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When the culture of compassion fails in nursing


Is it incivility, horizontal violence, bullying, ageism, policy failure or racism? It’s difficult to comprehend the lack of compassion and humanness from one nurse to another. It happened to a nurse with a stellar reputation for over 45 years who was dedicated to her patients, profession, and staff around her.

One day this nurse was staring at the patient census board for longer than a couple of minutes.  Another nurse, who felt the action was “a bit off”, reported it to her nurse manager at the end of the shift. The nurse manager asked the nurse whose behavior was reported to sign for a drug screen. The nurse had no employee representation. Her immediate supervisor was not there, and no one followed the policy of the observation period asking this nurse if she had difficulty sleeping, was not feeling well, or if she was taking cold medications. Instead, she was made to believe if she did not sign the drug screen she would be fired. After signing, the nurse was escorted off the floor by security to an occupational health nurse who tested her for drugs and alcohol, all of which were negative.

Can you imagine the nurse’s embarrassment and disappointment after this experience? She was always early to work and had not missed a day of work in 5 years. She was psychologically shattered by the experience.

Where was the awareness of the suffering and concern for this nurse? As healthcare continues to advance and grow more complex with technology nurses must not lose the fundamental aspects of compassion.

The nurse was seen by her primary care NP who drew multiple blood tests that showed she was not only anemic, but hyponatremic. Her symptoms were inexplicable, and she took a medical leave. These symptoms remained persistent  for the next couple of months, and she would go from specialist to specialist trying to put together what was wrong with her. Her B12 level was only 74 pg/mL, and her sodium level was 124 mEq/mL. She was becoming forgetful. She was diagnosed with pernicious anemia, confirmed by gastroscopy biopsy.

She had inexplicable feelings of cold and sensations that frightened her. She was seen by neurologists, endocrinologists, nephrologists, and primary care physicians. This went on for 3 months before she experienced a grand mal seizure. She had been having seizures all along, confirmed by 48 hours encephalogram monitoring at home prior to her grand mal seizure.

The nurse was admitted to an acute care teaching hospital and as luck would have it, a neurologist who specialized in infectious disease was savvy enough to put together her symptoms and diagnose her with acute limbic encephalitis, confirmed by lumbar puncture and blood tests.

If the nurse manager had the competency, humility, candor, experience, education, and compassion to know that this nurse’s behavior was completely out of the ordinary, she would have been sent to the emergency department and possibly diagnosed and treated much sooner.

We have to be careful not to label someone over the age of 65 who may be vulnerable with a cognitive change or a decline in sensory abilities compromised by stress and illness. Nurse managers must not only be the agents of change but also be guided and motivated by compassion to teach their nurses to create an environment that is supportive, safe not only for their patients, but staff as well.

We owe it to our patients, staff and colleagues to be committed to have compassion and a humanistic approach. Sadly this does not happen as frequently as we would like it to occur. We need to be committed to treat others with respect and foster an environment of compassion. Is this not why we became a nurse in the first place?

This nurse was virtually erased, devalued and robbed of all integrity in her chosen profession. Her shock has not diminished and she never got to say goodbye with dignity and respect. At this time she continues to require continued treatment and care from her neurologist as she will be on CellCept and Keppra for 2 years to reduce the activity of her immune system.


Geraldine Mceachern has been RN for 45 years. For the past 15 years she has been a director of case management in various hospitals in the metro Boston area. She was a nurse manager in the coronary ICU at Boston City Hospital.  She advocates and navigates the healthcare system, assisting both her staff and patients alike by providing leadership, collaboration, and optimizing outcomes.

The views and opinions expressed by Perspectives contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.


  • I became a nurse as I was about to turn 40 and it isn’t the older nurses that are the problem it is the young ones. They are mean and two faced and take every opportunity to bully the older nurses just getting out of school. I have seen time and time again them do everything in their power to get older new nurses fired. The nurse managers don’t want to be bothered so if you go to them about it they will fire you. The doctors just want to be surrounded by cute young things with tight butts so forget about working anywhere but med surg and the female managers take the men over women every time. When I was in nursing school my instructors tried to fail, bully what ever they could do to thin the heard. All they should have done was tell me the truth. I would have run as fast as I could.

