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I doubt there is a nurse who hasn't heard the claim that we "eat our young."
While many people decry the way nurses treat each other, the specifics of abusive or "bullying" behaviors is not well understood.
To effectively intervene in situations where toxic work environments lead nurses to exit the profession, understanding the dynamics of relational aggression (RA) can be helpful.
Females and males express negative feelings differently across different ages and stages of development. This is relevant to female-dominated professions like nursing.
Most hospital nurses are confined to a small area and expected to work schedules that don't permit an opportunity to leave for a brief respite. The constant stimuli of noise and light as well as the close interactions with co-workers can create tension.
Given the tendency for women to use more relational behaviors during times of conflict and the context within which many nurses work, the potential for RA is undeniable.
What Does 'Eat Their Young' Mean?
This expression refers to the negative and even hostile behaviors of nurses toward newcomers.
Today, as nursing has become an attractive profession for second careers and adult learners, those "newcomers" are not necessarily the barely adult-aged women of yesteryear. A different kind of generational difference is now apparent in any profession, but especially nursing.
For the first time, four different generations of women can find themselves in close company as nurses, nurse practitioners, and physicians at all points in their career.
The entering class of medical schools is likely to be just over half female, which means students, residents and fellows will be interacting with nurses who are much like them.
"Oh boy, the students," one nurse told me, rolling her eyes. "The women are the worst. It's the classic power struggle, but more extreme because we're battling each other as well as the system."
"They're just determined to break me," a female resident said, referring to nurses on one unit where she had to spend a lot of training time. "Every time I go up there, they form rank and won't help me. Of course, I've heard they treat each other the same way when I'm not around, so I just try to shrug it off."
When Words Become Weapons
Mary is having an off day. That nagging little headache threatens to blossom into something much bigger, but she has patients to see and charts to complete.
When a co-worker approaches her with an innocent question about her lunch break, Mary barks out a reply and walks away without waiting for her response.
It's that easy.
All of us have the ability to be too aggressive, often without realizing we're hurting others with our behavior. We all have the capacity to be on the receiving end.
While a simple apology and an explanation of your peevish mood will most often undo the damage you've inadvertently inflicted, that isn't always the case.
'Chronic Marys'
There are also "Chronic Marys," who are stuck in an RA rut and unable to say a positive word about their work lives.
Chronic Marys can turn a work environment toxic with gossip, rumors and the big "HIM," i.e., humiliating, intimidating and manipulating behaviors.
Their persistent pattern of making others seem incompetent, using threats or power to get what they want from those who are unwilling, and masterminding plans to undermine and discredit co-workers are just a few examples of the way HIM can be used.
 Those on the receiving end of a Chronic Mary's negativity often wonder what they have done wrong.
Lisa, an NP, described months of HIM behaviors when she took a new position at an institution where nurse practitioners still had to prove their mettle in order to be accepted.
The nursing supervisor, threatened by Lisa's advanced education and friendly relationship with physicians, undertook an organizational "campaign" much like the ones I have observed in middle schools.
No one would help Lisa. Her attempts to be friendly were met with eye rolls or blatant ignoring. The physician who had sponsored her tried to intervene to no avail.
She persisted in the job, but after several months, her health began to suffer. She developed hypertension and insomnia, dreading each new workday. All her attempts to change the HIM dynamic that had taken on a life of its own were unsuccessful, so she ended up quitting.
"No one believed I could do the job and they ended up being right, but not because of my abilities or lack thereof. It was sabotague pure and simple," she concluded.
What could have helped this situation?
First, understand that RA is not about you. The common theme I hear from targets of RA is: "Why me? What have I done wrong?" If you're in that position, tell yourself this one-word answer as many times as needed until you believe it: "Nothing."
The next step to take is setting emotions aside and focusing on the facts. Keep a record of the times when a chronic Mary makes a comment that suggests your performance is subpar, especially if she's your boss. Monitor occasions when she forces you to do things you don't want to, and document what happened.
When you've got a credible list, select the four or five behaviors that bother you most. Ask Mary if you can meet with her, preferably in a neutral setting like the cafeteria or coffee shop.
Present her with your observations, but do it in a matter-of-fact way and avoid judgment.
Instead of: "You just don't like me and everyone knows it!" say, "During this meeting, you remarked that I needed to 'pick up the pace,' but you didn't offer specifics. Can you tell me what you meant?"
Remember that Mary is most likely feeling threatened and a bit intimidated herself. Do everything you can to be pleasant but firm. If there is something you are doing wrong, you would like to be told about it so you can change it - but most often this is when
Mary will realize her behavior has been inappropriate. When presented with "data" rather than drama, aggressors often recognize the inappropriateness of their behavior, especially if you have documentation.
The legal term "hostile work environment" has gained new strength in recent years. Sometimes it's a tough case to win, but as tension on the job increases, more workers are choosing to pursue it.
If you don't get anywhere with Mary, you can consult with your human resources department and share your factual observations with them.
Why Is Mary Mean?
What makes a Chronic Mary?
RA is more about the aggressor than it is about her victim or target, although both women might share a common emotion: social anxiety. Studies have connected bullying and RA with being fearful and nervous about social interactions in both young people and adults.
It may seem unlikely, but Chronic Mary may be concerned about connecting to her peers.
Somewhere in her life, Mary has developed insecurities about the way she is perceived by others. That makes her launch the preemptive verbal strikes that will protect her from disapproval and rejection from others.
Most often, Chronic Marys don't even realize they're at the extreme end of the aggression scale, but they long for connections with their peers that are genuine and supportive.
If you sense that others fear rather than accept you, think about your interactions over the last 24 hours. Do your co-workers seek you out and enjoy your company, or are you the one who controls all the interactions, doling out those HIM behaviors described above because you believe others "deserve" it?
Once you've assessed the situation and gained some insight, be on the lookout for situations where you are the constant aggressor. You may need professional help to explore why RA has become a way of life for you, but it is always possible to change - and you'll be happier for it.
Stuck in the Middle
There's another important group of women in the RA dynamic, one I call "Middlers."
Middlers are those that watch RA take place and don't know what to do about it. Sometimes, they facilitate the aggressor's actions by laughing or even joining in with the HIM behaviors. Most often, they feel uncomfortable.
Middlers can play an important role in change. Letting a chronic Mary know gossip isn't appealing or watching others be humiliated is not a spectator sport can be a powerful anecdote to RA. Even something as simple as saying: "Ouch! That hurts," when HIM behaviors are used against another can be effective.
While women may be criticized for being "mean," the opposite is also true. Caring and nurturing are relational behaviors observed more frequently (but not exclusively) in females, across the lifespan.
While it takes emotional energy to perpetuate and cope with RA, a few simple strategies can help you change a work environment from hurtful to healthy.
Be the nurse who promotes healing at your workplace, and many will benefit in both immediate and enduring ways, yourself included.
Cheryl Dellasega is the author of five nonfiction books on issues affecting women including, When Nurses Hurt Nurses:Recognizing and Overcoming the Cycle of Bullying. She is the founder of Club and Camp Ophelia , which helps diverse groups of girls confront and overcome relational aggression. She is professor of humanities in the College of Medicine and Professor of Women's Studies at The Pennsylvania State University.
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