Chapter 5: Building Compassion for Co-workers

“Suffering is a significant and pervasive, though often invisible, aspect of organizational life.” (Kanov et al., 2017)

As nurses, we are expected to notice suffering in our patients. However, we may not be attuned to, or even consider, that our co-workers may also experience suffering. We may have been told during our education, or by our manager, that professionalism requires that we need to hide our feelings (and hence our ability to suffer) when we are at work – even when our suffering is the result of witnessing the suffering of our patients (Bagdasarov & Connelly, 2013; Funk et al., 2017). This stoicism may result in reduced compassion for our co-workers, and even eventually for our patients. Paradoxically, one study found that hospital employees in the finance and business side of hospitals reported more compassion from co-workers than those in the patient care side (Lilius et al., 2008).

Research indicates that compassionate responses in the workplace add to, rather than distract from, the essential business of that workplace (Lilius et al., 2008; Simpson et al., 2020). Workers who treat each other with compassion, and who work with leaders who express compassion, experience positive emotions and a feeling of psychological safety, which can lead to improved organizational commitment (Chu, 2016; Lilius et al., 2008) and improved patient care (Beardsmore & McSherry, 2017). Compassionate workplaces can also help mitigate some of the negative health effects of workplace stressors such as verbal or physical violence from patients and families (Zhang et al., 2018).

When compassion is a part of the workplace, teamwork is enhanced, co-workers look out for each other, and people enjoy going to work. When co-workers nurture compassion for each other, negative behaviors, such as workplace bullying and harassment are not allowed to take root (Simpson et al., 2020). Unfortunately, nurses in almost every country experience higher rates of workplace bullying than other occupational groups (Johnson, 2018). Cultivating compassion in the workplace has been proposed as one way to eliminate workplace bullying (Simpson et al., 2020). At the end of this chapter, I will specifically discuss what you can do if you are a target of or witness workplace bullying or harassment, and how you can respond with compassion and strength.

In this chapter I will use the NEAR (noticing, empathizing, assessing, responding) Model of Organizational Compassion (Simpson et al., 2020) as a framework for discussing how to build and sustain compassion for co-workers. This framework is similar to the processes involved in expressing compassion that I outlined in Chapter 1. While the authors of this model state, and I wholeheartedly agree, that developing compassionate workplaces is not merely the responsibility of individuals but needs to be a focus of the organization as a whole, particularly those in top leadership positions, I feel this model is a useful guide for discussing individual-level compassion in the workplace. In the next chapter, I will discuss how nurses in formal leadership positions can work to create systemic change by introducing compassionate policies and processes into the workplace.

Building Compassion for Co-workers: Noticing Suffering

Before compassion towards co-workers can be activated, we need to become aware that they are suffering. There are several reasons that we may not always notice that co-workers are suffering. If their suffering is of a personal nature, they may not mention it, and may even go to great lengths to hide it. In most modern workplaces, we have created clear boundaries between our home life and our work life. These boundaries make it difficult for us to discuss our life outside of work in detail, especially areas that are sensitive (Kanov, 2021). Even when a co-worker is suffering because of a poor outcome experienced by a patient, or a difficult workplace situation, we may not notice. Healthcare professionals are socialized to cope with stressful events in the workplace by suppressing their emotions and carrying on with the next task on their to-do list (Davidson et al., 2017). When outward displays of distress are absent, it is difficult to know when a co-worker is upset by an event at work. Finally, the current focus on resilience may also mean that we are less likely to discuss suffering with co-workers as openly discussing suffering may indicate that we are not resilient (Aburn et al., 2020).

In the United States, nurses commit suicide at a higher rate than the general population, which suggests that nurses have a lot of unresolved suffering and depression (Choflet et al., 2021; Davis et al., 2021). In a retrospective study which compared nurses who died from suicide with non-nurses who died from suicide, the nurses who died from suicide were more likely to have job-related stressors (Choflet et al., 2021). As those of you who work in nursing know, the types of workplace stressors that nurses experience include (but are not limited to) violence from patients (Lanctôt & Guay, 2014; Yao et al., 2021), workload and staffing issues (Louch et al., 2017), and secondary trauma related to caring for sick and dying patients (Sheppard, 2015). The COVID-19 pandemic has exacerbated all of these issues (D’Ettorre et al., 2021). Poor workplace relationships, conflicts and poor communication are also cited by nurses as major workplace stressors (Louch et al., 2017). These factors are also roadblocks that keep us from noticing (or feeling empathy for) suffering that our co-workers are experiencing.

Now that we have explored why we may not notice when our co-workers experience suffering and distress, let’s explore how we can build our ability to notice when our co-workers are experiencing suffering. After you read this section, I invite you to complete an exercise designed to help you build your awareness of your co-workers’ moments of suffering and distress.

One of the best ways to notice when a co-worker is experiencing suffering or distress, and to develop compassion for them, is to get to know them. Given the fast-paced environment in many healthcare organizations, this can be difficult. When I worked as a hospital staff nurse, there were limited opportunities for nurses to interact with each other informally at work. If we arrived early, we might spend a few minutes chatting before shift report began, or we might even exchange a few pleasantries with the nurse we were giving report to. Once the shift began, there were few moments to talk – we were instructed not to talk about personal matters in the hallway or nurses’ station (but sometimes we did - because we are human), and because we would cover each other’s breaks, we rarely took breaks together.

