A few weeks ago my friend and colleague, Dr Lorna MacLellan, graduated with a PhD. Professor Isabel Higgins and I had the honour of supervising her throughout her candidature. Lorna explored the transition experiences of ten Nurse Practitioners (NPs), interviewing them each 3-4 times during their first 12 months of practice. The findings from this study revealed a pervasive problem in the upper echelons of the nursing profession. Although the metaphor of ‘nurses eating their young’ has become an a recognised part of the nursing vernacular, Lorna’s study identified that bullying also pervades senior levels of the nursing profession and manifests as ‘tall poppy syndrome’.
Nearly 3000 years ago Heroditus told the story of how King Thrasybulus was asked by a fellow monarch about the best way to govern his kingdom. In response the King went to a nearby field and, walking through the rows, whacked the heads off the tallest, brightest ears of corn. The Romans continued the analogy in their literature, but changed the corn to poppies, and the term ‘tall poppy syndrome’ was coined (The Histories, 440 BC).
NPs were first endorsed in Australia in 2000 as a result of more than ten years of political lobbying by the nursing profession. However, their numbers have been slow to increase and in 2016 there were only 1380 endorsed NPs. The multiple challenges associated with transition and, in particular, recurring episodes of tall poppy syndrome, may be partly responsible this problem.
Tall Poppy Syndrome describes a social phenomenon in which people of genuine merit are resented, attacked, cut down or criticised because their abilities or achievements elevate them above or distinguish them from their peers ~ Segen’s Medical Dictionary (2012).
In Lorna’s study the experiences of the ten NPs varied, and although a few experienced a relatively smooth transition, many encountered such a difficult and turbulent beginning that they resigned without completing their first year of practice. Many of the NPs were plagued by self-doubt, insecurity and feelings of isolation as a result of horizontal violence and the lack of support they received.
The NPs were victims of professional jealousy and they described how their nursing colleagues frequently conveyed disrespect and contempt for the NP role. At a time when the NPs needed support and camaraderie, they were often the victims of bullying, hostility, sabotage and tall poppy syndrome. The comments below illustrate their concerns:
They’d say, “How dare you come down here now that you think you’re cleverer than us and want us to change practice.”
When I started going to help her service, she became very threatened –as if she thought I knew more than her … it was really bizarre. … it was horrible.
I didn’t get told information. They were secretive, not wanting to share, because knowledge is power.
Some people were so resentful … that whole tall poppy thing … it was extremely difficult and it was a big obstacle for me to be happy in my role.
The negative, unsupportive behaviour of other nurses left some of the new NPs feeling powerless and ill-equipped to negotiate a place for themselves within the healthcare team. Colleagues in positions of authority misused their power and overtly and covertly undermined the NPs’ progress. To often nurses, managers and more experienced NPs withheld information, set unrealistic expectations, over-scrutinised and criticised the new NPs, and excluded from them team meetings and social events.
What became apparent from the NPs’ stories was the stark contrast between their initial hopes and expectations and what actually transpired. Although some rose to the challenge with tenacity and resilience, others felt anxious, disempowered and overwhelmed by the bullying and political gatekeeping they encountered, and eventually felt they had no option but resign from their role.
Some people will be jealous because they see you enjoying the success they don’t have from the work they haven’t done.
Although nursing is in dire need of confident, successful, high profile leaders that we can admire and emulate, the risk of being cut down as a tall poppy remains a significant problem. While the driving motivation for these negative workplace behaviours is not well understood, what is known is that professional jealousy, bullying and turf wars impact NP recruitment and retention, leading to gaping holes in service provision, particularly for vulnerable populations and rural and remote areas.
Sadly, the types of experiences described by the participants in this study are not limited just to NPs. Tall poppy syndrome rears its ugly head in many spheres of nursing (including nursing education), and can lead to toxic workplaces and demoralised staff. I can’t help wondering how different the nursing profession might be if there was less focus on ‘cutting down’ our colleagues and more attention to supporting them to grow and excel.
You’re going to feel like giving it up. You’re going to struggle.
You’ll have days where you wonder, ‘what’s it all for?’
You’ll have days when people attempt to break you down,
or challenge your intelligence, skills and right to be where you are.
You’ll have moments when you question your own abilities and perhaps your sanity – but you’ll rise!
You’ll rise because your strength as a nurse is not determined by one grade, one shift or one job.
It’s an ongoing journey of learning, honour, humility and a chance to make even the smallest
difference in the lives of your patients. (Unknown)
This blog post is based on the following article:
If you would like to read more about this study access the following papers:
MacLellan, L., Higgins, I. & Levett-Jones, T. (2015). Medical Acceptance of the Nurse Practitioner Role in Australia: A Decade on. The Journal of the American Association of Nurse Practitioners, 27(3), 152-159.
MacLellan, L., Levett-Jones, T. & Higgins, I. (2015). Nurse Practitioner Role Transition: A Concept Analysis. The Journal of the American Association of Nurse Practitioners, 27(7), 389-397.
MacLellan, L., Levett-Jones, T. & Higgins, I. (2015). A Game of Snakes and Ladders: Negotiating the ups and downs of endorsement as a Nurse Practitioner in Australia. Contemporary Nurse Journal, 50(2-3) 139-148.
MacLellan, L., Higgins, I. & Levett-Jones, T. (2017). An exploration of the factors that influence nurse practitioner transition in Australia: A story of turmoil, tenacity and triumph. The Journal of the American Association of Nurse Practitioners, 29, 149–156