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call attention to one’s own abilities and shut out others in the process. It is a self-fulfilling process of isolation and the antithesis of collaboration, which is essential in today’s multidisciplinary approach to care. It may be that Maureen is overwhelmed by the level of illness of the patients in the MICU, and this is an unconscious mechanism that she is using to convince herself that she is in control and won’t make an error in caring for such ill patients. Although it may come across as an ego trip, her insistence on being right may be a symptom of fear, not superiority.
To test out the hypothesis, the unit manager should work with the senior nurses in a coordinated effort to informally reach out to Maureen. They should try to develop a closer relationship with her rather than being offended by her behavior (as annoying as it may be) to get to know her beyond the specifics of her direct work with patients. It will take time, commitment, and a genuine interest in adopting Maureen to the team for this approach to work. The key to turning this around is for the nurse manager to remind the senior nurses not to take Maureen’s comments personally, but to be willing to dig deeper into what is causing her to act in this manner. Trying to get to know Maureen as an individual on a level of colleagueship rather than “upsmanship” could help to lessen her anxiety and help her relax to the point where she can share in a more authentic manner. It is entirely possible that when she feels more comfortable and less on edge about how she has to “perform,” she will openly share her concerns and be willing to learn from the experienced crew, who can teach her a lot of what she needs to know.
It is also important for the unit manager to review the orientation program for new nurses to a specialty unit. There is a great deal to absorb, and the support, coaching, and reinforcement of how the team works and how she can move comfortably into the team is a critical area of such an orientation.
The support role of the manager of the unit is critical to Maureen’s success. Weekly meetings to explore how things are going, to formally review her behavior, and to coach her on alternatives could be very helpful to Maureen as well. She is clearly a babe in the woods on the way to Grandma’s house. The senior nurses can either be the big, bad wolf and eat her up over time or take her under their collective wing and smartly show her the way to a satisfying career on the MICU. It is a choice; if the outreach is successful, the entire team will benefit and grow in the process.
In healthcare, working harmoniously with others is a challenge at every level, from staff nurse at the bedside to nurse executive in the boardroom. At every turn, there are difficult and demanding people whom you must “win over” to a healthier approach to communicating and engaging in the work at hand. Team development, positive reinforcement, and celebrating success go a long way to developing a culture where people are more willing to play together in the sandbox. It is a challenge and why nursing is a “practice” profession. We learn and grow every day.
–Nancy M. Valentine
That big “S” on Maureen’s chest may stem from competition, insecurity, or even social exclusion by peers. Have coworkers constructively given her feedback on her behavior or silently witnessed it? They may have talked about Maureen’s behavior among other nurses or have started to avoid talking or working with her. As the nurse manager, you may have seen her display the behavior or seen her peers scatter at her approach, which can and does affect patient and nurse safety.
Begin by documenting what you observed or heard her say. Start a private conversation with Maureen in your office to initiate coaching. Gently determine what the main issue is for her behavior. Coaching may be effective in eliminating Maureen’s behavior, but it might not change coworkers’ attitudes toward her. All staff must be educated on negative behaviors in the work environment and what professional behaviors are expected. As with Ron, if the behavior does not abate, begin additional disciplinary action.
We all need to be mindful of our behavior and reactions toward each other. Educate staff on appropriate responses to the perpetrator based on the behavior immediately, constructively, and assertively. If the power balance is apparent, the nurse manager must address the issue. Educate on assertive communication to stop the behavior before the cycle of disrespect, conflict, and bullying escalates. Speak to and post expected professional behavior and empower nurses to use the chain of command to help change the nursing culture.
–Peggy Ann Berry
reflections
First, put yourself in Maureen’s shoes. From a 10,000-foot perspective: How do you think she became the person she is today? Is it possible her behavior stems from insecurity? What can you, as the nurse manager, do to try to support the super nurse so she doesn’t feel the need to crow about how much better than everyone else she is?
Next, think about the colleagues Maureen is chronically standing up. What can you do to support them? How must they feel? The nurse managers’ challenge in this situation is to support these nurses without deepening the divide between colleagues.
summary
Although many people might not think of nit-picking, fault-finding, and criticism as forms of bullying, they are, in fact, behaviors called relational aggression (RA), which uses words and behavior as weapons. RA can be linked with all kinds of adverse physical and psychological outcomes. RA has sometimes been called “female bullying” because while males tend to aggress physically (or through war), women have a long history of using more covert, relational ways to express conflict.
It is the nurse manager’s responsibility to create a climate of cooperation and respect on the unit. First, and perhaps most importantly, the nurse manager needs to role model the kind of behavior(s) employees are expected to adopt. Next, each person must recognize that he or she has the potential to act out the behaviors of being too aggressive, too passive, or standing by while another person is being bullied. Identifying specific situations that may provoke each type of behavior will help stimulate a discussion of helpful alternatives. As with most things, initiating a frank conversation on the unit about bullies, victims and silent observers is a good place to begin.
There are, however, nurses who are always on the attack, stuck in the “RA Rut.” No matter what the situation, this nurse is in aggressor mode, ready to humiliate, intimidate, or manipulate. The nurse manager should make use of careful documentation and confrontation when aggressive behaviors occur so there is a record of either improvement or continued mistreatment of peers.
Finally—just remember that we are all human. We all have good days and bad; we all have deep dark stories that cast light on why we are the way we are. We’re all dysfunctional in some way. It’s important to hold people accountable and take action to try to make things better. But, it’s also important to remember that there is usually a (relatively compelling) story behind toxic behaviors.
Fostering Cultural Change
Before taking the quiz, read the following:
The “super nurse syndrome” (Dellasega, 2009) occurs when one nurse believes he or she is automatically a better nurse and more skilled than everyone else. Are there super nurses in your hospital? On your unit? By any chance could you be a super nurse?
Answer the following questions to explore further.
Use a scale of 1–10 with 10 as “agree as much as possible” and 1 as “disagree as much as possible,” respond to the following:
• I believe that I am a very skilled nurse.
• My supervisors and other administrators consider me a good nurse.
• I am the best nurse in my organization.
• The feedback I get from my coworkers about my nursing abilities makes me feel as confident as possible.
• I am more skilled than most of my coworkers.
These questions are meant to prompt reflection on how you view your own competencies in comparison