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I recorded a podcast episode version of this post, to listen to it, simply click play below.

What Went Down

On TikTok recently, there has been a trend called the “ick” trend. Essentially, people do share their “icks” (annoyances) in short 1–3-minute videos. Many were lighthearted and poking fun at one another.

The few that I observed posted by healthcare providers were all sharing “icks” about other healthcare workers. For example, a nurse saying to a doctor, “My ick is when you have coffee breath every morning!” or other minor inconveniences of the job related to supplies or process. I had yet to observe one directly mocking patients.

Then, I saw the video in question. It was of of four labor and delivery nurses sharing their “icks” but they were all related to patient behavior. I do not want to share the actual video, but here is the transcript of the 1-minute video:

• Nurse 1: My ick is when you come in for an induction, talkin’ about: “Can I take a shower and eat?”
• Nurse 2: My ick is when you ask how much the baby weighs, and it’s still in your hands.
• Nurse 3: Dad comes outside and asks for a paternity test, right outside the room door.
• Nurse 4: Saying you don’t want any pain medicine, no epidural, but you’re at an 8 out of 10 pain with just a Cervidil, and you’re still close, fingertip.
• Nurse 3: When we’ve already told you to push your call light, but every five minutes, your family member comes back at the front desk, asking for something else.
  • Nurse 1 on the side imitating a patient: “Excuse me, excuse me, can I have some water? Excuse me, can I have a blanket?”
• Nurse 3: Another ick: when you’re going room to room between one baby mama and your other baby mama. ICK!
• Nurse 1: It’s the unlimited trips to the nurses station for me.

All four nurses were in their scrubs, filmed at work (and appear to be on the clock), and have their badges on. The name of the hospital was not shown or shared, but easily deduced by the public.

Online Response

Many people stitched the video, responded, and commented saying that it crossed the line to openly mock patients, particularly during vulnerable moments. Many stated that most of the requests/actions, with the exception of the two about the father, were reasonable.

Many expressed disgust and disappointment, stating feelings of judgment. Below are various comments:

• “People think… oh man if this is what my nurse thinks, I can’t ask for what I actually need because I’m worried I’ll get judged. Last thing we want.”
• “Childbirth is the most vulnerable time for a woman.”
• “Some comments are for your friends and for no one else to see. Normalize that.”
• “Imagine watching this, knowing they delivered your baby”
• “”No job is perfect but we don’t broadcast it on TikTok”
• “Do they think we give birth everyday and it’s something so casual? New mothers ask a lot of questions, especially considering the state they’re in”

Other healthcare professionals chimed in as well, stating they don’t condone the behavior, and that patients have the right to receive non-judgmental care, and shouldn’t be constantly worried if their genuine questions and concerns were going to end up being mocked online later.

Other nurses have spoken in defense of them.

Arguments have been:

• Nurses need an outlet; we’re humans too
• They genuinely feel that way, as many do, so what’s wrong with being honest about it? The only difference between these nurses and others is that they have the courage to say it.
• That’s not how they meant it, so it shouldn’t be taken that way
• They’re allowed to have frustrations with patients, they shouldn’t lose job over it
• Making funny social media posts is how we cope and connect with other nurses
• Nurses have free speech like anyone else
• Patients shouldn’t look for this information (or for nurses online who are just venting… it’s like looking up their address

Despite these arguments, the overwhelming majority of nurses online have shared that they do not condone the behavior and that it is problematic.

From what I can tell, it wasn’t that individual previous patients complained to their employer. Rather, there was such public outcry that their employer found out about and took action. (Please feel free to correct me here, as I am not personally involved and trying to put pieces together online.)

Response from the Employer

The four nurses were terminated by their employer, Emory Health. You can read their formal statement here.

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A post shared by Emory Healthcare (@emoryhealthcare)

It was not publicly stated if the nurses were reported to the Georgia State Board of Nursing, however given how public and viral the video was, I would not be surprised if a formal complaint was made. Regulatory boards are required to investigate any complaints, so they could also be facing disciplinary proceedings regarding their nursing licenses. This would require legal representation and possible fees or suspensions of their nursing licenses.

