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How The Acts Of Unkindness Is Being Perpetuated In Nursing By Leaders Of The Profession At Various Levels By Adeaga Damilola Olusegun RN, ROHN, BNSc, MSc. Occ. Health, NEBOSH
Date Posted: 15/Sep/2020
BACKGROUND 
You visit the hospitals and see nurses with aggressive mien, hard faces, sombre looks, and repulsive attitude, with very few ones radiating smiles. You hear patients complaining “Oh!  These nurses are just wicked!”  Some people even have internalized, stereotypical beliefs that nurses lack sympathy.  Many patients and relatives have come back to relive the harrowing experiences of how they were poorly treated by some nurses while they or their people were in hospital for care.  Some other clients, for instance, women attending ante-natal clinics, in the labour/delivery room or taking their babies for infant welfare clinics etc. have experienced at least one form of insult from attending nurses.  Some of these unpleasant attitudes include not showing dignity, respect and courtesy to patients/relatives (e.g. not greeting and welcoming properly), negative body language (e.g. looking down on, snubbing and using harsh tone of voice), yelling at, hurling abuses and insults; ignoring confused patients or looking away from those in need of assistance or direction, not offering adequate explanations to patients or relatives with enquiries. 
 
Unfortunately, patients and relatives are not the only ones at the receiving end of this.  Junior and student nurses have also been heard narrating their ordeals and bad experiences in the hands of their tutors and senior colleagues in the clinical area; a case of nurses eating their young ones (‘cannibalism in nursing’)
 
INTRODUCTION
Going by the aforementioned scenarios and situations, it appears that nurses’ acts of caring have now been replaced by uncaring attitudes.  One wonders why this is so.  Why is it, that people whose ultimate mantra is to care for other people with empathy, gentleness and hope have now become uncaring and unkind? 
 
Many reasons and excuses have been given as the cause of this.  These reasons are mostly associated with the unconducive working environment and condition of the Nigerian nurse which include working under stress and pressure always (due to manpower shortage), lack of equipment, hectic work schedule, poor salary and lack of incentives, job-related stress factors and so on.   As confirmed by many studies, there is no doubt that nursing profession is stressful, and that nurses are encumbered with a lot of stressors and pressure at work which include nagging bosses, facing difficult task, difficult patients/clients, lack of helping hands when needed, poor working condition and environment and some more.  Irrespective of all these negative factors, there is no justification for a nurse to act contrary to the mantra of nursing profession, which is to care.  It is worthy to remember that the ability to be able to handle difficult situations (emotionally), hold one’s head up and calm under pressure is one of the major attributes of a good professional (especially nurses).  
 
Despite all the aforementioned reasons, one important reason has often remained unmentioned, and this is the fact that some nursing leaders (problem within) are the primary cause of this problem (i.e. why some nurses have mean attitude).  Just as the Yoruba adage which says‘kokoro to nje efo, ara efo l’owa’; translated as ‘the insect that eats the vegetable resides on the vegetable plant’.  The aim of this article is to explore and discuss why this is so, and also to suggest some solutions.  
 
NURSING LEADERS IN EDUCATION AND PRACTICE 
Who is a leader?  
A leader is anyone who is in a position of authority to direct, control or influences other people.  Such leader may also be seen as a role model/mentor, with followership of protégés or mentees.  This type of role model-protégé relationship is not uncommon.
 
Who are the Nursing leaders?   
In this context, they include any nurse in leadership (senior) position and in place of authority over other nurses (junior or younger nurses).  These ones include but not limited to nursing tutors/lecturers in the schools of nursing/universities, and hospital/clinic nurses (especially senior ‘veteran’ nurses who are called to with various titles like ‘matron’, ‘superior’, ‘apex’, ‘oga’ etc.).  These ones have students, and junior nurses under their authority.
 
