Webinar: How to Stop Incivility & Bullying on a Nursing Unit

The statistics show that incivility and bullying are alarmingly prevalent on nursing units. This has a negative impact on nurses and coworkers as well as patients and hospital systems as a whole. In this webinar we presented real-world, helpful information on how to stop incivility and bullying on a nursing unit.

Webinar participants were able to:

• Learn all about:
• Examples of common uncivil & bullying behaviors
• How bullying at work affect nurses
• How incivility & bullying affect hospital systems and patients
• Strategies you can use to deflect these behaviors
• Formulate a personal plan to nurture a positive working environment in your nursing unit
• Get your incivility & bullying questions answered
• Apply what you learned to improve your work environment
• Chat with other attendees and connect with Lacy during Q&A

Lacy Hager MSN, Ed., RN, R.T.(R)(MR) is a Nurse Educator Program Development Specialist at Level Up RN. Lacy has an Associate Degree in applied science majoring in Radiology from Owens Community College. She is also a registered MRI technologist. Lacy earned her Nursing Degree from Chamberlain College of Nursing and has been a nurse for 9 years. She is very devoted to educating and breaking the stigma on mental health. She has been in nursing education for 6 years and takes pride in helping others reach their career goals of being a nurse.

Full Transcript

CATHY PARKES: Well, thank you again for coming. So I just want to take a moment and let you guys know how we're going to handle things this evening. So I'm Cathy with Level Up RN. And tonight, we have a great presentation from Lacy Hager, who's a key member of our Level Up RN team. And so she's going to do her presentation. We're going to allow some time for questions and answers. And then we're going to have a giveaway after that. We're going to give away three of our decks, your choice of which deck you want. You do have to be present to win. So we'll be doing that after we do the Q&A. And then, after that giveaway, if you guys have additional questions, we have many members of our nurse team here to provide their perspective and to answer any additional questions that you have. So we're happy to provide our input and our experience when it comes to incivility. All right. So without further ado, I want to introduce you to Lacy Hager. She is a nurse educator program development specialist at Level Up RN. So Lacy has a degree in radiology from Owens Community College. She is also a registered MRI technologist. She earned her nursing degree and nursing education degree from Chamberlain College of Nursing. She has been a nurse for nine years and a nurse educator for six years. Lacy takes pride in helping others reach their career goals of becoming a nurse. In her free time, Lacy likes to walk her dog, travel, and sleep. And I think we can all relate to that sleep part, right? So I'm going to hand things over to Lacy now. Thank you so much, Lacy.

LACY HAGER: Thanks, Cathy. Good evening, everyone. Thank you for coming and joining this webinar with us this evening. As Cathy said, I'm a nurse educator program developer with Level Up RN. I'm excited to be here and presenting to you this evening on incivility in nursing. I do have several team members, as Cathy said, on the call. So if you're familiar with Zoom, there's a Q&A section, and there's also the chat section. If you have specific questions that you would like me to answer, please throw them up in the Q&A section. My colleagues will be kind of focusing on the chat in that area as well. If you registered and are here with us this evening, you will be getting a follow-up email from us, and you will have access to this recording as well. So that will be coming your way shortly after the presentation. So before we get started, I want each of you to take a few seconds here and think about why you chose nursing as your profession. Whether you want to share this in the chat, you're more than welcome to, but if not, I want you to think about this just from your own personal stance. Are you a nurse now? Are you a nursing student? Have you been a nurse for 30 years, five minutes? Whatever it may be, I want you to think about what drove you and drew you to the profession. So in the past, when I talked to students and nurses alike and asked the same question, most people's response is going to be, "I want to be able to help people." I want to give back from maybe an experience that you had, or something along those lines is usually very positive feedback that I receive. I have never-- and I will say still to this day, I have never come across somebody who says, "I want to become a nurse so I can be nasty to people. I want to put others down. I want to hurt people's feelings and make fun of them." However, if you are in the nursing profession, you are aware that incivility is kind of directly linked to the nursing profession and is still happening today.

LACY: So tonight, one of my main goals is to kind of look into this topic, see what it looks like, why it's happening, and how we can combat it, and hopefully change that within the nursing culture. So to get started, we'll look at our learning objectives. We would like to improve nurses' viewpoints on preventing uncivil behavior in a nursing unit, entice nurses to execute and promote a more civil working environment, formulate a personal plan to nurture civility within a nursing unit or wherever you're currently working. Our learning outcomes, I'd like to be able to at least identify three behaviors that could be categorized as uncivil behavior, describe at least two strategies that a nurse can use to stop this behavior when they arise in a nursing unit. Report two effects uncivil behavior could have on the nurse, two effects it can have on a patient, and then two effects that this could have on the organization as a whole. So we'll kind of recap on that at the end of the presentation to make sure that we hit all of those key points.

LACY: So what is incivility? When I think of this, it's kind of an umbrella term here. Okay? so you can see there's many different terms on the screen, and these come directly from the American Nursing Association. So incivility is one or more rude, discourteous or disrespectful actions that may or may not have a negative intent behind them. Bullying is repeated, unwanted, harmful actions intended to humiliate, offend and cause distress in the recipient. Lateral violence or horizontal violence is deliberate and harmful behavior demonstrated in the workplace by one employee to another. So and you can see my hand motions, I talk with my hands a lot, and lateral is like nurse to nurse negative behavior. Vertical is when it's kind of coming from the top down or from the bottom up. So really, we're going to be looking at deliberate, harmful behavior that would be coming from charge nurse and then down to the staff nurse on the unit. So it's more of a vertical or hierarchy there.

LACY: So, in 2015, the ANA made a position statement related to incivility. The statement stated that registered nurses have a duty and responsibility to create and sustain a culture of respect, free of incivility, bullying, and workplace violence. Now think to yourself. Where you're working, do you see these behaviors? Have you been a part of these behaviors? Are we upholding what the American Nursing Association has kind of put into place? Registered nurses employees across the healthcare continuum, including academia, so if you're on this call and you're a student, this applies to you in your current role as a nursing student. We have an ethical, moral, and legal responsibility to create a healthy and safe work environment for the registered nurses, as well as all members of our healthcare team, healthcare consumers, the families, and the communities which we serve. So it's not just registered nurses. This encompasses everybody involved, including our community in which we serve.

