Nursing is not an easy job. Nurses high-quality care to complex patients. If that does not make our job hard enough, we get yelled at, punched, kicked, and spit on by the confused and the just plain rude. We also take fire from family members that are aggressive, overbearing, and manipulative. Navigating the barrage of physical and verbal abuse has been so normalized it has become routine. We dip and spin gracefully using customer service skills, service recovery techniques, and sometimes… restraints. However, the assault on nurses is not always external.

Nurses struggle with violence that is 100% avoidable:

Negative self-talk

They are extremely invested in the care they provide their patients. That is a good thing, but sometimes it borders on toxic behaviour. Nurses over analyze details far beyond what critical thinking entails. All the “should’ve, could’ve, and what if” thoughts invade our minds. Those lead to negative self-talk of “I’m not good enough…” Once negative self-talk starts it is easy to get caught in a downward negativity spiral of increasing intensity. Nurses start feeling guilty for things they have no control over.

What Causes it?

A straight-forward example for the origin of negative-talk is when a patient deteriorates or dies. Nurses replay the scenario over and over. They comb through every detail and they try to find an answer for what was missed or done wrong. Whether they truly missed something or not, a nurse will find some reason to beat themselves up over.

A more complex reason for negative self-talk— one that happens just as frequently, if not more— is when nurses forget the little things: the cup of ice, jello, or warm blanket. How can nurses keep a million critical details straight and forget the easy stuff?

Simple: It’s because they are keeping a million critical details straight.

All the phone calls, orders, labs, assessments, and re-assessments for patients get processed and prioritized based on importance. Completed tasks are removed, every new piece of data gets added into the equation, and re-evaluated for priority. In other words, nurses are constantly re-prioritizing their priorities. The more critical or time-sensitive a situation is, the higher it moves up the list. A request for a warm blanket takes a backseat when a patient is about to fall. That trip to the nutrition room for a jello does not happen for a couple hours because you are stabilizing a new patient from the ER. Nurses do everything in their power to meet patient needs both big and small in a timely manner, but that is not always possible.

When you finally have time to check on your other patients, one (or more) is mad that you took so long and even more upset that you forgot to bring their simple request with you now. This springs complicated negative-self talk. Nurses do a million things in a shift, but forgetting that simple thing, the cup of ice, becomes the defining moment for them. It does not matter if they brought someone back from the dead with CPR, they fixate on the lie that they are not good enough.

3 Ways to Combat Negative Self Talk

  1. Accept that you are human: The one characteristic that every human being has in common is that we are flawed. We miss things. We forget things. Now, a large contributor to negative self-talk is due to the nature of mistakes in Nursing can have life-or-death consequences. It is important to be vigilant and strive for excellence for the sake of your patience, but no nurse intentionally chooses to harm their patients. Depending on the type of mistake, there may be legal consequences to mistakes. If that is the case, then you need to own up to your actions. However, most situations nurses beat themselves up for are outside of their control.
  2. Debrief: One way to stop the runaway train of negative self-talk is to bring others into the conversation. Find a co-worker or friend you trust to talk about the situation. Formal or informal debriefing of the scenario allows for an objective perspective to stop the lies in their tracks. It is powerful when a co-worker says they know what happened and you did everything you could. If you could have done something different or misses something, talking it through allows you to process what happened and move on instead of stewing in a growing cloud of internal negativity.
  3. Replace the lies with truth: There have been studies done on thought patterns and neurotransmitters. When you go to do something, your brain sends a signal through the neurotransmitters to the muscles and tells them to act. The more you repeat that act, the easier it becomes. This is where muscle memory comes into play. The neural pathway has been used to the point where you do not have to think— your body does it naturally. This pattern can also be seen in thought patterns. The more you think negative thoughts, it takes less effort to go the negative route and that will begin to dominate overall attitude and beliefs about the world.

When negative thoughts comes, do not let them control the narrative. Speak truth over the lies:

I’m not a good nurse —> I am a good nurse
I’m not good enough —> I am doing my best with the situation I am given
I must have missed something —> Patients die and I cannot always predict it

It will take time for positive self-talk to become muscle memory. The responsibility of nurses places a lot of pressure and causes us to misplace guilt on ourselves. Because of this, the natural path our thoughts want to take is negative. However, with time, practice, and grace you can strengthen the memory of the positive thought pathways creating a more balanced, realistic, and healthy view on your contributions as a nurse. Speak truth into your life and take the time to speak truth into your co-workers’ lives. Compliment them when you see how they interact with patients, handle a difficult situation, or offer help to others. Be a witness to the good in others and help them fight off negative self-talk by being an objective observer.