Do nurses have to justify themselves…to each other?


I worked with a DNP student as her “clinical mentor” for the last year and a half. During one of our meetings she told me that she has had to justify her decisions at every point in her nursing career. When she first became a nurse she chose a BSN program. Then in her first job she was working with all ADN nurses who treated her differently because of her 4-year degree. When a position opened up in the Emergency Department, this nurse got the job because she had a BSN and she dealt with even more fall-out.

When my colleague decided to pursue a master’s degree, she was given a hard time for choosing  to become a CNS (Clinical Nurse Specialist) rather than an NP (Nurse Practitioner). Her most recent experience with having to justify her nursing career and education path was when she began an online DNP program. Why DNP and not PhD? Why online and not on campus?

My colleague’s story reminded me of discussions I’ve had in the past about how nurses treat each other and the age old “nurses eat their young.” I imagine this type of behavior happens in many professions; my biggest concern, though, is that what is known as the most trusted, the “caring” profession, would participate in it.

What is it about nurses or nursing that contributes to this phenomenon? Is it the stress we deal with in our daily jobs – leaving no energy for interpersonal relationships? Do our work settings or the people we work for cause us to feel inadequate leading to insecurities and jealousy? Does questioning ourselves lead to questioning others?

I have witnessed nurses who are incredibly loyal to each other and would do anything for one another. I have close, lifelong friendships with nurses I worked with years ago. I’ve also seen nurses treat each other unkindly and not support each other.

I believe that leadership makes a huge difference. In my experience, nurses who are valued, respected, and given autonomy treat each other better than those who feel micro-managed or not trusted. Management can make or break a nurse’s experience and maybe even how she or he treats their co-workers. That, of course, can trickle down to patient care, which is the whole point of what we do!

Leadership also happens in the classroom. Those who teach and shape nurses can encourage them to support each other and by doing so strengthen the profession. Leaders of our local, state, and national organizations can do the same. And those nurses who are on the front line, feeling the effects (good or bad) of professional relationships, can contribute to making nursing a consistently friendly profession by taking a leadership role in their workplace, or their professional organization. At the very least they can be friendly and helpful to their nurse colleagues.

I am proud to be a nurse, and I’m a passionate advocate for and supporter of the nursing profession. So when I hear stories like the one my friend told me, I get concerned. There are enough stresses and challenges in health care today. By standing together, nurses can make a difference to patients and to each other. I envision nurses as a group of health care professionals who have each others’ backs. I see nurses as being excited for another nurse who is advancing his or her career or education – an opportunity for growth as an individual, a team, a unit, and most important for improving patient care.

7 thoughts on “Do nurses have to justify themselves…to each other?

  1. Ah yes, the ever-present discrepancy between the ideal and the real. It has been a source of much thought the entire time I have been involved with nurses, the difference being that I have had several other professions so that some of the things that I see are simply issues of people being people. Nurses, as people, tend to act the same way people do in other professions.

    Yes, an extremely small number of people have opportunities to stand out as particularly caring people, who are an inspiration to all of us. But this has been true in every profession that I have worked in. Some mathematicians, statisticians, actuaries, social workers, appliance repair people are more honest, responsible, willingly orient new workers in a supportive manner, pass on accurate, useful information as opposed to misleading, incorrect, or inappropriate information.

    These people exist at each tier in every profession/occupation I have been privileged to work in. . True, most other professions/occupations do not lay claims to being the one, and only “Caring” profession. But there are caring people in every profession/occupation.

    The overwhelming majority of people I have encountered in every profession/occupation interact with an air of “benign neglect”, an approach that works particularly well to ensure that all but a minority of colleagues at worst cause no particular breakdowns, are focused on getting their work done, are comfortably absorbed in their own lives, and get most of their life satisfactions from their activities away from their workplaces, so they don’t vie with each other for attention at work, nor do they seek satisfaction by denigrating their colleagues.

    But, the are always those who feel inadequate and who seek to bolster their own self image by pointing out the imagined errors and inadequacies of their colleagues. I recently started doing what I had intended to do when I entered nursing school in 1997. I work at a hospital that I could ride to on a bike, if it weren’t so hot, in 5 minutes from my front door. I work the night shift and most of my colleagues are ASN nurses, so take that MSN’s comments and add a PhD in nursing to the fold. Most of my colleagues don’t really care about my BSN, MSN and PhD and I am certainly quite reserved in my approach.

    This makes sense because I am busy learning all sorts of things I never learned before or while I learned them and used those skills for a short period of time, fingers that do quite adequate “hunt and peck” typing sufficient to complete a dissertation have proved to be quite poor at poking the Pyxis screen, chasing the constantly changing positions the cursor needs to be in when working with the disastrously ergonomically challenged Meditech system and especially useless when attempting to extricate pills and tablets from ridiculously resistant packaging.

    Having worked in so many other fields I cannot imagine any other profession, the members of which would tolerate incompetently designed software, packaging that resists opening or a device that requires you to login dozens of times a day when you work in a locked room and are the only person in the room 99% of the time. Why on earth do nurses accept such intolerably flawed work tools?