LACY: So how do we know if something we've experienced-- you might be sitting here going, "Oh, wow. This one time at work, this happened," or "I wonder if this falls into this." So we're going to kind of get into the nitty-gritty. We're going to take a look at these behaviors and kind of see and maybe be able to compare something you've experienced and does this fall under this umbrella term of incivility. So the first form or way that these behaviors come in-- and again, if you are in nursing school or are a nurse now, you've heard the term overt and covert behavior. So the first way is overt behaviors. The way I remember this is overt starts with an O, and overt behaviors are very open. They're out in the open, and anybody can see what the behavior is. There's really no question it's noticeable. Others see physical action, facial expressions, gestures, those types of things. So if I'm name-calling and I'm yelling, or I'm rolling my eyes and putting my hands on my hips, or I'm throwing things or actually have physical contact with another colleague, this is overt behaviors. And these, again, are those really obvious out in the open ones. I think most of us would not have a difficult time saying, "Oh, wow, this is incivility."

LACY: The second type is covert behaviors. And this is where it gets a little bit questionable, and people aren't really sure. Is this right? Is this wrong? I kind of always think if you have to question if it's right or wrong, it's probably not okay. But covert behaviors are more subtle. And the way I remember the difference between overt and covert, covert starts with a C. So it's covered up easily, right? So a lot of people can't see that. Not easily displayed, something that others may not notice. The big thing here is we don't understand the intent of the action, so we don't really know what that person is thinking or plotting, I would say, in their mind when they demonstrate these behaviors. And so when you look at unfair assignments, refusing to help someone gossiping, maybe withholding information, sabotage, exclusion. And so when I think of this, you can't really say, "Well, I know they withheld information from me because they were trying to be negative and nasty to me." But we don't really know. Was it an honest accident? And so you can see where the covert behaviors, this is kind of that gray area. So definitely a little bit harder to identify.

LACY: So now that we've looked at this, ask yourself, have you experienced this personally? Have you maybe been involved with this? Have you observed this with other people in your work area? We know that this is current and ongoing in the profession, and we really have to be able to identify it and call it out. So let's look at some statistics and see maybe this is the first time you're hearing of this. And I hope it is, and I hope you've never experienced this or these types of behaviors. But I will tell you that student nurses experience incivility in academia in their clinical training. And sadly, this happens very early on in our training. That kind of going down to then the novice nurses most likely to become the victim. How many people have heard nurses eating their young? Has anybody heard that terminology? So maybe when you were in nursing school or-- yeah, so it's kind of this expectation, right? So maybe you're in nursing school, and you're getting ready to graduate, and you're like, "Oh gosh, I'm going to go out there, and they're going to eat my legs off or gnaw on my arm. They're going to be mean and nasty to me." If this is the culture that we allow, then we're never going to get a change. So we have to stop that. And yes, I was the same way in nursing school. I just kind of had that understanding that was like, "Okay, you're the student nurse. You're going to go out there. You're going to get kind of beaten up a little bit. It's toughen up. That's how it goes." So, unfortunately, that is kind of the culture, but tonight I would like to give you some empowerment to go out and kind of change that.

LACY: So we do know that this is-- we see in the chat, a lot of people are saying, "Yes, yes, that's kind of my understanding as well." So these statistics on this slide really make my stomach hurt, and my heart hurt. Okay, so 44 to 85 percent of nurses are victims of some type of this behavior. Okay? 44 to 85 percent. That's a lot, a lot, a lot of nurses. And then even higher, 93% of nurses have actually witnessed this, which again, we need to empower these nurses to be able to report this. And it is largely underreported, and we know a lot of times it's underreported because we may not really know if it falls under that umbrella term. But we could also be a little bit fearful for retaliation, right-- fearful of retaliation. Yes, and Inge, I see your comment. And, yeah, so we are going to talk about that in academia and how it can be a manager or a supervisor or it could be a faculty member and how we can address that. We definitely will get into that. And those are hard conversations to have. And again, fear of retaliation or even legal issues. So sadly, you see that it is live and happening.

LACY: So we're going to take a look at a few clinical scenarios. So those of you-- I see there are quite a few people who are saying they're in nursing school. [laughs] Welcome to Sim, it never goes away. This is going to be our first interaction, and this interaction this evening is going to be between Nurse Tony and Nurse Amy. So we're going to listen to their first interaction here.

TONY: Thank you for calling the emergency department. This is Tony speaking to you. How may I help you?

AMY: Hi, this is Amy from the ICU. I'm calling to speak to the nurse taking care of John Smith, who is being transferred to the ICU.

TONY: Hello, Amy. I actually have John Smith. Thank you so much for calling down to get the report.

AMY: No problem.

TONY: Okay. So the patient is a 55-year-old male, came in by ambulance around 12:00 PM today. He called the squad because he was having chest pain and shortness of breath at home.

AMY: And that gets him a bed in the ICU?

TONY: Well, this is what the physician wants so that he can closely observe the patient. There were changes on his EKG that the physician found questionable.

AMY: Questionable? Like what? What about his lab work? Is anything questionable there?

TONY: The labs have all seem to come back normal so far.

AMY: I don't know. What about a previous cardiac history? That might be good information to share.

TONY: I was getting to that next.

AMY: You ER nurses need to learn what's important and what to tell the ICU nurses when giving a report.

TONY: I'm really sorry, I felt like I had everything you'll need.

AMY: Whatever. This is expected when taking patients from you guys. Just bring him up here so I can figure out what's really going on with this patient.

TONY: Okay. One more thing, I wanted to let you know about this family.

AMY: Look, Tony, I don't have time to worry about his family right now. Okay? If he dies down there from a questionable EKG that clearly no one can figure out, I will figure out the family situation.

TONY: He was just hoping he could have his wife and daughter with him. He's very anxious right now.

AMY: You know the rules. One visitor. Get it figured out before he comes to the unit, and again, get him up here before you kill him down there.

TONY: Okay. I'll bring him up now.

AMY: Good plan. See you in a few. Bye.

TONY: Bye.

LACY: Okay. So that first interaction between Tony and Amy. Thoughts on not one. Very abusive, verbally abusive. Yeah, absolutely. Just really rude and uncalled for. So we can see or hear in that scenario lots of overt. We don't even need to see her. The picture kind of demonstrates her and maybe her eyes rolling, but a lot of just kind of that name-calling and bullying, "You ER nurses." Those of you who work in healthcare, you know there's kind of that known, I guess, tension between the emergency room and the ICU nurses. So again, we need to work cohesively as a team, so let's listen to a different way this call could have went when Amy and Tony interacted.

TONY: Thank you for calling the emergency department. This is Tony speaking. How may I help you?

AMY: Hi, this is Amy from the ICU. I'm calling to speak to the nurse taking care of John Smith, who's being transferred to the ICU.

TONY: Hello, Amy. I actually have John Smith. Thank you so much for calling down to get the report.

