Toxic Nursing, 2nd Ed. Cheryl Dellasega

culture of trust that encourages the staff to report errors quickly and accurately without fear of repercussions from other staff. And when errors like the one in this scenario occur, the approach should be to seek opportunities for new learning at all levels.

      –Melissa Snyder

      My first concern in this situation would be Liandra’s well-being—assuming, of course, that the patient has been taken care of. I would act quickly to address the situation by reinforcing the process to be followed when mistakes are made, stressing that patient safety comes first. With Liandra, I would try to identify factors that may have contributed to the mistake in case system issues need to be corrected.

      Next, I would have a unit-wide discussion on errors. This would provide an opportunity for all ER personnel to discuss how we as professionals address mistakes. It would be helpful if others volunteered ahead of time to share incidents in which they have made errors and how they dealt with both the ethical and emotional aspects. This might be the venue to further examine the damage done when negative talk occurs around a coworker’s performance.

      Finally, I would want to check back with Liandra and make sure her professional self-esteem is back on track. If she continues to feel guilty and unsure of herself, the likelihood of future mistakes will increase. Other senior nurses could also be encouraged to be supportive of Liandra and check in with her from time to time.

      –Cheryl Dellasega

      reflections

      Most of us played the game “telephone” as kids, where a message begins with one person and is slowly—and reliably—distorted as it makes its way from one person to the next. As the nurse manager, what can you do when this type of thing happens on your unit? If gossip is just part of human nature—and we won’t be able to eliminate it—what can we do to constructively manage it?

      In the case above, Liandra makes a mistake. When errors occur on your unit, how does the staff react? Does the person who made the error feel free to report it? Are others in the unit emotionally supportive of the nurse who made the error? In short, what type of environment has been cultivated on your unit? Are you satisfied with it?

4.3 Secrets

      scenario

      For several months, Maggie has been trying to get pregnant. She and her husband, a resident in the same hospital where she works, have gone through several special treatments to try and have a child. When she finally conceives, she tells only Alice, another nurse supervisor with whom she is close.

      “Please keep it to yourself,” Maggie says. “I’m worried something might go wrong, and anyway, I’m applying for that new position in nursing education. If they know I’m pregnant, I might not get the job.”

      Alice tells Maggie she will keep her secret, but over coffee with Donna, she hints about some big news that is about to break. Donna, who knows Maggie, guesses at the secret, which Alice refuses to confirm with anything more than a smile. Donna then progresses to tell two other people who “promise” not to reveal what they know, and so on. Eventually, Maggie learns about Alice’s betrayal and confronts her—so angry that the relationship is permanently damaged.

      nurse leader insight

      In this scenario, Maggie has not directly contacted the nurse manager. However, it is safe to assume that the nurse manager will be aware of the issue through other staff. At this point, the manager must address this issue with both Maggie and Alice. Because Maggie is angry and feeling betrayed, these emotions must be addressed. It is also important for Maggie and Alice to meet to discuss the situation.

      Maggie may need some coaching to help her manage her intense feelings of anger and betrayal, while Alice needs coaching regarding her inability to keep information in confidence. Working on ways to re-establish trust is imperative not only to maintaining the relationship between the two nurses, but also to maintaining the integrity of the unit as a functioning whole. The manager’s role is not to get involved in the personal relationships of the staff, but to assist all staff in maintaining relationships that are professional and support the overall workings of the unit.

      Assisting staff in recognizing the difference between professional and nonprofessional communication is crucial and must be reinforced in circumstances like this one. It is important for the manager to help Alice understand that this indiscretion makes others question her ability to keep information confidential. Confidentiality is essential in healthcare settings.

      –Melissa Snyder

      This situation provides a good opportunity to apply rules protecting patient privacy to standards we set for coworkers. If the facts of this situation were slightly different, Alice would have violated HIPAA laws about privacy of information.

      Respecting a person’s request for confidentiality is part of a trust relationship, and trust is integral to teamwork. Team-building and morale activities can help everyone move forward with a better understanding of ways to support and respect each other.

      The influence of body language as part of communication is important. Something as subtle as rolling your eyes or sighing loudly can turn a neutral message negative.

      If the opportunity presented itself, I might also have a conversation with Alice or Maggie to see whether the relationship between them can be repaired. There’s no way to undo the damage, but it might be possible to forgive and move on.

      –Cheryl Dellasega

      reflections

      Good news is hard to keep to yourself. Sometimes when we gossip, it’s not necessarily malicious—we’re just so excited to be part of something new, fun, and exciting that the words tumble from our lips. The problem, of course, is that this type of behavior can cause serious dysfunction. Have you ever experienced a similar situation? Was there fallout in your unit? What did you do to address it?

4.4 Rumors

      scenario

      Tanya, an RN in the ER, is on break during a slightly slow day shift. She decides to catch up on texts. While composing a message to Dean, a nurse on the evening shift, she gets a call and stops to respond to it.

      The caller is Sonya, who wants to share some news with Tanya: Susan, the ER nurse manager, is going to be “replaced” by the end of the week. Tanya has had a rocky relationship with Susan, so she considers this good news and can’t wait to text Dean. As soon as she stops talking to Sonya, she texts Dean: “Guess what? That b---- Susan is going to be fired!”

      Accidentally, Tanya sends the text to Deandra, who is one of Susan’s best friends. Deandra instantly contacts Susan, and learns that Susan is, in fact, being promoted and another nurse manager designated.

      nurse leader insight

      In this situation, Tanya’s behavior is extremely unprofessional. Two key issues seem to be occurring simultaneously within this scenario. First, the use of technology in communicating information must be addressed. Within a matter of minutes, Tanya has managed to involve four other nurses in her unprofessional and inaccurate communication. The second issue involves the derogatory terms used in sharing the information about a colleague.

      With regard to the first issue, as the nurse manager, it is important to discuss professional and unprofessional communications both in person and via technology. The most critical message is the need to confirm the accuracy of all information before sending it forward via technology. Because of the speed of communication, inaccurate information can be distributed to known and unknown sources within seconds—and it cannot be easily corrected when new information emerges. Tanya must be reminded of this. It is also important to discuss this issue with the entire staff so that everyone recognizes the power and the detriments of communicating through technology.

      With regard to the second issue, this language is unprofessional and disrespectful. Even though the message was intended