‘Toxic Nursing’: How to cope with cliques, campaigns and high-school drama

iStockphoto | ThinkStock
iStockphoto | ThinkStock

In the Spring 2014 issue of Scrubs (get your copy here!), we gave you an in-depth look at incivility in the hospital with “Toxic Nursing.”

Now we’re sharing more on this subject with an in-depth look at nurse cliques and high-school drama.

Nurses describe a variety of behaviors that teen girls often call “drama.” There are “campaigns,” where a group of nurses targets a coworker, ganging up on him or her so he or she becomes a persona non grata. There are drama queens who deliberately create trouble and discord. There are those who display “two-faced” behavior—i.e., the nurse acts sweet when managers are around and sinister when they are gone. Even patient assignments can be used as a weapon to punish individual nurses.

Terri Townsend (“Break the bullying cycle,” 2012) describes the “bullying culture” of the nursing profession and its adverse impact on health status, patient care, and finances. She states that most nurses have witnessed this behavior, and that nurse managers are the ones who can break the cycle and create a new culture. Her advice: “Nurse managers should encourage staff to report bullying incidents, ensure that those who experience and report abusive incidents will be safe from retribution, and take action to discipline bullies, counsel victims, and implement corrective measures to prevent recurrence. Bullying can be addressed by unit-based councils, with council members serving as role models for other staff members” (Creating a healthy work environment, para. 3). Also, a zero-tolerance policy is helpful.

A nurse manager who commented on Townsend’s article wrote the following:

Love that the managers are being bashed here and for good reason. The manager sets the tone in any environment. I am proud to say that through my zero-tolerance policy I got rid of the bullies in my units when I started 4 years ago. Step up or step out—not hard. For those of you who are staff nurses, my advice, document everything and continue to report it. [Bullying] is being looked at on the federal level as a workplace issue like discrimination so there is hope that things will change. (Townsend, 2012, Comments, para.11).

Sandra Barton and her colleagues (“Dissolving clique behavior,” 2011) describe the exclusion that occurs within health care, stating that “Managers must recognize whether their staff is working as a team or as a clique.” They believe nursing cliques have a negative impact on retention and lead to adverse physical symptoms in employees. Because retention rates, absenteeism, and cost figures are used to evaluate the performance of nurse managers, the impact of cliques may have a personal repercussion. They advise not blaming, promoting teamwork, good communication skills, and celebrating differences.

Hutchinson, Jackson, Wilkes, and Vickers (“A new model of bullying in the nursing workplace,” 2008) presented an elegant analysis of bullying that expresses what nurses post about and often tell us. They are the first to describe organizational aspects (informal organizational alliances, formal and informal reward systems, misuse of authority) as antecedents of bullying, which manifest initially as personal attacks, then an attack on work product, and finally an attack on reputation and competence.

A bullied nurse often develops a perceived failure or flaw as both an employee and a person in response to abuse. Hutchinson and colleagues say that the process just described often leads to stigmatization of the nurse as incompetent. They, too, describe a normalization of bullying that occurs because of a lack of accountability and a tolerance of bullying, because these individuals are often high performers. Indeed, they may even be the ones who get promoted. They assert that while policies may be in place, informal alliances prevent them from being fully implemented, often because the nurse manager is a bully.

Susan Johnson, one of our commentators, believes that nurse managers need to check in with all parties in situations of conflict, including witnesses, before taking action, because bullies can retaliate against people who report their behavior. This creates a situation in which people are reluctant to bring forth further complaints due to fear. Furthermore, when bullying behaviors include criticizing the clinical competency of others, targets are often reluctant to report this to managers, because they are afraid they will be disciplined or fired for poor performance. If there are clinical performance issues, managers are in a position to deal with these; however, they also need to make sure that they deal with the behavioral issues as well (such as publicly criticizing the performance of another nurse).

Mary Johansen (“Keeping the peace,” 2012) suggests that nurse managers use the following strategies to keep the peace:

  • — Clarifying what constitutes conflict
  • — Being aware of your conflict-management style
  • — Avoiding a perception of punishment
  • — Initiating dialogue
  • — Being a coach
  • — Discussing conflicts proactively
  • — Raising awareness and ability through education and training

Johansen provides a case scenario and evaluation that can be useful for raising awareness and ability.

Vignettes, Commentaries, and Reflective Thinking

The remainder of this chapter presents vignettes about cliques, campaigns, and high-school drama, commentaries about the experiences represented in the vignettes, and opportunities to explore or reflect on the material.

(Scrubs ed. note: these vignettes will be presented in subsequent articles…read parts twothree, fourfivesixseven, eight and nine!)

Adapted with permission from Toxic Nursing by Cheryl Dellasega, PhD, RN, CRNP, and Rebecca L. Volpe, PhD. Published 2013 by The Honor Society of Nursing: Sigma Theta Tau International.

Like us on Facebook and join the Scrubs Family