Despite these obstacles, I did develop close relationships with many of them over the years. If you are working through this book with people that you work with, you have found a way to get to know each other, too! Some of the ways my co-workers and I connected on a personal level were through potlucks at work, participating in fund-raising activities together (such as Relay for Life which raises money for cancer survivors), and occasional get-togethers outside of work. Organizations can facilitate social connections by making it easier for nurses to have opportunities for social interactions (Simpson et al., 2020). I will discuss this in more detail in Chapter 6. Social media platforms also provide another way for nurses to connect outside of work (Simpson et al., 2020). (Unfortunately, social media also are a way for nurses to engage in cyber bullying, and workplaces need to be aware of this).

You do not have to be best friends with the people you work with to develop compassion for them. Nor do you need to spend time with them outside of work. Asking about their children, their pets, their hobbies, or what they did on their vacation are easy ways of getting to know a co-worker on a personal level. A simple statement like, “How was your weekend?” can go a long way to opening a connection with someone that we work with.

When we get to know our co-workers, we are more attuned to their suffering. We can then pick up on cues that they are having a bad day – either because of work, or because of what is going on outside work. As nurses, we are very good at doing emotional labor – which is (as discussed in Chapter 2), the act of displaying an outwardly neutral or positive emotion while feeling a difficult emotion (such as anger or grief) internally. So, unless we know our co-workers well, it may be difficult for us to realize they are suffering.

Getting to know our co-workers also makes it more likely they will trust us and share their suffering. This trust can be broken if we share their story with others without their permission. For example, a co-worker may not want everyone on the unit to know that their mother is in hospice. The best rule of thumb is to always ask, “Can I share this with our other co-workers, or is it private?”

If you are willing to share your own difficulties and moments of distress with colleagues, this also opens the door for them to share with you. It can be tricky to balance between over-sharing and the appropriate level of sharing, which is one reason some people are reluctant to say anything when they are distressed at work. A simple statement such as, “I am feeling sad today because XXX, who was a patient I really enjoyed caring for, died yesterday,” demonstrates an appropriate level of sharing, and demonstrates that you are human, and are open to hearing about your co-workers’ moments of suffering, hardship and distress.

I now invite you to complete the following exercise that will allow you to gauge your level of social support at work. There are no right or wrong scores, everyone has different needs for social support. However, if you are reading this book, I will assume you want to build and sustain a compassionate nursing practice, and social connection is a key component of compassion. If you feel you do not have enough social support at work, I invite you to think about what that means in terms of your ability to bring and express compassion in your workplace.

EXERCISE: Exploring Social Support in your Workplace

Either by yourself, or with your co-workers, complete the following questionnaire [adapted from the Workplace Friendship Scale (Nielsen et al., 2000)]. Higher scores indicate that you have more friendships at work. I encourage you to keep an open and curious mind as you do this exercise.

After you complete the questionnaire, I invite you to consider the following as you review your score.

• What do your answers tell you about the degree of social support in your workplace?
• Are you happy with the level of social support you get at work (some people prefer not to be close friends with their co-workers, and that is totally okay)?
• If you do not feel you have enough support, what do you think you can do to improve the social support in your workplace?

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Building Compassion for Co-workers: Feeling Empathy for Co-workers and Assessing their Suffering

As mentioned throughout this book, compassion is defined by the motivation to act to relieve suffering. Therefore, it is not enough to take note of our co-workers’ moments of suffering. After we notice they are suffering, in order to be moved to act, we need to have empathy for them. We also have to assess their suffering to decide whether we feel we have the capacity to act to relieve their suffering (Kanov et al., 2017), and whether we feel they are deserving of our actions, or if the suffering rises to our definition of distress that needs to be addressed (Simpson et al., 2020). I will discuss these two steps together as they overlap with each other, may occur in any given order, and often occur simultaneously. Indeed, sometimes empathy occurs after our assessment that our co-worker is deserving of our compassion, or that their suffering merits a response.

Since I have discussed empathy in previous chapters, I will assume we have a common understanding of what it means to feel empathy in the context of the suffering of another person. Therefore, I will begin by discussing impediments to empathy in the workplace. Unfortunately, in most workplaces, particularly in healthcare settings, there are many factors that block our ability to feel empathy. In fast-paced occupations which require a lot of cognitive energy, and in which there is an emphasis on productivity, workers may “miss or purposely avoid suffering cues entirely” or “downplay or dismiss the suffering” of their co-workers (Kanov et al., 2017). If we do not feel we have the time to engage compassionately with a co-worker, we may ignore signs of suffering, minimize the severity of their suffering (“it’s not that bad – I have experienced worse”), or decide the person can handle it on their own. This cognitive move allows us to move on with our busy work life while maintaining our image of ourselves as a kind and caring person.

Please note that I am fully aware that most workplaces are organized in such a way that in order to do one’s job well, there is little time or energy for empathy and compassion, so I am in no way blaming individuals for their inability to respond to every moment of suffering they witness in their workplaces. Afterall, we all have jobs to do, and if we do not do them, we may experience suffering in the form of a bad evaluation, or worse – loss of employment! In the next chapter I will invite you to explore organizational elements that block your ability to feel empathy, and what you can do to overcome them.

Empathy often requires advanced cognitive processes such as perspective-taking, which is an attempt to imagine what another person is going through (Davis, 2017). In a busy healthcare setting we may be so busy taking care of our patients, or meeting deadlines if we are not involved in direct patient care, that we do not have time, energy or mental capacity to engage in this cognitive process. So, even if we do notice that our co-workers are having a rough day, or that they seem to be distressed, we many not cognitively process that they are suffering, and will not feel empathy for them. We might even think that their suffering is self-inflicted, or the result of a shortcoming – such as incompetence (the assessment part of feeling compassion for a co-worker).

