By
Jan Marie Graham and Nadine Smith
December 2020
Print Version
What you need to know
This study explored situations where Registered Nurses acted in accordance with the professional scope and role description, policy, and procedure but were perceived to be harsh, uncaring, or insensitive. Fourteen RNs from Manitoba shared stories of their challenges and experiences, coping strategies, and recommendations for change.
Why this research is important
This research provided an opportunity for participants to share their stories and identify strategies to improve the working environment for Registered Nurses in Manitoba.
How this research was conducted
This study used a qualitative exploratory approach based on phenomenology. Fourteen RNs were interviewed using a semi-structured questionnaire. Interview transcripts were analyzed and coded using NVIVO software.
What the researchers found
Participants shared experiences of when they felt they were judged as being harsh or uncaring. They provided examples such as setting limits and enforcing boundaries with clients and family members, providing negative feedback to students and sometimes failing them for unsafe practice, and following policies and directives from management. Participants explained why they acted the way they did in a particular situation as part of their nursing roles and responsibilities. Although there may have been discomfort, discontentment, and difficulties—at the end of the day—the participants advised that they were just doing their jobs in accordance with the scope of practice and organizational policies and procedures.
There were two themes that emerged from the interviews: (1) feeling judged and (2) system issues. Feeling judged related to the nurse’s image in terms of the public’s perspective and expectations of a ‘good nurse’ as well as the individual’s personal image and reputation. System issues were evident in relation to limited resources in health care, the availability and education of those in leadership and administrative positions, intraprofessional and interprofessional team issues, and nurse abuse.
Participants were asked how they coped with the difficult situations they had shared. Responses regarding coping and resilience were evident through the themes of reflective practice, knowing self, practicing self-care, having strong work and personal relationships, and seeking formal support and professional help.
Recommendations were sought from the participants and categorized into the following themes:
- Relational practice – This included the provision of client-centered care while ensuring that team members take care of each other with kindness, compassion, and acceptance.
- Talking it out – All participants discussed the importance of and need for opportunities to debrief.
- Leadership – Participants appreciated the complexity and scope of leadership roles but needed leaders to be present (available in the workplace), competent (provide education regarding leadership), and compassionate.
- Seek support – Participants described the need to seek formal and informal supports.
- Education – Several participants identified the need for education about conflict management, managing difficult people and situations, and how to have difficult conversations. Some also noted the need for ongoing education for the public regarding the role of the nurse.
How this research can be used
Recommendations are made regarding nursing practice, leadership, and education.
About the Researchers
Keywords
- image
- leadership
- nurse
- responsibilities
- roles
Editor: Christiane Ramsey
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