Getting terminated is scary and embarrassing enough, let alone in a very public manner.

My Perspective

I’m a big fan of humanizing people, so I want to do that with this situation for everyone.

I’m sure this is a watershed moment for these nurses. It is likely embarrassing and devastating. I’m sure they worked so hard to get through school and work in that unit, and likely did not realize the implications of posting a video like that.

I also want to humanize the patients. Working in L&D, you get used to your everyday life but for most people, giving birth for the first time is a terrifying and highly vulnerable experience. You ask “stupid” questions, you’re scared, you don’t know what to expect, maybe you weren’t fully informed about things, and you desperately don’t want the nurses to think poorly of you so you do things to try to help but they may end up annoying people more. It’s genuinely scary.

When I gave birth, despite being a nurse myself, having a doula, my husband there, and lots of medical family members felt terrified and ill-prepared.  I cannot imagine giving birth and later seeing my nurse mocking my behavior online, with thousands of views. I would have felt violated and mortified.

I want to walk through each of the arguments defending the nurses, and my thoughts on them.

Argument #1 – Nurses Need an Outlet; We’re Humans Too

Quote from a comment on my TikTok: “I told a creator to be kind because she was mocking patients and family with her friends, she told me it’s a way of coping because of the job”

We do have a stressful job. We’re often not treated fairly or well. We are absolutely humans too. However, let’s first talk about professional standards in general.

When you go online and you publicly identify as a registered nurse, you go from being just any person to representing the profession. Doing so comes with added responsibility.

“Online content and behavior has the potential to either enhance or undermine not only the individual nurse’s career, but also the nursing profession.” [ANA Principles for Social Networking and the Nurse, Guidance for Nurses, PAGE 6]

When you go through the process of going to nursing school, applying to a regulatory board, passing board examinations, and then getting a license, you are now held to a different standard than general public. You are not only responsible to your employer and the public, but also your state board of nursing for your conduct – on and off the clock.

When you decide to be a nurse, you agree to abide by certain rules, regulations, and standards to be able to actually say I am a registered nurse. Just because you went to nursing school doesn’t mean you’re automatically an RN.

You must be registered with a regulatory body whose duty is to first protect the public. They do this by ensuring that only adequately trained individuals without criminal records are granted licenses, and by monitoring and holding license-holders accountable for infractions. Therefore, if a nurse gets convicted for child abuse, stealing and/or distributing drugs, etc., the board of nursing investigates and goes through the proper channels to prevent this person from practicing as a protection mechanism for the public.

There are ethical standards we are held to as nurses, again, which is a step up from your normal non-professionally licensed member of the public.

I know we talk about these things in nursing school and they seem so textbook like and unrelatable, but they very applicable to this situation and I want to talk about two.

The American Nurses Association, which is the largest professional org for nurses has a code of ethics that we are held to. This is likely cited in your State Practice Act, which you are legally required to abide by. This code of ethics has multiple provisions, and then explains those out more specifically in what are called “interpretive statements”. I want to discuss two that are applicable here.

“The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.”

PROVISION 1 of the ANA Code of Ethics

Interpretation: The need for health care is universal, transcending all individual differences. The nurse establishes relationships and delivers nursing services with respect for human needs and values, and without prejudice. An individual’s lifestyle, value system and religious beliefs should be considered in planning health care with and for each patient. Such consideration does not suggest that the nurse necessarily agrees with or condones certain individual choices, but that the nurse respects the patient as a person.

My translation: Regardless of what you think about that person … how annoying their requests are … how weird their religious practices or values are … how different they are … how tired you are … how frustrated you are with staffing, their questions, or requests … your patient needs to be respected as a person. This isn’t something that you can disregard based up frustration; it is a requirement of the professional role in which we hold.

“The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.”

PROVISION 2 of the ANA Code of Ethics

Provision 2.4 discusses professional boundaries as an aspect of this.