One thing that I have noticed from my interviews with nurses about workplace bullying is how often they felt judged by their co-workers or their supervisors. Fear of being judged by co-workers is a major reason why nurses (and other workers) typically go to great lengths to hide their suffering at work (Kanov et al., 2017). Many new nurses also report that they are bullied by more experienced nurses because they ask too many questions or seem insecure about how to handle certain patient situations. Some experienced nurses seem to forget that it takes time to translate what you learned in school to the practice setting. In Chapter 7 I will discuss how we can support and mentor new nurses in a compassionate manner, and alleviate the suffering associated with transitioning to a new role.

As I alluded to above, judging the performance of others is a major impediment to compassion in the workplace. I vividly remember one incident from my own years of working in a hospital in which compassion was not present, but judgement was. This occurred on a shift when I was asked to float to a different unit from the one I was assigned to. Over the course of the evening, I noticed that one of the other nurses on this unit had a very heavy workload. Her patients were high acuity, and she was also given several admissions during that shift. At the end of the shift, she told the charge nurse that she did not get a dinner break and asked to be approved for 30 minutes of overtime to compensate for this. The charge nurse refused to sign off on her overtime because, “you did not manage your workload appropriately. You need to learn better time management skills.” From my perspective, the staff nurse had an unreasonable workload and was met by an uncaring and unsympathetic charge nurse. It is doubtful that she would ever ask for help in the future and would probably go to great lengths to seem like she was managing her workload. Not surprisingly, that particular nursing unit had a hard time retaining staff and had many long-term vacancies (which is why I was asked to work there that evening)!

Our empathy can also be blocked if we compare our performance with that of our co-workers, or feel that we somehow have to compete with them. Competition and comparison are cognitive states that inhibit compassion and empathy as these feelings stimulate our incentive and resource seeking neural pathways which shuts down the neural pathways associated with compassion (Gilbert & Mascaro, 2017). Sometimes we compare our performance to others as a way of boosting our fragile self-esteem. Dr. Neff (2017) explains that comparison can arise when we lack self-compassion. We may focus on the “flaws and shortcomings in others as a way to feel better about ourselves” (p. 21). If you find yourself judging your co-workers a lot, or comparing yourself with them, I invite you to explore why this might be happening.

The following exercise is designed to engage your empathy for your co-workers, and to assess their suffering in a positive light. As you do this exercise, and as you start to notice moments of suffering of your colleagues in real life, notice any tendency to dismiss or diminish their suffering. Notice any tendencies to assess the suffering as “not worthy” of response, or “not severe enough” to engage with. I invite you to keep a curious and open mind, and to remember that we all judge each other (and ourselves!), but that this judgement can block our compassion and our ability to connect fully with each other.

EXERCISE: Building your Ability to Feel Empathy for Co-workers and to Assess their Suffering in a Positive Light

This exercise is designed to help you increase your ability to notice the suffering of your co-workers and to assess their suffering in a positive light, both of which enhances your ability to feel empathy for them. In this exercise, we will focus on suffering that is related to workplace issues, because in my experience those are the least likely to stimulate empathy. Your workplace may be different, but I found that nurses were more likely to act compassionately towards their co-workers who were suffering due to personal issues (especially major ones like a fire, or a death in the family) than those who were having work-related suffering.

This exercise has many steps, and you may wish to break it up into several sessions. It may be one that you revisit from time to time, especially if you find you are prone to judging your co-workers. This exercise can be done either alone, or with others.

1. First imagine that you are an impartial person observing your unit or department. Think of a common scenario at work that causes nurses to feel overwhelmed. Perhaps they are caring for a patient who is seriously ill or who is high acuity (or they have more than one high acuity patients!). Perhaps it is a shift where the nurse has a high volume of discharges and admissions. Perhaps there is a lot of documentation to complete but the needs of the patients make it difficult for them to find the time to get it done. Or, if you are in a non-clinical setting, perhaps there is a tight turnaround for a project or a looming deadline. As an outside observer, notice what is happening on the unit or department in any of these challenging situations. Who seems to be having the greatest difficulty? Are the nurses on the unit helping each other? If you journal, take some time to write down your thoughts. If you are doing these exercises with a group, discuss your thoughts with each other.

2. Now remember a time at work when you felt overwhelmed. Just pick one scenario, I am sure there are many. As you think of this shift, I invite you to close your eyes and do a quick body scan. What are you feeling? Where do you notice tightness or pain in your body? What is happening to your thoughts?

3. Next take some time to practice your self-soothing skills. Find your anchor, take some deep breaths if that helps you, and offer yourself some kindness. You might say something to yourself like, “I see that you are distressed and are suffering. I know that you are a competent, caring person and that you do the best that you can each and every day you go to work. I wish for you to experience peace and joy at work.”

4. Next think of a co-worker that you feel close to. Imagine that they are having a difficult shift or workday. What might they be feeling? What are you feeling as you imagine their suffering and distress? What are you thinking? If judgmental thoughts pop up, just explore them – then make an effort to get past them.

As you imagine the difficulty this co-worker is having, or has had, think about how you might help them, or how you have helped them in the past. Are you able to take over some of their tasks? Are you able to offer them words of kindness and support? (I know it is probably dependent on your own workload.) Explore how it feels to express empathic concern and compassion.

