‘Toxic Nursing’: How to cope when a coworker helps everyone on the team…but you


Upset nurse

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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 in-depth look at interpersonal conflict on the job.

The psych unit where Diane works often admits violent patients. Since there is a “no restraint” policy, nurses and technicians depend on each other to manage aggressive patients.

One day at work, Diane accidentally offends Julia, a co-worker, by interrupting her during a lunchtime conversation. Julia sees Diane’s offense as one more in a series of rude behaviors and blows up at Diane. Diane realizes her mistake and quickly apologizes, to no avail.

Thereafter, Julia makes a point of helping every other nurse on the psych unit but ignoring Diane’s requests. When a difficult patient is admitted and assigned to Diane, Julia tells Leon, a psych technician, to “help out,” and walks away.

Expert Commentary

Diane needs to bring her concerns to the manager. She can ask Leon and other witnesses to back her up. In this case, the manager might need to facilitate conversation between Diane and Julia (possibly with a neutral third party) to resolve the underlying issue that led to the problem. In addition, action plans can be developed for both Diane and Julia. The manager needs to make it clear to Julia that refusing to assist another coworker is not an option and might be grounds for disciplinary action. The manager or another party can also work with Diane on modifying her behavior so that she is no longer perceived as being rude.
–Susan Johnson

By not helping Diane in this situation, there is a real threat and danger of violence to her. If Julia doesn’t help, Diane could be physically harmed. Something serious might happen; then, how would Julia feel?

When Julia was offended, Diane apologized right away, but it wasn’t accepted, so she might wonder what she needs to do to be forgiven. Diane could ask Julia what would make her feel better, since an apology doesn’t seem to have done the trick.

Regardless, it’s wrong for Julia to leave her out on a limb and put her in harm’s way because she’s angry. A nurse might not always realize the consequences of his or her behavior, so it’s advisable to think upfront about what you’re risking—in this case, harm to a nurse from a patient.
–Kathy Curci


Do you work in a unit where interpersonal conflict causes patient and staff safety issues? If yes, how have employees come to believe that this type of conflict is acceptable?

In health care, what factors lead a nurse to believe it is OK to put colleagues and/or patients at risk? As the nurse manager, what can you do to try to create a healthier working environment?

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 eight of nine; don’t miss parts one, two, three, four, five, six, seven and nine!

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