experience entitled them to treat me like I was an idiot despite the amount of education I had.

  3. @Nurse Rami I think it’s absurd that issues like this exists. We are adults and so much of the bullying that occurs is just incredibly childish. And what’s worse is when it’s some one in a leadership role. Why are these type of people allowed to manage people? Who thinks this type of behavior is ok in the work place, yet for some reason it’s continually allowed, year after year, and employer after employer.

    I love nursing, but I agree that some nurses are terrible and really make the job hard.

  4. @Fritzie I’m so sorry you had to endure that.

    My experience with nurse-on-nurse bullying was similar. There was one nurse who was nice to my face, but ended up being the instigator causing everyone else to publicly attack me. She had real issues with RNs and would target the newer ones when the came. 

    When I worked along side her everything seemed fine, but I was around the corner one day and overheard her saying terrible things about me and the care I provided patients. I asked someone else on another shift and they confirmed that she did that to me and other new grads. It crushed me.

    When the boss is in the same corner of the bully it becomes almost an unwinable fight. 

    There are so many areas of nursing that you can try, and I promise there are other places that aren’t toxic. Sometimes it takes a while to find where you belong. 

    Thank you for your comment. I sincerely appreciate that you took the time to make it. 🙂

  5. Lived it, felt it, saw it, tried to use Humor to diffuse it, lipped off when it was pushed to the max. Had a fabulous Lead who allowed me to take classes in becoming more assertive and confront these “BULLIES”. Whenever she received a “Complaint”: usually BS with proven documentation that they were lying. I asked if I could “handle it. With a smile and her blessing I confronted the 2 or 3 usual suspect’s. Their response was usually “Oh its just a different viewpoint—NO YOU LIED & STIRRED THE POT.” 
    There was only 1 Bully oops RN who I was warned that I needed to confront as she systematically targeted RN’s at random, I included. I JUST COULDN’T DO IT, to this day I do not know why, we worked together well, but looks are deceiving. When new management arrived she found a new best friend & helped the New Manager eradicate the majority of our staff.  

    We ALL slowly lost our positions, done in a very nasty manner. By that point I was out of gas and couldn’t fight back. 0ver 30 RN’s including Leads quietly disappeared and the New Director received a bonus for “cutting costs”. That was 5 years ago and after 33 years as a RN, BSN, my career has never been the same. I don’t miss all the CRAP but I do miss that “PLACE” that I belonged to for so long. Have tried several other area’s of Nursing, nothing feels quite right but have not given up.  Fritzie

  6. I can very well relate with you. I’ve faced bullying in nursing through multiple forms. Many times it was obvious to the point the person said mean things to my face, but mostly i hear nasty rumors being spread about me only because i choose to do what I feel should be done for my patients. I would add that it is not only miserable nurses that love to make another person’s life miserable, but I also encountered some doctors who spread poor rumors about the nurses who are not afraid to defend their patients by questioning some physician’s orders. I mean, I love my job and I’m truly passionate about what I do, but sometimes I really hate nursing and nurses because of the way I am bullied constantly not just by my coworkers but also my boss. I wish there was something that could be done, maybe a new law could be created in nursing where people could report issues like these.

  7. It has been my experience that these nurses are often the most insecure and feel the need to point of the flaws of others in an attempt to cover their own shortcomings.

  8. Not Nurse Ratched

    Just found your blog…love it. I was just talking to a new employee about the strange dynamics in our hospital of constant writeups for bullshit. I would find a nicer word if appropriate, but actually, it's bullshit. I literally can find no logical explanation for the amount of time people take to look for faults and write them up. It takes effort. Perhaps I'm lazy, but unless someone is putting a patient in danger and making no effort to correct it I just don't have that much drive: know what I mean?

  9. Drake, thank you for your concern. You've actually inspire a blog posts soon to come. Thank you for that, and really thank you for your always thoughtful comments and interest in my passion 🙂

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