This was not a road she expected to find herself traveling. The journey began in 1991, when she was out of a job, separated from her husband, and the mother of five children, all younger than 11. She was introduced to a lawyer who offered to handle her divorce for free—if she agreed to become a nurse. Never one to turn down a good deal, and recognizing her dire straits, Bartholomew accepted the deal.
She packed her five kids into the car and drove to North Carolina so family could watch the children while she attended school and studied. Eventually, her hard work paid off and she started her first position as a nurse. Almost immediately, she witnessed the perverse hierarchies involved when physicians and nurses talk to each other.
"Every time the nurse would call to report a temperature, the physician would slam the phone down, even though we had guidelines to call if the patient's temperature was above 102 degrees," says Bartholomew.
She knew that the belittling, demeaning, and hostile behavior she witnessed throughout healthcare was a serious problem.
"I realized it was something that carried over" and affected patient care, because a person cannot perform cognitive tasks when his or her emotional state is compromised, says Bartholomew. "No human being can think clearly when they are upset. When you create healthy relationships, you are providing a safety net. Our patients will never be safe until all caregivers feel safe enough to communicate—to challenge, question, advocate, and ask for clarification."
As Bartholomew progressed in her career, becoming manager of a 57-bed orthopedic unit in a downtown Seattle hospital, she worked on improving nurse-physician communication and she experienced amazing results.
She turned her attention outside her organization and began to talk about the issue to others. What she was saying struck a nerve. As she presented to hospitals and conferences, nurses would come up to her, weeping, and tell her their stories. She added the need to improve nurse-to-nurse horizontal hostility to her mission and became a celebrated author, speaker, and educator on the topic of bad behavior and the patient safety imperative for changing culture.
"It's just absurd that the two people who are providing the care are not required or expected to communicate on a daily basis," says Bartholomew, noting that poor communication "is the No. 1 cause of errors."