Toxic Nursing, 2nd Ed. Cheryl Dellasega

for our patients. There are many challenges associated with feeding patients, including their willingness to eat, the food, and the time and staff available to help. Let’s schedule a meeting with the unit manager to discuss our concerns and address this issue.”

      Finally, the nurse manager should be aware that supportive staff “running interference” may be contributing to an unhealthy alignment of us versus them with the physicians.

      –Beth Boynton

      While the claims of the physicians might be correct, the way they expressed them was inappropriate. Given the way the information was presented, the physicians’ rudeness could be considered bullying. Either way, I believe that Hector should talk to the physicians and tell them he was frustrated not by what they told him, but by how they told him.

      –Dilek Yildirim

      reflections

      Are physicians expected to demonstrate respect for the skills of nurses in your organization and vice versa? What behaviors show respect or diminish it? Can you identify situations where rude interactions disrupted the workflow or caused emotional distress?

      What is the difference between physicians who connect well with the nursing staff and those who do not? Think about specific behaviors they use and make a point of reinforcing them in all physicians.

      How can you help all team members be more explicit in supporting each other? If members of the interdisciplinary team don’t get along, what can you do to improve the workplace climate?

1.3 Putdowns

      scenario

      Crystal, an LPN, is especially hostile toward young new nurses who are coming to work on the outpatient surgery unit. She has been at the unit for 20 years and feels she is constantly “put upon” by fresh graduates who need to learn the policies and procedures. Lucy, one such new nurse, is a bit clumsy. During her first week in the unit, she trips and falls near a patient’s bed. The next week, she bumps into Crystal when she’s hurrying down the hallway with an armful of supplies.

      When Lucy is trying to wheel a patient out of the unit in an oversized wheelchair and takes several tries to turn a corner, Crystal explodes. “How dumb are you?” she asks Lucy, pushing her out of the way and grabbing the handles of the wheelchair. “It’s just not that hard to steer one of these around.” The patient is shocked by the outburst, and Lucy dissolves into tears and flees to the bathroom.

      nurse leader insight

      This is similar to the situation with Hector, except the disruptive behavior is coming from a seasoned LPN. The nurse manager should have addressed this behavior long before Lucy arrived, but with new knowledge he must start when he can. In this case, the nurse manager could talk with Lucy privately to help her prepare to address inappropriate behavior. The nurse manager could also meet privately with Crystal to set the tone for new expectations. An apology to the patient is also warranted. The nurse manager could suggest that Crystal apologize to the patient and Lucy together or separately.

      The trick here is to recognize that such moments are filled with tension and awkwardness, yet are extremely therapeutic and powerful. Making the time for them, letting the tension settle for a few moments, and then moving on with clear new expectations will help to minimize shame and maximize behavioral changes. It is also a management concern to be on the lookout for training needs of the new nurse and possibly job-match questions.

      –Beth Boynton

      I believe in most of the situations, Crystal has the right to react. But the reaction described here shows a lack of civility and a surplus of rudeness. I think Lucy should record the unfavorable events she has experienced in her new job and judge Crystal’s attitude toward other nurses—especially fresh ones. She should also give some time to herself and Crystal to settle things down. But if Lucy is still getting the same rude reaction after a while—especially after she has found her footing and begun to act more responsibly—she should discuss the problem with Crystal and warn her about her impatient attitude with new nurses. Then, if Crystal’s bad behavior persists, Lucy must go to the administration with her recorded events and ask them to warn Crystal about her rude attitude.

      –Dilek Yildirim

      reflections

      Do you believe rudeness between nurses of different rank or tenure is intentional? What are some ways to find out if insecurity or a sense of threat is the root cause of conflict and bullying or more of a personality style?

      Would the scenario with Lucy have evolved to the same intensity on your unit, or would you have intervened earlier? How have you handled the “Lucys” of nursing?

1.4 Cynical Character

      scenario

      Gloria is a mature nurse and longtime employee on the pediatrics unit. She got her diploma at a three-year school 30 years ago and has worked at the same hospital ever since. A series of mishaps have led Gloria to the edge of bankruptcy and divorce. Always a negative person, she has become downright bitter and speaks out at every opportunity.

      “They don’t care about nurses,” she says when the hospital announces a temporary hiring freeze. “They just sit in their offices on their fat behinds and count dollars.”

      “She was a terrible nurse. We’re better off without her,” Gloria comments when Trinda, another longtime employee, transfers to the ER. “I can’t imagine how she’ll function with more work.”

      “This will be a terrible week, I can just tell,” is Gloria’s refrain on Monday mornings.

      While some nurses have learned to ignore Gloria, some newer employees begin to feel stressed by her cynicism and pessimism.

      nurse leader insight

      In this case, the nurse manager must address Gloria’s negative behavior at work, despite awareness and concerns about her personal issues. Doing so can be tricky, but it’s important to express concern about the latter while giving constructive feedback and possibly initiating disciplinary processes regarding the former. One way to do this would be for the nurse manager to set up a private meeting with Gloria to talk about some concerns she has. Offering to do this after work or giving the employee some choice, within reason, about when to meet would be a supportive gesture. In the meeting, the nurse manager might say something like this:

      Gloria, I’m concerned about some negative and inappropriate comments I’ve heard you make and some of your colleagues have shared with me recently. One was about Trinda and what a “terrible nurse” she is. Another was about the hiring freeze—something to the effect that “the hospital administration just sits in their offices on their fat behinds and counts dollars.” Do you know what I’m talking about? Can you understand why I am concerned?

      Then pause. Let the feedback sink in. Gloria may have any number of reactions. She may get angry or teary, deny, apologize, or stay silent. After a moment, continue:

      I expect you to stop these toxic comments, and I want you to consider this a verbal warning. Do you think you can put on a more positive attitude at work?

      Pause again, before continuing:

      I also want you to know that I am interested in your feedback or concerns you have about policies and procedures or even your colleague’s performance, and there is an appropriate time, place, and process for that. Are you willing to share your concerns in an appropriate way?

      Once again, pause. Then say something like the following:

      Lastly, I want you to know that I’ve heard through the grapevine that you are going through a rough patch at home. Is there some way I can help you? Have you considered using the employee assistance program or taking a few days off? You have a lot of valuable experience, and I’d like to find a way to keep you on the unit with a healthier