It Happened to Me, but It Will Not Happen Through Me
Breaking the cycle of fear in healthcare: How psychological safety transforms clinicians and patient care.
I still remember my first day of nursing clinicals.
I was standing in an elevator when an experienced nurse asked me why I wanted to become a nurse. Like so many people entering healthcare, I gave the answer that felt most natural to me:
I wanted to help people.
I expected encouragement. Maybe a smile. Maybe even a story about why she had chosen nursing herself.
Instead, she told me that nursing was a hard job and that I probably should have thought my decision through more carefully.
I remember being confused. Was wanting to help people somehow not a good enough reason to become a nurse?
That was also the day I first heard the phrase:
"Nurses eat their young."
I thought it was crazy.
Why would the people who had already walked this road discourage those who were just beginning it?
At the time, I assumed it was an isolated experience. Maybe she was burned out. Maybe she had simply had a bad day.
More than a decade later, I understand that the problem is much larger than nursing.
I have moved through healthcare from nursing assistant to registered nurse, working in areas including cardiology and neurocritical care, and eventually continued my education to become both a family nurse practitioner and psychiatric mental health nurse practitioner. After more than four years working in psychiatry, I have learned that "eating our young" does not stop when someone earns another degree, changes roles, or gains a new title.
Sometimes, providers eat their young, too.
But I have learned something else along the way—something I believe is far more important:
It happened to me, but it will not happen through me.
We Can Demand Excellence Without Creating Fear
Healthcare should demand excellence.
Our decisions affect people's lives. New clinicians should be challenged. We should be expected to defend our clinical reasoning, recognize what we do not know, accept correction, and continually improve.
Patient safety requires accountability.
But accountability and humiliation are not the same thing.
There is an enormous difference between being challenged and being diminished.
Education says, "Walk me through your reasoning."
Mentorship says, "Here is what you missed. Let me show you how to recognize it next time."
Healthy leadership says, "I disagree with this decision, and I want you to understand why."
Fear-based leadership communicates something entirely different:
You should already know this.
You should be afraid to ask.
Your ideas are not worth hearing.
Do not make a mistake.
Eventually, the learner stops learning and starts surviving.
What Fear Does to a Clinician
When clinicians are repeatedly made to question their competence rather than develop it, the effects do not necessarily end when the interaction is over.
You begin second-guessing decisions you were once capable of making.
You rehearse a question in your head before deciding whether it is "safe" to ask.
You hesitate to offer an idea.
You become more concerned about how someone will respond to your clinical decision than about discussing the clinical reasoning behind it.
Eventually, even asking a reasonable question can create a knot in your stomach.
Work becomes something you dread instead of a place where you are excited to learn.
For some people, that anxiety follows them home. Confidence deteriorates. Tears become common. Panic replaces curiosity.
Then something particularly dangerous can happen.
Clinicians become afraid to say three words that every healthcare professional must remain comfortable saying:
"I don't know."
No matter how experienced we become, there will always be something we do not know.
A safe clinician recognizes that.
A dangerous culture teaches people to hide it.
That is why this conversation is bigger than hurt feelings.
It can become a patient-safety issue.
Psychological Safety Does Not Mean Lowering Standards
Supporting clinicians does not mean telling everyone they are doing a wonderful job regardless of performance.
It does not mean avoiding difficult conversations.
It does not mean accepting unsafe clinical practice.
Some of the people who have helped me grow the most have challenged me. They have questioned my reasoning, corrected me, and expected more from me.
The difference was simple:
I knew they wanted me to become better, not smaller.
A strong mentor does not need a learner to feel incompetent in order to demonstrate expertise.
A strong leader can say, "That decision concerns me, and here is why," without communicating, "You are incapable of making good decisions."
One creates reflection.
The other creates fear.
We should know the difference.
What Happens When Good People Become Afraid to Speak?
Healthcare advances because people ask questions.
Why are we doing it this way?
Could there be another explanation?
Is there a better treatment?
What if we tried something different?
Yet we sometimes create environments where newer clinicians quickly learn that the safest professional strategy is silence.
They stop bringing forward ideas because they do not want to be embarrassed.
They stop asking questions because they do not want to appear incompetent.
They stop challenging assumptions because hierarchy has taught them that experience automatically means correctness.
Think about what we potentially lose when that happens.
