clearing toxicity: scenarios, insights, and reflections
2.1 The Battle of Degrees
scenario
Rosemary is right out of college and proud of the BSN she earned through hard work, perseverance, and encouragement from her parents, who took out several loans to finance her education. Her first job is on a post-surgical floor at General Hospital, where most of her coworkers are older and long-term employees at the institution.
Rosemary is the newest nurse on the unit. During orientation, her preceptor, Eilene, comments frequently on the differences between a nurse with an associate degree and one with a BSN.
“Why go to school for so long?” she asks Rosemary in front of a group of nurses. “I have an AD and I’ve done just fine. They ought to just grandfather us in.”
“That’s right,” another nurse with the same background adds. “Forget all this encouragement to get a four-year degree. We know just as much as they do.”
Rosemary begins to feel targeted by comments from Eilene and other coworkers. She questions whether she really did make the right choice in obtaining a four-year degree and becomes anxious about her performance.
nurse leader insight
I would start by having a conversation with Rosemary to explain why some of the older nurses are feeling this way. They aren’t really targeting her personally, but it’s a reflection of a lack of understanding on their part.
To a degree, there is some validity to what Eilene and the other nurses are saying. Initially, there is a basic understanding common to BSN and AD nurses. What Rosemary needs to keep in the back of her mind is that over time her ability to think and see beyond the basic technical functions will become evident.
It may also be a lack of exposure to nurses with advanced degrees that makes the other nurses feel as if there is no difference. Rosemary needs to value the experience of her new coworkers but also remember that she brings a piece to this work environment that they do not have. The nurse manager needs to tell them the new nurse might have something to teach them, too.
The other thing the nurse manager might want to do is have a conversation with all the older nurses (including the preceptor) and let them know that while they are valued for their experience, they need to remember this is a new nurse, and they were new nurses at one time, too. They need to guide and support her in the way they wanted to be.
A general rule is, don’t judge a person by initials at the end of the name.
–Kathy Curci
The topic of ADN versus BSN nurses is a “great debate” among many. Unfortunately, the mere mention of this topic to two or more nurses will likely end in a heated discussion. Arguably, there are many pros and cons of various entry-level options in the nursing profession. Despite some program differences, both ADN and BSN graduates sit for the NCLEX-RN exam and are held to the same rigid standards for licensure and practice. The caveat to this scenario is that seasoned ADN nurses, such as Eilene and her colleagues, may feel threatened by this push for higher education in nursing because many organizations now hire or promote only BSN-prepared RNs. Obtaining a BSN is admirable and offers many pros such as job security, research-/evidenced-based practice concepts, and an overall broad knowledge base. As many healthcare organizations are in a quest for Magnet® designation, one mandate is the percentage of nurses who must hold a BSN in that organization. The BSN also provides students with an introduction to research and how to apply evidenced-based practice to nursing care. Having extensive courses in psychology or other humanities also brings the BSN-prepared nurse an eclectic knowledge base, which will help strengthen critical-thinking skills. This is not to say the ADN does not have these attributes. The ADN may indeed have acquired this through self-learned practice and continuing education. However, in the era of “proving oneself,” the lack of such a degree unfortunately supersedes one’s credibility.
Rosemary, the new BSN, is now faced with trying to defend her degree while preserving her preceptor’s dignity and credentials. The last thing Rosemary wants to do is damage her relationship with her colleagues or appear to be better positioned in the organization due to her higher degree. It may benefit Rosemary to acknowledge both the pros and cons of her degree to avoid undermining or overrating herself. Sharing her feelings and concerns with her mentors may be the best remedy to an awkward situation. For example, Rosemary could state that while she is proud of her degree and looks forward to sharing her knowledge to help move the unit forward, she is really eager to learn and grow from practical experiences set forth by Eilene and her other colleagues. New BSN graduates need to position themselves as confident in their educational pathways yet very curious in the quest to learn from those senior to them, regardless of degree. Working toward a “team approach” rather than a “me approach” is the key to overcoming degree dichotomies. Both seasoned and unseasoned RNs have opportunities to learn from one another.
–Cheri Clancy
reflections
How do you handle a mix of educational backgrounds on your unit? When there’s tension between different subgroups of nurses, are you inadvertently drawn into supporting the ones who are most like you or most like your own background?
Do you believe there is a difference between nurses with two, three, or four years of education? How do you, as a leader, adjust your style to address these differences, if at all?
2.2 The Right Kind of Experience
scenario
Coretta is eager to succeed at her first job in the OR—a position she has dreamed of since she first entered nursing school. She has gone through orientation and is now working as a “real” nurse after passing her boards.
As a student, Coretta did a review of the literature on handwashing procedures used in the OR for one of her classes and got an A from her professor. During her first month on the job, she makes some
subtle suggestions to her coworkers, based on what she learned from the research for her paper.
“Are you kidding?” responds Helen, who has worked as an OR nurse for 25 years. “Is that what they teach you in college? Wait until you have some experience under your belt, and then you can give other people advice.”
From that point on, Coretta is labeled a “know-nothing” nurse. Every time she questions why a procedure is done a certain way, her coworkers roll their eyes. At her first evaluation, her nurse manager suggests that Coretta should focus on learning from her more experienced coworkers.
Coretta emails one of her professors and tells her about the situation: “I feel like all my classes count for nothing! Maybe nursing isn’t the right profession for me.”
nurse leader insight
I think that the nurse manager really needs to step in here. This is a learning opportunity for Coretta. Coretta may need to time things differently and wait until she is there longer. She could be guided to build a relationship and earn respect before she suggests that they could do things better.
It’s not clear why Coretta would expect things to be any different. She needs to respect the fact that the unit has their own way of doing things that have been in place for a long time. They may even have ways that are more effective. Just because something is in the literature doesn’t necessarily mean that it’s practical and works with real patients or for a particular unit. I tell my students, “Your patient didn’t read the literature.”
I would probably take a step back and say something to the older nurses to prevent a divide, too. Coretta is making suggestions in an effort to help, not to suggest she knows more than the other nurses. Her motives are genuine. All of us