Interpretation: Nursing care is intimate in nature, which sometimes causes the line of limitation within professional relationships to blur. However, nurses must recognize and maintain appropriate boundaries within relationships. Nurse to patient and nurse to colleague relationships differ from those that are personal and unstructured, like friendship.

The intimate nature of nursing care and mutual dependence upon colleagues to walk through them with patients can cause the blurring of limits in professional relationships. We must maintain authenticity to ourselves while maintaining professional boundaries. It is our professional responsibility to do so. When it is jeopardized, it’s up to us to seek assistance (manager, or whomever) to remove ourselves from the situation.

My translation: Things get spicy at the nurse’s station. We go from inserting a foley into a patient in one room (an extremely embarrassing and vulnerable moment for a person), seeing someone die in another, and someone else gets caught doing drugs in the bathroom of another room. Navigating all of that with your colleagues’ bonds you in a unique way. It is very easy to lose sight of what’s professional and what’s not, especially during private moments between colleagues that are not observed by leadership, management, or others.

We are in a position where we must exercise personal restraint out of respect for our patient when no one is watching. Despite the spicy-ness or odd situations we find ourselves in, we need to remain professional and respect our patients as humans – even if they’re annoying us, frustrating us, or rude. Going online and mocking patients, especially those with reasonable requests, would not be upholding this aspect of our ethical code.

Please don’t misunderstand me here: I’m not saying patients have a license to say whatever they want to us. Patients have rights and responsibilities. They are responsible for their behavior. So, if you’re being disrespected, demeaned, or harassed by patients or visitors, you have every right to respectfully lay down the law.

Further, because we are held to a higher standard, we need to think of the implication and impact of our actions, not just the action itself and if it helps you cope with the situation.

While I agree that nurses need an outlet for actively processing the trauma we see and feeling seen and heard by someone – making videos mocking patients isn’t how. And honestly, it’s a short-sighted and emotionally immature way to cope. I see nurses post insensitive videos online all the time.

My reaction isn’t: LOL Wow yea that is so annoying when patients do that! Ah that nurse is so funny!

My reaction is: *Cringe* Yikes, this is a bad look and a really childish way to express frustration

It can be very difficult to tell what’s okay and what’s not, because there are a lot of medical and nursing humor videos online that are funny and appropriate. The major line here is where we make fun of patients or make content at the expense of another person.

Things that are generally deemed okay and non-cringe worthy:

• Poking fun at a colleague together with that colleague who agrees to it and thinks it’s funny
• Pointing out big picture/system-wide flaws or issues in a comical way
• Self-depreciating humor (the overprepared nursing student, the ridiculously relaxed nurse, the type-A ICU nurse, etc)
• Using mistakes, missteps, or miscommunications as teaching moments (“So this ridiculous thing happened to me, and here’s what I learned”)

Things that are cringe-worthy and cross the line:

• Openly making fun of patients or loved ones – especially when in vulnerable situations (especially anything involving procedures or needs involving a patient’s private areas) just to get a laugh
• Hazing and mocking colleagues – this is extra cringe-worthy if it’s followed with, “Come on, it’s just a joke! Can’t you take a joke??”
• Pranks that make light of serious situations (for example, funny music in the background while pulling a body bag out of the supply room)
• Saying rude and unkind things and justifying it by saying it’s honest (FYI you can be honest without being cruel)

Now, I’m not trying to police speech here. People are free to say what they want, but know that there are natural consequences to overstepping ethical boundaries and violating hospital policy.

I realize this might feel like this is saying to nurses:

We will treat you terribly…. force you to witness trauma on a regular basis… require overtime… not give you cost of living raises… and expect you to do more with less… and by the way, you can’t utter a word about it online.

That’s not what I’m saying here. There is a hard line between taking steps to change an unsustainable work situation perpetuated by your employer and coping with the natural challenges of the job. Even at the best hospital in the world, at the end of the day you’re still working with the public, seeing trauma, and will need to figure out a way to cope with that. Going online and mocking patients as an outlet for you to vent your pent-up negative emotions is immature.

