Why Are Nurses Still Bullying Each Other? Let’s Talk Toxic Nursing Culture (With Jeri Ford and Danielle Palomares)

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This week's episode we are diving into a very hot topic right now and something that I personally feel should be covered way more in nursing school because it's so prevalent and affects us every single day and this is how to deal with toxic co-workers in Nurse Belize. For those who don't remember, I have been a pediatric nurse for almost 13 years now, which I can't even believe saying that sometimes. Ten of those years I was a travel nurse which means that I have worked with all types of personalities all over the country. I've worked with many specialties within pediatrics like clinics, inpatient floor, step down units. I'm now in the PICU ICU. I've floated to countless other units like CT ICU for pediatrics of course, ER. I've just worked in a plethora of units and I have experienced all types of personalities and so I have many stories and I've seen firsthand many accounts as well. But even after these 13 years I still feel like my ability to confront these types of personalities could definitely use some improvement and that's why I'm super excited to welcome back my favorite nurse therapist Danielle Palomare. Danielle, can you remind our listeners a little bit about you and your expertise? Yes, hi, Jerry. Thank you for having me back. I am Danielle Palomare. I am a trauma attachment and sex therapist that works with a lot of healthcare providers and especially nurses and physicians. And I am just really excited to talk about this because this has been coming up over and over in sessions lately. And I remember when we were talking about like what to what you have been seeing you mentioned this and I'm like oh my gosh this is something that I feel like like I said I feel like nursing school should come that's how important it seems like to me because that's how prevalent it is which as I was like researching for this article I did find some notes. It says there is an article that I found on NIH and I'm just going to read the quote really quick because I found it so interesting. It says nurse bullying is a systemic pervasive problem that begins well before nursing school and continues throughout a nurse's career. A significant percentage of nurses leave their first job due to the negative behaviors of their co-workers and bullying is likely to exacerbate the growing nurse shortage. A bullying culture contributes to a poor nurse work environment increased risk to patients, lower patient satisfaction scores and a greater nurse turnover which cost the average hospital four million to seven million dollars a year which was crazy and you would think that out of nurse CEOs would be hearing this and be like we got to do something about this. The other thing I saw to the other staff that they said was within the first six months of post-graduation 60% of nurses leave their first job due to the behavior of their co-workers that shocked me. It didn't shock me that it happened. It shocked me that 60% will leave their first job. That's to me astronomical and not okay. It seems like the concept of nurse bullying seems foreign to those outside community because their nurses are amazing. How could they have bullies? How could this really actually be happening? It's probably not even that bad. But nurses are human, physicians are human, techs are human, and humans come in all forms and all all humans have good and bad moments. So because of that, it unfortunately is a very real thing in the industry as I'm sure you've seen a million times yourself. Yeah, yeah. It is unfortunately common. I think the hierarchal nature of so many hospital systems unfortunately like set the stage for this as well. So I guess to get started because there's so much to talk about in so many stories, I feel like they're just like coming in my head even more than the ones I already wrote down in my notes. But do you see, so you already mentioned this a little bit, but do you see this often in the nurses that you work with? Oh yeah. And I think what I'm noticing lately is I'm seeing it more from nurses that are kind of freshly entering the field. Like a huge shock of like what is going on? I feel like I'm being hazed. Like that word keeps coming up and you know over and over again, I feel like I'm experiencing hazing. Like this person's out to get me and I'm not sure if it's in my mind. If I'm making it up, maybe I need to toughen up, but just a lot of self-doubt, a lot of self-almost like gaslighting of their experiences. But when we really look at it, yeah, like there are behaviors and there are things that nurses are telling me that are just really unfortunate and really toxic. It's interesting that you said the new thing too, just because I am not new, however, I'm newly in the ICU role, new-ish like a year or so. And then of course, floated before to different ICU, but that's not quite the same as starting fresh. And I definitely feel that way now. I'm like, this is a whole other world, which I can give that into a little bit, but it's interesting you when you're in that new role, I feel like you're more prone to. Yeah, I have. And I'm totally and I'm seeing it a lot with transitions. So transitioning into new systems, into new departments, yeah, like I think it's more common to see that, you know, when you are switching up roles. Right. So I guess why big picture starting, like why do you think that, I guess that's a ploy loaded question, but why do you think that that is? Why do you think the medical world, because I know it's not just nursing, it's the medical world in general. Yeah. Why do you think that that has like this toxic environment sometimes? Yeah. So I think this is a really layered question. We could probably do another podcast on this, but I think if I had to whittle it down, I think that on a macro level, what I've observed, both from caring on a personal level for, you know, hospitalists and a lot of healthcare workers, but also in my practice is that the hierarchal nature itself of the healthcare world makes it really easy for there to be abuses of power because there are power dynamics that are supported by the system. And it's tricky because these hierarchies exist for also a reason and often a really valid and good reason, but it can be very insidious. It can be easy for people to take advantage of those hierarchies by abusing the power. So that's one part of it. You know, I feel like that's probably the like the biggest overarching, like totally, like the biggest thing. And like I love that you pointed out to like that they're ins, these are hierarchies are sort of are, I don't know if the word is needed, but they're in place for almost a reason in the sense that there has to be the one person that makes the call at the end of the day and not a million people. It's like a doctor or the charge nurse or things like that. And then because that's the way that it's set up and the way that it's needed, it does lead to that's interesting. I've actually never thought about it that way, but we do sort of need that structure in the setting when it comes down to it. Interesting. Right, but it can be easy for certain personalities when they land in those positions. And I hear more of like, I mean, frankly bullying from like charge nurses, like that's what I'm hearing a lot is like, you know, younger nurses or nurses that are transitioned into a new role, a new environment, and they're like, oh my gosh, I feel like the charge nurse is out to get me. And it's really tough because there's a natural again, this hierarchy. Right. I also feel like, and I think that's something we touched on to like the generational thing is also is also big. And then I feel like Gen Z, which is wonderful. I love them for this. They're kind of coming in and being like, I hate this. This is we got to change this, but then the people who have been in our war are still like, no, this is how we do it. Yeah. Yeah. Well, I think we see this a lot in all sorts of places in our society of like folks that have endured and been through a lot really feeling like, well, you also need to endure and go through a lot. Yes. Right. Like I had to live through this. I suffered and experienced the pain you got to do it to. Oh my gosh. I catch myself and I I in the biggest proponent for being young to or nice to our sweet little young and but I catch myself sometimes when I hear them being like, this is it. I'm like, this is the way that you know, buckle up, sweetheart. Like I find myself thinking that sometimes and I need to like catch myself, you know. Yeah. And I think it's tricky. Like there's a nuance to this conversation. There's a both in an end because I do think that depending on subspecialty and like what you're dealing with on the day to day, there is a real need to also be able to compartmentalize and have a thick skin and get it done and focus on patient care. But again, it can be that the power differentials can really create an environment where if you are underneath someone that is really kind of toxic, right? And kind of almost thrives off of feeling in control and in power. It can be really unsafe. And I almost wonder if some people don't really know that that's something within them until they get into these roles of power. And then they're like, and then maybe, you know, maybe I'm not sure. I also have noticed to Why do you think that there's, I'm sure it's maybe hard to answer, but different personalities or different reasons that this happens within roles or units or specialty? Yeah, so it's, and I think we were talking about this earlier. I'm always really nervous to sort of say that there are certain like tendencies in certain roles. But of course, I mean, there are, right? Like, you know, we can say this even for therapists, like a lot of therapists are attracted to the fields and becoming helpers because they themselves know what it's like to have needed help and to have leaned out and reached out and seen how powerful that is. And so a lot of people find themselves doing this work because they also have had their own lived histories, whether it's like they want to be caretakers or if they end up in a position for example, they