When What's For Lunch Is You: Dealing With Workplace Bullies.

Nurses eat their young.

Bullshit.

Nurses don't eat their young any more than electricians do, or bookstore clerks do, or lifeguards do. There are bullies in every profession; the thing about nursing is that we're expected to be all warm and cuddly and friendly and healing angels of peace yadda yadda. So when "horizontal violence", or bullying, happens, everyone clutches their pearls and has a little crinoline-lifting moment.

Still, if you have to deal with a bully at work, things can suck hard. I deal with three on a regular basis. Two I've dealt with fairly successfully up to now and the other I've ignored. Here, therefore, are the three types of bullies you'll encounter most frequently and the ways I've come up with to handle these people. More suggestions in the comments would be welcome.

(Nota Bene to new nurses: If your manager is the one who's determined to clean your bones, get a new job. There is no winning with a bullying boss, unless you're willing to spend a whole lot of time and effort to get them reprimanded repeatedly and then fired. If you're new, quite frankly, you have better ways to spend your time. Get the hell out and leave the crusade to older nurses who don't have to worry about ruining their future careers through one bad apple. Seriously.)

Bully Number One: The Know-It-All.

This person just wants to help you. Yeah, right. They know more than you do (debatable) and are better at their job than you are (extremely debatable), and are determined to let you know it every single time you two work together. It's wearing and exhausting to have to listen to unsolicited advice when you're trying to get something done, and a lot of what the Know-It-All does involves criticizing (ever so subtly!) the people who taught you how to do those things in the first place.

How To Deal With Bully Number One: Speak Up.

This is the hardest sort of bully to work with, though he's often the least damaging to you personally and professionally. Bullies in general are easily recognized by other people that you work with; it's likely that this guy has a reputation that preceeds him. Still, he can make you (meaning me) freeze up and screw little things up when he's got you under the microscope, no matter how much experience you've got.

Therefore, the only way to handle such a person is to be frank. You have to tell them--sometimes repeatedly, in a variety of situations--that you're doing fine, thanks, that yes, you understand that X, Y, and Z lead to Q, and that the way you're running that line is just fine with your preceptor, manager, and the attending.

Doing it respectfully is the key. Doing it without losing your temper is critical.

Oh, and by the way: Never, ever, ever ask this type of person for help. They'll likely defer to the patient care aid, the charge nurse, or Santa Claus before actually being useful.

Bully Number Two: It's a bird! It's a plane! No, it's Off-The-Handle Man (or Woman)!!

This sort of person can be nurse, doctor, or aid. Or respiratory therapist or X-ray person or whatever. The thing that distinguishes this sort of bully is that everything will be fine for some time.....when suddenly, they'll blow up at you over a situation or problem over which you either have no control or weren't involved in in the first place.

There's usually shouting involved. There's also usually hand-flapping, eye-rolling, and perhaps some loose spittle here and there. It's scary and can be enraging, but like the Know-It-All, the actions of OTHM, while disturbing, really don't make much of a lasting difference to anybody.

How To Deal With Bully Number Two: Employ Heavy Weaponry.

This is another sort of situation you gotta deal with immediately. It's fresh in my mind because I just had a mild, drama-free showdown with our local OTHW the other day, and here's what I did:

I waited as calmly as possible until she finished screeching, and then I said, "There's obviously a problem here. Let's take it to Boss Lady as soon as she gets in."

OTHW backed down immediately, saying that oh, no, that's not necessary, but--and here's where the heavy weaponry part kicks in--I would not let her off the hook. She'd yelled at me for something completely beyond my control, made some remarks about my parentage and my personality into the bargain, and scared hell out of a student I was precepting.

So in the morning, off we went to see Boss Lady. As we walked into her office, I said, "OTHW got very upset with me this morning, and so we need a mediator. I'll let her talk first." And then I sat down and made myself comfortable while she ranted.

This is, again, crucial: you must let the nutjob spew gaskets and bolts all over before you respond in a reasoned, logical manner. Not only will it make you look like a fair person, but it's golden for getting your point across in such a way that showcases the other person's wackiness.

Not only, then, do you show your boss where the problem is, but you do something equally important: you let OTHperson know that you are on it, you are down with it, and you are not afraid to bring it to their doorstep (as the kids say). Not being intimidated is what makes these bullies leave you alone.

And finally, Bully Number Three: She Who Must Not Be Named.

I have no good name for this person. If there's a nurse that eats her young, this is the one: passive-aggressive, condescending, subtly critical, and prone to complain about other nurses to residents and attendings. This is the bully that you have to watch out for, as she can be damaging to your reputation as a nurse and your standing with your boss and the people who aren't there all day (like doctors).

How To Deal With Bully Number Three: Get Ready For The Long Haul

Unfortunately, like all things toxic and explosive, this person is the hardest sort of workplace bully to handle. You can go about it two ways: ignore what's happening and just keep your head down, or write everything down and make a near-Federal case of it when you have enough evidence.

You know how everybody always tells you, "Write everything down", right? Well, it's true: it does give you ammunition when and if you want to confront SWMNBN in the boss's office. (Don't ever do it alone, without a senior person there. That way lieth disaster, verily.) You'll need to be as careful at recording what she says or does as you would be in documenting the care of a very ill patient with litigation-happy family: that's the only way to keep yourself from becoming mired in she-said/he-said Hell.

Try to mitigate this person's actions and words by forging close relationships with the doctors and nurses (and everybody else) you work with. In dealing with our unit's SWMNBN, the reputation that I've developed--carefully and consciously--over the last eight years has been invaluable. You may not have that depth of experience, but it's never a bad time to start building respectful, open relationships with your peers.