AMY: No problem.

TONY: Okay. So the patient is a 55-year-old male, came in by ambulance around 12:00 PM today. He called the squad because he was having chest pain and shortness of breath at home.

AMY: And that gets him a bed in the ICU?

TONY: Well, this is what the physician wants so that he can closely observe the patient. There were changes on his EKG that the physician found questionable.

AMY: Questionable? Like what? What about his lab work? Is anything questionable there?

TONY: The labs have all seem to come back normal so far.

AMY: I don't know. What about a previous cardiac history? That might be good information to share.

TONY: I was getting to that next.

AMY: You ER nurses need to learn what's important and what to tell the ICU nurses when giving a report.

TONY: Amy, you seem upset with the information I'm providing you. I just want to make sure you have a clear picture of what is going on currently with the patient. If you have questions when I'm finished, I'll be more than happy to address them at the time. I don't think it's appropriate for you to categorize us, ER nurses, and be laughing and making inappropriate remarks. I'm trying to do what's best for the patient and give you all the details that you need.

AMY: Tony, I apologize. I'm just really busy up here and completely took it out on you for no reason. Thank you so much for stopping me. Please proceed with your report. Again, I'm sorry I took out my frustrations on you.

LACY: Okay. So thoughts on that. I do see some comments in the Q&A, and I'm going to address those here in just a minute. So way to go, Tony, right? Tony stood his ground. He stood up. He stopped Amy in her tracks. He was very respectful and stayed factual, right? So I always think back to-- my mom used to always say, "Two wrongs don't make a right." So we don't want to attack Amy and say, "Well, you ICU nurses." We just want to stay very factual. And again, in this situation, the experience went very well. Those of you who are commenting in the Q&A section, it did maybe amp that up, right? So it increased the toxic behavior, and then you didn't want to work with them. And sadly, that can happen. Again, not every case scenario is going to go in that positive direction. That's where we would have to follow the chain of command, whether you would be going to your unit manager. A lot of times, there is going to be a anonymous hotline that you could call. But definitely, you would want to follow your chain of command at the hospital facility or the medical facility you're working at or within the campus or college university that you're attending. So this definitely is happening in both arenas there.

LACY: But I always, always, always would encourage you to address the person first. Because just like Amy and Tony, Amy was like, "Oh, wow. Tony, thanks for stopping me." We all know high stress, high anxiety, working-- just all of those things, we can really get wrapped up in the moment. And sometimes somebody's saying, "Wow, that hurt," or "That was really uncalled for." You're like, "Oh, wow. I apologize." So again, in this scenario, it did go well, and they were able to kind of stop that behavior in its tracks. However, if Tony didn't feel comfortable doing that, he would have maybe had to talk to his manager or to the emergency room manager. The thing I don't want to happen is to say, "Oh, yeah, I called down to the ER, and that nurse down there she acts that way all the time. It's just who she is. Okay?" So kind of pushing that under the rug and making excuses for her behavior, that is not okay. And that's not going to get us with an end result of changing the culture within nursing. So definitely some things to think about. So let's look at the second interaction with two other-- this is actually going to be between a nurse and a physician.

DR. JOHNS: Hello. Dr. Johns here.

HEATHER: Hello, Dr. Johns. I'm sorry to bother you. This is Heather. I'm calling about your patient who had bowel surgery today. It is on 8 orange.

DR. JOHNS: Who? What patient?

HEATHER: You had that patient who had bowel surgery today and 8 orange.

DR. JOHNS: I had four bowel resections today. Which one is it?

HEATHER: Mary Miller in room 1254.

DR. JOHNS: Of course, it is. What's she complaining about now?

HEATHER: Well, she's been pretty restless, and she keeps saying she doesn't feel right.

DR. JOHNS: Of course, she is. I'm sure she just wants more pain medicine, right?

HEATHER: Well, she's described it not as pain, but more as something doesn't feel right.

DR. JOHNS: Well, I just moved her bowels around this morning. I'm sure things are just settling back into place. Listen, she's a complainer. I've treated her for years now. It is 3:00 in the morning. This is not an emergency. I will see her when I get there at 8:00 for rounds. Okay?

HEATHER: Well, I took her temperature. It was a little elevated.

DR. JOHNS: What's a little elevated?

HEATHER: It was 99.6.

DR. JOHNS: That is not a fever. Are you new? What was your name again?

HEATHER: My name is Heather. And, yes, I'm fairly new. Her bowel sound seemed to have slowed, and her belly is firm.

DR. JOHNS: Okay, Heather, when you call a doctor in the middle of the night with no data or evidence of a real problem, it's not going to go well for you. You should only be calling me in an emergency.

HEATHER: Well, I spoke with the charge nurse before calling you, and she agreed we should contact you. The patient's vital signs are increasing, and we gave her pain medicine.

DR. JOHNS: You are all over the place right now. Who's in charge tonight?

HEATHER: Natalie.

DR. JOHNS: Of course. No wonder she told you to call. She can't make a decision on her own if she had to.

HEATHER: I'm really sorry. I just feel like I need to let you know what was going on and see if you want us to do anything.

DR. JOHNS: What I want you to do is stop calling and wake me up in the middle of the night with nonsense.

LACY: Okay. So thoughts on that call. So nurse to physician. Yes, Erica, I loved it. She could have improved on her SBAR. Correct. So, yeah, when planning the presentation, it was like, "Oh, this nurse is kind of all over the place." Right? However, that does not give the physician the right to treat her that way. So the physician could have maybe coached her a little bit more on what he was looking for or have asked her to call back. But, yeah, he was degrading the patient. He was degrading the charge nurse and then ultimately hanging up on her, which was very rude. So I'm sure it was very frustrating for the physician to not get straight to the point. However, she was a newer nurse, and she was trying to advocate for her patient. So kind of faults on both sides. But let's see how the call could have gone a little bit differently.

DR. JOHNS: Hello. Dr. Johns here.

HEATHER: Oh, hello, Dr. Johns. I'm sorry to bother you. This is Heather. I'm calling about your patient who had bowel surgery today and is on 8 orange.

DR. JOHNS: Who? What patient?

HEATHER: You have a patient who had bowel resection today, and they're on 8 orange.

DR. JOHNS: I had four bowel resections today. Which one is it?

HEATHER: Oh, I'm sorry. It's Mary Miller in room 1254.

DR. JOHNS: Of course, it is. What's she complaining about now?

HEATHER: Well, she's been pretty restless, and she keeps saying she doesn't feel right.

DR. JOHNS: Of course, she is. I'm sure she just wants more pain medicine, right?

HEATHER: Well, she has not described as pain, but more as something doesn't feel right.

DR. JOHNS: Well, I just moved her bowels around this morning. I'm sure things are just settling back into place. Listen, she's a complainer. I have treated her for years. It is 3:00 in the morning, and this is not an emergency. I will see her in the morning around 8:00 when I'm there for rounds. Okay?

HEATHER: Well, Dr. Johns, I understand it's 3:00 in the morning, but that does not give you the right to talk down to me. I'm calling because I strongly believe something is wrong with the patient.

DR. JOHNS: Well, all you have told me is that something doesn't feel right, and I know the patient is a complainer.

HEATHER: Well, I have more information about her assessment if you would let me share. The patient has an elevated temperature, blood pressure, and heart rate, and on assessment, her bowel sounds are decreased, and her abdomen is distended and feels firm. She says it is painful upon palpation.

DR. JOHNS: Oh, wow. Yes, thanks for calling. Let's get a CT scan while heading to the hospital.

HEATHER: Okay. Sounds good. I will see you soon.

DR. JOHNS: Okay. Goodbye.

HEATHER: Bye.

LACY: Okay. So thoughts on that. Did it go a little bit better? She was able to address the physician. Erica, I'll agree with you. Yes, it definitely went better, but it's improved. Yeah, Erica, you're definitely on it. She's like, "It's improved, but the nurse still could have had it together a little bit better." But she was advocating for herself and for the patient. So don't forget, we as nurses are there to advocate for our patients, but we also have to be able to advocate for ourselves, right? So, yeah, the provider actually apologized, right? "Oh, I'm sorry. I should have listened." So I think we can all agree that she should have been a little bit better prepared, and her charge nurse probably should have helped her with her SBAR prior to approaching the physician. However, you get on the call with a physician, and it's anxiety ridden that first time. Again, kind of that hierarchy type thing, and we can't make excuses that the physician can treat the nurse that way or it's the middle of the night, those types of things. Now that can be even a little bit more scary addressing a physician versus maybe another nurse. So if you didn't feel comfortable stopping Dr. Johns in the footsteps there, maybe when the physician got to the unit, you could have said, "Dr. Johns, when you hung up on me last night, that didn't feel good. That was really discouraging because I was trying to do something to advocate and protect the patient, and you just blew me off." So again, staying very factual and letting them know how it made you feel and potentially how it affected the patient's care is going to be good.

LACY: Now we know, again, there are just downright kind of nasty, grouchy people out there, and they're not going to care. However, address it head-on if you can. If not, we're going to escalate it. Nursing manager maybe to head of surgery, whoever that may be. If you're dealing with a resident, that might be then on to the attending physician. And then again, we always have that anonymous call reporting system for most hospital systems they do have. However, in my experience and other experiences that I've seen most of the time in a hospital situation, if you're dealing with a nurse or a physician in one of these types of situations, and you stand your ground, and you stay respectful, they usually respect you. Now, right or wrong, but you stand up for yourself, you advocate for your patient, and you say, "No. I have this gut feeling or the assessment shows," and you continuously push for what you think and know is right. They will respect you, and they'll listen to you next time around. So a lot of times, we think about the person who's a little bit more quiet, is a little more passive, is kind of who gets bullied. And that is, again, not saying that's right or wrong. But if you can stand your ground and stay respectful, a lot of times that that does get you a little bit further. And, yes, absolutely, Mia, have that assessment piece ready. So we all learn about SBAR in school, have that important information down, and start with that. Make sure you're identifying yourself and what patient you're talking about, especially if you're going to wake somebody up at 3:00 in the morning. They might not even know their own name at that point if they were really in a hard sleep.

LACY: Okay. So our third and final interaction. So let's hear how this talk goes looks like over tea and cookies.

Speaker 1: Hey, guys. How's everyone doing?

Speaker 2: We're good. What are you so happy and excited about?

Speaker 1: Okay. See the new guy over there. He's been in orientation a month now and still knows nothing.

Speaker 3: Really?

Speaker 1: Yeah. I was talking to Joe today, his preceptor. He said this kid is the worst new grad he's ever had.

Speaker 3: What is it with these new nurses. They are just downright dumb.

Speaker 1: I know, right? When I graduated, I know I still had a lot to learn, but we were not this dumb.

Speaker 3: They think they are all that because they have their BSN, but they are so far from being competent.

Speaker 1: Joe said he was struggling with hanging fluids and connecting an antibiotic piggyback. Seriously, what school did he go to? And he was telling Joe how he felt really overwhelmed having four patients. Seriously, dude, welcome to med surg. Wait till they give you eight.

Speaker 2: Wow. Sounds like he's a keeper.

Speaker 1: Yeah. Joe doesn't think he'll last a week out of orientation.

Speaker 2: What are the educators saying about it?

Speaker 1: You know how they are. They make excuses for all these new grads, and they want to baby them.

Speaker 3: Well, it sure wasn't like that when I got my first nursing job. It was sink or swim.

Speaker 1: Right? But, like I said, there is no way we were that dumb. Joe also told me he was scared to start a catheter on a patient because he had never done it before.

Speaker 3: Seriously, what are they even teaching them in nursing school these days?

Speaker 1: I don't have a clue, but by the sounds of it, they'll pass anyone at this point.

Speaker 2: Well, hopefully, I work opposite days with him once he's out of orientation.

Speaker 1: I know, right?

LACY: Okay. So thoughts on that. So as we can see, this is Joe on the other side of the screen, right? So he's in maybe the break room area; he's really stressed. He's having a hard time, right? Think back to when you were a new nurse, or think back if you're a new nurse and getting acclimated and all of that coming to life. It's overwhelming. Yeah, fear of this could happen, and you hate they all agreed. Absolutely. So they just kept feeding on each other, right? So let's listen to kind of the retake on this. Yeah. Lots of bad attitudes. Lots of bad attitudes. So let's see how one of the nurses could change the direction of this conversation.

Speaker 1: Hey, guys. How's everyone doing?

Speaker 2: We're good. What are you so happy and excited about?

Speaker 1: Okay. See the new guy over there. He's been at orientation a month now and still knows nothing.

Speaker 3: Really?

Speaker 1: Yeah. I was talking to Joe today, his preceptor. And he said this kid is the worst new grad he's got ever had.

Speaker 3: Come on, guys. I don't think it's fair to be talking about him like that. If you haven't even worked with him, let's not spread rumors about anybody.

Speaker 1: Whatever. Listen, Joe said he was struggling hanging fluids and connecting an IV piggyback. Seriously, what school did he go to? Then he was telling Joe how he felt really overwhelmed having just four patients. Seriously, dude, welcome the med surg. Wait till they give you eight.