This applies to nurses who are 22-years-old all the way to 72-years-old. Just because a nurse has been around the profession for a long time doesn’t mean they’re mature and exercise good judgement.

The challenging aspect is when you’re new in the profession is to know what’s appropriate and what’s not. People naturally tend to default to the assumption that if someone is older, they must know more and defaulting to their judgement is safe. I’ve seen 23-year-old fresh new nurses who are way more mature than some of their 30, 40, and 50-year-old counterparts.

Simply put: Age doesn’t dictate professional maturity.

So, YES, we need to cope. We need to be seen and heard, and our complex experiences need to be validated. But this needs to be done privately, with dignity and respect for yourself and the people under your charge. Venting online is shortsighted way to cope that only factors in your personal needs, not those who you are hurting to do so.

We are better than that – and we can hold ourselves to a higher standard.

Public perception and optics are absolutely an aspect of this. If every nurse who was frustrated or annoyed by patients put up videos that made fun of them, that essentially tells the public, “You’re not safe with me. I am judging you, even at your most vulnerable, and you cannot trust me.”

Imagine this: You go to your therapist and tell them all the vulnerable details of something that happened to you… something you’ve never told anyone before and finally got the courage to say it… and then later you get on TikTok and see your therapist mocking how you handled the situation. Wouldn’t you feel exposed and betrayed? What would this communicate to you, as their patient? Rightly so, therapists also have similar ethical and professional standards as nurses because they too are caring for people during very vulnerable times.

So, how do we do cope if venting online isn’t cool?

Nursing is tough and seeing trauma regularly at work creates turmoil. It is not sudden, like a slap in the face or the flipping of a light switch. It’s a slow burn – and you can muddle through for a long time before you find yourself having a desire to go online to make edgy videos because the likes and engagement makes you feel seen and heard in a way you desperately need … or you find yourself emotionally numb just to be able to get through a shift … or anxiety is getting harder and harder to keep under wraps.

Don’t wait until it’s an emergency to see a therapist, like I did in 2017. After my first appointment, I was mad at myself for waiting so long. In addition to therapy, journaling is highly effective for processing situations. You don’t have to be a good writer and literally no one has to see it. These are great prompts.

You can also establish a standard nurse-friend coffee date, or join and online nursing community that isn’t just a venting space.

Finally, I do have a few great book recommendations (below are all Amazon links):

• Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others by Laura van Dernoot (This is my #1 resource for this and it’s outstanding)
• Fierce Self-Compassion by Dr. Kristin Neff
• How to Do the Work by Dr. Nicole LePera
• How to Meet Your Self (workbook) by Dr. Nicole LePera (full disclosure, this is the only one I haven’t read personally but her other book was an absolute 10/10 and this already has great reviews)

I believe these all have audiobook options as well and are likely available at local libraries.

Argument #2 – Nurses Have Free Speech

Next, let’s talk about free speech. Yes, that absolutely exists in this country. However, when you are in your place of employment, you must abide by their policies and procedures. Also, as a publicly identified nurse, you are also held to your State Practice Act and code of conduct/ethics.

This means that you cannot walk around saying whatever you want, free of consequence while employed by an organization, licensed by a regulatory body. The same is true of every other job in which a professional license is required. Just like a doctor can’t walk into your exam room and say, “Wow, you’re fat!” or “Ugh, I hate taking care of Asians” … or a teacher can’t go in their 7^th grade classroom and proclaim, “Jesus Christ is the only lord and savior and if you don’t agree with me you’re going to hell!”

So, the free speech argument simply doesn’t hold up.

Argument #3 – Patient Shouldn’t Look Up Nurses Social Media

Another commentor said: “I would find it so weird to have a patient look me up on social media. I don’t post much anyway but I think that’s as weird as looking up my address.”

Yes, this is weird. But people are weird. People probably shouldn’t look other up, but they do. Much like people shouldn’t rob your home or break into your car, but they do.

Feeling like you should be able to post whatever you want and just expect people to not look for it and find it is like not locking your doors because people shouldn’t break into your home. The reality of the world we live in is that people do ridiculous irrational things, including looking people up online and breaking into people’s homes.

