How “We” Shapes Workplace Culture in Mental Health Wards

Mukesh Devrari

Mental health facilities are remarkable institutions. They are residential units designed for mental health patients. They are part of a hospital, and the units are called wards, but there is nothing inside them that resembles the traditional hospital setting you might imagine. The nurses who work there often have minimal understanding of physical health. Some nurses who have worked outside the mental-health domain may bring additional knowledge to the table, but overall, the focus of these wards is on mental health, often on behaviour.

Because nursing is not always considered a highly technical job, there is a tendency within these facilities to create ready-made solutions for different situations that guide nursing decisions. Nurses rarely get opportunities where they are required to think outside the box. In fact, if proper guidance is not created to support them, the quality of care delivery would dilute considerably. It becomes sensible to guide them through a situation-rehearsed model. They should have some prior understanding of the options and solutions they may need to offer when confronted with particular scenarios.

Language is also a concern, as many nurses in the ward are noticeably careless in how they speak to lower-ranked staff. As it is a key component of social identity, it plays an important role in forming “in-groups” and “out-groups” within the workplace, and can further reinforce hierarchies and exclusion (Wilmot et al., 2024). They often use discretion to establish their power, and they frequently use the term “we” when speaking to non-nursing staff, signalling a subtle but noticeable otherisation. 

Here is an example of how new nurses might use the word “we,” and why you should be prepared to face this form of separation that might irritate you. You are often helpless in these moments unless you pursue higher studies and bridge the gap that creates such humiliating situations.

One nurse in the ward was pregnant. She posted a simple message in the staff social-media group, which included registered nurses, enrolled nurses, housekeepers, health aides, occupational therapists, and others. In a normal conversation, a very friendly nurse—who was brought up in New Zealand and is culturally more Kiwi than Asian—said to a health aide, “Are you coming to her baby shower? We are going.” Now, the question is: who is this “we”? She means the nurses. If she were speaking to someone else, would she still say “we are going”? Who exactly are “we”? If you are new to the ward or hospital, you might not notice it, or you might feel slightly hurt by it, but remain silent because you are too thankful for finding a job that pays a decent amount of money for doing relatively minimal work.

Another example is less remarkable but still telling. A patient might ask for something, and a nurse—who is generally a decent person and does not intend to be rude—tells the staff member, “We don’t do this in the ward; we do it this way.” She uses the word “we” to create distance, establish her rank, and reinforce her authority. Instead of using logic, rationale, or effective communication to explain why a certain action is appropriate, she leans on the subtle hierarchy embedded in everyday tasks where different healthcare professionals cross paths. In this context, who are “we”? The “we” is the same as in the earlier example. Nothing can be more disparaging to the self-respect of a person who works hard and is willing to cooperate, and respects the workplace hierarchy. It discourages them from working collaboratively. Workplaces with strict power levels can make some people not listened to and not understood (Kwok, 2020).

Culturally safe practice in New Zealand focuses on protecting Māori and highlights the values inherent in Māori culture, but such an umbrella is also needed for people working inside the hospital at every level. There is also a tendency in a system mostly managed by European or English-origin Kiwis to dismiss concerns raised by others. As a result, this circle of “we” expands and contracts based on the needs of the group. It is not static. Its components and its design may change, but its purpose remains the same: the use of power over others in the tiny universe of hospital wards.

References

Kwok, C. (2020). Epistemic injustice in workplace hierarchies: Power, knowledge and status. Philosophy & Social Criticism, 47(9), 1104-1131. https://doi.org/10.1177/0191453720961523

Wilmot, N. V., Vigier, M., & Humonen, K. (2023). Language as a source of otherness. International Journal of Cross Cultural Management, 24(1), 59-80. https://doi.org/10.1177/14705958231216936