And, if it comes to the point that you have to say something to your boss (it might not; often this bully's teeth are pulled when you ignore her or him), it's usually best to meet alone with the boss and show them the evidence you've compiled, then let him or her take it from there. The more ammunition you have, the better--and the higher quality ammo you've got, the better. If a doc reports that SWMNBN told her that you'd not done some vital thing, ask the doc to write that down for you, and keep it with your other documentation.

I wish you luck in dealing with this particular bully. I was fortunate that, when my unit's bully complained to an attending about the care I supposedly hadn't given a patient, she chose an attending with whom I'd just discussed that care, and with whom I have an excellent working relationship. The doc basically nipped that particular bitch in the bud, and I've had no problems since, but it was pure chance that it happened that way.

Tell your fellow Faithful Minions and any new Minions out there how you deal with bullies in the comments, please. And thank you.

Well, that was an interesting phone call.

Dear Doctor Dipwad:

If I call you several times in the course of a night, warning you about subtle neurological changes that your patient is having, please don't blow me off.

Because, if you do, I will be forced to call your attending at oh-damn-thirty and let him know that the subtle changes you blew off have become something truly horrible. By that time, of course, the patient will be already on the way for a stat scan, and I will have alerted surgery. 'Cause I'm good like that.

So when your patient (whose changes you ignored) is going to surgery for an emergency skull-chop, and your attending isn't happy about that, and I'm running mannitol much faster than it probably ought to be run, and there are intubation trays all over the place, just remember: dealing with it now means you'll have less to deal with later.

And, dear Doctor, once it's been established that you were indeed a Dipwad about things, please please please don't try to blame it on me. Don't tell your attending that I didn't notify you when things started to go pear-shaped. Don't tell my boss that I failed to catch the subtle changes that I called you about four different times. There's this little thing called charting that I do that will put paid to your story. Also, the page operator has a computerized record of all the times that I tried to make you see reason.

All that being a further Dipwad will do is make my boss call me in the middle of a nap to make sure it's okay that she accesses my charting. I'll say it's fine, and you'll be sitting there in a conference room with my boss and *your* boss, and I'll be on speakerphone, and then things will begin to get very depressing for you.

I'm just sayin'. You interrupted my nap like I interrupted yours, but the consequences were very, very different.

(The patient will be fine, by the way.)

Carnival of Crackpots!

Once, many years ago, I read a book called Letters to Ms. It had selections from the first ten years of the magazine's editorial letters, divided into sections like "Praise", "Criticism" and "Crackpots". In the introduction, the editor told the story of how Gloria Steinem once got a postcard accusing her of being a "Commie witch bitch lesbo...who sleeps with n$#*%*#s. Isn't that just like a Jew?" Ms. Steinem reportedly pinned the postcard up in her office to remind her of what she was doing right.

May got an interesting comment the other day about how female nurses are perverts who grope unconscious male patients. It was, of course, in all caps. No other content, either; apparently the crackpot who sent that one in had only that to say.

And I get the occasional crackpot as well. It's not enough that people post bizarre two- or three-word comments ("Obama Sucks!" "Clinton Kills Babies!" "Repent or DIE!"); sometimes they send me emails, too. The most recent one was a Photoshopped picture of Obama shining Sarah Palin's shoes. Lovely. 

Then there was the long, ambitious screed about how nurses these days look totally unprofessional in scrubs and should wear dresses and pumps instead, with white stockings. If the guy (yes, it was a guy) writing had stopped there, it wouldn't have reached Crackpot status, but he continued rambling, working in Feminazis and lesbians and the death of American society and how we were all going to burn when the Second Coming finally shows up, and how if men would only take back their rightful place in society, things would get considerably better, what with the Blacks and Jews and Wimmins knowing their place again, and all had gone wrong because nurses now wear pants.

Paragraph breaks, people. Paragraph breaks. Just because you're insane doesn't mean you should ignore the rules of composition.

And, of course, I get the occasional Crap Email From A Dude (Jezebel FTW), usually somebody who is or claims to be a third- or fourth-year medical student or a first-year resident, about how much nurses in general and I in particular suck. Mostly those are over-written, longish screeds that have a high syllable-to-content ratio. Only once has one been even vaguely threatening, and that poor sot wrote from his school address. With his actual name attached. And all the ISP information there, too. 

*sigh* What is it with kids these days? Back when *I* was writing veiled threats in email, I not only was grateful to be able to do it on a greenscale screen, but I knew enough to use a Web-based email anonymizer.

Overall, I would say that the male-to-female ratio of Crackpots is four or five to one. The men are more concerned with me being a ball-busting feminazi bitch who castrates the decent, hardworking men she runs across (actual quote!) or my refusal to fit into their stereotype of nurse-as-handmaiden and tend therefore to be more openly offensive. The few female practitioners of Crackpottery are much, much more worried about the state of my eternal soul and whether or not, with my attitude, I'll ever find a nice (presumably uncastrated; won't that be a surprise to ChefBoy) man to marry. Once in a while they send things that play music and show fluttering putti or cherubs or whatever when you open them, then cause my virus-snagger to go nuts.

There are a lot of really, really cool emails too. The vast majority of emails I get are from people who were either students or new nurses when I started blogging, or who went back to school in part (so they say) because of what I've written here. That warms the cockles of my hard, blackened, castrating feminazi heart. Or it would, if I hadn't already given it to Satan to show my allegiance (actual quote!)

I'll just keep deleting the nasties and keeping the nice ones for now. Meanwhile, I'm off to make a big ol' pan of macaroni and cheese and some tasty castrated-male soup with a side of shredded nurse caps. Yum!