Speaker 3: Come on, guys. This is a really inappropriate conversation to be having. Let's go talk to him and see how we can help.

Speaker 1: Okay. Fine. I guess we can go see if he wants to sit with us.

LACY: Okay. So a little bit better, maybe. So we have that one nurse who is like, "Whoa, whoa, whoa, hold on. This is totally inappropriate." Right? And I see in the chat, some of you are going like, "This is scary." I'm assuming you might be students getting ready to graduate. I see you not getting a lot of hands-on experience in the clinical setting. And like Cathy said in the chat, we'll get there. I promise I'm not going to leave you hanging. But, yeah, excellent job of the nurse who was able to stand up. So think about this. You're in your peer group at work, and they're talking about the new guy who you really don't know about. It's the easy thing to do to just kind of go along with it, right? Hehehe, yeah, whatever, even if you don't agree with it. But it takes a lot of courage to stand your ground and to stand up to your peers and say, "Hold on, this isn't okay." So kudos to that nurse for doing that.

LACY: Now, maybe she didn't feel comfortable doing that. Another thing she could have done is just said, "You know what? I'm going to leave the conversation because I don't want to be a part of this." Because we all know in reality, the group might not all say, "Okay, well, let's go check on him." We're going to again have those toxic people who this is just the way they are. But, again, we don't want to associate with them, and we're not going to fuel the fire for what they're doing. So the nurse could have just gotten up and left. Again, this is something that definitely needs to be reported. Okay? So again, charge nurse, nurse manager, following that chain of command because you know darn well that poor nurse heard everything they just said. And so again, even if he was already doubting things, he feels even-- I mean, it's like kicking you when you're down, right? So and we have to really remember we all came from that student nurse and being overwhelmed in our first nursing job, or if you transition to a new specialty that takes you right back to being that novice nurse. So definitely important. And we're all in this together. So we really need to be a team. So we want to build everybody up because those are our team-- those are our teammates and our team players. So we really have to be cohesive. So, yeah, it showed a lot about her character for sticking up for the new guy.

LACY: So these three scenarios, again, might be a little overexaggerated for the idea of simulation or getting the point across. However, I can promise you these three scenarios were pulled from interactions that I've experienced or my other team players have experienced. And that's why we brought them to you this evening. So some of you may not be chatting in the chat or maybe sitting here going, "This doesn't happen," or "This has never happened to me. This has never happened where I work. I've never experienced this. So why should I care?" Right? Well, first of all, we should care because it's affecting the nurse that it's happening to. There's three things that this is going to affect. It's going to affect the nurse. It's going to affect the patient, and it's going to affect the organization as a whole. So we're going to run through those so you can see how this really is a trickling effect, and it all goes hand in hand.

LACY: So think about that guy back here and his expression of like, "Oh my gosh, nursing is so hard." His mental health could potentially be in jeopardy. Think about if you just heard that conversation as the new nurse in the break room. You're going to sleep very well tonight? Are you going to be ready to go for work tomorrow? No. You might have a little bit of anxiety, low self-esteem, right? Yeah, talking badly about the patients-- yeah, absolutely. They can still hear you and still hear what's going on. A lot of times, depression can set in, negative coping skills, right? So now I'm really anxious. I'm not sleeping well. I might start using some sleep agents. I might start drinking or using other substance. And then sadly, we have seen suicide with this as well. So this definitely can affect our mental health or the mental health of the nurse who's being bullied. Physical health, we know that our mental health and our physical health are linked, can have increased cardiovascular disease issues if our mental health isn't in check. But think about work-related injuries. Do you think that male nurse in that scenario would have went and asked any of those women sitting at that table like, "Hey, could you help me move my patient who might be a little obese"? So he could get hurt, or maybe there's a new piece of equipment he's never used it. Will he now go and try to use that equipment on his own without asking for help? So he might hurt himself; he might hurt the patient. We don't know. So definitely looking at that for physical health as well. Decrease job satisfaction.

LACY: So I saw somebody was talking about not really trusting your colleagues, right? You don't trust your colleagues. You don't trust the institution you work for because they're not providing that safe environment that they're supposed to be doing. You don't really feel part of the team. You're kind of the outsider, and that's no fun. So ultimately, I wake up tomorrow morning, and I'm feeling all of these ways. I'm not going to go to work, so I'm going to start calling off. That's going to affect the other members on the team. Sadly, this also leads to people leaving the nursing profession as a whole. So please, please, please know your first nursing experience-- if it's a bad one, do not let that be the end all be all. It's not that way everywhere. And that's, again, why we're talking about this tonight so that we can hopefully stop these behaviors. So definitely don't want people leaving the nursing profession because, again, we're here to help people. We want to improve patient outcomes, so we have to try to change the culture within our units.

LACY: So again, maybe it still hasn't hit you yet. You're not really sure how this is affecting you. That very first question I asked you at the start of the presentation. We're all here for the patient, right? We want to help people get better. I want to get back to the community, whatever that may be. Ultimately, this is going to affect patient safety. Increased medical errors, so going back to are we not asking for help. What about those medications that we have to ask for sign-offs or double checks, those types of things? Are you unsure of like, "Did I set this pump rate right? Did I do this right? Well, I don't really want to ask them because they were already making fun of me. I didn't know how to put a catheter in"? So again, patient safety. Decreased quality of care. Why? Because these nurses who are being bullied are now calling off, and we're short-staffed, especially now with COVID, right? So these people keep calling off work, or the nurses who are being bullied are calling off work. And it's affecting the team as a whole, which then is going to affect our patients. Which ultimately is going to result in negative patient outcomes, which then says, "Hey, I was at hospital XYZ. I had my gallbladder removed, and I had the worst care ever. The nurses were rude, or they only came and checked on me when I put my call light on." And that word spreads, right? So now the patients aren't satisfied, and that doesn't look good as a whole.

LACY: And then the organization, and I know a lot of times people are like, "Nobody cares about the organization." Right? Well, financial loss will circle right back around and affect you as the nurse who works there. Whether you're directly or indirectly involved with the behaviors that we're talking about. Financial losses. 23 million over a course of the year for financial losses based on these behaviors. More so, call offs, right? So when I'm absent from work, whether I'm using paid time off, sick time, short-term disability, long-term disability, who knows what that is? $11,581 per year per nurse in the United States. Yeah. So think about that.

