[usPropHeader] Error loading user control: The file '/CMSWebParts/WK.HLRP/LNC/LNCProductHeader.ascx' does not exist.


  1. Salladay, Susan A. PhD, RN

Article Content


Unacceptable behavior? No kidding

I've struggled with my weight for years and recently started working with a new weight management center. Most of my colleagues have been very supportive, but one of the physicians just rolled his eyes and said, "Here we go again." Now when he sees me, he asks if I'm "behaving myself." Last week he started carrying around miniature staplers and clicking them under my nose (supposedly this is a hint about gastric bypass surgery). When I told him the teasing makes me uncomfortable, he said, "I'm just kidding around; where's your sense of humor?" How can I put a stop to this harassment?-K.M., WASH.


Kudos to you for speaking up! Bullies bully because they're insecure, and diminishing another person gives them feelings of pleasure and control.


The behavior you describe constitutes workplace harassment and bullying, and should be reported immediately to your nurse manager and the facility's Human Resources department. The physician needs to be formally counseled by his department chair and/or the chief medical officer on appropriate workplace behavior. As a victim of workplace harassment, you could have a legal case against your employer if the situation isn't addressed.


To confront the bully on the spot, ask your supportive colleagues to help. I recommend using a technique developed by OR nurses called "Code Pink" in some facilities.1 (Because Code Pink is an alarm for infant abductions in many hospitals, another designation may be more appropriate in your facility.) Practice this technique first!

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

When the bullying physician comes on your unit, have a spotter inform you and then rally your colleagues. Make yourself visible in a hallway or other public area like a hallway. As the physician approaches you with the staplers, call out clearly: "Code Pink, I'm calling a Code Pink." On this signal, all your colleagues come quickly to your side and stand silently with you, perhaps even forming a circle of support around you. Maintain the silent circle until the physician has no choice but to walk away. No words are spoken and no threats are made, but the technique is so effective that a bully rarely needs a second lesson.



1. Toward civility: ANA, nurses promote strategies to prevent disruptive behaviors. Am Nurse. January-February 2014. http://www.theamericannurse.org/index.php/2014/02/27/toward-civility. [Context Link]



Bridging a cultural divide

My patient, 42, is recovering from a hysterectomy. She has strong Islamic beliefs that include wearing the hijab (a black dress that covers her entire body and a veil) while hospitalized. According to her family's wishes, the surgery was to have been performed by a female surgeon and team. But due to a communication mix-up, a key team member was male. The error was discussed with her husband, who's understandably upset, and my patient is distressed too. This has made it almost impossible to give her appropriate nursing care because she's reluctant to let anyone-even female nurses-examine her incision or touch her. How can I regain her trust and provide care that's competent, safe, effective, and ethical?-J.R., MICH.


Your patient's reluctance to accept nursing care may stem from a loss of confidence in her caregivers as you suggest, but it may also reflect her cultural framework. Muslim women who adhere to a strict code of separation regarding touching may not accept uncovering their bodies or being touched by anyone, even a woman, who isn't Muslim.1


If your hospital has female Muslim nurses or social workers on staff, offer the patient an opportunity to meet with them to discuss her concerns and seek solutions that everyone is comfortable with. Meanwhile, go the extra mile to maintain her modesty. For example, put a sign on her door asking everyone to knock and wait for a response before going in so your patient has time to cover her body and hair before anyone enters. Honor her dietary preferences, which are a key aspect of Muslim culture. When giving care, avoid exposing any more of her body than absolutely necessary. Ask if she wants a female relative to be present during nursing and medical procedures.2


Find out as much as you can about your patient and her faith, and take care to communicate your respect for her beliefs. If she has a copy of the Holy Qur'an at her bedside, for example, take care not to touch it or place any objects on top of it.


Also keep in mind that she may not share certain values regarding patient autonomy and informed consent that are intrinsic to the American healthcare system. For example, she may prefer to have her husband make healthcare decisions for her. If this is the case, the healthcare provider may ask the patient's permission to discuss the matter with her husband, then document this discussion in the medical record.2


By showing your patient respect based on your knowledgeable understanding of her faith, you can help rebuild her trust and encourage her to accept the nursing care she needs for a speedy recovery.



1. Nursesaida's Blog (n.d.). Religion and Muslim culture on human beliefs. http://nursesaida.wordpress.com/about. [Context Link]


2. Hammoud MM, White CB, Fetters MD. Opening cultural doors: providing culturally sensitive healthcare to Arab American and American Muslim patients. Am J Obstet Gynecol. 2005;193(4):1307-1311. http://coe.stanford.edu/courses/ethmedreadings07/em0703mahari2.pdf. [Context Link]