    Carpenters don’t use circular saws that require the user to login with a user ID and password/fingerprint check every time they cut a board. Their nail “guns” don’t ask them to verify that they want to put a nail into whatever surface their nail guns are pressed on when the trigger is pulled.

    Accountants don’t sign off on every column of numbers their spreadsheets add up and yet nurses accept the most dysfunctional tools I have encountered in any profession/occupation I have ever worked in.

    Most of my colleagues have never written computer programs and have only recently been exposed to software that actually works, as in speeds up task completion rather than slowing it down. My experience in these three areas: incompetently designed software, restricted access medication packaging and ergonomically disastrous equipment reminds me of the original purpose of the QWERTY keyboard – to slow down the typing speed of the fastest typists because the typewriter keys stuck together when typists exceeded the tolerance of the machinery. Rather than fix the real problem

    Yes, there are a few nurses that are constantly pointing out the failings of other nurses. I have certainly come in for a great deal of it myself in the last few months, but they are the same people that behave poorly in every profession/occupation. They are constantly complaining that they are the only ones who do their jobs right. Sometimes they are complaining about individual nurses or they couch it as the imagined inadequacies of “Day Shift/Night Shift”.

    I understand that I could try to have a discussion with this person but there is no real common ground. I want to learn how to do my work as a dance, one which will leave me invigorated at the end of a shift. (S)he wants to get all the work done in half the time available? It isn’t that I don’t want to dance efficiently, the biggest gap is what each of us want to do with the time remaining after we complete our tasks. I want to spend the freed up time thinking about the unique characteristics and needs of my patients, my colleagues and my work environment and how to improve outcomes, (s)he wants to kick back and read a book, watch a movie on a laptop/phone and chatter on incessantly about how much better a nurse (s)he is.

    We “care” for patients because that is the work we do, just as the best carpenters care about the people they build houses, cabinets and bookcases for and this is reflected in the way they work and the end products of their dances. But it is always going to be a small number of people in nursing and other professions/occupations who care the way we would both like to imagine that nurses would care for patients and each other.

    Eventually I will have a lot of things I would like to do differently, and some people will appreciate it, many won’t and 1-2 may ever be on the same wavelength I am on with what most will likely think of as my ill-informed PhD view of nursing.

    For my part I do my best to ignore the isolated problem nurses. On that, most of my colleagues and I are in agreement. But I also go out of my way to do nice things at work because I am deeply troubled by the general sense of oppressiveness and the spiritual and material deficits. So I spring for pizzas, I bring really good Vitamin C (Chocolate) to work. I also keep the other Vitamin C at work because someone is always feeling sick.

    My goal is that both my patients and my colleagues will feel materially and spiritually richer when I walk out the door. Warm fuzzies are what I want to leave behind and what I hope others will increasingly prefer to leave behind as well.

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  2. I think there are two issues here. One springs from a lack of compassion, and another from a lack of understanding. While it’s true, experienced nurses have been known to be short on patience with younger ones, the examples noted here do not sound like that was the issue.

    It seems to me the questions posed are fair ones. We should all be ready to answer for our choices. It’s normal for people to wonder. It’s common for peers in any field to inquire of others pursuing further education and a new career path.

    The questions are apt to come from a lack of understanding. Nurses have worked closely with other practitioners but likely not as closely with someone with a DNP. Our profession has changed so much over recent years and there are now multiple nursing degrees and titles, all requiring different numbers of years of training and various levels of responsibilities. It’s confusing. Those questions posed by your friend’s peers could have been asked by anyone outside our profession, too. And the choice of online versus in the classroom is a big topic these days deserving much more discussion.

    While some of the people quizzing your friend may have been motivated by criticism, I think we should be clear that questions are always a means to educate. If we aren’t asking questions, we won’t get it at all. Our profession has made choices to offer many specialties and it is our responsibility to convey the value those specialties add.

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    • Mary,
      You are right. I definitely combined two different issues in one post! I appreciate your point about questions, and I agree that it is important to keep asking questions. To me the way we ask them makes all the difference.

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  3. I have practiced with an Associate degree among primarily diploma prepared nurses when our community developed the first community college program (1969) after all area hospitals had closed their diploma programs. A new type of nurse was not welcomed. Within 1 year I began my BSN studies at the #1 program in the US. Some faculty were sceptical, others were nuturing. My nursing experience acquired at an exemplary medical setting prepared me well. Within 4 years, I was teaching in a diploma program (with a very dysfunctional DNS). I completed my MN while teaching in a community college in rural WA. My graduate education was exceptional. Later I taught for 10 years at college and University settings while completing my Ph. D at the University of Colorado. It was by design that I sought to study Watson’s caring curriculum. and I benefited from excellent faculty role models in research and caring. At every level, nurses were always questioning another’s background or educational preparation. One must just rise above the noise and keep striving for greater competence in caring while conveying professional standards of practice to the negative critics!

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    • I agree. You make good points. Rising above the critics or naysayers is always the best practice. These issues aren’t unique to nursing, and the requisite maturity and professionalism isn’t unique to our profession either. It’s just typical growing pains.

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