The nurse training; be it in the school of nursing or the university entails learning the science and special art of caring; as the main mantra of nursing is ‘to care’.  As observed nowadays, there seem to have been a deviation from this mantra.  The public now sees nurses as a ‘necessary evil’ rather than ‘angels of mercy’ that they are meant to be.  A critical and an objective look at this issue will reveal some truths and realities about this negative public perspective.
 
In every profession, mentors are important in preserving and promoting good practices (standards and integrity) as well as the profession’s name.  This also applies to nursing leaders who are expected to promote the mantra of caring but as sometimes observed, the opposite appears to be the case as there are inpatient, harsh and abusive bullish ones who end up becoming nightmares to young nurses (one reason for absenteeism among student nurses during clinical postings).  One can say that some nursing mentors are actually the ones teaching the upcoming nurses how to be uncaring. 
 
Many  nurses  are  uncaring  and  unkind  as  observed  and  experienced  in  many  hospitals and institutions (both government and private) nowadays.  The primary cause of this can be traced to the fact that many nursing leaders are unpleasant; they only teach ‘caring’ in theory but they do not reflect it in their personal relationship with their students, protégé  or patients.   Caring in nursing is beyond theoretical lessons; it is practical and transpersonal.  As such, it has to be learnt and experienced practically but the opposite is what many nursing mentors do.  How then do upcoming nurses learn the art of caring when their mentors do not treat them with care, and are unkind to them?  Training others to become a nurse is not all about ‘do-what-I-teach’ only but also ‘do-what-I-do’.  A person will most likely do what he/she observes than do what he/she is told to do.
 
WHY AND HOW SOME NURSING LEADERS TEND TO BE UNCARING, TOWARDS THE UPCOMING NURSES
 
1.1 Incompetence and lack of control
Some  nurses  tend  to  use  aggression  to  cover up  for  their  incompetence and lack of control.  This aggression is usually directed at junior colleagues (and patients).  They bully and instil fear into the junior ones (playing the hierarchy card) so that the junior ones are not able to challenge them, complain or come up with dissimilar opinions.   For instance,  a  lecture  bullying  students  or  a  senior  nurse  dismissing  a  junior  colleague embarrassingly in order to cover up for her incompetence (compensatory mechanism using aggression) knowing well that such junior nurse dares not to challenge her.  They often turn themselves into an unapproachable god of thunder which should be revered, and ready to strike anybody (student/ junior colleague) at the slightest ‘provocation’.  Leaders like this are unapproachable by the younger nurses.  
 
Furthermore, some of these nursing leaders adopt the authoritarian leadership style which uses fear as a tool of control.   Student/junior nurses lose their composure at the site of such lecturers and senior nurses; some even scamper for cover on sighting their nursing tutors or ‘matrons’ on the corridor.  No student or junior nurse dares to voice a suggestion or opinion for the fear of being seen as confrontational or rude.  This leadership style is not the best.   It demoralizes and slave-drives followers.  The nursing profession cannot thrive in such oppressive environment.
 
