Peer pressure gets us in trouble from the time we’re little kids. We want to fit in, fly under the radar, and not be a goody-two-shoes. As life goes on, the trouble gets worse. At 4 years, we might snitch an extra Oreo because our older cousin double-dog-dared us. At 13, we might sip a beer. At 15, we might have sex even though we don’t feel ready.
Standing up for what we believe and stating what we truly think is right gets no easier as we get older. I would argue that it even gets increasingly trickier the older we get, because peer pressure turns in to pressure from colleagues, supervisors, and entire institutions. The stakes for refusing to bow under the pressure are higher. Gone are the days of time out. Instead, standing out from the crowd can cost us our jobs or at least make our lives miserable.
Going along with the status quo is a slippery slope in medicine. At some point it changes from displaying a lack of integrity to outright fraud or malpractice. Where is that point? It is in the middle of a sea of gray areas, and the more you look for it the grayer it gets.
"We’ve always done this" is the number one push to follow the crowd in nursing. There is tremendous pressure to stay the course, even if the course is failing. The squeaky wheel often gets the pink slip. I don’t think most people set out to break the law or violate their professional values and practice acts. Instead, I think that we let a small thing slide because it doesn’t seem worth causing trouble over. Then, because that one thing slid by so easily, we do it again. We do this repeatedly until things have reached an unconscionable level, and at that point we are faced with a decision. Do we speak out and say no? Or do we keeping letting things slide?
If we choose the former, we run the risk of having it accurately pointed out that we’ve said nothing in the past. Why bring it up now? If we choose the latter, nothing will ever improve, but we avoid immediate negative reactions.
Unfortunately, this inertia leads nurses into a culture of letting things slide, even up to the point of not reporting serious errors by our colleagues. Situations become cloudy when they’ve built up over time, and nurses quite rightly fear retaliation for speaking up. We have become complicit in hiding our own stories.
Here are a few examples of particularly egregious issues that no nurse would speak up about out of fear.
- A physician did not hit "sync" during a cardioversion.
- A psychiatrist said, "I’m going to just give these kids shots every hour until they realize they’re not in charge anymore."
- A charge nurse allowed her best friend to sleep for a few hours during her shift because the friend wasn’t getting enough time with her kids.
- An administrator said, "We’re just not going to give narcotics anymore here. It’s too much trouble to get them."
- A nurse manager said, "I’ll find a way to get rid of [that nurse]. You can always make up something believable."
Who will challenge these things? It is every nurse’s responsibility to condone ethical behavior, but what about when doing so will get you fired?