The next great clinician, educator, researcher, or healthcare innovator may currently be sitting quietly in a meeting with an idea they are too intimidated to share.
Leadership should make that person more willing to speak—not less.
Someone Probably Taught Them This Way, Too
This may be one of the most uncomfortable parts of this conversation.
Many of the healthcare professionals who lead through intimidation were once learners themselves.
They may have been humiliated during rounds.
They may have been told that questions demonstrated weakness.
They may have worked impossible hours and been expected to accept it without complaint.
They may have learned that surviving mistreatment was simply part of becoming a "strong" clinician.
Perhaps someone once ate their young, too.
Understanding that matters.
But understanding a behavior does not require us to continue it.
We can have compassion for what shaped someone while still deciding that the behavior should stop with us.
Pain does not have to become tradition.
Being treated poorly during our own development does not earn us the right to treat the next generation poorly.
In fact, it gives us an opportunity to do something much more meaningful.
We can say:
It happened to me, but it will not happen through me.
Experience Should Make Us Better Mentors
There comes a point in a healthcare career when our responsibility changes.
We are no longer only responsible for becoming competent ourselves.
We become responsible for helping someone else become competent.
That is an extraordinary privilege.
Knowledge should make us more willing to teach, not more protective of our status.
Experience should make us remember how frightening it was to make our first independent decisions.
Leadership should not be measured by how quiet the room becomes when we enter it.
It should be measured, at least in part, by what happens to the people after we have invested in them.
Do they become more capable?
More thoughtful?
More confident?
More willing to ask for help when they need it?
Do they eventually become people who teach others with the same respect?
And perhaps the hardest question:
Are we secure enough in our own accomplishments to celebrate when the people we teach eventually surpass us?
We should be.
Because that is the point.
I Have Experienced the Difference
I know the difference between these environments because I have experienced both.
There were periods in my career when support was minimal and when only a small number of people reminded me of the clinician I was capable of becoming. They helped me maintain perspective, resilience, and confidence when I struggled to find those things within myself.
I will never forget those people.
I have also been fortunate enough to transition into an environment where I am surrounded by people who genuinely want me to succeed—not only professionally, but personally.
The difference has been profound.
Support did not make me weaker.
It did not make me complacent.
It made me want to learn more.
It made me more comfortable asking questions.
It made me more willing to acknowledge what I did not know.
It made constructive criticism easier to receive because I understood that correction was intended to help me grow rather than make me question whether I belonged.
Most importantly, it allowed me to devote more of my emotional and cognitive energy to the reason I entered healthcare in the first place:
the patient.
All these years later, the answer I gave that nurse in the elevator has not changed.
I still want to help people.
Tomorrow Has Arrived
For generations, healthcare professionals have repeated phrases like "nurses eat their young" as though they describe an unavoidable rite of passage.
They should not.
Neither should the physician, provider, administrator, professor, preceptor, or manager equivalent.
We know more now.
We understand burnout better.
We understand trauma better.
We understand psychological safety better.
We understand the relationship between organizational culture, communication, and human performance better.
Tomorrow has arrived.
The next generation of healthcare professionals does not need easier standards.
They need better teachers.
They need people willing to challenge them without humiliating them, correct them without destroying their confidence, and teach them without making them afraid to learn.
If you have been practicing for years, someone is watching you.
Someone remembers how you respond when they do not know an answer.
Someone remembers whether you made it safe to ask a question.
Someone may even decide what kind of nurse, provider, physician, educator, or leader they want to become based partly on the way you treated them when they were still finding their footing.
That is an enormous responsibility.
But it is also an extraordinary opportunity.
We cannot change every healthcare culture overnight.
We cannot undo every experience that shaped us.
And we cannot control how every leader chooses to lead.
But we can control what happens next.
So when it becomes our turn to teach, mentor, supervise, precept, or lead, perhaps we should remember the people who made us question ourselves—and then remember the people who helped us believe in ourselves again.
Then make a choice about which one we want to become.
It happened to me.
It may have happened to you.
But it does not have to happen through us.
Teach them.
Challenge them.
Correct them.
Hold them accountable.
Encourage them.
Let them ask questions.
Let them have ideas.
Let them grow.
And if one day they become better than we are, celebrate them.
Because that was never our failure.
That was our job.