are a charge nurse or they are the attending at the end of the line. There may be something about their personality that really feels safe and in control and powerful by having that position, right? So you can imagine how this could attract though at the same time, people that are using that position in the workplace to kind of make up for internal deficits deep down, which is why we sometimes hear this like adage of surgeons kind of getting, you know, like so many surgeons have narcissistic personality disorder. That's a really common one, right? You know, and so while we don't want to have such binary and judgmental, you know, we don't want to throw those labels like, you know, like that. At the same time, there are some pieces to this, you know, folks that have not processed certain things. Right. Man, I want to add that to, like when we come like later, I want to remember to talk about that or just now like to remember that. I'm thinking of that for myself too. Like when when I'm feeling that in the moment or when I feel like I'm being quote, "haste" or bullied or maybe not even that severe, but just their energy is off towards me because I'm the new person or they don't trust me yet or I don't really know what it is like, but to try to think of it's just like really an issue with them and is an issue necessarily, but something they're going on like that's going on in there as I feel like that's maybe a helpful way to try to reframe it when you're in the moment maybe too. Yeah. Yeah. Definitely. This is one of the kind of strategies that hopefully we can talk about, you know. And then I also, the piece too, I think, you know, would be, you know, we have to talk about trauma, right? So I think so so much of the bullying and the toxicity is supported because a lot of healthcare workers are traumatized. They might not know it. Like we talked about this in the Vicarious Trauma episode. Yes, which I think you guys should go listen to that. Yeah, but there's rampant, rampant, Vicarious Trauma people are dysregulated and we don't use our highest most sophisticated skills when we are dysregulated as well. Yeah. On top of that, like the trauma, but I know we talked about too, like high stress, long work hours. Like I feel like these are all things that even maybe someone who I just my example earlier when I feel like I do have a younger person and my first thing is to be like buckle up honey like this is how it is. I am only at that point when I have had like a terrible day and then they're saying something like that or you know things like that. So I think that like the high stress, the long hours that just exhaustion, the trauma, maybe like will make someone react like this when maybe it's not innately in their nature at first and then they just yeah, they're under stress basically. For sure. And what I'm hearing you name is a version of compassion fatigue, like kind of an empathy fatigue, right? Like buckle up. Yeah, no, we're going to be seeing patient after patient suffering today. Like get over it. Yeah, let's get it together. Yeah. Yeah, I'm really hard to be mindful of it, but right, like exactly like you said when you're like under these high pressure things, there's I mean, it's you know how the time to sit and be mindful. So right. Maybe that's coming from that perspective too. Interesting. I also wanted to point out too because I feel like what you just said is you're seeing this more in new nurses and I have noticed personally within myself, but also just observation of other things that I feel like this starts a lot in preceptorship, but I don't know if you've heard. I know that charge nurses is a huge thing, but I also have heard it within people feeling this with their or their preceptor. The person who's supposed to be teaching them, learning them or making them helping them grow. And I have just seen it personally, a maker break a nurse's confidence, their ability to trust themselves starts within that for because you know, everyone listening to this knows and I'm sure within your field too, nursing school doesn't teach us really what we actually need to know. We got the basics. The learning is going to happen the second you hit that floor and if you are with someone who is a nurse bully and who looks down upon you for not knowing things when you're there to learn the things, it sets up this thing. And I've just I've seen that so many times and I think that's something that we don't have time to talk about probably on this podcast, but as a as a career and a profession, we really need to stop putting these people in charge of growing our new nurses. If they have a history of being this way or former complaints, the other side of that is that typically the ones who are bullying are the ones who have been on the units the longest so they probably are precepting. So it's kind of like a catch 22 there for sure. Hey nurses, looking for exclusive discounts. Nurse.org has you covered deals on everything. Save big on the essentials you need to excel in your career. Don't miss out. Visit nurse.org/discounts for the latest discounts made just for you. Well, it's