LACY: How does that affect us if we're not involved in this? You're not going to be getting your pay raises. Right? We're not going to be getting our pay raises. We're not going to have the most current and up to standard equipment. We might want to go and get a certification for something or go to a conference to learn how to provide this top-notch care. The hospital's not going to have the funding for that because they're paying it out in nurses who are calling off work because their mental health isn't intact, because we have bullies in that in the hospital facility. Okay. Those high turnover rates. Med-surg nurse, $92,000 a year for that training. Specialty nurse-- I'm sorry, per nurse, not per year. I'm sorry, per nurse. So if you just graduated and you become a med-surg nurse, roughly $92,000 is paid out when you're not included in the numbers of nursing care, right? You're following your preceptor around, and they're helping you, but you're not actually calculated in taking your full workload by yourself. Specialty nurse, ICU, critical care those types of areas, $145,000 per new nurse. So think about it, what if I get all the way through my training and then this bullying happens, and I can't take it, and I walk away? That's $92,000 or $145,000 that the hospital organization just flushed down the toilet because we have to start this process all over again. So if we continue to allow these behaviors to happen, it's a vicious cycle, and the organization is going to go downhill. The level of care is going to go downhill. And then, the nursing staff is not going to be there and be able to provide the care that we would like to give to our patients.

LACY: So again, ultimately poor reputation in the community, in the industry. When I got my first nursing job, I worked at a level one trauma center, and they were Magnet certified. I wanted to work there because here in Ohio, it was a very reputable facility, and I was proud to work there. You don't want to work at XYZ Hospital that everybody says, "Oh, they went there, and they had horrible care, and their food was bad, and the nurses were angry." And you think our patients don't see when we're not a cohesive team. They do. They do. So it is a big circle, and it all falls into play. So keep that in mind when we're looking at this. So how do we change this? This is a big-- this is a $100,000 question, right? If it were that easy, we wouldn't have this problem. But in 2016, the Joint Commission created standards of healthcare, and the standard holds every organization responsible for mandating and recognizing these behaviors. So I know I can see comments and examples here, and we know this isn't happening. So I want each of us to really feel empowered and think about, "Man, how can I make the difference?" Again overnight, we're not going to make this change.

LACY: Kurt Lewin is a change theorist, and I always like his theory. It was easy for me to remember. He used the ice cubes, if anybody remembers that. You had the ice cube. You have to unfreeze it. You make the change, and then you refreeze the ice cube. And that's where we're moving. So we want to acknowledge there's a problem, and we need to address these factors in each situation. So that's kind of our unfreezing. We got to tear it all apart. We've got to figure out what's going on and say, "Hey, there's a problem, and we're going to fix it." Now, whether change is going to be effective is going to be how it's addressed. So again, we have to get everybody on board and have a understanding that there is that problem. That can be difficult. Hopefully, during the changing process, we're going to start training our staff. We're going to start implementing new policies, and we're going to come to agreement on what our new culture and on the unit is going to be and how we're going to proceed with these behaviors. We really want to start nurturing that respectful environment. Then once we get that all played out and everything looks good, we're going to freeze again. We're going to freeze, and this is how our new norm is. There's no more, "Well, that's how she is," or "We were having a bad day," or whatever. We need to be able to address each situation individually and promptly when it happens, and we want to encourage all the nurses to hold each other accountable. And this is hard. Guys, this is hard, and it doesn't get easy, especially when we're in those high stress, COVID times, right, high workload. All of that is going on. It can be difficult to keep these cultural changes in mind. Okay?

LACY: So the novice nurse. I saw a lot of people saying, "Hey, this happened to me in nursing school," and I feel for you. As an educator, this was something that I always talked about in the classroom. And again, we have to look to our organization to support us. And sadly, if that's not happening, then your experiences isn't positive. So as a novice nurse, it can be very difficult, right? You're like, "Well, we just said at the beginning of the presentation, nurses eat their young." Right? So my advice to you is to come into that new role, whether you're a student nurse in your clinical rotations or you're a brand new nurse on a unit.

LACY: A lot of our previous or more seasoned nurses might still have a licensed practical nurse or an associate degree. A lot of hospitals across the country have different expectations. I'm currently in Ohio, and a lot of our facilities are now only hiring nurses with BSNs. That is not to say that if you have a previous degree and you are in a current role, that doesn't mean you're going to be fired. And thinking back to that, I think it was the second scenario, it said, "Oh, these BSN nurses, they think they're all that." Right? So come in and be very humble. "I know I'm a new nurse. I acknowledge that you're that you have all of this experience." Right? No matter what their nursing degree is, if they have 20 years experience over you, they have a lot to teach you. A lot of lived life experiences that would be very helpful to you., so if you come in with this chip on your shoulder, probably they're not going to be real receptive. But if you come in and be honest and say, "You know what? No, you can laugh at me, I've never put in a Foley catheter, or I've never hung this, or I've never done this, but I really want you to help me. I want you to show me how to do it because I really respect you. And I've seen you work with the patients, and the patients really respect you."

LACY: If you come in with that open arms, "help me, I want to learn" idea or thought process. Usually, these nurses are going to take you under their wing, and they're going to nurture you. And they're going to say, "Hey, wait, this is a good egg. They came in. They weren't that know-it-all nurse. They wanted the help, and they wanted to learn." So kind of checking your own self at the door when you come in because we all know, and I saw some of you saying in the chat, right, you haven't had a lot of clinical experience yet, and that can be scary. But coming in with that type of attitude and being very humble can benefit you walking into a new nursing unit and preventing these behaviors from hopefully happening to you.

LACY: So quick knowledge check here that we hit all of our key points for the evening. So the three behaviors we could categorize as uncivil behaviors. So what were some of the things we looked at as being the negative behaviors that we didn't want to see? Yeah, lateral violence, but what did that look like? Yeah, overt, covert. Yeah, name-calling, yelling, eye-rolling. So those are all the obvious things. Then we have the things that kind of can be covered up, right? The unfair assignments, maybe the gossiping, withholding information. So all of those things are going to fall into that negative behavior. Good. Two strategies that a nurse can take to stop this behavior on a nursing unit. So what were two things we saw these nurses do in the simulated experiences? Yeah, absolutely. Address them in the moment, maybe address them later, speaking up and advocating. Right. Absolutely. And then again, we talked about that; you might have to report the behavior. But yes, standing your ground and speaking up, and actually advocating for others is going to be your best thing here.

