Running Head: THE EFECT OF NEGATIVE TALK 1

The Effect of Negative Talk about Patients Amongst Healthcare Professionals

Andrea M. Garcia

James Madison University School of Nursing

THE EFFECT OF NEGATIVE TALK 2

The Effect of Negative Talk about Patients Amongst Healthcare Professionals

Introduction

The way in which nurses speak about and to their patients is extremely important and our

voice is a powerful tool that can be used as means of help for the care that is being provided.

Within the healthcare setting we may encounter patients who are seemingly unpleasant for

whatever reason – their weight, stench, grouchy personality, and so on. As nurses we vent to one

another and use humor to help cope, using terms such as psycho, jerk, whale, or idiot, to describe

our patients. Although these comments are not spoken in the presence of our patients, this habit

is disrespectful, unprofessional, and can have a greater impact than many seem to realize. Dr.

Kahn writes in the article “When Battlefield Humor Backfires” in regards to negative talk behind

the patient’s back that when we speak in those terms, “they become the ‘other’; their humanity is

obscured by their psychopathology” (Kahn, 2010). These negative terms immediately cause a

poor perception by their incoming caretaker and can negatively impact the quality of care that is

then given. In addition, a study was conducted among nurses and doctors in various countries

and results showed a positive correlation between negative gossip among one another and

emotional exhaustion/depersonalization (Georganta, 2014).

Background

During the morning rounds for my psychiatric mental health nursing clinical, the nursing

students observe and listen as the nurses from the night shift go through the background of their

different patients, how they behaved during their shift, and anything important that the nurses

coming onto shift should know. During this time, I witnessed and heard conversation about the

patients that included things such as a scoff and comment of “oh you have that patient? they’re

shitty good luck with that” or “we have a lot of buttheads in the unit today” when discussing the
THE EFFECT OF NEGATIVE TALK 3

“care plan” for the patients. In response to these situations, I merely raised a brow and made eye

contact with my fellow nursing students with a facial expression of surprise. An alternative to the

situation could have been be to speak up to the nurse and ask her to not speak about patients with

mental illness in that way. This situation caused me moral distress. This is because moral distress

is defined as when the ethical answer is known but the action to take is unclear (American

Nurses, 2018). These statements are not appropriate comments to be made about patients,

however what action is right to take is not necessarily clear.

Methods/Findings

In order to analyze this situation, the Eight Key Questions from James Madison

University will be used (The Madison, 2013). The Eight Key Questions are a set of values to

help one think through an ethically challenging situation. The questions assist in guiding one’s

thought process to make the most ethical or right decision.

Fairness is defined by asking “how can I act equitably and balance legitimate interests?”

In this scenario, the different parties/ interests that must be addressed are the patient(s), nurse,

and myself as a nursing student. The nurse is desiring to communicate how a patient has been

acting so that the nurses coming on shift can be prepared. The interest of the patient is to heal

and be cared for by the nurses. By thinking about fairness I must think about what action I can

take to help balance these interests, and in this case I think the nurse needs to reassess her

language in order to better address the patient’s needs.

Outcome is thought of as, “what achieves the best short and long-term outcomes for me

and all others?” In this situation a possible short outcome could be that since the nurses are used

to speaking this way in front of one another, a patient or patient’s family member overhears the

nurse speaking in this manner in a more public setting. A possible long-term outcome is for me
THE EFFECT OF NEGATIVE TALK 4

as a nursing student if I say nothing, is the nurses continue speaking in that way about patients,

and overtime it impairs their care for the individual due to a shifted mindset about the nature of

the patient’s illness. We must also consider the outcomes for the nurse. Short term is that the

nurse receives a form of comedic relief in that moment. As for me, a short term outcome of

witnessing this interaction is anger and frustration and overtime would lead to decreased respect

and trust of the nurses that I am learning from.

Responsibility can be thought of as, “what duties and/or obligations apply?” Our duty

when taking on the role of a nurse is to be a patient advocate, to provide support, and care

holistically for our patients. In addition, it is to provide care without bias or judgment about the

individual and provide equal care. I don’t believe that this situation displayed responsibility of

the nurses to best care for their patients.

To address character, we ask, “what action best reflects who I am and the person I want

to become?” In answering this, I consider what type of nurse I would like to be. I would like to

be a nurse that cares unconditionally for my patient’s regardless of their socioeconomic, sexual

orientation, religion, race, etc. I want to be empathetic and genuine in my care for them. To me,

the way these nurses spoke about their patients does not reflect who I am or the type of nurse I

want to become. I also want to be someone who is an advocate and speaks up when I see that

something is not appropriate.

Empathy is considering what I would I do if I cared deeply about those involved. If the

patient was someone whom I cared deeply about such as a family member, I would not want to

talk about, or have others talk about the patient in a degrading manner as theses nurses did.

To address authority, we need to consider what legitimate authorities expect of me. A law

that as nurses we required to abide by is HIPPA. HIPPA protects patients from unauthorized
THE EFFECT OF NEGATIVE TALK 5

sharing of personal information. In this situation, the information being shared was not necessary

for improving patient care, thus violating HIPPA.

In considering the rights (innate, legal, social) of a patient, the patient has a right to safe

and effective care which could be inadvertently affected by negative comments – even if not

made directly towards the patient. Liberty does not necessarily apply to this situation because the

patient is unaware that these comments are being made and there is no decision between the

patient or nurse to make.

In seeking out the American Nurses Association (ANA) Code of Ethics, I can use

provision one to help guide the most ethical decision. Provision one states that the nurse is to

practice “with compassion and respect for the inherent dignity, worth, and uniqueness of every

individual…” regardless of economic status, personal attributes, or the health problem

(American Nurses, 2018). In striving to be ethical as a nurse, speaking in derogatory ways about

our patients is not a form of practicing with compassion and respect.

Conclusion

In thinking through and analyzing this situation ethically, I have become more

knowledgeable about how my actions as a nurse can affect my patients. Whether it is affecting

nursing students, the patient, the patient’s family, or the care that is provided, it does have the

potential for negativity in the healthcare setting. What I could have done as a nursing student is

difficult to determine. I could have spoken up or spoken to the nurse later on, however I feel that

as an inexperienced nursing student it may not be in my place to say anything, especially not as

the discussion is occurring. An alternative could be to speak to that particular nurse individually

later on and let her know that the way she spoke made me feel upset and that I viewed it as

disrespectful.
THE EFFECT OF NEGATIVE TALK 6

References

American Nurses Association (2018). Code of ethics for nurses. ANA. Retrieved from

https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/

Georganta, K., Panagopoulou, E., Montgomery, A. 2014. Talking behind their backs: Negative

gossip and burnout in hospitals. Burnout Research 1 (2). 76-81. Retrieved from

https://doi.org/10.1016/j.burn.2014.07.003

Kahn, M. (2010, Aug 23). When battlefield humor backfires. The New York Times. Retrieved

from http://www.nytimes.com/2010/08/24/health/views/24case.html

The Madison Collaborative. 2013. Eight key questions handbook: ethical reasoning in action.

Retrieved from: https://www.jmu.edu/mc/8-key-questions.shtml