It’s also cancel-culture city, and people seem to be actively looking for a reason to get people fired. To not be conscientious of this is somewhat naïve and short-sighted.

If you put something online, assume everyone will see it: Your grandma, your patient, your hospital CEO, the hiring manager at your dream job – everyone.

You should Google yourself regularly just to see what comes up. When people have a bad experience, many look the person up online. I know many nurses who get friend requests and DMs from current and former patients! I even had a patient’s son Google me while I was actively giving his dad a bed bath and he pulled up my Instagram right there.

Another RN on TikTok did have a legit point I do want to mention. She said:

“The problem is the public and corporations see a hard line drawn between what’s right and what’s wrong to post, but it’s all gray… or wrong. If a patient showed me a picture of myself eating pizza with my kids or in a modest swimsuit, I’d be mortified. But I also posted it because it was a happy moment that I wanted to share with those I love. We shouldn’t post about patients, but we also need to be seen as humans FIRST. People need to separate the profession from the person.”

Ok, I 1,000% get this perspective and think we need to discuss it.

When you take the ANA code of ethics and stances on social at face value, it looks like nurses can’t post anything online about themselves, which in today’s online world, feels like you’re really missing out on a big part of life.

Unfortunately, that’s the reality of what the world we’re in today. If you post pics of yourself in a swimsuit or with your 6 year-old daughter, but don’t want that patient who hit on you to see it, then you need to have a very private profile that is difficult to find.

I know physicians, nurses, doctors, therapists, etc. who alter their name a bit, have a default pic that’s a landscape, and lock down the privacy settings to the max. If you do want to be more visible, the tradeoff is knowing that not only will patients see this, as will current and future employers.

(Spoiler alert: People Google you and look at all of your social media when you apply places.)

This is simply part of working with the public while holding a professional license. My husband, who is a professional counselor, and friends who have worked in mental health and the criminal justice system do the same.

It is wise to be protective of your personal information and life when you hold a professional license for a position that involves dealing with the public directly.

Argument #4 – They’re Just Being Honest, We Shouldn’t Take it Personally Because They Didn’t Mean it That Way

Just because you feel a certain way does not mean you are entitled to share it in a professional setting.

There is a difference between intent and impact. I can intend to just be silly and make a joke, but if someone says, “Hey that actually is pretty hurtful and inappropriate” – that needs to be accepted and we need to authentically inquire about the impact. There was a clear disconnect between what I meant to do and how it was received.

Important point: We don’t always get this 100% right. Being a human means being open to being wrong and repairing connection. But this doesn’t mean we free from accountability and natural consequences because our intent was good. This is why being conscientious and thoughtful is crucial.

When someone says that what we said was hurtful/wrong/inappropriate and we just say, “Well that wasn’t my intent. Stop being sensitive. I’m just being honest,” this denies the reality and experience of the other person. And, as a nurse, again, we’re held to a higher standard.

Providing patients with dignity and respect often requires us to regulate our own emotions and check our judgement and bias at the door before responding. That is maturity and professionalism. We don’t just say whatever we want, whenever we want simply because it’s honest. There’s a difference between being tactfully and professionally honest and being mean.

Patients are not the customers at Taco Bell with ridiculous orders. They’re the person in a vulnerable position who is likely putting on a brave face because they don’t want to get judged by their care givers. They also are likely not the best version of themselves, probably don’t have great coping mechanisms (or access to them), and are not familiar with complex culture of the hospital – which is where we ironically feel most comfortable.

We know they put on a brave face for their loved ones, and heck, even the doctor. When the doctor explains things to them, they often don’t have questions at that time, but as soon as the doctor leaves the room they ask us the questions they were too embarrassed to ask the physician.

We’re supposed to be the safe space. We’re supposed to not judge them, be present, provide compassion and care. We are here to provide care to the patient, not leverage the patient to have a place to discharge our negative emotions.

