Why are nurses acting like rude shop assistants?

4 June, 2010 | By Mark Radcliffe

I walked into a shop; I was the only customer. I was thinking of buying a Kit Kat or asking if they had any hats.

There were two people behind the counter and I wondered if they felt overstaffed or wary of impending cuts the way everyone else is. They don’t need two people, I thought, but it was nice that they could keep each other company. Because that was what they seemed to be doing.

I smiled and said: “Excuse me but…” only to be told to “wait a moment” because assistant number one, a disengaged blonde with too much eyeshadow, was telling assistant number two, an overweight woman who looked perpetually angry, about someone called Darren who had stopped wearing socks because his mum refused to sew “left” and “right” into them any more.

‘Being talked around or ignored is depersonalising, particularly for someone burdened with patienthood and all its trappings. Yet it still happens’

Darren reasoned that this meant he had a 50 per cent chance of putting his socks on the wrong feet and that risk was too great. Assistant number two looked livid.

Still. They were finishing. Often in such circumstances it is the third person who breaks the rhythm of exchange and provides the transition from closed and excluding conversation to open and enquiring but, at this point, I had nothing to say. I coughed, they looked at me, I shrugged.

Finally, assistant number two spoke: “They’re all made abroad, you know. Socks are. China probably. Or Holland. That’s why. Anyway, what can we do for you?”

I wanted to say “What?” or “Holland?” but I shrugged and said: “Do you know - I’ve forgotten what I wanted,” and left.

The Care Quality Commission’s annual report says that nearly one quarter of patients report nurses talking “over” them. Being talked around or ignored is, of course, fundamentally depersonalising, particularly for someone burdened with patienthood and all its trappings. Yet it still happens as much now as it ever did.

Now, far be it from me to insult the more talented retail assistants out there, but many of them are untrained in communicating. They may pick up that smiling helps but some of them hate their jobs - the hours, the pay, the annoying customers - so much that the only power they have is the power of rudeness.

Nurses, however, are educated in communication skills. They have the ability to know what constitutes good communication and the knowledge to reflect on how and when to apply it.

So, why are many not doing as well as they could? Is it thoughtlessness? Have they forgotten what they knew? Having a bad day? Or is it sometimes something worse? Something slightly more sinister? Are there nurses who choose - perhaps subconsciously - to be rude? Choose to make someone feel unseen? Because they feel angry or powerless or undervalued?

It’s a worrying choice, isn’t it? The idea that some nurses are lacking in basic communication skills or are choosing to be rude or aggressive. Either way, it needs to be addressed. Communication is the heart of nursing; if that stops beating, we are really in trouble.

Readers' comments (52)

Anonymous | 5-Jun-2010 9:23 am
I can't believed that you are surprised ! I have beenin Nursing for 10 years, and have comeacross so many disgruntled, tired and angry nurses that, to find one who isn'tground down by their job is rare. the trouble is, or so it seems to me,is that they become trapped in their job, working overtime that they don't want to work, staying late on their shifts on a regular basis, and rather than saying no, and forcing the management to then address the real issue, that of understaffing, they carry on. grumbling, getting stressed out and angry. I know it's hard, to say no, as a nurse, you are always aware of your patients, and the people in charge know this ! I would argue that what Nurses need is assertiveness training not more communication training !
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Anonymous | 5-Jun-2010 10:12 am
what nurses need is a communicative manager who sees you regularly answers your questions honestly doesnt give you the standard bull s...t answers, one that actually listens to you, and at least tries to get changes even if its only part way to what we need they dont have to be your best friend or buddy,
what i have is some one i rarely see doesnt even bother to answer e mails or when they do one or two words i kid you not!!does not communicate changes i find out always from other people usually quite by accident and this manager gets paid huge amounts and before people think this may not be right i am part of a huge trust and many many of my colleagues have expressed same concerns how can we change apathy when we are led by people like this i would add i have a good line manager who a tries her very best, but she is out in the cold like every one, i also have a good team i work with we support each otherbut its very hard to remain positive when being led by such indifference.
and whilst i can understand how the above author feels but i still can not understand peoples rude behaviour how ever stressed tired they are, that should not impinge on your attitude to patients like the old sayring goes you leave your problems at the door but so many people now parade at work on social net work sites its just not areas of nursing that need to be addressed
customer care and communication training springs to mind for the rudies as for the managers well we all know and i am not being negative they never seem to last long
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Anonymous | 5-Jun-2010 10:13 am
Anonymous have has it in a nut shell. I am in a job where there is an ever increasing expectation to work longer and longer hours - but the longer I stay the more work appears to come my way. It makes nurses tired, and tiredness as we all know leads to irritability and decreased positive communication skills. I have reached the point of reassessing what I actually wantworkwise, as my home life suffers from the pressures of my work life. I think the multitude of surveys conducted forget that we are actually human doing a gnerally good job, but often under immense pressure - which does have an impact on how we behave. I'm not condoning or excusing , just offering an explanation. I for one would like 'nurse-bashing' to stop. I don't hear my medical colleagues talked about in quite the same way - do you ?
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Doug Langdon | 5-Jun-2010 10:32 am
Could it be that these days we are selecting nurses, on the basis of their academic ability rather than their aptitude for the job.

