Department: Manager matters
When considering the many high-level responsibilities of the nurse manager, the attribute of courage becomes a necessity. It takes bravery and nerve to do all of the following:
- grow in your role as a nurse by becoming a new manager
- transition from a peer-level nurse to a nurse leader
- confront the daily challenges of delivering safe and efficient healthcare
- maintain ethical practice standards in the face of naysayers
- face ongoing negativity (from some)
- mentor and coach staff members who others may not believe in.
We see courage expressed in so many ways, at all levels of care in our organizations. The late Dr. Richard Hader (former Nursing Management Editor-in-Chief), who displayed more courage than most of us can imagine in our lifetime, said, “The sheer responsibility of leadership is scary, but if you choose courage over complacency, you and your staff benefit.” It's this element of complacency that has compounded the current culture of bullying and nurse-to-nurse hostility that many workplaces, and, unfortunately, managers still tolerate.
Breaking away from the crowd
As new managers settle into their roles, side conversations and events occur all around them related to staff bullying and hostile behaviors. At times, it becomes easy to ignore these unacceptable behaviors, especially in the face of the tremendous workload confronting nurse managers. However, the longer these issues are disregarded by the manager, the greater the impact on recruitment and retention of staff, patient safety, staff satisfaction, unhealthy work environment, and ability to function as a trusting and cohesive team. Table 1 provides examples of acts of bullying and hostility specific to nursing. It's important to note that some of these behaviors are covert, whereas others are overt.
It takes an extra dose of courage and commitment for the new manager to eradicate these negative behaviors because the process of shifting this culture involves:
- changing the status quo of acceptance (possibly from the previous manager)
- changing your actions/lack of action in response to these events
- educating staff members about the underpinnings and dynamics of workplace bullying/hostility
- fully committing to ending these behaviors, which encompasses a lot of time and energy.
Finding your courage
How paramount is this problem really? If you're thinking your staff members are different, or your organization is different, consider the data in Table 2. With limited current studies related to this topic, a lack of standardization of definitions, and no consistent process to report bullying or hostile events, healthcare hasn't done a great job of recording unacceptable behavior events or collecting reliable data.
With the right tools and resources, along with a plan of action, even the most novice manager can play a pivotal role in shifting to a healthier workplace for all. Tools and resources should include some of the following:
- the organization's policy related to unacceptable behaviors and/or code of conduct
- The Joint Commission Leadership Standard, LD 03.01.01, which states that it's the leader's job to maintain a culture of safety and put an end to negative behaviors
- the American Nurses Association brochure “Preventing Workplace Violence”
- the American Nurses Association e-book Bullying in the Workplace: Reversing a Culture
- Toxic Coworkers: How to Deal with Dysfunctional People on the Job by Alan A. Cavaiola and Neil J. Lavender
- Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other by Kathleen Bartholomew.1
Your success in impacting change will be reflected in this investment of time to read/collect these tools and resources. It's imperative that the manager has an understanding of how these unacceptable behaviors became engrained in the nursing culture. Knowledge related to proven strategies to change unacceptable behavior patterns is important because it provides a solid base for the courage needed to move forward with the action steps recommended in this article.
In addition, you're building a library of powerful resources to empower and engage staff members in shifting the culture of unacceptable behaviors. (See Table 3.)
“Hear me roar!”
These unhealthy workplace activities take a toll on the best of leaders, even those with years of experience. In addition to having a proven impact on patient safety, we know that when leaders have the courage and confidence to promptly address those responsible for these unacceptable actions, everyone benefits. Behind the scenes, be sure to evaluate your own professional actions, mannerisms, and so on, to make sure that you aren't role modeling bad behavior. Sliding back to old, negative habits can easily occur at all levels of an organization, including management.
In addition, always remember the strong emotional hold a bully can have on his or her victim, which can result in staff unwillingness to report or honestly complete surveys. The process of manager rounding provides the perfect platform to personally observe staff member interactions, so take advantage of this time. Your ability to advocate for staff members who are victims of bullying and hostile acts will impact staff, patients, and the profession.
American Nurses Association. Bullying in the Workplace: Reversing a Culture
. Silver Springs, MD: American Nurses Association; 2012.
Bartholomew K. Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other
. Marblehead, MA: HcPro; 2009.
Cavailoa AA, Lavender NJ. Toxic Coworkers: How to Deal with Dysfunctional People on the Job
. Oakland, CA: New Harbinger Publications, Inc.; 2000.
Hader R. Lessons from a Visionary Leader
. Philadelphia, PA: Wolters Kluwer; 2013.
© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. All world rights reserved.
The Joint Commission. The Joint Commission 2014 Hospital Accreditation Standards
. Oakbrook Terrace, IL: Joint Commission Resources; 2014.