The Journal of Continuing Education in Nursing

Editorial Free

Retraining the Elephants in the Room

Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN

Perhaps it was the intensity of this year's political activity that made me think about an elephant. Or maybe it was George Lakoff's book, Don't Think of An Elephant: Know Your Values and Frame Your Debate (note, please, that the book is not on the top 10 list of readings for policy development, and yet is tremendously valuable). Or maybe it is because Charlene Wexler's new book, Elephants in the Room, was published.

The related idiom there's an elephant in the room refers to a topic no one wants to discuss (Cambridge University Press, 2016). The use of the elephant seems appropriate because it is a large lumbering animal—not something one would not notice if the animal were actually in the room. Most of us can think of topics that represent the elephant in the room in our workplaces. They are the unmentionables, and the good news is that the list is shorter than it used to be. In recent years, with an emphasis on a just culture, we have begun to talk about some of those taboo topics more openly. They have included such topics as ageism, incivility, illegal or questionable practices, racism, and unethical behavior. Yet, the elephants remain. What are the names of some of those elephants, and how do we retrain them?

Some of those names that remain relate to incivility, racism, political intolerance, lifestyle intolerance, and gender inequity. Because we are trying not to ignore the elephants anymore, we have options to deal with them.

We still find places that feed the elephants. In other words, we find ways to make the problems worse and try to shut down discussion. Although a few of us openly embrace discussing sensitive matters, not discussing them allows us to each stay in our shell of perception, and nothing gets accomplished.

We find other places that try to starve the elephants, hoping they will die out, but someone must secretly feed them because they often are resuscitated, sometimes at the most challenging times. An example of this might be trying to be overly politically correct.

We can kill the elephants, but that could create a challenging workplace. What (or who) might get killed next? We see examples of this frequently when an authority figure makes clear that we will “never speak of this again.” When that happens, people are not only anxious about the elephant but now are also anxious about themselves. What happens if I do speak up, one might ask.

We could also retrain the elephants in the room. Let me suggest some strategies for how to do this.

As I see it, the elephant keeps doing its reappearing act because prior efforts to ignore it have allowed free-roaming opportunities. To make it personal, many of us might feel free to yell back at someone who yelled at us if a rule were not in place that forbade such responses. That is why the elephant keeps returning—because few have said it is unacceptable to feed the elephant or to allow it in the room without acknowledging it is there. Many of us probably work in organizations with mottos such as “if you see something, say something.” We know how to do this with suspicious-looking abandoned bags. We do not know, however, how to announce the presence of the elephant and how to help others usher it out!

We are so consumed with critical knowledge related to the care of patients that we forget the fourth cornerstone of the Quadruple Aim (2014): the influence of the workplace. We cleverly perform workarounds and often brag about how clever we are to have figured out a solution to a challenging problem without making a policy or practice change that addresses the elephant (i.e., the nonfunctioning policy or practice). Yet, those workarounds are often a reflection of an elephant in the room. We may not feel safe to challenge a nonfunctional policy, or we know the unit will be penalized if it expends money on product B that may perform exactly what is needed if we can obtain product A much less expensively. The list goes on!

You know how people who have fleeting ideas may say “squirrel?” They do that to let you know their mind has raced across to another topic—much like how a dog is on a definitive trail and sees or smells a squirrel and races off to catch it. What if we all just took the risk to say “elephant” each time we saw something being ignored that really needed to be addressed? I think the challenge is in having the courage to say “elephant” and expect others to be responsive. We can teach people to listen better and to communicate in sensitive ways where no one feels attacked and that still allows us to call an elephant an elephant. We need to retrain people so they can retrain the elephants!

Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN


  • Bodenheimer, T. & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12, 573–576. doi:10.1370/afm.1713 [CrossRef]
  • Cambridge University Press. (2009). Cambridge academic content dictionary. Retrieved from
  • Lakoff, G. (2014). Don't think of an elephant: Know your values and frame your debate. White River Junction, VT: Chelsea Green Publishing.
  • Wexler, C. (2016). Elephants in the room. North Charleston, SC: CreateSpace.
Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN

The author has disclosed no potential conflicts of interest, financial or otherwise.


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