Before you move on to the next step, send this person some kind and caring thoughts. You might think, “I know that xxx is a caring and competent nurse. I wish for her to have peace and joy at work. I will support her to the best of my ability.”

5. Finally, think of a co-worker who you do not connect with. Perhaps you have felt judgmental, or un-sympathetic towards this person. Perhaps your personalities clash, or you have unresolved conflict. Now think of a time when this co-worker has struggled with the similar issues as the ones that have been problematic for you or the co-worker you identified in the previous step. What emotions and thoughts are coming to mind as you think of this person’s struggles? If feelings of empathy, support or kindness are not present, just take a moment to explore that, without judgement or self-criticism. What would it take for you to feel empathy and compassion for this person? What would that feel like?

If it is difficult for you to feel empathy, support or kindness towards this co-worker, recall the feelings you had towards the co-worker you felt close to. See if you can transfer the empathy you had towards that person to the co-worker who you do not connect with. If you are still are not feeling empathy towards this particular co-worker, end the session by reminding yourself that they are human, just like you and your other co-workers, and just like you they are worthy of your kindness and compassion. Just like you, they also want a job that brings them joy, and which is not a source of suffering.

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Building Compassion for Co-workers: Taking Action to Relieve Suffering

The last step in a compassionate response to suffering involves taking action. Action can be as simple as acknowledging the suffering of another, or it may involve more concrete support. In this section I will discuss some of the ways you can act to relieve the suffering of your co-workers, and will invite you to explore what facilitates, and what hinders, your ability to act to relieve suffering.

Your co-workers may experience suffering due to personal issues outside of work, or their suffering may be work related. I will first discuss suffering due to personal issues because in my experience this is the type of suffering co-workers seem to be more willing to acknowledge. When it comes to personal issues, most workplaces tend to be more supportive when personal suffering is due to a large, unexpected tragedy, such as a fire, an automobile accident or a major illness. I have witnessed great support – donation of money as well as of paid time off – for co-workers who had major traumas. However, I have also noticed that when there is a prolonged personal issue, such as an extended illness, a divorce which has created child-care issues, or a substance abuse issue, support is either non-existent or wanes rapidly.

While most of the barriers to responding to suffering due to personal issues that are ongoing are due to organizational policies (I will discuss this in Chapter 6), there are ways that individual co-workers can respond to this type of suffering. While offering material support may not always be possible if a co-worker is having chronic child-care issues or a messy divorce, just acknowledging that your co-worker is “going through a difficult time” and providing a listening ear may be enough (Lilius et al., 2008). Little gestures like giving them a card, buying them a cup of coffee, or picking up some of their workload or shifts can also be ways of showing support. In the following exercise I invite you to explore ways you can respond compassionately to co-workers who are experiencing personal issues. Then I will discuss how you can compassionately support co-workers who are experiencing work-related issues.

EXERCISE: Compassionate Responses to Personal Suffering in the Workplace

You can do this exercise alone or with a group. You may do it as a thought exercise or by writing your answers down.

1. First think of a time when you were able to act with compassion to help a co-worker who was suffering with a personal issue. What did you do to help them? What facilitated your ability to act? What emotions are you experiencing as you think back on this event?

2. Now think of a time when you were aware that a co-worker had a personal issue and you were unable (or unwilling) to help them. What impeded or got in the way of your ability to help them? (Try to be honest, perhaps you just did not feel empathy for them. If that is the case, you might non-judgmentally explore the reasons why empathy was missing.) What emotions are you experiencing as you think back on this event?

3. Finally, imagine you have a chance to relive your experience with either the co-worker who you were unable to help or the one you helped. What might you do differently? What might you do the same? What emotions are you now experiencing?

4. If you are doing this exercise with a group from work, discuss some ways you can help alleviate your co-workers’ suffering due to personal issues. What systems can you put in place that will help people feel safe expressing their personal difficulties? What systems can you put in place that facilitate compassionate responses to personal-related suffering?

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Depending on your workplace and the amount of teamwork that is present, acting to relieve suffering related to the workplace may either be easier or more difficult than acting to relieve suffering related to personal issues. In this section I will discuss actions that we can take to help each other cope with suffering related to workload issues. In the next sections I will discuss what we can do to address conflicts in a compassionate manner. At the end of the chapter, I will discuss how we can help co-workers (or ourselves) when workplace bullying, incivility or other forms of harassment occurs.

Workload issues (such as having more work than you can reasonably do) are present in almost every setting that nurses practice (Alghamdi, 2016; Swiger et al., 2016). During the COVID pandemic, which was raging as I wrote this book, workload issues were exacerbated (Lucchini et al., 2020). Even before the COVID pandemic, nurses reported that due to staffing ratios, high patient acuities and administrative requirements (e.g. paperwork or charting) they frequently did not have enough time to complete all of their tasks, let alone take breaks (Blackman et al., 2015; Bogossian et al., 2014). As a result of workload issues, nurses report feeling that they have given sub-optimal care, leading to feelings of job dissatisfaction and moral distress (Bogossian et al., 2014).

When I worked in the hospital as a staff nurse, there were more shifts that were “crazy busy” than “quiet,” and the problem only got worse as the years went by. As nurses in research studies have reported, and as you yourself may have experienced, the “crazy busy” shifts were characterized by too many admissions, high acuity patients, unrealistic staffing ratios, and charting systems that were redundant and time-consuming (Blackman et al., 2015; Bogossian et al., 2014). However, for much of my nursing career I had supportive co-workers who would help each other out (when we could!). If we had a patient who was gravely sick and needed to be transferred to an intensive care unit, or if there was a patient who was coding, we would step in and take care of each other’s patients. We would help each other turn patients, clean patients, and everyone pitched in to pass meal trays. We would also help each other with procedures such as inserting foley catheters, naso-gastric (NG) tubes or IV lines. One nurse I worked with disliked inserting NG tubes, so I would help her with that, and in turn she would help me with IV lines (a skill she performed better than I did).