1.2. Sheer wickedness, unprofessionalism, jealousy and unnecessary pettiness
a. Some people react negatively to unpleasant events happening in their personal lives, and this does not exclude nurses.  Nurses like this usually react by transferring aggression unto others (especially unto junior colleagues, patients and patients’ relatives).  Nurses face a lot of pressure; work pressure (workload, long commute to and from work, stress of shift duty etc.), and home-front pressure (being wives, mothers and home-makers).  Inability to cope with these pressures may make some nurses radiate negative energy to people around them.  They may lash out and punish their students/junior colleagues heavily over minor offenses that verbal warning could have sufficed; they react harshly to patient’s/relatives’ requests
b. Some nurses are just unprofessional (as also found in every other profession).  These one just do not appreciate the reason why they are into the profession.  They are abusive in words and manners, hateful and use demoralizing words on their junior ones e.g. ‘you are mad’, ‘shame on you’, ‘you will never make it in this profession’ etc.  These are the ones that will always harshly criticize and embarrass their students or junior colleagues in the presence of patients and other hospital workers.  While one is not against correction and criticism, such should be constructive and should not aim at public shaming.  Areas of strength of the junior nurse should be harped upon while areas of weakness should be pointed out for improvement.  Recognition and praising should be done in the open while rebuke should be done in the closet.  Open rebuke especially in the presence of patient/clients and other health professionals tends to break the confidence and self-esteem of the nurse.  This is one of the reasons why some nurses lack confidence, and are not respected by the patients and other health professionals
c. Some others go beyond professional boundaries to discipline junior/student nurses.   At times one wonders whether such senior nurses have human feelings at all.  For example, confiscating and destroying personal effects that do not conform to their ‘image of how a nurse should look’ such as earrings, fancy wrist-watches, necklaces, shoes, ipods, and mp3 players of student nurses.  There are other ways of instilling discipline without going up to such wicked and wasteful extent
d. In other cases, some nursing ‘superiors’ make the upcoming nurses do the ‘dirty’ tasks (like ‘you are the junior nurse, so you do the ‘shit jobs’).  Some assign inconvenient shift duties e.g. constant night or weekend shifts to student/junior nurses, and assigning difficult and ‘dirty’ tasks to junior nurses without offering adequate support (purposely setting them to struggle with the task and be embarrassed) just because they are not in terms with the  junior nurse.  The reality is that nurses perform some ‘menial tasks’ in their course of duty but such tasks are not reserved exclusively for any particular cadre of nurses.  Every nurse should be proud to do them.  Nursing duties should be fairly allocated and not used as forms of punishment
e. Some hold on to some unnecessary pettiness and prejudice, thereby using such as a basis to punish student/junior nurses e.g. picking on a student/junior nurse and ‘dealing’ with him/her because she did not greet (or ‘greet properly’) while passing by on the corridor/ward (the junior nurse might be absent-minded while passing by); feeling slighted because a junior colleague talks with confidence and facts whenever she talks, and such nurse is termed ‘arrogant and rude’; picking on a student/junior colleagues for non-issues like being too pretty and attractive, and prying into her private life with unfounded and unsubstantiated speculations that such student/junior nurse  must  be dating doctors/patient’s relatives or lecturers in order to curry favour.  These are acts of bullying and harassment
 
1.3. OTHERS-MUST-ALSO-EXPERIENCE-IT SYNDROME
Some senior nurses are fond of making statements like ‘during our own time nursing was hard and we went through hell’, ‘no escape route for you upcoming nurses’.  One often hears nurses recounting their ordeal, and also vowing to make upcoming nurses go through the same.  Consequent to this, upcoming nurses are even accused of seeking corner/short-cuts, implying that upcoming nurses must also experience the hardship.  These senior nurses believe that things should not be easier for the upcoming nurses.  
One even hears some remarks like ‘it is part of the dues/training’ as if undergoing hardship and wickedness is part of the training process of becoming a caring nurse.  How can that be?  Nursing training is totally different from the military/para-military professions where they are being toughened up and trained under duress and hardship.  Nurses should be trained to be gentle and firm in caring.  This still does not mean that discipline and standards should not be maintained in the profession but it should be discipline with care and love, and not discipline with wickedness.  The fact that one does not enjoy certain privileges and rights during one’s time does not mean that others coming behind should also be denied such privileges and rights, where available.
 
2.  THE DOWNSIDE OF THE ABOVE-MENTIONED DEMEANORS
In the ways mentioned above and many more, seeds of wickedness are sown into the minds of upcoming nurses.  These seeds germinate and the fruits start manifesting (consciously or unconsciously) later in their professional lives.  Some of them emulate these unpleasant acts and unleash these abusive behaviours on others nurses coming behind.  This is best explained with a boy child (protegé) who later becomes an abusive husband because he grew up seeing his father (mentor) doing the same to his mother.
It is also worthy to note that many nurses are being frustrated and psychologically disturbed due to these uncaring behaviours from their senior ones.
 
3. SOME SUGGESTED SOLUTIONS TO REVERSE THIS MENACE
3.1. Re-orientation
Nurses generally need to have a re-orientation, especially nurses in leadership positions or positions of authority.  Trainings in the domains of leadership, people management, emotional intelligence, change management etc. should be given to nurses at all levels because nurses are leaders.  Leadership is not about making people fearful of one but about making positive impacts in the lives of people around (junior colleagues, patients and their relatives).  Leadership qualities are not attained by promotion (e.g. from staff nursing officer to matron) but by having the appropriate leadership training, qualities and skills.  Nursing leaders must attend some sort of certified training courses in leadership, administration and management
3.2. Catch them young
Nurses should be taught about positive leadership, right from their school years so that the skills and traits are inculcated in them from an early onset, and they can also grow with it.  Leadership and management topics should be included in the behavioural science component of the nursing school curriculum
3.3. Adapting modern and innovative trends
The fact that some senior nurses had difficult times during their training days or early professional lives does not mean that they must also make upcoming nurses undergo the same difficulties, especially when there are easier alternatives.  This has been a major clog in the wheel of progress of nursing profession in Nigeria.  Life should be made easier for those inside the profession so that the profession can be more attractive and appealing to those outside
3.4. Nurses in various positions should start showing care, love and support to one another.  It is high time nursing leaders in educational and clinical settings started showing care and kindness (in a professional manner) towards junior colleagues and students.  They should always act in a professional manner, desist from open rebuke or criticism, and be supportive to them.  They should model good behaviours and attitudes around these junior colleagues who see them (the senior nurses) as their leaders, mentors and role models.  Nurse leaders should not build walls around themselves but rather make themselves accessible and approachable to the junior ones
3.5. Checks
Measures should be put in place to curb unruly and unprofessional behaviours by nurses.  A fair system where anonymous reports can be made with investigations carried out and redress should be put implemented.  Many hospitals, institutions and nursing departments have this in place (e.g. disciplinary committees/panels, tribunals etc.) but majority of these mechanisms are no longer active or fair in their dealings.  There should also be measures to protect the reporter/complainant/whistleblower (who may be a junior nurse/student) from retribution.  Lack of such protection discourages many victimised nurses from seeking redress or standing up against injustice, and this has allowed the menace to continue
 
4. CONCLUSION
Nursing is a science and also an art.  This means that the art of caring for others must be learnt practically and not only theoretically.  The lecturers and senior nurses must not only preach caring but they must also practice it, even when they have to instil discipline in errant students or junior colleagues.  Student nurses must feel the care first-hand (from their professional leaders and mentors).  This means that their mentors (lecturers and senior nurses on the wards) must model good and caring behaviours around them.  It is often difficult for a person to give what he or she lacks.  A student/junior nurse that never experienced care from his/her mentors while in training may likely not give it (i.e. proper care and empathy) to others (i.e. to patients, relatives and junior nurses).  A leader exhibits the traits and characters he/she has already learnt and imbibed as a follower.  It is important that good nursing leaders are developed out of the upcoming ones (who are future nursing leaders) by showing them love, care and support.  Young nurses need to accept the existence of these problems, openly and freely identify and discuss them so that they can be solved, and also that they do not become guilty of the same accusations they accuse their leaders of.  
All these are necessary in order to making nursing an interesting profession, and launder the image of the profession
 
 
PLEDGE: ‘As a future nursing leader I will not abuse or tolerate abuse amongst or on junior nurses or any of my team member’
 
CAVEAT:
• This is not to say that the issues mentioned in this article are exclusive to nurses or the nursing professions. No! It pervades other professions too
• Quarks/‘auxiliary nurses’ employed by the private clinics are the also culpable of this menace but that is a discussion for another time
• The  writer  of  this  article  is  a  professional  nurse,  and  has  over a decade  of  nursing experience as a student and professional nurse in various settings within and outside the country.  This article represents the writer’s experience and opinion as a student nurse, professional nurse, as a patient and as a patient’s relative within Nigeria.  The views of the writer may not be generalised but they are based on many observations he has made during his training and practice.
 
GOD bless all Nurses all over! 
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