The toxic nurse

As a student I encountered a toxic nurse on every placement I undertook. I have yet to meet a student nurse who hasn't met one somewhere during training.

They are the nurse who takes great pleasure in telling you how rubbish your training is, using phrases such as "I was running a bay by the end of my first year" and "the training was much better in my day", at best these comments are just irritating, at worse they are confidence crushing. Personally I had 3 experiences in which i was reduced to tears by the actions of a toxic nurse whilst on placement.

Unfortunately they are also, very often, the nurse who has appalling interpersonal skills and can leave their patients in tears too. I can go home at the end of a shift and cry to my family, if you are a patient you don't have that luxury. And if you are in hospital, chances are you are unwell. This can make you feel vulnerable enough, what you don't then need is your nurse making you feel like crap.

During a placement in my final year I encountered a prime specimen of toxicity. She was vile towards me from day one, although I am happy to report there was only one occasion when she reduced me to tears and I had to leave work early. Fortunately I didn't have to work with her that often but I remember one incident when I threw caution to the wind and challenged her behaviour. We were caring for a patient who was at the end of life. She had been started on the Liverpool Care Pathway and when her family arrived I sat in with them whilst the doctor explained what was happening (as an aside, this was in fact a shining example of this conversation, one which I have stashed away in my mental file of "how to do things right", a great doctor, shame she is no longer at the trust). One of the relatives brought up the subject of euthanasia, not in the sense of wanting to bump her off but in the sense of a family member who didn't want to see a loved one suffer unnecessarily. Unfortunately, later he also broached this subject later with toxic nurse, who proceeded to go round the ward telling everyone that this relative wanted to kill off his loved one. Having been in the room when this subject was discussed with the doctor and obviously having a more sensitive understanding of the nature of the relatives query, I felt I had to speak up. So I did, I pointed out that she seemed to have misinterpreted the question and that it was actually inappropriate to discuss this with every other member of staff She didn't like it at all. In fact she spent the rest of the shift giving me evil 'death stares'. I did the right thing though and to this day I am proud of myself for standing up to her. Although I doubt she will ever have the compassion to understand the context of the relatives question, at least I stopped her gossiping.

It is always difficult to know what to do in these situations. My husband, the polar opposite to me, is always encouraging me to stand up for myself. Sadly I often lack the confidence to be this direct, in fact I don't know many people who would feel confident in standing up to toxic nurse in this way.

So what is the answer?

Well, when it comes to those "constructive" comments about modern nurse training I have found that agreeing with them often works a treat. For me this is the truth, I feel MY nursing education lacked balance between theory and practice. However, I think this is an age old problem and the training undertaken "back in the day" had its issues too. For a start, the nursing profession has changed radically in the last 10 years, let alone the last 50 years. The rise of the nurse specialists and the nurse consultants is paving the way for recognition of nursing as a profession of its own standing, with its own theory, knowledge and evidence base. We are longer expected to accept doctors orders without challenge and the new generation of nurses are educated to see ourselves as an entirely separate entity to our medical colleagues. We are no longer the doctors handmaiden. 

So yes, we may not have the same practical exposure to hands on nursing as our predecessors our nursing education does prepare us in ways that previous, more vocational training, did not. How many "old school" nurses had to undertake modules on areas such as research critiquing? Not many I suspect. This doesn't make either training right or wrong, in fact I think there is still a long way to go before the 'perfect' nursing course is developed.

So ignore these comments, smile and walk away. I doubt there will ever be agreement by staff on what is adequate and appropriate training!

Now, the issue of the toxic nurse who impacts on their patients. The best advice I can give is to encourage them to complain, reassure them that this WILL NOT impact on their treatment and offer support and information to empower them to do this. There are other official routes you can follow depending on the severity of what is happening. Sometimes (and thankfully i have never witnessed this) the situation may require an adult safeguarding referral to be made. If the treatment is in any way abusive this has to be reported. And, I suppose, overreacting to suspicions of abuse is always better than doing nothing.

So, if you are a student and you encounter the toxic nurse, I would highly recommend talking to the ward manager. I appreciate this is not always possible but if it is, they are they ideal person to talk to. It may be that your complaint is the final straw after a long list of complaints and could be the tipping point. If this is not possible then maybe talk to someone at university, you should have a link nurse you can contact or your personal tutor will be able to advise you. 

If you are a staff nurse, again I would recommend talking to your ward manager. Not that this becomes any less challenging once you are in blue! If you are a member of a union you can contact your union rep. No on should ever make you feel like crap at work, especially not the people you need to rely as a newly qualified.

So these toxic nurses need to be stood up to, as difficult as that might be. They are not only a danger to junior colleagues and patients, but to the reputation of the nursing profession as a whole. With more emphasis being placed on the importance of transparency, and increasing protection offered to those who whistle-blow, there are increasing avenues through which to report bad practice.

And if all else fails, debrief with people who love you. For me its my man in uniform, my parents and my fellow newly qualifieds. And a hug from legoboy (son) and peanut (daughter) always goes a long way to restoring my equilibrium!