I want to acknowledge that the real issue with workload is that due to cost-cutting measures and an increasing emphasis on productivity, nurses’ workloads are often unrealistic (Everhart et al., 2013). While an individual nurse may feel helpless to change these systemic issues, as a collective nurses can, and are, working together to force their hospitals to enact safe staffing ratios. I know it can be hard for some nurses to speak up for better working conditions, however workload issues not only cause suffering for workers, they also affect the quality of care and patient outcomes (Everhart et al., 2013; Macphee et al., 2017). Therefore, advocating for better staffing ratios and reasonable workloads can be viewed as an act of compassion towards both our co-workers and our patients.

There are many other work-related issues that can cause suffering at work, and it is beyond the scope of this book to go into them all! I will just mention a few more here. Violence and verbal abuse from patients and/or their support people is a cause of distress for almost every nurse. Taking care of sick and dying patients can also cause suffering, especially when patients are children or young adults. There are also situations that cause moral distress, such as giving care that seems futile and even seems to be causing patients undue distress. Nurses can also have physical suffering due to work – nurses have high incidence of musculo-skeletal injuries and may be working with back pain or another work-related injury (Dressner & Kissinger, 2018). As I stated at the beginning of this paragraph, I cannot list all the ways we may experience suffering related to work! I am sure you have some examples that I did not list here.

In the following exercise I invite you to explore ways you can respond compassionately to co-workers who are experiencing work-related distress and suffering. The work-related issues and compassionate responses that you identify may be similar to, or different from, the examples I have given in this section.

EXERCISE: Building and Sustaining your Ability to Respond to Co-Workers’ Work-related Suffering

You can do this exercise alone or with a group. This exercise is similar to the one you did in the section on responding to co-worker’s suffering that was of a personal nature. The only difference is that in this exercise, your focus will be on responding to suffering that is caused by work-related issues.

1. First think of a time when you were able to act with compassion to help a co-worker who was suffering with a work-related issue. What did you do to help them? What facilitated your ability to act? What emotions are you experiencing as you think back on this event?

2. Now think of a time when you were aware that a co-worker had a work-related issue, and you were unable to help them. What impeded or got in the way of your ability to help them? (If the impediment was a lack of empathy, try to set aside judgement – either for yourself or your co-worker). What emotions are you experiencing as you think back on this event?

3. Finally, imagine you have a chance to relive your experience with the co-worker who you were unable to help. What might you do differently? Imagine yourself doing these actions. What emotions are you now experiencing?

4. What differences did you notice in your feelings, thoughts and judgements when doing this exercise and the previous one? Which one was easier, or were they both the same?

5. If you are doing this exercise with a group from work, discuss some ways you can help alleviate your co-workers’ suffering due to work-related issues. What systems can you put in place that facilitate compassionate responses to work-related suffering? What systems can you put in place that will help people feel safe expressing their workload related struggles?

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Building Compassion for Co-workers: Conflicts and Compassionate Communication

In any relationship conflict is inevitable. Handled correctly, conflict can be productive, it can be a mechanism whereby workplaces resolve issues in a creative manner (Kim et al., 2015). Handled incorrectly, conflicts in healthcare settings can contribute to poor patient care, lack of teamwork, job dissatisfaction and turnover (Kim et al., 2017). Skilled communication and a degree of empathy for the other person can be key factors that differentiate healthy conflict from unhealthy conflict (Klimecki, 2019).

When conflict arises at work, it can be helpful to realize that it can trigger the emotional centers of our brain (our amygdala), and our natural tendency may be to either fight, to flee or to freeze (Chou & Cooley, 2018). In this triggered emotional state, our response to conflict will undoubtably be uncompassionate, as the neural pathways associated with fighting, fleeing or freezing block the neural endocrine pathways associated with compassion (Gilbert, 2013). If you find yourself in a conflict at work (or at home!), before you engage in conflict resolution, you should first take some time to bring your body and mind back to a calm, deactivated state.

I do realize that if a conflict arises in the middle of an emergency, such as a coding patient, a major trauma or a difficult childbirth, it is not possible to step away and calm down. In these types of situations, if you realize that you are in a hyper emotional state, remind yourself to take some deep breaths, quickly find your anchor, and return your focus to caring for the patient. After the crisis has passed, the team can discuss any conflicts that might have occurred and can figure out ways to prevent future conflicts in similar situations. If you are not in a position within the organization or unit to initiate these types of conversations or debriefings, perhaps you can illicit the help of your manager or a nurse educator (if your unit has such a position) to facilitate the conversation.

While we may not be able to change group-level dynamics, we are always in a position to control how we handle our reaction to conflict. Since there are many books and classes that teach conflict resolution skills and assertiveness training, and it is entirely possible that your organization is willing to send you to a conflict resolution course, or that it already offers that type of training periodically, I am not going to discuss conflict resolution in detail. Instead, I offer the following pointers to help you nurture a compassionate mindset towards conflict resolution. These pointers also can help us navigate many issues that come up in workplaces, even if they are not overt conflicts.

The first step to healthy conflict management is to try to understand the other person’s viewpoint (perspective taking) and emotions (empathic concern). Perspective taking is cognitive skill (Longmire & Harrison, 2018, p. 894), whereas empathic concern is an emotional response, and both can be useful skills for conflict resolution, negotiation, and other forms of communication. While you can try to imagine what one of your co-workers are thinking or feeling, the best way to take their perspective or to stimulate your empathic concern is to ask them what they are thinking or feeling. It is entirely possible that they will not share their thoughts or emotions with you either because they do not have a level of trust in you, or because they are not really sure what they are thinking or feeling at that moment. However, by asking these questions you have at least indicated that you are willing to look at the issue from their point of view.

It is very important to avoid making assumptions and jumping to conclusions when we are in a conflict with another person (indeed these are important at all times!). Humans have a natural tendency to process information quickly and to make assumptions based on this “quick thinking” (Kahneman, 2011). While rushing to judgment may be a useful skill when we encounter an actual danger (like a snake or growling dog), it can be an impediment to successful conflict resolution or communication. Quick thinking also activates our hidden biases, which are usually counterproductive to conflict resolution. To avoid making assumptions, it can be useful to consider the ladder of inference (which I will discuss in the next paragraph). The ladder of influence is a model that illustrates the process our brain uses when we jump to conclusions (Chou & Cooley, 2018; Schlegel & Parascando, 2020).

The first rung on the ladder of inference is the sensory data that is available to us (Senge, 2006). Our brain simultaneously processes multiple stimuli all the time, filtering out what it thinks is useful, or only attuning to certain facts due to a process known as confirmation bias. This filtering process is the second rung on the ladder. We then add our interpretation to the sensory data that makes it into our consciousness, drawing a conclusion which may or may not be accurate. Finally, we act on the interpretation of the data we processed, unaware that there might be other data we did not recognize. Our actions cause a reaction which starts the ladder of inference all over again (Senge, 2006).

For example, perhaps your co-worker (Suzy) does not greet you as you pass her in the hallway. Because you have had a conflict with her in the past, you decide she is ignoring you, and you may conclude that she is angry at you. Consequently, you ignore her the next time you see her, and eventually you and Suzy are barely on speaking terms.

Let’s imagine that you have just read about the ladder of inference. You see Suzy in the hallway and she does not greet you. Later, you run into her in the med room, and decide to check your assumption about her lack of greeting. You say, “I saw you as you were coming in this morning. I guess you didn’t see me?” Suzy then admits she didn’t see you until you had passed by, she was preoccupied because she had a fight with her teenaged son this morning about homework that he did not complete. She is worried that he will not pass tenth grade algebra. While you and Suzy continue to have disagreements, you now have a working relationship and are able to discuss your disagreements in a compassionate manner.

It is very important to stay aware of our emotional state when we have a conflict. Look for signs that you are being triggered by strong emotions such as anger, fear, embarrassment, or any other emotion that may lead you away from compassion, and which may make you say something you regret. It can help to stay connected to your anchor and to make sure you engage in an occasional conscious breath cycle. Sometimes we need to take a time out, or step away from a conflict to process our emotions.

When dealing with conflicts, it is important to focus on the problem, not the person (Chou & Cooley, 2018). You cannot change people, but you can ask them to change their behaviors or what they do in the workplace. It can help to remind yourself, and the person you are having difficulty with, that you have a common interest – in a healthcare setting it is likely to be doing what is best for your patients. In an educational setting, your common interest will be supporting student success. (Of course, If the other person is not patient or student focused, there may be a whole different set of concerns!)

Focusing on the problem helps us retain good working relationships with our co-workers, even those whose personality gets on our nerves. I once worked with a nurse (I’ll call her Laura) who seemed to be a bit flighty and unfocused. Laura sometimes had difficulty with time management, which meant that some of her work did not get accomplished. When she was stressed, she often had a high-pitched laugh, which annoyed some of the other nurses. Because of her time-management issues, the nursing manager created a performance improvement plan for her. One of the objectives of this plan was that Laura would attempt to laugh less. This is a prime example of focusing on the person – Laura’s laughter was an unconscious habit, and the more she tried to suppress it, the more she lost focus, which was the real root of her problems.

Conflicts and miscommunications will always be a part of the working world. When we take the time to develop relationships with our co-workers and to practice compassionate conversation techniques, issues which arise can be resolved quickly. In the next section I will discuss incivility, workplace bullying, and harassment – situations that can be tricky to resolve. But first, I invite you to complete the following exercise on managing conflicts in a compassionate manner.

EXERCISE: Building and Sustaining your Ability to Manage Conflicts Compassionately

This exercise can either be done with a group or on your own. If you are doing it on your own, I suggest you write out your answers to the following prompts. If you are doing it with a group, I suggest you take some time to think of your answers (perhaps writing them out), then discuss your answers with as a group.

1. Think of a recent conflict or miscommunication that you had with a co-worker. Ideally think of a scenario where the issue was resolved satisfactorily. What was the central issue? Was it work-related or person-related, or a combination of both?

2. What was your perspective on the issue? What emotions were you feeling?

3. At the onset of the conflict or miscommunication what were your assumptions about the other person’s perspective, motives, emotions, or thoughts? Did your assumptions change during the course of the conflict or miscommunication, and if so, how did they change?

4. How was the conflict or miscommunication resolved? If it was not resolved, what is the current relationship between you and this co-worker? What might you do now to resolve this issue? If the issue was not resolved, and the conflict is on-going, perhaps you can work with your group to come up with phrases you can use to revisit the issue with your co-worker. If you are working on your own, perhaps you can write out a script that you could use.

5. If you identified a conflict in the first step that was resolved, now think of one that is ongoing. What lessons can you take from the first example that you can apply to the current conflict? What emotions or thoughts are present as you think of this situation? What assumptions do you have about the other people involved in this conflict? How might you check whether these assumptions are accurate?

6. Finally, as a group, (or by yourself), think of some ways a team can develop good working relationships even if there are disagreements or conflicts that are never really resolved. Perhaps there are just differences of opinions about how some (hopefully minor) things should be done in the department or unit. How can the members of your team “agree to disagree” while maintaining a cordial working relationship? (I have found that humor helps in these situations, but that might not work for everyone). If your department or unit has a code of conduct, consider including language about conflict resolution, including an option to “agree to disagree” with respect.

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Building Compassion for Co-workers and Yourself When Workplace Bullying, Incivility and Harassment are Present

Workplace bullying, incivility and harassment from co-workers are workplace issues that are present in many nursing workplaces. Incivility is rudeness or unthoughtful behavior that violates workplace norms. Incivility may or may not be intentional, and is generally a one-time occurrence (Pearson et al., 2005). Workplace bullying is an extreme form of incivility. Workplace bullying can involve the same types of behaviors as are present with incivility. However, when workplace bullying occurs, the behaviors happen frequently (usually at least weekly) for a long duration of time (six months or longer) (Johnson, 2018). It is generally believed that workplace bullying is an intentional act targeted towards a specific person or persons (although the perpetrator may deny intent). On the other hand, incivility may not be directed towards any given person. Workplace bullying and incivility have negative impacts on patient care (Johnson et al., 2020), they negatively affect nurses’ health and well-being (Johnson, 2018), and are a reason that nurses leave either their workplaces or the profession of nursing (Johnson & Rea, 2009).

Harassment can manifest similarly to workplace bullying. In the United States this term is used to refer to negative behaviors directed towards a person due to their gender, religion, ethnicity, race, disability, or other legally protected category. In the United States, there are no laws that protect workers against workplace bullying, however there are laws that require workplaces to protect workers against harassment (although these laws have proven to be difficult to enforce and do not provide a lot of protection for employees). Other countries, such as Canada, Australia, Sweden, and France have laws that require workplaces to address workplace bullying as well as harassment.

If you are on the receiving end of harassment, bullying or incivility at work, I encourage you to discuss the issue with your managers and co-workers whom you trust. My own research on workplace bullying has demonstrated that managers can be the source of bullying, and also that some managers will not take action to help you, but I have also found that there are managers who are quite supportive and have the expertise to address workplace bullying (Johnson et al., 2015; Johnson & Rea, 2009). So, unless your manager is the perpetrator of bullying, you should definitely talk to them before deciding on another course of action. If your manager is the problem, consider enlisting the help of your co-workers and someone from human resources. If you cannot get help, seriously consider finding another place to work. One of the advantages to being a nurse is that there are a lot of different employment opportunities, and it is not worth the hassle to stay in a workplace that is toxic.

Building resilience and striving for compassion or forgiveness towards the perpetrators of incivility, bullying or harassment can help buffer some of the negative outcomes you may experience if you are the target of these behaviors. Research has shown that nurses who are resilient and exhibit psychological hardiness have lower levels of stress and other negative outcomes from workplace bullying (Teo et al., 2021; Van Heugten et al., 2021). I want to emphasize that compassion and forgiveness are no substitute for getting away from the situation or working to get the person to stop abusing you! You may not be able to feel compassion, forgiveness or healing until the situation has resolved, and indeed, it may take time (and help) to be able to generate these feelings (Van Heugten et al., 2021). If you are not ready to work on forgiveness or compassion for the perpetrator of workplace bullying or harassment, that is okay. In the meantime, work on recognizing that you are not to blame for their behaviors, there is nothing you did to deserve this treatment, and focus on cultivating self-compassion and taking care of yourself.

Support from co-workers and family also helps targets of bullying and harassment recover (Van Heugten et al., 2021). If you are experiencing these issues at work, talk to a trusted friend, family member or seek counseling. If you witness these behaviors at work, offer support to the target. While co-workers do not necessarily have the power to get the perpetrator of bullying to stop their behavior, they can offer other support (Thompson et al., 2020). One of the most important ways that co-workers who witness bullying can help is by providing written documentation of the incident to managers, human resources, or lawyers (Johnson et al., 2015). Without written documentation, it is very difficult for anyone to pursue disciplinary action.

It goes without saying, if you find yourself engaging in uncivil or perhaps even bullying behaviors at work, you need to change your behaviors. Perhaps you grew up in a home where people were unkind to each other – or you may even have suffered abuse when you were a child. Perhaps you have anger management issues. Or maybe you just have a gruff personality or a wry sense of humor that others think is unkind. I was once told that I was acting as a bully at work. This was when I was a charge nurse on evening shift. The day shift charge nurse said she felt like I was bullying her when I challenged her staffing decisions (the day shift charge nurse was responsible for determining staffing levels for evening shift). We had an open discussion, and I agreed that my behavior was probably hostile as I felt we were often short-staffed on evening shift due to her decisions. We agreed that I would start the shift by greeting her kindly and asking about her day. We did not reach an agreement about staffing because this conversation took place during my last week at that hospital (which is probably why she felt safe initiating it).

