By Susie Branagan, BSN, RN
The person I was afraid of that night was a nurse.
At about two in the morning, she stood up and asked who wanted coffee.
She went around the station and got everybody. She asked the secretary. She asked the two nurses charting on the far side. She asked the aide who had just sat down for the first time in four hours. She asked me, and I declined, because I knew what she was about to do and I didn’t want to have any part of it. Then she picked up her badge and walked out.
Katie was still sitting six feet away at the computer station, she wasn’t asked if she wanted coffee and nobody said anything.
Katie was a nurse eleven weeks off orientation. She was quiet and she was careful and she wrote everything down, which is what good new nurses do and what nobody has the patience for at three in the morning. She was an excellent new graduate overall.
The nurse who left her out had been on that unit for 32 years. She had a buzz cut and forearms like a person who has turned patients her whole life, and she stood closer to people than people wanted her to stand. She was the most experienced clinician in the building on nights. She picked up more overtime than anyone. If you called out sick, she was the reason the unit still ran.
Everyone knew what she did to new grads. I knew before I ever worked with her, because somebody told me in the elevator on my first week, the way you get told which ice machine is broken.
Every time it came up the answer was the same sentence in slightly different clothing.
“She is too valuable.”
“She is the most experienced person we have.”
“We are short. Nobody picks up like she does.”
I have been a manager since then, and I understand the other half of that sentence better than I did standing at that station. Our manager was newer and timid. She did not receive a report from the retiring manager, there were no witness statements in this nurse’s file. No documented pattern with anybody’s name attached to it. Everything that happened, happened at night, in front of four people who were going to be working beside that nurse again on Thursday.
On nights there is no manager in the building. No HR, no educator, no director, nobody above the charge nurse until seven in the morning.
The quizzing started around one a.m.
She pulled her chair over so that she was beside Katie instead of across from her, close enough that Katie had to turn her whole body to answer. Then she started asking questions.
“What is a normal potassium?”
“What do you do at 6.2?”
“What is the reversal for heparin?”
“What is the reversal for warfarin, how fast can you push it?”
“What is the max dose and what happens if you exceed it?”
Every one of those is a thing you look up. That is the job. You look it up, because looking it up is how people do not die. But she was not asking so Katie would learn them. She was asking so that the four of us at that station would watch Katie not know.
She got louder as it went. Katie went red from her collarbones up. She kept saying I would look that up, and every time she said it, the nurse said something like:
“That is not going to help you when he is coding, is it?” and looked around the station to see who was listening.
I was listening. I had my eyes on my screen, and I was scrolling through a chart I had already read.
I did not laugh. I want to say that because it matters to me, and I also know that it is the smallest possible thing to be able to say. Nobody laughed. The problem was that four licensed adults sat inside eight feet of that and made themselves busy.
Then came the verbal bullying.
“Look at you, you are a baby! You know nothing! And you are going to regret how little experience you have.”
Katie did not cry at the station. She got up and she said she was going to go check on room fourteen and she walked down the hall, and she was gone long enough that I knew, and I stayed where I was.
We were cowards, some of us, some of the time, and that is not the whole of it. If I said something, it was me against her, by name, alone, at three in the morning, with nobody to confirm it, and then I worked beside her every third night for the rest of my time on that unit. If I wrote it up, it surfaced in daylight with my name on it and hers, and the answer was already prepared and had been for nineteen years. She is too valuable.
What every one of us wanted was a way to bring somebody there. A supervisor, security, whoever was closest. It did not matter who walked in. It mattered that somebody walked in without one of us having to be the one who decided to make it a thing, and that they saw it while it was happening, because in daylight it is your word against hers, and while it is happening it is just what is happening.
We had no button at all, for her or for anybody else. If you needed a person you got up and went and found one, and getting up meant leaving Katie sitting there by herself, which is its own kind of answer.
A duress button is not just a patient device. I have wanted one with patients and I have wanted one with families and I have wanted one standing at a nurse’s station at three in the morning next to somebody who shares my license, and the feeling in my chest was the same every time. Unsafe is unsafe. It does not check the badge of the person causing it.
I would guess that happens thousands of times a night in this country and gets called something else. “A personality or a difficult coworker,” “Old school” and “That’s just how she is.”
A supervisor standing at that station inside a minute would have ended it, because that behavior does not survive a senior witness. She would have gone back to her charting and Katie would have finished her shift without any of it. And there would have been a record. Somebody pressed something at 1:14 in the morning. Somebody pressed something again on the twelfth, and again on the twenty-sixth. This no longer is a rumor anymore. That is a pattern, and a pattern is a thing a manager can and SHOULD do something with.
When people say violence is part of the job in healthcare, it is not usually a decision anyone makes. It is the accumulated weight of a hundred nights where the thing that happened was not quite reportable or was reportable but not by anyone who could afford to report it, until eventually it stops registering as an event at all.
Katie came back to the station around four and finished her shift and charted everything correctly.
I wanted to advocate for her. I was afraid of that woman. All of us were, and a room full of licensed adults being afraid of one nurse should tell you what nineteen years of protection buys a person.
What I did instead was smaller and I did it every shift we worked together. I checked on Katie. I found reasons to be near her. I took her questions so she would not have to ask them out loud at that station. I told her when she did something well, because nobody else was going to. I kept her under my wing the entire time we worked together, and I would do it again tomorrow.
Katie was a good nurse. She was careful and she was thorough and she was going to be excellent, and not one thing that happened to her that night had anything to do with her.
No new grad deserves this, and it is not a personality quirk with no consequences. New nurses leave the unit over it. They leave the profession over it. They develop depression that does not lift when the shift ends, and some of them develop suicidal ideation, and none of that ever shows up in a turnover report as bullying. It shows up as “pursuing new opportunities.”