interesting because I experienced this even as a therapist and I had my own biases coming into the field of like, oh my gosh, being a therapist, all the supervisors that I work for are going to be safe. Right? Like they're going to be especially if they're like a trauma-informed supervisor. Surprise, surprise. That's not the case. I ran into a lot of very unsafe people and you hear rampant stories and that's in therapy. So you can imagine in nursing where there's even less focus on one's nervous system, right? The psychological, the relational. Of course, of course, we're going to have mentors that are not mentoring in a way that's actually effective, right? And what I mean by that is effective in helping their nurses be regulated and kind of in that wise energy so that they can make the best decisions. When we shame people, when we bully people, we're contributing to their dysregulation. And when people are dysregulated, they are going to make more mistakes, right? Very much so. Yeah. Yeah. I mean, even within me, I've been a nurse 13 years almost. And starting ICU, I just remember I was this was kind of recently I'll share this story. It was I wasn't even underpriced. I'm off orientation. I'm my own nurse, but it's this one particular nurse who still knows and I'm new with an ICU role. And I was giving some bolus off a pump and she just I wish I could remember specifically the way she's saying it, but she was asking me because in pediatrics, we do everything based on kilograms the way how they way. She was asking me what's the dose based on kilos. I kept telling her the dose based on not and she she said, what is it? What is it in kilos? And she the way she was saying it. And I'm like, I know what I'm talking about. And I knew my patient like the back in my hand, but when someone comes at you in that way, it shuts me down. And so in that moment, I felt like I even looked dumber than she already clearly thought I was when really that's not the case. It's just the way that she was coming at me was like, just shut me down completely. And I feel like I'm okay. I'm a good nurse and I'm confident within myself, but that's the only situation was only okay because I am confident now. Like if we're doing that to our new grad nurses, I can't even. I mean, there's no wonder they're walking out 60% of them are leaving. You know, that's crazy. Well, yeah. I think what you just mentioned brings up the adage that I often share to a lot of my couples actually, which is tone Trump's message. Yes. Right? But tone is also really difficult to call out. So if you are experiencing, you know, workplace bullying or these kinds of aggressive, it can be difficult to call it out because the person can easily just say, what I was just asking for the information. Right? But you felt that tone and the way it was said, and it was said in such a way that sparked something in you, which is I kind of heard you say, I felt like I was dumb. It made me feel small, right? Yes. And then you notice that your own pattern when that hits you and that hits that part of self is to like clam up withdraw. So right. Makes sense. And that was inside. That was a side that I've never even seen of myself. I feel like if I have coworkers listening to this or the ones that were working the past would be like, you, you shut down. Like are you kidding me? Because that is not I'll go toe to toe with people usually, but it was just something about that. And I'm like, and I really made me be like, wow, we cannot do this to our sweet little baby nurses because yeah, they'll never stay. Yeah, truly. Anyway, okay. So I feel like that's we've listed so many things and I feel like all of them play an equally important role and sort of the way that we've got to this, the where we are in the state of healthcare right now and the way it has been. I'm hopeful that Gen Z will get us more aware of these things. I think that that they have a special unique thing that they're doing with certain things and talking about feelings. And I hope that that brings some awareness to what's going on. I guess we sort of talked about this to one question I had for you. What are some common themes that you see within nurses specifically? I do think you mentioned like like the charge nurses, the preceptors. Do you see a lot of issues with nursing physicians necessarily? - Yeah, I think that, so a couple of things, I do think overall, if I really zoom out and think about all the folks I've supported, I would say physicians often have a much stronger, I'm gonna use some parts language, like therapy language, but like protective parts that are really, really good at staying zipped up. - Okay. - Right? - So like, what I mean by that is there might be a tornado going on on the inside, but they are really good at not showing it. And it causes distress behind the scenes. We don't necessarily see it, but one of the most common things physicians tell me in my office is, I must be the only person experiencing this. It's not in my attending friends seem to be having this issue. And yet all their attending friends are in my office saying the same thing. So they're zipped