My advice

Know your hospital’s social media policy. I know there are many aspiring TikTok nurses out there. Know if posting content filmed at work is a fire-able offense. My guess is that it was for these L&D nurses. The more of a following you acquire, the more visibility there will be. Therefore, the more careful you need to be to ensure you’re following the rules and not giving anyone any reasons to question your judgement or notify your employer. Remember to review this policy regularly, as they are updated often.

 Audit your own social media profiles. Do you need to delete some content that seemed like a good idea at the time, but now you view it differently? Check in on your privacy settings. Google yourself. If you’re a pretty private persona, see how difficult it would be for a patient or someone to find your account(s).

Be clear with yourself about your social media boundaries. There are natural consequences to oversharing. While you may retroactively delete things, people can still screenshot things, download videos, and use the Wayback Machine. What internal checks do you need to follow before you post something (Is this mocking patients? Is this helpful to anyone or just making fun of someone? How would I feel if someone emailed a link of this to my boss? Am I comfortable with a patient finding this post?)

Check in with yourself. Do you feel the urge to post things that are at the expense of patients? Do you feel unappreciated, or that there isn’t someone in your life you can privately discuss things with so you can be seen, heard, and validated? Are you feeling emotionally numb or disconnected from yourself to such a degree that the best way for you to feel better is at the expense of others? Consider some of the books and coping techniques mentioned earlier.  

Connect with someone who understands. This can be 1:1 situation with a therapist (online or in person!). Many hospitals have EAP and free counseling as a job benefit. Schedule a regular coffee date. Join an online community.

A word of caution for online communities; do not join one that is just nurses venting. I’ve seen dozens of those over the years, and they all end up making people feel worse and become very toxic because it’s all complaining and no action. It feels good to get things off your chest at first and chat with people who understand your unique struggle, but the benefit from that quickly fades.

I have a community of nurses available, The FreshRN VIP Community. Spoiler alert – mocking patients is against our community rules. But we support one another and connect. It’s a non-Facebook community that you can interact with under a pseudonym if you’d like. Enrollment comes with access to 3 courses (Preceptor Pro, Critical Thinking, and Charge Nurse Jump Start) along with small group coaching sessions with me, access to my asset vault, interviews, and more.

The take home message

When we feel isolated in our suffering and frustration is when we can have these lapses in judgement and make bids for connection that are at the expense of others. Don’t let that be you. Connect with other nurses, identify what’s going on with you specifically (exhausted, not appreciated, hurt, degraded, whatever it might be), process what you’re feeling privately with trusted people, and get some helpful coping mechanisms in place. This is maturity and growth.

When you do, that need to get online, and “vent” will dissipate.

This is something we all need to do for ourselves – no one is coming to do this for you, nor will it just happen as a natural byproduct of working as a nurse for years. It is not a passive process.

Rather, proactively working through the intense situations we’re apart of before they snowball into anxiety… privately expressing anger and frustration… seeking out connection with others so you’re seen, heard, and validated… not overextending yourself at work and saying no when necessary …

These are all ways to prevent us from becoming the numb, checked out, angry, cynical nurse – and be the nurse who is wise, caring, compassionate, empathetic with boundaries, and present for patients but also at home too. So, my charge to you if you find yourself going down that path is to have the courage to take steps to redirect your route.  

The last thing we want collectively is to see nurses continue to post these highly insensitive videos for the world to see, which will drastically impact our credibility as caregivers to the public at large. The impact of this can get serious when viewed on a population-level, if it escalates into patients being fearful of being honest with their nurses out of fear of judgement or withholding care. Naturally, this would negatively impact patient outcomes, which undermines our efforts as nurses entirely.

This is especially devastating if it can be prevented entirely with some self-awareness, emotional regulation, and trauma stewardship. All of which is actually essentially providing care to ourselves because, once again, we are humans too.

References

• https://www.nursingworld.org/social/
• https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/social-networking.pdf
• https://www.ilga.gov/commission/jcar/admincode/068/068013000A00900R.html
• https://www.iasn.org/advocacy-policy/illinois-nurse-practice-act/
• https://www.instagram.com/p/Cl7PNp2IbaE/?utm_source=ig_web_copy_link