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Posted 8 months ago
Nurses Heal Thyself: A Culture of Silence
Culture and Nursing: When Shelli was a new scrub nurse with only six months experience, she failed to anticipate that the surgeon would need a particular scalpel. Immediately, her preceptor deftly slapped the correct blade into the impatient surgeon’s
outstretched hand with a glare in Shelli’s direction. The surgeon said nothing, but a look of disappointment briefly flashed across his face. At that moment, Shelli learned that if she was not on top of the surgeon’s needs, she would end up feeling embarrassed and
looking incompetent. Shelli did not find this information in her orientation manual.
We learn these unspoken rules very quickly in order to survive. We know which physician not to ever call in the middle of the night, which nurse talks about us behind our back when we ask a question, and whether we should even bother to write up an incident
report or approach a coworker with a concern we have about ‘their’ patient. This knowledge is vital to our survival because it determines whether or not we will be accepted by the group.
It’s called culture. Human beings rarely, if ever, succeed at accurately perceiving their own culture. Anthropologists say, “It’s like a fish talking about water. It’s the last thing the fish ‘sees’ because it constantly surrounds him.” Yet nothing is more powerful than this
unseen force. So deeply entrenched is culture that no one talks about it: the unspoken rules and behaviors (called ‘norms’) are never written down, and yet everyone knows them. We learn these norms the hard way by the process of assimilation –
When individuals merge and form a group, there are always things they can do, things they must do and things they can never do. For example, healthcare workers do not typically share their feelings in high-tech, high-pressure environments because feelings are
perceived by the general nursing culture to be ‘soft stuff’. Ironically, this belief couldn’t be further from the truth. Feelings not only matter, but are conveyed unconsciously because 93% of all communication is non-verbal. In a study of collaboration among
residents, nurses and physicians the single most important factor to producing positive collaborative outcomes turned out to be affect – our bodies consistently express what we feel (McGrail). For example, think of your own workplace. Is there someone you
work with who you think doesn’t like you?
The feeling you are getting that someone doesn’t like you –even if they’ve never said anything- is dead on correct. Herein lays the problem and the biggest contributor to nurse-to-nurse hostility: a culture of silence. We don’t check out the intended message in the
non-verbal interaction. Nurses rarely if ever confront each other because their main style of communication is passive-aggressive. As part of their conflict resolution in nursing, they just avoid it. When over 4,000 nurses were asked why they don’t speak their
truth, the answers were consistent (Bartholomew):
First, we have to admit that having some conversations requires courage – especially if the conversation should have happened a long time ago. And then, we need to learn a new communication model – like the “Juice Pull Conversations” -which allows us to
confidently speak our truth. Remember starting your first IV? Remember the nervous fear of hurting someone unnecessarily, of puncturing the vein? But after starting a hundred IV’s, you feel skilled and competent. The same is true for the skill of engaging in
difficult conversations – the first one is always the hardest. But the damage of not having the conversation is far worse - like gangrene for our profession because we don’t sense the urgency or see the damage.