Anger: The Mismanaged Emotion

Sandra P. Thomas

Disclosures

Dermatology Nursing. 2003;15(4) 

In This Article

Nursing Anger

Oppressive conditions present nurses with justifiable reasons to feel anger and hostility. In their work environments they are often prevented from meeting their physical needs (breaks and meals), personal needs (scheduling), and professional needs (autonomy over practice and administrative support) (Carlson-Catalano, 1990). Forced cross-training and mandatory overtime contribute to a sense of oppression. There is a widespread perception that management is nonsupportive. A massive five-country study of 43,000 nurses found that fewer than half of the nurses reported that management in their hospitals was responsive to their concerns, provided opportunities for them to participate in decisions, and acknowledged their contributions to patient care (Aiken et al., 2001). Nurses in the author's studies, as well as those surveyed recently by Fletcher (2001), decried the lack of support from their immediate supervisors. Perhaps the most deeply distressing consequence of the unsupportive environment was the general feeling that they could not provide the kind of patient care they wanted to give because of insufficient time and resources (Brooks et al., 1996; Smith et al., 1996). One study participant said she felt like the character in the fairy tale Rumpelstiltskin who was put in a room full of straw every night and told to produce gold (Smith et al., 1996).

There is no question that nurses have legitimate cause to be angry, given these egregious violations of their workplace rights and professional values, but there is abundant evidence that much of their anger is mismanaged. Taking it out on each other is destructive and will never lead to problem solving. In fact, it is leading to exodus from the profession. A study of nurse burnout showed that nurses with the highest burnout scores reported the greatest amount of conflict with other nurses (Hillhouse & Adler, 1997). Conversely, group cohesion strongly influences job satisfaction (Lucas, Atwood, & Hagaman, 1993). The more a nurse perceives support from colleagues, the less he or she burns out (Duquette, Kerouac, Sandhu, & Beaudet, 1994).

In the concluding section of this article, general strategies for managing anger will be described. However, dealing with the horizontal hostility in nursing requires more than learning effective anger management. There must be healing of the emotional pain that has been inflicted by all of the sniping and backbiting. Thomas (1998) recommends that nurses make a commitment to supportive colleagueship, reach out to one another, share of themselves, listen to their colleagues as they disclose their real selves and honest opinions, and then respond with warmth and empathy -- especially in times of discouragement and distress. Nurses should refuse to get caught up in workplace negativism or destructive gossip. They should congratulate colleagues who obtain promotions, certifications, and advanced degrees. Nurses could institute "wellness days" for their workgroups (Extended Services Team, 1997), and socialize in hikes or picnics outside the workplace to build team camaraderie. If there is festering conflict about a specific issue, a psychiatric nurse specialist could lead a series of meetings with nurses on the unit. Brandman (1996) provides an excellent example of a conflictual situation in a neurologic intensive care unit that was ameliorated by a series of six 1-hour sessions every other week, in which anger and pain were processed with the guidance of the psychiatric nurse specialist.

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