up. Whereas I do think maybe nurses, I notice have a little bit more accessibility sometimes to their emotional world, or they feel a little bit less clamped up and compartmentalized. So sometimes they can spill over and come in and be like, "Gosh, I got dysregulated during my shift last night." - Right. - Right. And so that's like one theme I noticed, but it's nuanced. - Right. - That's good. I feel like that's good of us to be able to, at least be able to like put a name to the feeling or at least be getting better or trying to work towards that. But you did mention, I don't know if this, I don't know if this is still the case, or I remember when we first talked to you, mentioned that nurses are the hardest ones to consistently show up to therapy. Is that still true? (laughs) - Yes, unfortunately. - And you know, I have to give nurses a lot of credit. A lot of the tests to do again with like, being shift workers and it can be difficult to find the scheduling. They're also exhausted. Whereas physicians that maybe have like a more standard clinic, or you know, they only have 12 service blocks a year. It can be easier for them to actually make it to therapy. So that is a really big, I think, factor and barrier. But also, I do think that there is just a certain kind of a different ethos. Like I noticed physicians are like, I'm gonna come in and I'm gonna tackle this therapy thing. I'm gonna be really good at this. Like, and so they're like kind of determined. - So they wanna be good at everything, right? - Right. - I notice nurses, and because so many of the nurses I support are already coming in and are feeling a little bit more unraveled to begin with, right? That it can be really scary to do the kinds of therapy that I specifically specialize in, which is more of the duct work and more experiential processing deeper things. And a lot of nurses tell me, I wanna do this work, but I also don't want to become dysregulated because I am already on thin ice. And so that's what's hard is that the process is slow and it takes a long time actually, 'cause we don't want nurses to feel flooded by the therapeutic process and unable to do their jobs. - Yeah, I could see that. I could really see that being a big thing. - So I'm really used to nurses disappearing on me, all this was made. Like we'll do some really great work for a few months. We'll start getting deep. You know, we've done a lot of work to help them contain so they can still show up to their shifts. And then all of a sudden I won't hear from them. That is very common with my nurses. - They come back, they come back. - Okay, I'm like wiping it sweat off my brow because I did that. I mean, I wasn't going to, I was going for relational relationship type things when I went to therapy, but I also totally ghosted her. Yeah, so I'm like, guilty is charged. - Yeah. - Interesting. Okay, so little advice, if that's something you've done or you've thought about maybe if you're feeling overwhelmed, like pull it back a little bit or show up but go like more or less or something, what would you say to them? - Yeah, I would just say that, you know, try to find a therapist that's ideally really, really trauma informed so that they can really center the importance of going slow, nervous system regulation, and then also buckling up because the challenge is so many people want to come into therapy and they think, "Okay, I'm going to go in for some quick tips and tricks and coping skills, right?" Like more CBT style, like talk therapy. But the reality is a lot of times the things that are triggering nurses run deep. They run deep, they're views of self and views of others. My needs don't matter. I'm not good enough. No one's ever seen me. And that is really what's getting activated on a very subconscious level by these toxic colleagues. And so that takes time to process. We can't do that overnight and it's going to be longitude and all and it's going to take frankly years in some cases depending on the level of trauma that folks are showing up with. - Mm-hmm. Yeah, I can completely see how that would, they think they're signing up for one thing and then they get into it and they're like, "Oh, never mind." - Right. - And then it's overwhelming so they bail. So I have a lot of empathy for that. - Right. And so sort of along those lines, something else I was wondering too or what are some like physical signs? I think this probably hard a little bit. Physical and mental wellbeing, like effects of working in these environments that you've seen in your practice. - Yeah, yeah, it's interesting. I literally had a session last night with a healthcare worker who came in and they were like, "I had a headache all week since our last EMDR session." We really pulled up a lot of things and then we did more processing and by the end of the session they said, "Okay, that headache is gone. I feel relief." So there are real connections and I know that this can feel woo-woo and for some people that are in the healthcare, I get a lot of rolled eyes sometimes. But of course, there is a connection between the physical manifestation of emotion and distress and dysregulation