Letter to the Editor by Francisco Ayala to OJIN topic "Nurse Safety: Have We Addressed the Risks?"

Nurse Safety: Have We Addressed the Risks?

December 16, 2021

Response by Francisco Ayala to OJIN topic "Nurse Safety: Have We Addressed the Risks?" (September 30, 2004)

Dear Editor,

As an amateur beekeeper, I’ve observed interesting innerworkings of bee behavior. I’ve observed clean, hygienic, caring creatures that do everything for their hive and their brood. The minute there’s an outside force, whether it be a bee from a different colony or an invader, the caring ceases and a targeted attack ensues. Surprisingly, this targeted behavior is sometimes directed towards their own members; the result is often exile from the colony or worse. In healthcare, we also see this predatory and paradoxical behavior exhibited in nursing. Possible triggers include burnout, patient load, or the current stressors of the pandemic. Whatever the case may be, there is a clear dichotomy between student/novice nurses and experienced nurses/preceptors.

Being crowned the most trusted profession is overshadowed by how we treat our own. While I am proud to be in a profession where patients find us to be caring, trustworthy, and have awarded us this distinction, there is a different narrative at the nurse’s station, in the breakroom, and in other common staff areas. I recall my personal experiences of dread when going to clinicals. I felt unwanted or a burden to my preceptor. The feeling was palpable! When I became an educator, I continued to see this angst and worry in my students due to the same pattern of behavior demonstrated by the staff nurses/preceptors.

With years between my time as a student and now, the fact of the matter is that incivility in the workplace continues to exist. It is concerning that it has been allowed to exist throughout the years. There is a culture of negative behavior towards incoming nurses. The American Nurse Association (ANA) created a position statement to oppose such behavior back in 2015. The position statement by the ANA reads as follows, “nurses are required to create an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect” (ANA, 2015, p.4). It has been six years since this publication; the problem still exists. Our new nurses, who were once eager to carry out their lives work, purpose, and meaning in our profession, have become easily burnt out and fallen victim to workplace injustice by fellow nurses. What is the driver for this behavior? Why do we do this to our young? What actions do we need to take?

There is currently a widespread nursing shortage. During these unprecedented times, burnout has risen in health professions. This multifactorial process has created significant shortages in nursing staffing, increased nurse to patient ratios, and an increased demand for a more robust nursing workforce. With an aging patient population, a rise in retiring baby boomers, and a retiring nursing workforce, the issue appears will get worse before it gets better (NSI Nursing Solutions, Inc., 2021).

The eager, young faces are our future. It saddens me to see the dedication, struggles, and perseverance of our young nurses be rewarded in such a way by those who should be mentoring and encouraging these individuals. It is no surprise that literature has shown an inverse relationship between organizational support and stress levels among new nurses. Socialization is an important determinant of new nurse burnout (Kerin, 2020). As such, priority should be taken to create relationships, and provide mentorship to our young nurses. To increase and maintain our workforce, a symbiotic relationship must exist between our young nurses and the experienced nurses mentoring them. Let’s work together to be a happy, symbiotic colony of happy bees.

Francisco Ayala, MSN, APRN, FNP-C


American Nurses Association (ANA). (2015, July 22). Incivility, bullying, and workplace violence [Position Statement]. Practice & Advocacy. Retrieved from: https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence/

Kerin, Ú. (2020). Professional socialisation processes help facilitate the transition from student to qualified nurse. Evidence-Based Nursing, 23(2), 47. https://doi.org/10.1136/ebnurs-2019-103078

NSI Nursing Solutions, Inc. (2021). 2021 NSI National health care retention & RN staffing report. Retrieved from: https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf