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Is there any hope for an RN working at a hospital with a from-the-top-down dog-eat-dog mentality among nursing staff?

Dear Donna,

I am disheartened and frustrated with nursing as a profession. I came to nursing as a second career and have regretted my decision to enter the profession. The changes over the past five years have resulted in what I perceive to be a dog-eat-dog mentality from the top down.

There has been an increase in the RN to patient ratios and increased pressure on already overworked nurses to please patients to promote patient satisfaction scores. It is now a nurse’s responsibility to conform to certain expectations, with DONs threatening to fire or punish the nurses who do not conform, which has created an environment of fear and competition.

As an RN on a floor, I don’t have time to market the business for the business/marketing department anymore than they are able to run down and help me pass meds.

I have pressure to perform safely and to provide quality care, but I am unable to fix others. I can empower, but I cannot and should not be responsible for others’ choices. I worked with a manager who did not have a healthcare-related degree, who asked staff to watch a training video wherein a woman at a desk was approached by a child who was not feeling well. She tucked the child in and took her temp, etc. The message was patients want their mothers. How codependent and disempowered are we that my role has been reduced to having to be someone’s mom?

I feel RNs have become a disposable commodity for the hospital administrators. How do we create union and support among nurses so we have a voice? We need to be empowered and respected. I am afraid there is no hope and it will have to get much worse before it gets better.


Dear Donna replies:

Dear Disgruntled,

Clearly it’s time for a change in your professional life. I travel all over the country and speak with nurses every week in various work setting and geographic locations. While some are feeling as disheartened as you are, there are many who are working in environments where they feel empowered, involved and respected and are doing great things. Read “Knowing when it’s time to move on” (

You’re right when you say you can’t change others. You can only change yourself and your circumstances. You don’t mention much about yourself, but it’s time to take stock and take action. Gain control of your career rather than let others control it. This might include going back to school if you have anything less than a BSN. Higher education is a way to expand your mind and your opportunities. Read “Go back to school and change your life” (

You also need to get out and network with those in nursing and healthcare who are positive, upbeat and doing positive things in the profession. You can find people like this through professional associations such as the American Nurses Association ( Attend local chapter meetings as a guest for now if not a member. As people tend to adapt the mindset and the outlook of those they spend time with, this will be particularly beneficial to you. It’s important to meet new people and create a support system in nursing. Otherwise you get a narrow, distorted view of nursing and healthcare.

Realize that hospital work is only one type of work setting for RNs. Explore your options. Talk to nurses working in different settings and specialties. Read “Nursing – A new paradigm” (

Nursing is one of the most diverse professions on the planet and there are plenty of very positive people and places to work. Be proactive in managing your own career and propel yourself forward. You just might gain a new perspective in the process along with new opportunities.

Best wishes,


By | 2014-01-02T00:00:00-05:00 January 2nd, 2014|Categories: Blogs, Nursing careers and jobs|0 Comments

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