‘Toxic Nursing’: Coping with inappropriate feedback

Digital Vision | iStockphoto | ThinkStock
Digital Vision | 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 inappropriate feedback.

Day after day, Priscilla watches Melissa, the evening shift fulltimer, bully her coworkers. She is bossy and insulting to other nurses, but especially to Amanda, the day-shift nurse who usually reports off to her.

“Make sure you get your facts straight,” she tells Amanda in front of a crowd of their coworkers. “Yesterday I checked on the IV you said was fine and it wasn’t. The site was red and clearly infected, so now that patient is very uncomfortable.”

“Are you saying I did something to deliberately hurt a patient?” Amanda asks.

“Yes, pretty much,” Melissa snaps back. “You’re in charge of an accurate report, so if you tell me something that clearly couldn’t have been true, you’re responsible.”

Amanda pauses for a moment to collect herself, clearly upset, while Melissa grabs the medication cart and stalks off down the hallway.

Expert Commentary

The main issue in this scenario is that Melissa is giving inappropriate feedback to Amanda. If there are issues that affect patient care, she needs to discuss them with Amanda privately or ask management to address the issues. It is never appropriate to give feedback regarding patient care in a public manner.

There are several actions that Priscilla can take in this scenario. She can first check with Amanda to see how she feels about the situation and whether she has discussed it with Melissa or her manager. If the two feel comfortable, their next step might then be to discuss the issue with Melissa. If they take this step and the behavior doesn’t change, they need to talk with their manager. Similarly, they should talk to their manager right away if they feel talking with Melissa will escalate the situation or lead to retaliation. Priscilla can offer to go with Amanda when she talks with the manager to provide moral support and corroboration of Amanda’s story.

Both Amanda and Priscilla should be willing to document any complaints they have. The manager needs to let Melissa know her current behavior is inappropriate and take the initiative to set expectations for future behavior. The manager needs to follow up with Amanda, Priscilla, and Melissa on a regular basis to make sure the behavioral changes are being made.
–Susan Johnson

Amanda needs to stand up to Melissa and say, “You will not talk to me like this, period.” If Amanda can’t do it alone, she needs to have the nurse manager there for support. It’s hard to believe Melissa treats only Amanda this way. It’s more likely that for her whole career, she has treated coworkers in this manner.

Melissa comes off as not a very nice person. It’s hard as a new nurse to stand up to someone who’s been there a long time, but frame it as having respect for yourself. If someone is upset with a nurse, the nurse needs to tell the person, “You know what? If I’m not doing something right, I want to learn from it.”

Melissa is not being helpful in her feedback to Amanda. The bullying behavior isn’t likely to be corrected in one conversation, but it needs to be addressed with the aggressive nurse. If a new nurse can’t do it alone, the nurse manager has a responsibility to make sure Melissa and all nurses treat everyone—coworkers and patients—with respect. If a nurse can’t be a team player, then he or she is going to have to go play somewhere else.
–Kathy Curci


What do you think is going on in Melissa’s life that creates the need to “dress down” other nurses in public? Is it possible that the culture of your unit makes Melissa feel like it’s OK to engage in this type of behavior? What are some steps you—the nurse manager—can take to try to adjust the culture of your unit?

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.

This is part three of nine; don’t miss parts onetwofourfivesixseveneight and nine!

Like us on Facebook and join the Scrubs Family