Or, What I learned in my first job after nursing school. Part Three of three-part series.
During my years as a nursing student, civility was not formally addressed in our classroom or clinical settings. It was implied that we were to treat professors and fellow students with respect, but we were not taught skills to deal with matters of incivility. It is important that nursing students and recent graduates recognize incivility and learn skills to deal with these issues because, although it can be very challenging to confront professors, co-workers, and managers about such matters, it is crucial to successful practice of our profession.
Although our professors did not teach us about civility, I talked with my mom [Cindy Clark, creator of Clark’s Five RITES of Civility] about the importance of civility and why it matters. And as I matured as a nursing student and began my career as a young nurse, I felt equipped to recognize incivility and address the problems I encountered.
After graduating from nursing school, I started my first job as a psychiatric nurse, working with troubled adolescents. After three weeks of general orientation, I was on my own and, within four weeks, had become a charge nurse on the unit. For a new graduate, this was a lot of pressure. At times, I was left in charge of 24 teens, while supervising five staff members. This was stressful enough, but we were working with some adolescents who were violent and seriously mentally ill. The unit could change from complete calm to mass chaos in a minute, and it was my job to prevent that from happening.
I remember very vividly the first day I cried on the job. The morning started out quietly but, just before lunch, the calm was shattered with screams, shouts, and threats. What had been a relatively quiet setting suddenly crumbled around me and, to my surprise, I found that it was prompted by my manager’s actions. For some unknown reason, he purposely antagonized some of the patients, then walked off the unit and left me to deal with the aftermath.
In that moment, five seasoned staff members looked at me, expecting me to handle the volatile situation. I had to make some very difficult decisions that day, not black-and-white decisions but ones that required me to use all the critical thinking skills I had developed in nursing school and, up to that point, on the job. Throughout the entire episode, I was running on pure adrenaline, and it wasn’t until I was reporting to the next shift that I broke down. Yes, I was upset about what had happened, but mostly I was very frustrated.
After leaving work that day, I called my mom to talk about what had happened. I realized that most of my frustration boiled down to my manager’s involvement in the situation, topped off by my lack of training and experience in making difficult decisions. Mom and I discussed ways to address this particular situation to prevent it from happening in the future—not only for myself but also for other new graduates and, especially, for the patients.
Rite No. 4: Engage and commit to personal and organizational change
The next day, I asked my manager if I could talk with him about what happened the day before. I was very nervous going into the meeting, because I did not know how he was going to react to what I had to say. During our meeting, I talked about his involvement in the situation and how I felt as though he had walked off the unit at the very time we needed his help. Surprisingly, he completely accepted responsibility, and we discussed what he could have done differently. We spoke candidly and talked about how we would handle future situations. I expressed concern about my inexperience as a charge nurse and shared how my lack of training hampered my ability to make immediate decisions amidst a crisis situation.
I left that meeting feeling a lot better about myself and better prepared to deal with similar situations that may occur in the future. I had proven I could talk to my manager about important matters without succumbing to intimidation or fear. From that point on, I talked to my manager about ways to improve my work, and it made my transition much smoother. I was able to voice my concerns and stand up for myself and other new nurses.
Shortly after my meeting with my manager, the hospital implemented a “new-graduate meeting” every other week in which we are encouraged to discuss concerns, fears, and issues we are facing. I soon realized that several other new grads had the same concerns I did, and we now had a voice to make changes.
Looking back, if I had not talked with my manager about my concerns, my first work experience would have been very different. Instead, I was able to address the problem early and not let it fester. Yes, it takes courage to meet with a manager and express your true feelings, but it’s worth it. That’s why it’s important for nursing students to learn how to handle acts of incivility during their academic education and to learn skills needed to address issues they will face during their nursing education and throughout their career as nurses.
Students and new graduates are nursing’s future. If we can teach them about civility and how to advocate for change, the nursing profession will be in excellent hands. RNL
Molly Clark, BSN, RN, a 2011 graduate of Carroll College School of Nursing in Helena, Montana, USA—she played soccer for the Fighting Saints!—was recently commissioned as an ensign in the U.S. Navy Nurse Corps. After completing Officer Development School in March, Clark will be stationed at the Naval Medical Center in Portsmouth, Virginia.