  • Wonderful article that leads to self reflection

  • Julia Kathryn Kaefer
    June 4, 2019 7:41 am

    Excellant article to help with awareness of how this profession is not physically demanding but emotionally. I to experienced this in my career as a provider over 35 years. Upper managent devalues the role of the nurse, needless to say this impacts the care to the patient. Emotionless instead of compassion will be the new healthcare trend if nurses do not stand up together and take a stand as to why they went into nursing!!!! Follow your heart!!!!!

  • It starts with the top down. When administration devalues nurses, bedside nurses do likewise. Strong leadership should stop be aware of the bullying and stop it. Some only know how to make them selves look good by criticizing and tearing down others. A supportive atmosphere is sadly lacking today. Was the nurse that incorrectly observed the situation ever corrected?

  • I read these remarks and I have to agree with all of them! As a nurse for 29 years most of it in ICU, I was subjected to harassment by nurses on the day shift who never worked a night shift in their careers! I have never understood nurses devaluing other nurses, don’t we get enough of that from the hospital administrations? The older nurses need to stop sticking it to the younger nurses and start mentoring, and the younger nurses need to understand they could learn some great stuff from the older nurses!

  • Bullying, in my humble opinion is a where the new nurse has to be shown by their preceptor all of their all knowing and all seeing eyes. Esp with a well season nurse who has already seen it all. Its not rocket science. I am 52, and have work for 23 years in ICU, SICU, MRT, vascular surgery, and transplant ICU heck I work in ICU while going to school. I did not learn any thing in school while in. I got lucky and this wonderful woman took me under her wings and taught me everything I need to know. My next 2 times in clinical I was wonder woman.
    JACHO and whoever else that can do it needs to rip these nurseses and battle axes a new on. But, it is getting worse exponentially . I think when a blowhard wants to get rid of a nurse its done covertly. I plan to stand up to my bi*** this week and see where it goes from there.
    If this harassment does not stop people will stop entering the nursing workforce. We are very much in a healthcare crisis.
    What made these people get the big head anyway? Blowhards are usually terrible nurses.
    As a result of my experience I’m insecure, 2nd guessing myself, and generally do not know what is up or down. I’v never been that way.

  • Jill Norton, WHCNP,BC
    November 26, 2018 3:35 pm

    No matter what the symptoms or behavior, it’s a good idea to focus on ruling out medical issues first. Making assumptions happens more than it should. Using our assessment skills to ask questions and really listen to the answers will go a long way in acting as professionals with compassion, and getting to the right actions in a situation.

  • Barbara Pinchera
    November 23, 2018 9:43 am

    Very insightful article. Incivility continues to be a problem in our profession despite many initiatives to address this issue.
    Unless we continue to bring these situations to light, incivility will persist.
    Thank you for speaking up!

  • Thank you for this article!

  • Loretta Turon RN,MSN,MBA,NE-BC
    November 21, 2018 1:28 am

    Nursing Asssistants are also bullied.

  • This is a good article highlighting the decreasing care of nurses towards nurses. What is additionally tragic is that nurses do not display compassion towards their nursing colleagues in an era of nurses being devalued by Management. Health is unfortunately becoming more and more corporatized and management in particular is now being modelled on business models where compassion/wisdom/integrity/caring are all devalued as they cannot be measured in monetary terms.

  • Thank you for sharing this story. This is an impactful reminder to treat our colleagues with compassion.

  • Exceptional article that posits how nurses are treating each other this day and age. We need to be more mindful of our colleagues, supporting them and taking the time to learn what is at the root of our “apparent disconnect” before judging. We advocate for our patients, but we fall short of advocating for our peers. Thank you for sharing this story as it is timely and earns great respect from me.

  • Thank you for sharing this story. This is an impactful reminder to treat our colleagues with compassion.

  • Outstanding article!

  • Unfortunately the nursing profession is plagued by the history of sexism and devaluation that continues to this day. It is a tragedy that oppressed groups tend to scapegoat each other rather than rallying together for mutual support.

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