and what's going on up here, right? - I am hoping that it's 2025 and us and the medical field can finally start admitting that they're absolutely-- - Of course. - It's a deep tie, yeah, to mental and physical, for sure. - So to answer your question in short, sleep disturbance says, feeling wound up and unable to relax once you aren't in a calm environment, right? Feeling a lot of rumination. So the toxic workplace specific to this, a ton of rumination. Like I cannot stop thinking about this comment that the charge nurse made last week. You might notice depression. You might notice that when you get off work, you just want to dissociate and binge watch shows or social media. So those are a few things that you might start to notice. - Guilty is charged on the binge watching in the social media, for sure. - Yeah. - For sure. I also know that I've just noticed 'cause I've trying to be more aware. I've 13 years in and I'm just now trying to be more aware, but I have also noticed that I feel like GI symptoms hurt me personally a lot too. Like what I know that I'm working with a certain person, even recently, even with this transition into the pick you, I feel nauseous. - Mm-hmm. - And I'm like, "God, I guess I guess I'll have myself." I'm like, "I need to snap out of it. It's not this bad." - Yeah, but yeah, I can see that. And I always think if I'm feeling like this, I just can't even imagine what the new nurses are the ones who don't have that confidence built up or feeling. - Oh yeah. GI issues are huge, as well as tightness and chest, shortness of breath, feeling shaky. Those are really common ones as well on a physical level. And then I feel like every episode we mentioned this book, but the book, "Trauma Stewardship" that you shared with me. I finally, since last time we spoke, I finished it. It's wonderful. It's by Laura Van der Nute-Lipski. There's a quote I just wanted to read that says, "Goli Jansen, an associate professor at Eastern Washington University recently concluded a study in which she found that quote, "When people perceive their organizations to be supportive, they experience lower levels of Vicarious trauma." Which you would think, of course, but that's like, there's studies on this. Like there's studies that if you are surrounded by support and things like that, that you are gonna be less traumatized in general, especially career wise, I just think that's important. And I just really hope that more organizations kind of take this bullying thing more seriously. - Yeah. Yeah, and unfortunately, when I was doing my own research on this, I was looking just kind of anecdotally on what people were posting on social media. And I saw so many videos of nurses talking about how they took steps to try to advocate for themselves 'cause they were in unsafe or abusive positions and they were punished. They were reprimanded by HR. And so yes, to your point, it is really difficult. You can't really outrun toxic systems on your own. Like these are systemic issues. - So sad, we're like, have to wrap up on time 'cause we could talk about this probably for so long, especially with all the stories and things. I guess I just wanted to say a little note that nurses are the only ones who understand what other nurses are going through. All we have is each other. We deal with more sadness and grief than the average career, the average person and our job is tough enough, not to mention the fact that it feels like there is a news article every single week about violence against nurses, which is an entire other episode in podcast. It's a violence against healthcare workers and almost every scenario that I read, who is there with for each other when that happens? It's your coworkers, your other nurses. That's who's there for you. The last thing we need is to be against each other. So when stuff hits the fan, you need each other and I promise you being the nurse bully will not earn you the respect that you're seeking in the long run. So I feel like communicating effectively, have each other's back, support one another, that's just what we do. need to do. And anyway, I hope this episode helped people. If anyone feels any more help or want to talk about it more or want to reach out to you, Danielle, where can they find you? Yeah, they can find me over on my website, Danielle, Polymaris.com or on social media, Danielle Polymaris, MFT. Amazing. So I hope you guys like this episode. Please take a moment to rate this podcast. If you haven't, write a review, leave a comment. If you liked it, what you found helpful or maybe even if you didn't, again, my name is Jerry Ford and you can find me on Instagram @JerryLynn_89 or you can find me on the nurse.org website. And that's it. Thank you so much. And thank you again, Danielle. This was wonderful. Oh, thank you so much, Jerry. It's been a pleasure. Bye, everybody. Thanks for joining Nurse Converses brought to you by Nurse.org. Help us grow by leaving a five-star rating and review on your favorite podcast platform. Nurse.org supports nurses with career and education tips, life advice and breaking news. Thank you for all you do and for being you.