The courage of this nurse to bring up this topic taught me several valuable lessons. One is that the person who is perceived to be a bully may not think of themselves as such, they might just be angry about a work-related or personal issue. The other lesson I learned is that starting a professional conversation, especially a difficult one, with a personal greeting goes a long way towards establishing camaraderie and trust. I have also learned that when I have conflicts with my co-workers, I make sure to end the interactions with an acknowledgement that I appreciate them, that I enjoy working with them (which I usually honestly do), and that I value our relationship. This seems to help us keep the focus on the work-issues rather than the inevitable personality issues that creep into workplaces.

EXERCISE: Finding Compassion and Regaining Equanimity after Difficult Experiences at Work

This exercise is comprised of several different mental exercises that you can do to help you heal from difficult interactions at work, such as incivility, workplace bullying, harassment or personality conflicts with co-workers. You can do them as meditations, or you can journal about your thoughts and feelings. You can also use these suggestions as starting points for conversations with trusted friends. Please note that severe bullying and harassment may result in PTSD, and you may need professional counseling to help you recover fully, especially if you are feeling suicidal.

1. The first thing I want to emphasize is that no one deserves to be treated badly at work (or anywhere else). Forgiveness does not require tolerating abuse. As the Dalai Lama said, when harmed by another we can think, “this person’s action is harmful and I must act to stop it, (however) he has the same wish to be happy as I do.” (The Dalai Lama & Chodron, 2017, p. 54). As I said before, the first step towards healing is to either work to get the abuse to stop, or to remove yourself from the situation (I do realize it can take time to find a new job, and that is not possible in every place, especially rural communities). As you actively take steps to end workplace bullying, abuse or harassment, take extra time to practice self-compassion and self-care. Repeatedly remind yourself of your inherent worth. Several times during the day remind yourself that you are fierce, self-confident and have the courage to do what you need to do to protect yourself. Surround yourself with supportive people.

2. When you are in a space to process the difficult situation at work, or if the conflict was relatively minor and short-lived, you can begin the process of healing. Healing will require some degree of letting go of anger towards the perpetrator and working towards finding compassion for them. After all, they are probably suffering too, since healthy, happy people do not treat others with disrespect. Know that it may take a long time to heal and get to a place of forgiveness and compassion. The Dalai Lama admits that “This type of kindness and compassion is developed only through reasoning and training; it does not arise instinctively.” (The Dalai Lama & Chodron, 2017, p. 54). Practicing lovingkindness meditations, like the ones I presented in Chapter 1, can help you get over feeling angry and resentful toward the person who hurt you. Again, know that this takes time, and you may need professional help, especially if you have experienced other forms of trauma or abuse in your life.

3. Another mental exercise that you can do to move past hate or anger towards someone who has wronged you is to think of a good quality that that person possesses. Perhaps that person is an excellent clinician. Perhaps they have a dog that they talk about, and you also like dogs. Again, if you cannot think of any good qualities in this person, think about how much suffering they must have in their life. Perhaps they treat you and others badly as a way of bolstering their own self-esteem, perhaps they are being abused at home, or have been abused in the past. Perhaps they lack people-skills and have few friends. Thinking of how someone who is harming us is also suffering can elicit compassion, but be careful as it can also elicit feelings of schadenfreude, or pleasure in the suffering of another person. If that happens, just notice it, and let it go. Likewise, revenge fantasies are counterproductive and lead us away from compassion.

4. Any time you start to process and recover from a traumatic experience like workplace bullying, harassment or abuse you may start to feel vulnerable again. It is helpful to find a healthy restorative practice to do afterwards. You might take a long bath, paint your nails, or go for a walk. Listening to uplifting music or watching a light-hearted movie may also help you feel restored. Just take some time to take care of yourself, and to give yourself some appreciation and love for the hard work you are doing to become a compassionate and resilient person.

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Conclusion

In this chapter we explored several of the ways we all can suffer at work. I also discussed how we can tune into the suffering of others and can strive to make our workplaces kinder and more compassionate. While healthcare organizations are busy places, and we may feel that we do not have the time to make personal connections or resolve interpersonal issues and conflicts, in the long run it is essential that we work to develop good relationships with our colleagues. It will make work more fun, it will provide us with support when we experience suffering, and it will help us resolve the inevitable conflicts that arise when groups of people come together. In the next chapter I will specifically discuss what nurses who are in formal positions of leadership can do to enhance compassion in the workplace. Even if you do not see yourself as a leader at this point in your career, I encourage you to look at this material as it is my contention that all nurses are leaders, even if they do not have a formal title.

Key Takeaways from Chapter 5

• Workplaces are not free from suffering. It is impossible for people to leave all of their personal suffering behind when they come to work. Work itself can also be a source of suffering.
• The NEAR framework: Noticing, Empathizing, Assessing and Responding provides insights into how we can nurture our compassion for our co-workers who are suffering.
• While we do not have to be best friends with our co-workers, consciously building supportive and kind workplace communities can help ease suffering, and can also help us productively resolve conflicts.
• When conflicts arise, it is helpful to: seek to understand the other person’s perspective; avoid making assumptions and jumping to conclusions; stay attuned to your own emotions; and to focus on the problem not the person.
• Workplace bullying, incivility and harassment are issues that are present in many workplaces. If you are on the receiving end of these behaviors, it is important to get help to end the behaviors, or to find a new workplace if the behaviors continue. Generating compassion for the perpetrator of these behaviors, and working to let go of anger are ways to begin to heal from these traumatic experiences. If the abuse was especially traumatic you may need counselling to help with the healing process, especially if you are experiencing suicidal thoughts.

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