In studying any specific culture, common phrases always arise from stories. For example, even though there is no water, when nurses are totally overwhelmed, they frequently say, “I’m drowning” because this metaphor comes the closest to how they feel in that moment. This phrase is not written down or taught anywhere in school. It is picked up and carried throughout the profession on the waves of culture.

It is important to understand these phrases because they are critical indicators of the deeper issues in our culture. Clearly, the word “drowning” indicates that many nurses have experienced a state of deep distress—and this is unacceptable.

Another common phrase is “She’s one of them now.” These five words point to the moment in the hospital culture when nurses first feel betrayed. They are used most frequently when a charge nurse becomes a manager; and sometimes when a nurse becomes a charge nurse. What do they mean?

This phrase represents a switch in alliance from a charge nurse having the back of every staff nurse, to a belief that the manager is now working for administration. It is the most enlightening phrase in the nursing culture because it points directly at the root cause of all nursing’s challenges: There are really two goals in every hospital—quality care and money.

This is not anyone’s fault.

What nurses need to understand is that administration is not the problem or the enemy. Our healthcare system in the United States is uniquely structured so that health is a commodity and investors profit wildly from illness and disease. As citizens in a democracy, we created and endorsed this structure with our votes.

But what if a nurse manager didn’t play the cultural game? Or a director? Or a chief nursing officer? They are usually fired. And so to keep their jobs and protect nurses as much as they possibly can, nurse leaders frequently find themselves in situations where they are forced to compromise their own values and comply with initiatives that ultimately hurt nursing. And in doing so, we are all betrayed: the nurse, the leader, and most of all, the patient.

When this phrase is no longer heard, nurses will thrive. How can we make this phrase obsolete?

• Frontline nurses can ask themselves what they need when they are about to say, “She’s one of them now” and professionally communicate requests backed by data and their managers to administration. Managers and nursing leaders would have to have their staff’s back at all times.
• As individuals, and then as a society, we can work to create a new system where healthcare is a service instead of a business; where frontline nurses are supported and nurse leaders are empowered to make the decisions they know will support safe, quality care.

Because the only thing preventing nurses working to their full autonomy and hindering cohesive nursing leadership is the structure that none of us created.

Kathleen Bartholomew, RN, MN, is an internationally recognized patient safety and health culture expert. Kathleen has spoken on leadership, communication, patient safety, and peer relationships to hospital executives and nurse leaders for twenty years.

All of her books come from her passion to understand the stories of nurses.  Her books, “Ending Nurse to Nurse Hostility” and “Speak Your Truth” illuminate our relationships with our peers and physician partners.  She is also co-author of “The Dauntless Nurse” which was written as a communication confidence builder.

Kathleen is also a guest Op Ed writer to the Seattle Times and has been interviewed twice on NPR’s “People’s Pharmacy”. Her Tedx Talk calls for changing our belief system from a hierarchy to equality in order to keep our patients safe – and also explains how disaster thrust her into ‘the best profession ever’.

You can also find more information about Kathleen on her website, Twitter, and Facebook.