Toxic Nursing, 2nd Ed. Cheryl DellasegaЧитать онлайн книгу.
managers can create a healthy working environment and offer better-quality care to their patients. The nurse manager’s challenge is to see the advantage of having a workforce of educationally diverse nurses on staff and then promote a safe, diverse working environment.
One way to begin this task is to start with the preceptors. Preceptors should be caring, informed, and proficient nurses—and overall great teachers. They must have respect for the new generations coming in as well as the knowledge and experience these “newbies” can bring to the unit. They must also know how to prepare new nurses for both the positive and negative realities of the profession and nurture their continued education for a better future. To accomplish these goals, they need to feel prepared and appreciated.
Another idea is to work closely with your new nurses during their first several months of employment. Provide them the tools they need to be successful in their career. Be their support system—make them feel comfortable discussing issues such as bullying with you. Show that you will provide them with some sort of resolution if they do share challenges such as relational aggression with you.
If we can address the source of the bullying problem, new nurse retention should greatly increase. To change the culture of aggression that may have taken root on your unit, lead the way to change. Be an advocate for your staff and provide an atmosphere of learning and gratitude. Help dismiss prejudices that exist with different educational backgrounds, and show your staff that each individual’s strengths are what makes your unit operate on a daily basis.
Fostering Cultural Change
If coworkers see each other as people as well as nurses, they are more likely to work collaboratively. Have nurses write on a small index card one “fun fact” about their hobbies, interests, or talents, along with their name. Create a Bingo type sheet with the reported fun facts in separate squares and ask new employees to find out whom they belong to. When they meet the person who matches the fun fact, they can write down their name and X out the square containing it. When they have a line of names, they can come to you and receive a small prize or check off part of their orientation list.
Alternatively, have one of your mature staff members interview newbies for some basic fun information. The interviewer can then introduce the newbie at the next group meeting. Sample interview questions include: “What do you like to do for fun?” “What made you go into nursing as a career?” and “How do you like to spend your birthday?”
3 | the know-it-all/criticism queen
We may not think of nit-picking, fault-finding, and criticism as forms of bullying, but when it happens chronically, it certainly is. According to the Workplace Bullying Institute (WBI), workplace bullying is “repeated, health-harming, mistreatment of one or more persons (the targets) by one or more perpetrators” (WBI, n.d., para. 1). In addition, the Workplace Bullying Institute states that bullying is abusive conduct from one or more perpetrators that can take one or more of the following forms (WBI, n.d.):
• Verbal abuse
• Offensive conduct/behaviors (including nonverbal), which are threatening, humiliating or intimidating
• Work interference—sabotage—which prevents work from getting done
Nurse researchers Anusiewicz, Shirey, and Patrician (2019) used a Rogerian concept analysis to define bullying in relation to new graduate nurses. They describe these three attributes (p. 250): “negative behaviors directed toward an individual who perceives themselves to be a target, a time frame of experiencing these negative behaviors (e.g., daily or weekly) for a prolonged period (e.g., several weeks), and the inclusion of a power gradient or hierarchy between the bully and target.”
This group believes that poor leadership and management are a leading cause of workplace bullying, which results in adverse outcomes on the micro and macro level of healthcare organizations.
How “bullying” is defined often leads to inconsistencies in reporting. For example, what one considers “verbal abuse” can vary from nurse to nurse. Loudly shushing another person can be perceived to be as abusive as shouting at someone they are incompetent.
In a meta-analysis of 45 published papers, Lever and colleagues (2019) found a wide variation in the percent of nurses who reported being “bullied” at work (3.9% to 86.5%). There was consistency in the consequences, however, with both physical and mental health problems resulting from peer aggression in the workplace.
There’s an archetype of women in the workplace: the Queen Bee. There is a “boss lady” (think Miranda Priestly in The Devil Wears Prada) who claws her way to the top and does everything she can to undermine, put down, and generally squash other women who are trying to achieve the same level of success. Interestingly, Zalis (2019) suggests the opposite is true, reporting on research that shows women are now forming their own “clubs” within the workplace. She believes that women who support other women are more successful, a difference that is not true for men.
And yet, somehow this claim doesn’t seem to ring true for nurses. We still seem to have “super nurses,” and these super nurses still seem to have hurtful ego trips at the expense of more junior colleagues. (Of course, not all super nurses are women; plenty of men fit this mold, too.) Perhaps this is one lesson that we can learn from our non-nursing colleagues: We should cherish, mentor, and cultivate our junior colleagues, not rip them to shreds. After all, unless we want to work until the day we die, we’ll need someone to fill our roles when we retire!
Sometimes, the harsh criticism we may give and receive can contain a grain of truth, leading the target to believe that the entire criticism has validity—or worse. Think of nurses who are told they need to “up their game” and advance their professional development. Instead of seeing the part of this feedback that may be well-intended and even complimentary, those who lack confidence and self-esteem may quit, believing they don’t have what it takes to be a good nurse.
More often, instead of being based on a kernel of truth, critical feedback is based on a distortion, fabrication, or misrepresentation. When this happens, victims have a choice: they can speak up or stay silent. If they speak up to defend themselves, they risk further mistreatment by the aggressor. If they stay silent, this seems to implicitly sanction the bullying behavior, and it may slowly build resentment, frustration, and anger. It may also cause some social anxiety in victims, who begin to dread social situations and experience anxiety because they fear being verbally trashed. This, in turn, can negatively affect job performance. After all, how can people be doing their best when they’re constantly looking over their shoulder, trying to anticipate the next obscure, unnecessary criticism?
Commentator Peggy Ann Berry notes,
Bullying behavior, incivility, and disrespectful behaviors are endemic in the stressed environment of nursing. Leadership education on disruptive acts can help nursing staff understand the multiple root causes of bullying behavior and how to decrease the bullying behaviors through their own behavior or response.
Sometimes, however, leadership education alone is not enough. Sometimes, the best approach is to point out the emotional and economic consequences of an aggressor’s overly critical interactions. If bullies understand that there is a zero-tolerance policy—and, the key, that the policy will actually be enforced—their behavior is much more likely to change.
There are no guarantees, though. Often, bullies have been bullies for much of their life, and changing life-long habits can be difficult if not impossible. However, for the sake of new nurses—the future leaders—we must do our very best to ensure that they are not chronically cowed by the know-it-all super nurse.
clearing toxicity: scenarios, insights, and reflections
3.1 Extreme Criticism
scenario
Ron, the night nurse on