Toxic Nursing, 2nd Ed. Cheryl Dellasega

ways of managing its negative consequences.

      Commentator Melissa Snyder articulates three approaches a nurse manager can take to address this type of inappropriate communication:

      First, the nurse manager must consistently work at establishing professional relationships between all employees based on trust and integrity. Without these core values, relationships cannot grow and mature, and the cohesiveness of the work team is constantly challenged. In a busy, stressful healthcare environment, nurses must feel supported by and confident in the abilities of their colleagues. Each of these scenarios betrays this sense of trust and support in both personal and professional ways. To establish trust, nurses must be empowered to share their thoughts and feelings regarding situations in a professional way.

      The second approach in dealing with gossip and trash talk is to foster a professional work environment that extends beyond the boundaries of a particular unit. Professionalism must be modeled consistently by the nurse manager and other expert nurses. In addition, all nurses should be supported in their socialization to the professional role with frequent opportunities to practice these skills and to gain new knowledge through professional development programs. Over time, this combination creates an expectation of professional behavior that guides how nurses behave at the bedside but also permeates all other aspects of their lives.

      The final approach is the need to address the role of technology and social media with all nurses. Nurses need to know that these technologies can be very useful but can also be very detrimental if not used with caution and consideration. Nurses need to know what the expectations are for their use of social media, and, if possible, there should be a clear policy indicating how these technologies can be used.

clearing toxicity: scenarios, insights, and reflections

4.1 Indiscretion

      scenario

      Liz is an OR nurse known for her love of “sharing” information about her coworkers. During her shift, she often goes from one nurse to the next, prompting them with “Did you know . . . ?” or “Have you heard the latest?”

      Most of the other nurses know what Liz is up to and have learned to deflect her. Even so, her constant desire to spread negative news creates friction in the OR—especially when Liz repeats information about one nurse to another. She is a master at taking tidbits of conversations out of context and sharing them with a person they are likely to upset.

      Penny, an OR tech, is good buddies with Liz and often collaborates with her to spread rumors. Between the two of them, Liz and Penny stir up lots of drama in the OR. One day, Liz and Penny suggest that Tara, a nurse who has been having marital trouble, has filed for divorce from her abusive husband. Within hours, everyone in the OR thinks that Tara’s marriage is on the rocks, and, when one nurse comes up to console her, Tara becomes upset. She goes to the manager and insists that something be done to curtail Liz and Penny’s “loose lips.”

      nurse leader insight

      The manager of the OR should go directly to the source of the rumor mill and confront both Liz and Penny about their actions. It is possible that the pair may find this to be a harmless activity or that they are really unaware of the way their actions are affecting others. This direct confrontation may be enough to curtail their desire to share rumors—especially if they are informed of the negative effects this behavior is having on other staff members.

      Sometimes, simply recognizing the problem is enough incentive to end the behavior. However, the manager should also speak with the staff as a whole. In this exchange, the staff should be empowered to speak up when they are uncomfortable with information that is being shared by their colleagues.

      Without a willing audience, the rumors cannot be spread—and this may be the most effective way of resolving the problem. In a unit such as the OR, where everyone must work together as an orchestrated team, integrity and trust are core values that are essential to building a cohesive work group. The rumor mill whittles away at the integrity of all who participate in this activity. Over time, it will affect the ability of the group to function as a unified staff.

      –Melissa Snyder

      Just as with younger girls, those who control the flow of information often perceive themselves as having a sense of power. Knowing the latest tidbits about classmates or coworkers and selectively sharing them (or not) can seem to bestow status and even popularity, but this tactic may misfire.

      As a manager, I would engage the entire OR staff in some way to raise awareness about the separation between personal and professional lives. Yes, it’s nice to have colleagues who care about you and your well-being, but the place to address those concerns is almost always face to face—not through an intermediary or third party. Depending on the severity of the problem, there might need to be a more systematic ongoing program to educate everyone on respect and civility.

      Distortion of information can also lead to serious misunderstandings about important topics. At a staff meeting, I would want everyone to use more caution in what they share about coworkers; the OR is a small community in and of itself where rumors can fly quickly. At the same time, I would indicate my approval of those nurses who use discretion and understand that when something comes their way, it should be kept confidential or at least not shared more widely.

      Lastly, I would have a conversation with Liz and Penny individually to try to gauge their time management, their job performance, and their professional development. If loose lips are causing problems with work, they need feedback on that. As well, given Liz and Penny’s ability to share information, I might invite them to develop a newsletter or some other form of communication to be shared by all OR personnel.

      –Cheryl Dellasega

      reflections 4.1

      Do certain nurses in your unit share personal information about coworkers with third parties? Do you? If you’re being honest, the answer to this question is ‘yes.’ It’s normal to talk about our friends and colleagues; the problem arises when we’re malicious or cruel.

      One critical question to consider is whether the gossip is disruptive to the unit’s cohesion. The question then becomes: what can you as the nurse manager do about it?

4.2 Out of Context

      scenario

      One busy evening, Liandra—who has worked in the ER for many years—makes a medication error, which is quickly caught and corrected by one of her coworkers. Despite the self-limiting nature of the medication mistake, Liandra is consumed with guilt. She can’t stop retracing her steps and trying to figure out what led her to give the wrong dose of medication.

      Carrie, Liandra’s coworker, works a double on the night after the mistake is made. She tells the entire night shift about Liandra, implying that the nurse manager is ready to take further action. By morning, the night shift workers are convinced Liandra nearly killed a patient and will suffer serious repercussions.

      One of them calls Liandra to console her and discovers the incident has been blown out of proportion. This is not the first time Carrie has been caught exaggerating at the expense of a coworker.

      nurse leader insight

      When things go wrong within a clinical setting, it is important to have established a culture in which the error is reported rapidly and the focus is not on blaming the person who made the error but on exploring why the error occurred and preventing future errors. In this scenario, Carrie has created a culture of blame through her exaggeration of the error made by Liandra.

      The focus is now on correcting the misinformation and negative feeling created by this exaggeration. As the manager, it would be important to directly address this issue with Carrie and help her understand how her actions have created an environment that is not only problematic for her colleagues but also shifts the focus from prevention of these errors to seeking blame for an error that