Toxic Nursing, 2nd Ed. Cheryl Dellasega

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СКАЧАТЬ sighs and walks away. Later, at lunch, she tells her coworkers that she thinks Beth is a “problem” because she isn’t taking the job seriously.

      nurse leader insight

      I would hope that Lauren, the preceptor, could develop a better understanding of how people handle stress and be able to identify that Beth wasn’t really laughing, but was simply attempting to cope. Maybe the conversation needed to occur right upfront. Lauren might say, “I notice when you get nervous you laugh. Is that really what’s happening?” This will validate what she’s seeing. From that point forward, others would know that Beth’s laughter is not making fun of them, nor does it indicate Lauren is not taking them seriously.

      I would say that if this progresses and Lauren says things like, “Never let a patient choose for themselves,” Beth needs to ask, “Why was that a wrong decision?” Otherwise, the comment won’t have credibility. Then Lauren needs to sit down with Beth and give her feedback on her rationale. She could tell Beth that the nurse knows the pharmacology and can make a better choice than the patient. The physician doesn’t give choices to the patient; the physician gives them to the nurse so the nurse can make the best decision. That’s part of developing your clinical practice: making important decisions and judgments.

      Given the way this situation unfolded, Beth really learned nothing from the feedback. It’s the preceptor’s job to help the new nurse grow and develop.

      –Kathy Curci

      Emotional intelligence (EI) is not an innate attribute but a learned skill that must be nurtured and developed. EI is the ability to identify your own emotions, use your emotions constructively, understand emotions in uncomfortable or hostile situations, and manage one’s own emotions and those of others to achieve positive outcomes. Nurses’ emotions play a vital role in nurse-patient perceptions as well as mentor-preceptor interactions. Because Lauren is in a preceptor role, it is vital that she be in sync with Beth’s comfort level. Beth’s nervous laughter could have been handled more effectively had Lauren had EI training. With proper leadership training and EI competence, Lauren could have identified the situations or antecedents that triggered Beth’s laughter and provided more time in teaching, explaining, or demonstrating the skill.

      Leaders who lack leadership competence and emotional competence cannot effectively manage others. Although nurses possess emotional intelligence in varying degrees, if it is fragmented, it can create an unhealthy workplace environment. In a healthy workplace environment, leaders are attuned to their emotions and the emotions of others in various situations. Incorporating EI training as part of the preceptor or leadership training programs is paramount for successful nurse leadership.

      –Cheri Clancy

      reflections

      Behavioral tics, mannerisms, or other responses to stressful situations can be traumatic for those who have them and are misunderstood by colleagues who only see the outward behavior. What is your responsibility as a nurse manager when such behaviors occur?

      At what point are personal behaviors unacceptable? For example, if you have an employee whose loud voice, overbearing presence, or other habits create discord among your staff, how do you intervene, knowing that productivity is being disrupted?

2.5 Trial By Fire

      scenario

      Dr. Smith is a surgeon known for his short temper and curt comments to nurses. While the nurses on the post-surgical unit are used to this mistreatment, they fail to tell Anne, a new nurse, that Dr. Smith expects a prompt report on his patients when he walks into the room, including the latest set of vital signs.

      One day, Dr. Smith enters a room where Anne is working. When Anne continues what she is doing and doesn’t acknowledge Dr. Smith, he pushes the bedside table away roughly so he can examine the patient. “You need to go back to school and learn how to take care of patients who just had major operations!” he tells her. Then he addresses the patient: “These new nurses. It takes years before they’re any good.”

      Wendy, one of Anne’s more experienced coworkers, happens to walk by the room just then and laughs. “Dr. Smith is at it again,” she tells the unit secretary.

      Anne comes out of the room, clearly upset. She sees Wendy and asks what she did wrong. “Oh, you’ll learn. Dr. Smith has his own way of doing things. We all went through one of his meltdowns,” Wendy replies with a shrug of her shoulders.

      nurse leader insight

      These kinds of incidents can sometimes be perceived as “paying your dues.” It’s been said that this is what you have to go through to get into this exclusive sorority. The same kind of hazing thing can happen if a nurse has special credentials or higher education.

      Right away, the chief of staff needs to have a talk with Dr. Smith. The fact that nurses have patterned their behavior to allow his behavior to continue is really a disservice to everyone. He obviously has no respect for nurses, and his judgment of being “a good nurse” may be skewed. The fact that they snap to attention when he comes on the floor is not how I would judge a good nurse.

      As the nurse manager, I would pull the nurses aside who let this poor person walk into a loaded situation and tell them I’m disappointed by their lack of support. Anne is part of this team, and the expectation is that they will work together and share information. Obviously, the nurse manager has supported this kind of behavior for it to go on and has allowed the nurses on her unit to act this way. The nurse manager needs to step up and tell Anne what’s really going on.

      Ultimately, the actions of nurses on a particular unit are a reflection of the nurse manager. She is responsible for the behavior of her staff.

      –Kathy Curci

      Creating a healthy workplace environment where nurses can speak up will increase staff morale and patient safety. Addressing inappropriate behavior when it occurs, if applicable, is the key to obtaining a healthy work environment. If Anne is thinking she is “just a staff nurse” and those acting inappropriately hold more power because of their position, then she should think again. This is a case where one person, Anne, the informal leader, can definitely make a difference. Staff nurses need to be patient advocates as well as team advocates. To accomplish this, Anne should address her concerns with Dr. Smith and her manager as soon as possible and in a private setting (not in front of patients). Anne can begin by addressing that she is new to the profession as well as the culture of the organization and the surgeon’s preferences.

      The National Labor Relations Act and the Occupational Safety and Health Administration give individuals the right to report incidents without losing their jobs or suffering other reprisals. Ensuring and maintaining a healthy work environment is the job of all members of an organization. According to a recent Gallup poll, nursing has been the most respected profession for the past seven years. This could not have been accomplished without earning the respect and trust of our patients and others.

      Nurses need to fully support the American Nurses Association Code of Ethics. The Code of Ethics state that professional nurses have an ethical mandate to become skilled communicators. To embrace this mandate, nurses need to look within themselves first and make initial efforts to foster healthy workplace environments. Having effective nurse-physician collaborations among nurses, physicians, and healthcare leaders is critical to sustaining strong interdisciplinary and intradisciplinary relationships. The Joint Commission recommends adopting a zero-tolerance policy for intimidating and/or disruptive behaviors and to incorporate СКАЧАТЬ