LACY: Report at least two effects uncivil behaviors could have on the nurse. So what were some things that we talked about that directly affected the nurse? Yeah, that's really our big one, guys, mental health, physical health, and then kind of just downward spiral from there. Not going to the job, and then I might not even want to be a part of this profession anymore. Right. Absolutely. Which is really sad because we know the majority of the people who go into nursing really have the heart to be there, so that's really sad to see that in the long run. So two effects it could have on our patients, so we have nurses calling off, people are leaving the profession. Yeah, patient safety, decreased quality of care, negative patient outcomes. Absolutely. Absolutely. Yeah. Nurses are afraid to ask for help equals risk for injury for the patients, risk for injury for the nurse. And then, as an organization as the whole, they're losing money. We have those high turnover rates and that poor reputation within the community. Okay? So I hope you can see that if you've never experienced this, I could literally jump out of my chair and cheer because that makes my heart very happy. And maybe it hasn't affected you directly or your unit directly. And that's another thing, "Well, our unit gets along. We're fine." Well, if the unit above or below you are somewhere within your hospital facility doesn't have this great culture, yeah, we're going to lose money, and we're going to lose the organization as a whole. So definitely something to keep in mind.

LACY: So as we kind of come to an end here, I know we're getting close to our hour with five minutes. I challenge each of you, whether you're a student, a nurse of 10 minutes, a nurse of 2 years or 40 years, as you lead this webinar this evening, go out into your current role and be the change that we need to see happen within our nursing profession. I prefer that we're known for our kind, caring, compassionate behaviors versus being negative, toxic work environment, those types of things. So I challenge all of you to go out there and be the change that we need to see for our profession to really prosper and grow. All right.

CATHY: So there's, I think, one question for you, Lacy, or maybe there's a couple of questions. Let's see.

LACY: Yeah. So the definitions and statistics. So I do have a reference sheet here. But, yeah, the ANA is the American Nursing Association. And then also, there was the Joint Commission, also has a lot of information on this as well. And, yeah, I saw from the anonymous attendee talking about kind of standing up for that, and then the issue becoming a little bit more toxic. So it looks like the student decided to stay back to avoid the person and their cohort, and that breaks my heart, especially coming from a background of education. I apologize for your experience because, as a faculty member, as somebody who is part of the academia really should be advocating and helping you work through those. So I commend you for sticking up for yourself. But as we talked this evening, it doesn't always go well. So to you also for staying behind, you'll have a better experience, and you'll be kind of better equipped to address these types of situations if you do see them in your nursing career. So very nice. And then--

CATHY: And either-- oh, sorry, I wanted to mention, in the chat, there's a couple of people expressing concerns about like they went to nursing school during this pandemic. They have not had the type of clinical experience that they would have expected, and they're worried that then when they start their new job, they're going to get made fun of, that they're worried about how they will be received. So I wanted to-- Meris and I actually talked about that the other night when we did our back-to-school live. So, Meris, do you want to offer your perspective about that?

MERIS SHUWARGER: For sure. So I am a pandemic graduate, right? Actually, Lacy Hager was my clinical instructor during my mental health rotation when COVID happened-- when it hit, and I actually got sent home from my mental health clinical for the stay-at-home order. So with the entire last year of my degree was online, and so same thing. I missed all of my specialties, and here I am, trying to go into critical care nursing. I'm trying to be a trauma nurse, right? And I'm thinking they're going to think I'm so dumb. I don't know how to do any of these things. And, yeah, there's a few people who do-- there are a few people who treat me that way. But I think the overwhelming odds are that you're going to end up on a unit with people who are happy that you're there, who want to see you succeed. And also, nursing school isn't about learning the skills, right? That's everyone's big concern right now. It's like, "I don't know how to do the skills." That's okay because we can teach anybody how to do a skill. I taught my five-year-old daughter how to put on sterile gloves, right? She knows how to do that. She's five years old, so you're going to be fine with your skills. It's all about practice and being willing to get in there and try it. It's the critical thinking. It's the understanding, the pathophysiology. It's all of that kind of stuff that is going to be really important. So you are still getting that in nursing school, and you're going to be well-prepared.

MERIS: And I want to say that one of the things that I think is a really good phrase to learn and use and memorize is I'm not stupid. I'm still learning. And I have said that before, and I had a nurse when I was a nursing student, and this was not even someone that I was working with. This was someone that I knew personally. And I was sharing that I had gotten to do a straight catheter, and I was so nervous. It was the first one I had ever done, but I did it, and I was so proud of myself. And she was just rolling her eyes, and she was like, "You were nervous to do a straight cath." And I was like, "Well, yeah. I had never done one before. It was a sterile procedure. I didn't want to hurt this patient, whatever." And she was like, "Good luck in the ER." And I just remember feeling my confidence just kind of deflate and feeling like, "Wow. Really? You've never been nervous to do something before? Whatever." And I said to her, "I'm not stupid. I'm still learning."

MERIS: And then I like to follow it up with anybody who treats you with incivility, no matter who it is, is, "Please treat me with the respect that I have shown to you." And that one, I think, is a really good one for calling it out without being rude in response, pointing out that you are being unkind to me. You are being rude, and I have not done that to you. So it's a very simple, so "I'm not stupid. I'm still learning. Please treat me with the respect that I have shown to you." And it doesn't have to be a huge, big thing. You don't have to, like, "I knew it. I went to school," just that and leave it alone. And I have actually had a provider come find me later. In the ER, it's a little bit different. I don't call doctors, really. They're just right there. And I had a provider come and apologize to me and say, "I'm sorry, I spoke unkindly to you. I wasn't mad at you. I was frustrated with another situation, and I apologize." And first of all, I was like, "You do apologize?" I was very caught off guard. But I think that it can also be a good reminder to you that you're going to be unkind to people sometimes, too, when you are stressed or frustrated or overwhelmed. And that's okay. We all do it. But it's important to then reflect, recognize. "I really shouldn't have said it that way," and then be willing to go seek somebody out and apologize, too. It goes both ways. And if you are willing to apologize and say those sorts of things, people will recognize that in you, and they will know that about you, and you will earn respect that way, too. So anyway, those are my two cents.

LACY: And I think to go off of what Meris said, a lot of organizations are also identifying that. That you haven't had your clinical experiences, so they are either extending your orientation or starting some sort of internship program. This is to kind of help mentor you along the way. Again, advocate for yourself, this time for you to come out of orientation, and you're not really feeling it, say, "Hey, you know what? I think I need a little bit more time." You need to advocate for what you don't know or what you don't feel comfortable with, and they will help you get those experiences. So again, you have to be able to speak up for yourself as well, to say, "Hey, I'm not comfortable." So very good.

