One of the most powerful, albeit often unspoken, expectations of those who choose emergency nursing as a career is that under no circumstances are you to allow emotions other than resilience, accompanied by a dose of toughness, to be shown to your colleagues. There is an erroneous belief among many providers within our arena that anything less than a tough veneer is a manifestation of weakness. Perhaps you have experienced this by comments said just within your earshot; "she'll never make it here - she's not tough enough," "don't put him out in triage - he's too nice to everyone," or maybe it is communicated at your emergency department with a rolling of the eyes or a derisive laugh. This kind of response from those around us can be particularly difficult when dealing with the sequela of the death of a patient or in the face of physical or psychological suffering of our patients or their families. In fact, an article which appeared in the December 2008 issue of the Journal of Emergency Nursing, I Get by with a Little Help from my Friends: Peer Emotional Support in the Emergency Department, outlines an innovative program designed to mitigate this culture. According to author Eric Griffin RN, MSN, RT(R), CEN, the peer support group concept at his facility developed initially as a result of peer hostility within the department and morphed into an organized program of support that has resulted in improved collaboration and collegiality. Mr. Griffin recently shared with Triage First that even those who are unable to attend the meetings may participate indirectly via the meeting minutes and provide subsequent suggestions and input. One of the factors that has helped this particular program be successful, according to Mr. Griffin, is leadership support and staff buy-in. There must come a point that those in the trenches say, "enough of this," and take appropriate and effective steps to address staff hostility and lack of peer support. As pointed out by Griffin, "I believe that senior emergency nurses do not get better at coping with their emotions over time; instead, we get better at masking our emotions."¹ This is a patient safety issue as identified by The Joint Commission's Sentinel Event Alert from July 2008² (discussed in literature review).

How long will we continue to say, "I'm fine, I'm fine" when we are anything but fine?

¹Griffin, E.E. (2008). I get by with a little help from my friends: Peer emotional support in the emergency department. Journal of Emergency Nursing, 34(6), 547-549.

²The Joint Commission. (2008). Sentinel Event Alert: Behavior that Undermines a Culture of Safety. Retrieved February 11, 2009 from http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm