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.

Filmed nearly 40 years ago, the “Politics of Caring” film provides history of the grassroots support groups and activities that we continue to build on. One of my favorite parts of the film is about 5 minutes in, when a group of nurses are discussing their frustration with hospital working conditions: “We don’t have enough staff, we don’t have enough time…” They talk about wanting to improve their working conditions, by moving to a different hospital, or unit, or leaving the hospital to work in the community described as “mecca”.

When I graduated nursing school it was not uncommon for nurses to regularly care for 8 or even 10 patients on a cardiac surgery step-down or transitional care unit. I knew this was not the way I wanted to practice nursing, and found my passion in community and home health nursing. The 2003 NurseManifest Study provided an opportunity to talk with my co-workers and colleagues locally and nationally, to better understand what changes were needed and desired by nurses to create their ideal working conditions. Some of the major findings were that nurses felt a lack of respect, a lack of voice, and a lack of unity. Now, over a decade later, my work is dedicated to research that tells the story of what it is like to practice nursing today, and that shows the value of nursing for patients and society as a whole.

Why everyone should care about nurses’ working conditions and staffing ratios was the subject of a recent New York Times Op-Ed “We Need More Nurses” by Alexandra Robbins. The op-ed piece mentions dozens of research studies providing the evidence that patients’ risk of death, infections, complications, falls, hospital and hospital readmission are greater when nurses are caring for more than 4 or 5 medical or surgical patients. Hundreds of readers’ comments brought personal stories and richness to the conversation from the views of nurses, patients, family members, physicians, administrators, and more.

Working conditions and labor force issues for nurses is an international priority, and one source of current information is the RN4CAST Consortium, consisting of nursing workforce research groups in 17 countries, including the United States. Currently the United States group, based at the University of Pennsylvania, is surveying over 250,00 registered nurses and advanced practice nurses about nursing care, patient outcomes, and general working conditions for nurses. You can learn more about their work, and the study director Dr. Linda Aiken here.

Another source of information and place for collaboration is National Forum of State Nursing Workforce Centers, comprised of nursing workforce centers in 33 states. The National Forum of Nursing Workforce Centers is a resource for finding information specific to your state, as well as about nursing workforce issues nationally. Their annual conference will be held next week in Denver, Colorado and you can download the conference brochure and registration information from their website.