CATHY: And don't hold back from that. All right. And like Meris said, you can teach anyone skills. Anyone can learn a skill. What you can't teach us attitude. So if you come with a good attitude and you hold your ground. So one of my experiences that my nurse team knows about, but I was a new grad, and I was on night shift, and the day shift nurse said, "Hey, can you change the feeding tube setup before you go?" And I'm like, "Well, I'd be happy to, but I kind of need you to watch me or someone to watch me because I've never done it before." And she's like, "You're kidding," total eye roll. "I can't believe you haven't done that." And I'm like, "No, I haven't done it." Period, end of story, right? And I just stood there, right? I held my ground. "I haven't done it. So it may not be a big deal. It may not be hard, but I'm going to need someone to watch me the first time I do it." And you need to think about that. This is your license, so you got to hold your ground. You got to make sure you get the help and the training you need to be safe and so you can protect your license. Caught her off guard by just being like, "No, I'm not kidding. I need someone to watch me." And later on, she came in, and she's like, "Oh, did I hurt your feelings earlier?" I'm like, "Yeah, you did. You did hurt my feelings, actually." And then again, she's all flustered. But after that moment, I had total respect from this woman, right? She saw that I was holding my ground, and I called her out on the behavior. And I also didn't put my license on the line. I pretty much demanded to have that help in that training before I did something, so yeah.

LACY: Well, you were advocating for your patient, right? You didn't want to harm the patient as well. So I think we always have to kind of take that back. If you don't feel comfortable to advocate for yourself, advocate for the patient and say that. "I want to make sure I'm being safe for the patient." And so you can always throw it back kind of on the patient, right? "I need to make sure I'm being safe for the patient," and that kind of can change the person's thinking as well and going, "Oh, okay. Well, maybe she really does care." And it's that type of way. So again--

MERIS: I just want to really quick-- sorry, this comment that says it's great hearing your experiences and knowing we're not alone. And I think that is like the super-duper huge point that I want to drive home is that it's not you, right? If someone is being unkind to you, it's not you. It is not only happening to you. You are in very good company, from really excellent nurses, from really experienced nurses, from smart nurses, from really good advocates who have been treated like this by their peers. And I think if you feel that way ever-- I mean, you're not always going to feel comfortable going to your charge, right, or to your manager. There's just situations where you may-- it's not worth doing that, right? It's not a huge thing, but I still don't feel comfortable. And I would encourage you to find somebody at work or even outside of work who you think of as a mentor or someone who is a friend or who has been where you are so that you can say, "Hey, like this nurse at work is, she is constantly giving me attitude." Whatever. Cathy told me that story before. I think I even passed my NCLEX, and I had that in the back of my mind. Okay, that's what I'm going to-- that's how I'm going to approach this. And so that's why I think it's so important, and why I love the online nursing community and everything is just because you're not alone. And I promise you, all of us have been through it, and somebody out there is going to have your back in solidarity.

LACY: Yeah. And I think you bring up a good point to, Meris, that in one situation, you might feel comfortable, but you might also come into another situation where you're like, "Yeah, I got this. I confronted." And you feel really good about this, and you're like, I went to that webinar, and I feel really well." And then, all of a sudden, something comes up, and you're like, "What do I do here?" So again, if you can stop the behavior in the moment, that's great. But sometimes, it's good to reflect. Take a moment, maybe run it past another colleague and say, "What would you do or think about this?" And then kind of have a game plan to be able to go back to that person and say, "Hey, remember last week when we had that interaction about whatever it was?" And then be able to do it because a lot of times, if we're emotionally driven, it can come off the wrong way as well. So I think it's important. Sometimes we have to stop count to 10, regroup and then be able to address it. So, yeah, I think those are all really good advice.

CATHY: All right. We waited to announce our winners. So we're giving away three decks. So first of all, I just want to thank Lacy. And I saw lots of thank-yous in the comments and that everybody really enjoyed your presentation, Lacy. I didn't fully understand the financial ramifications and some of these other consequences of uncivil behavior, so thank you so much. We have three winners. So here's how this will work. Our three winners, you can pick whichever of our flashcard decks available on Level Up RN that you would like. I need you to email support@leveluprn.com and let them know what deck you would like and probably provide your address, etc. So our three winners drawn randomly are Caitlin Turk. Caitlin Turk is the first winner. The second winner is Inge Halliday. And the third winner is Maria Larrea. So, Caitlin, Inge, and Maria, so make sure-- here, I'll put it in the chat. Email support@leveluprn.com, and we'll get that deck out to you. Okay?

LACY: So Cathy is putting that in, the support@leveluprn.com. Meris is also putting in a link to a Google Doc. And if you could take two minutes, even if that, to give us some feedback on the webinar this evening. That would be wonderful so that we know what you're looking for if this was beneficial to you. And then there's going to also be an area where if you have additional topics that you would like us to talk about or bring up, that would be great as well. So again, there's that Google Doc that Meris put in. If you could click on that link and give us some feedback, that would be very helpful.

CATHY: All right. Thank you, everyone, for attending. Super appreciate it. So glad this was helpful for many of you, and we will--

MERIS: Wait, one second. Sorry, there's an issue with the link. And as far as where to follow us, you can follow us on Level Up RN on Instagram, for sure. And, of course, leveluprn.com for lots of free resources. And our YouTube is the same. And try this. For sure this is--

LACY: Make sure you're also-- make sure you're going into the website and putting your email address in, so you're getting the current information. Says it still needs permission.

CATHY: It looks like--

MERIS: Well, it'll come in the email. Yeah, we'll make sure that it gets sent to you in the follow-up email afterwards, but we really want to get your feedback and everything. So please, if you have the time when it comes in that email if you would fill it out for us.

LACY: Yeah. And it should just take a few seconds to do.

CATHY: All right. Thanks, guys. Thank you so much for attending. Thank you for providing feedback.

LACY: "Are we staying to make sure the winners are still here?" asked Amber. I think--

MERIS: They were. Yeah, all three were.

LACY: Yeah. I think everybody responded. Yeah.

CATHY: Yep. I think all three responded. So I think we're okay. You're smart to ask, though, because the other day when I--

LACY: A girl can dream, right? Yeah. Amber, you've been here before. You know how that goes.

CATHY: Was that Amber? Was she at the one the other day? Was she at our webinar?

LACY: She must have been. She must have been. She was.

MERIS: She says she was.

LACY: I love it. Amber's like, "Wait, they have to respond and say they were here."

CATHY: Don't [inaudible] [inaudible]. Yeah. For sure [inaudible]. For sure. So, okay, we're going to be doing lots more for these guys. We've got more exciting stuff around the corner, for sure. So take care. Thanks again for attending. And we'll see you guys soon.

LACY: All right. Thank you, guys. Have a good night.

MERIS: Bye.

LACY: Bye.

CATHY: Bye.