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 gossip and ganging up.
Mia is the unit secretary on a busy surgical unit staffed with both LPNs and RNs. She takes a dislike to Gretchen, a newer RN who is working on her graduate degree in education and who Mia thinks is “uppity.”
“My class assignment this week is really hard,” Gretchen says to an RN coworker, within earshot of Mia. “You really have to be in the swing of school to stay on top of things like this.”
Mia waits until she is alone with Vicky, one of the unit LPNs. “You know, that Gretchen is really full of herself,” Mia tells Vicky. “I heard her talking the other day about how well educated she is and how only people who are real scholars can go to college.”
Vicky, who constantly worries the hospital will phase out LPNs, is instantly disturbed by Mia’s revelation. She tells the other LPN coworkers that the RNs think they are better than LPNs, and an all-out word war begins. At the heart of it is Gretchen, who receives no LPN help with her patients and is targeted by both the LPNs and, eventually, the RNs, who begin to believe she was insulting their educational preparation as well.
In this scenario, there are several behaviors that are inappropriate: gossiping, maligning the personal reputation of another worker, and refusing to help another worker. The behavioral issues cannot be pinned on one person, however. Unit-level intervention is needed.
The first step would be to provide a mandatory in-service on workplace bullying and incivility. The focus of this would be to educate staff about what types of behaviors are inappropriate. If there are any pertinent organization-wide policies that address this behavior, they need to be discussed in the in-service and posted in the unit.
The second step would be to craft a unit-specific code of conduct that addresses acceptable and unacceptable behaviors. All staff should have an opportunity to contribute to the drafting of this code of conduct, but managers should make sure that the specific disruptive behaviors they are currently experiencing are included. After the code of conduct has been drafted, everyone should sign it, and it should be posted in a prominent area. Individual copies should also be distributed. In addition, new staff members should be asked to sign the code when they come on, and all staff members should renew their commitment to the code on a yearly basis.
The code of conduct can be used by both managers and staff to call out incidences of undesirable behaviors as they happen. It can also be used by managers if they need to engage in informal or formal discussions with staff regarding behavioral issues. The manager also needs to follow up with Gretchen to make sure the problem is resolved and that she is getting the assistance she needs from the other staff.
This is a tough situation. The nurse manager has to be sensitive to the gossip that’s flying around and figure out how all this started. She needs to be frank and put her cards on the table to put a stop to the bad talk quickly. Everyone has to tell the truth so the nurse manager can trace the source of the rumors. Negative gossip can be infectious and permeate everything. If coworkers behave this way, it puts patients at risk, because there are different groups and one won’t help another out of spite.
First, hold a general meeting to figure out who is at the source of the word war. Then follow-up with that person one- on-one to tell him or her such behavior won’t be tolerated. It’s too disruptive. This situation was disrespectful to both RNs and LPNs. The unit secretary deliberately pitted one person against the other.
This is not easy, but it is a situation in which the RNs and LPNs must come together and the nurse manager must say: “Apparently there’s a general feeling that RNs are better because they are more educated. All of us bring certain things to the table, and everyone learns from everyone else. If you haven’t learned something today, you haven’t been paying attention.”
That discussion doesn’t mean one person is better or worse. Nurses have to stay focused on the fact that the patient is the center of what they are doing, so they can work together for his or her benefit. This needs to be an up-front conversation, and people need to be held accountable.
Do nurses on your unit develop cliques and engage in campaigns? Are nurses in your unit divided—RNs versus LPNs? What behaviors occur as a consequence of this division?
Do nurses with lower degrees feel threatened by nurses who have pursued or are pursuing additional education?
Are there certain nurses on your unit who refuse to help their colleagues out because of interpersonal conflict, as with Gretchen? If so, what can you do about it?
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.