It seems to me, that in the example given, the people concerned were not right for the task that they had been entrusted with and no amount of training would ever change their attitude to the customer.
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Anonymous | 5-Jun-2010 10:41 am
I think that the article is a little extreme as the greater majority of nursing, AHP and medical staff spend long hours communicating appropriately with their patients - remember that communication is not just by voice. I also think that what should be noted is that nationally agression towards the healthcare team has increased as the public that we serve fails to communicate appropriately with us and would prefer to resort to voilence than wods.
We are not perfect but neither are our patients.
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Anonymous | 5-Jun-2010 10:45 am
I don't think tiredness is an excuse for poor communication skills though I do see how being overworked, having poor leadership/support and feeling increasingly detached from one's work can lead to nurses being less engaged (with patients and relatives) due to resignation/apathy. Obviously this is not ideal either - but not the same as rudeness in my opinion. I've worked with many rude healthcare professionals (of various disciplines) and my opinion is that these individuals were in the wrong job as they lacked the necessary interpersonal skills for their profession. As a supervisor (in a previous job) I frequently challenged rudeness/poor communication skills (privately but not publicly supported by a weak manager) which made me quite unpopular with some staff and I can see how some senior nurses would rather not challenge their junior colleagues because of the backlash. We really need to look at leadership in the NHS. Strong service managers, strong team managers, strong charge nurses (and mentors to student nurses) etc. are absolutely crucial for delivery of a good patient focused service.
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Anonymous | 5-Jun-2010 10:48 am
Are you kidding me. Do you honestly think shop assistants would have to put up with the abuse nurses do. I was early for work the other day, went to help a member of staff clean up a patient. All I got was a mouthful of abuse and the threat of having my ******** eyes ripped out. Shop assistants have abuse hurled at them too but at least something is done about it.
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Anonymous | 5-Jun-2010 11:01 am
I work in mental health. I've been abused by patients on many occasions. However, I consider it part of my job that I am able to deal with this in such a way that there is no transference on to patients/relatives/colleagues. Abuse should not be part of our job but it is. Therefore we have do find a way to not let it affect the relationships we have with the people in our care. That said, I do feel that we need more support from managers and acknowledgement of the good work that we do - informal or formal. I haven't had an appraisal in 7 years! The CPS also have a lot to answer for as they often fail to make a case for prosecution when it concerns a mental health patient. Mental health patients can be as culpable as the next person depending on their individual presentation.
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Anonymous | 5-Jun-2010 11:15 am
The last comment from the mental health nurse is spot on....like alot of mental health nurses i do not take abuse from patients too seriously for the obvious reason they are unwell and i knew this would be the case before i started as a nurse in mental health.
However the CPS comment is the same thing i find frustrating, a patient smacks you in the face or puts a window through because you cannot get to a 24 hour garage at 3:30 in the morning to get them some cigarettes...and what makes this worse these same patients would never dream of behaving like this in a general hospital...and then somehow you are expected to just pout up with the reality that wont be arressted for assult despite just let off on mental health grounds......and the next day i have to pretend im not furious with that person and be courteous and polite to someone with no respect for my right as ahuman being..so yes to this sort of patient I am rude and not embarrassed to say so either.
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Anonymous | 5-Jun-2010 11:43 am
"I for one would like 'nurse-bashing' to stop. I don't hear my medical colleagues talked about in quite the same way - do you ?"

That's about what's perceived/accepted as their role, with nurses being there to worry about picking up the pieces afterwards. Surgeons who say they don't need to communicate well with patients because their job is performing a good operation are the ones who really get me!
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Anonymous | 5-Jun-2010 11:45 am
I think nurses have just got to the end of their tether .hen you are being verbally abused every day from patients and relatives you just think enough is enough.My daughter was explaining to a patient about preop procedures as she was very nervous when her husband suddenly aggressvely asked my daughter why she was speaking to his wife as though she was 90.My daughter is a very caring and gentle person and this really upset her as she was speaking in her normal voice.Why do we have to keep taking this,and why does no-one stand up for us.The ward manager said that my daughter was probably the best nurse on the ward for explaining things but nothing gets done about verbal abuse Patients and relatives will get away with it all the time.Whats the point in notices saying verbal abuse to NHS staff will not be tolerated. Its just a joke and an awful thankless job now.
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Anonymous | 5-Jun-2010 11:47 am
Are we in danger of coming over as winging? I appreciate that tiredness, stress and more importantly lack of time to give to each family, can lead to poor communication. But I strongly believe that as health professionals we should treat all patients with respect and consideration. Ill health can make the patient and their family feel disempowered and vulnerable; to be ignored by a nurse/receptionist who appears to be engrossed in paperwork/computer as happened to my husband recently, will inevitably escalate into an incident. In many years of nursing I have met some wonderful communicators, but there are those(in the minority) who appear to go out of their way to be obstructive and rude, I do wonder whether they should be in a caring profession?
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Anonymous | 5-Jun-2010 11:52 am
Apols -should have read whingeing! Why can't I spell on a computer? (not even sure that is right!
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Anonymous | 5-Jun-2010 12:01 pm
I have been nursing for almost 20years, communication was always a priortiy within my education. There seems to be a growing problem with communication skills. 40% of the staff I work with at my local hospital struggle with the English language let alone the concept of politeness and consent. Those that can speak English fluently have been stuck in a university and/or have not been outside a class room long enough to learn how to communicate with anyone other than thier peer group!!!
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Anonymous | 5-Jun-2010 12:07 pm
Nursing staff are over stretched and under valued and are expected to do more and more. It is high time higher management, including the Government woke up and smelt the coffee.
I have worked as a nurse for over 30 yrs and have faced many challenging times during more people with very complex problems with very little staff to provide an effective service and management staff fail to listen to the workforce, when they express concerns. I have a duty to protect my patients and my staff, but without their support this is futile. The organisation i am employed by see staff as being negative when they question changes. I have had a very busy week and my weekend will be ruined as i am totally exhausted. The staff i manage are not coping, but are expected to "get on with it", so its no wonder they are rude and sharp with their tongue with the public at times, they are over worked and very rarely get off on time. I feel totally unsuppported by management, even a phone call would suffice on occasions.The organisation has training in place that can be accessed, but staff can't get the time off to attend. The recruitment process takes an age. I have had vacancies for over 6mths plus. The Government want to provide services on a shoe string and all their concerned about is the next steps to re-organise services. Nusres' are not listened to enough. The managers need to spend more time on the frontline to actually see what is happening, because whenever problems are verbalised it is not believed.
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Anonymous | 5-Jun-2010 2:10 pm
I work in a female prison and have had every single rude insult and swear word thrown at me, sometimes we ignore it, as in my job if I (nick) the girl it causes me more grief as there is more paper work to do, and I have enough without that, we all get tired and stressed and yes we shouldnt have to put up with any rudeness, I have just been speaking to a travel companys admin team as I havent recieved my travel airline documents and cant check in on line and I travel on Friday and I was met with utter rudeness I spoke to the manager who was even ruder than the 1st lady, what Im trying to get to is sometimes the person is frustrated because they have had to wait, they feel they are not in control (which is me with my break away) we all end up shouting and the real problem is forgotten, we all have to give a little BUT yes as the previous writers have stated sometimes enough is enough as nothing gets changed and we nurses then get the backlash
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blands@btinternet.com | 5-Jun-2010 4:11 pm
A lot of nurses these days feel undervalued. You can't give from inside of you what is not there to give. You don't solely obtain your worth from studying at a university, you obtain your worth from studying, applying what you know, seeing it's positive effect and being told by another human being, you've done a good job and you're a valued member of a TEAM, which most of the time never happens.It is often forgotten we are a team, and we need each other.We are also human and not machines, something which is never taken into account. However, nurses are treated like machines which if they break down they just get replaced, and nurses know this. We talk constantly about putting the care of patients first, but what about putting the care of staff at the top of the agenda also. Perhaps this is the reason behind nurses eventual lack of committment to care.

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Brenda Wendt | 5-Jun-2010 5:15 pm
I have worked as an RN for 13 years now and found that most nurses are control freaks which is the main reason for being a nurse is for their empowerment. They are not caring people and really don't give a crap if the patient gets better or not as long as they are in control thats all that matter. I have worked with nurses that have actually laughed when someone has actually died on their shift don't they realise that this actually looks bad for them.
They treat each other like their work is some competition on who can out do with other always looking for someone they can report on now that this whistle blowing has become so big.
Yes there are some very caring nurses out there that will give their all but we are very few and far between and so sorry to say we are small in number which is not enough to make a difference.
I have been a patient and what a terrible experience it was. Do nurses actually know have uncomfortable a venflon is especially when it has been in for a couple of days but they didn't care they pushed the anitbiotic though and one time when I winced in pain this one so called nurse said Oh don't be a baby kids have these. She didn't know I was a nurse as I never put that down on my assessment sheet.
I just hope I never have to be a patient again.
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Anonymous | 5-Jun-2010 7:02 pm
Badly recruited, poorly trained, indifferently managed. Rarely Led. At the same time as....
More recognition and opportunity than ever before. Pay is not bad either.

What to make of it?

At the same time there are quite a few nurses that would be better working in a chip shop for all the emotional quotient they able to muster.
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Bernadette McPolin, SRN, B.Sc, M.Sc. Anae | 5-Jun-2010 8:56 pm
We have all at sometime experienced being on the receiving end of rudeness, therefore know how undermined and upset we feel when it happens. Think then how patients, ill, anxious, vulnerable and in a strange environment must feel when a nurse or any member of staff is rude to them. Nurses by virtue of their education (regardless of whether it is university or not), awareness, experience and common sense must know that being rude to a patient is not acceptable in any circumstances.
It is very difficult and demoralising having to cope with rude and unsupportive managers but 'dignity in the workplace' and respect for colleagues applies to them also and has nothing to do with rank. If they expect to be treated with courtesy and civility then they too must behave likewise.
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