Toxic Nursing, 2nd Ed. Cheryl Dellasega

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СКАЧАТЬ the last to know? Yes, unless a nurse manager is on the floor on a continuous basis interacting with staff, conflicts and complaints can go unreported and unnoticed. This is because the culture has taught nurses to be silent to those in power. However, nurse managers need to promote expectations on open communication, encourage staff to bring solutions to address problems, and provide transparency with solving these complaints. The staff needs to know why issues can’t be resolved yet or will never be resolved.

      –Peggy Ann Berry

      reflections

      It’s so easy—in life and at work—to be critical of others. We sometimes think to ourselves: “If only I had been there, this could have been done right!” Yet there is so much we don’t know about the reality of the situation, because we weren’t there.

      When nurses are critical of others, what can you do about it? What are some reasonable steps to take to try to help the criticism-queen see that they might not have the complete story? If things progress further—into a feud—what strategies would you employ to try to mend fences with other units in your organization?

3.3 Anything You Can Do, I Can Do Better

      scenario

      Although Maureen has worked in the MICU for only two years, the other nurses refer to her as “super nurse.” The nickname isn’t meant as a compliment. “One time, I had just worked a double and had barely kept on top of my patients, who were both very unstable,” recalls Sandy, a long time MICU nurse. “When I was telling Maureen about it, she assured me that nothing could be worse than the time she worked a double and had two even sicker patients.”

      “Maureen actually did an online search and printed out information on this weird EKG pattern my patient had one day,” says Terry, another MICU nurse. “She kept insisting she was right, even though it was a transient arrhythmia with no associated symptoms. During shift report, she made sure to mention her superior knowledge and made me look stupid.”

      Maureen’s one-upmanship goes beyond her interactions with nurses. When physicians come into the MICU, she rushes to help them and makes sure they know how efficient and in control she is. None of her colleagues are quite as able or smart as she is—or so Maureen thinks.

      nurse leader insight

      The idea of a super nurse is a fantasy, as no one can “know it all” in today’s fast-paced healthcare scene. Moving into an established work team can be very difficult even for experienced nurses, and it is just that much harder for a younger, inexperienced nurse to find a place on the team. One of the symptoms of an insecure and potentially anxious person is to call attention to one’s own abilities and shut out others in the process. It is a self-fulfilling process of isolation and the antithesis of collaboration, which is essential in today’s multidisciplinary approach to care. It may be that Maureen is overwhelmed by the level of illness of the patients in the MICU, and this is an unconscious mechanism that she is using to convince herself that she is in control and won’t make an error in caring for such ill patients. Although it may come across as an ego trip, her insistence on being right may be a symptom of fear, not superiority.

      To test out the hypothesis, the unit manager should work with the senior nurses in a coordinated effort to informally reach out to Maureen. They should try to develop a closer relationship with her rather than being offended by her behavior (as annoying as it may be) to get to know her beyond the specifics of her direct work with patients. It will take time, commitment, and a genuine interest in adopting Maureen to the team for this approach to work. The key to turning this around is for the nurse manager to remind the senior nurses not to take Maureen’s comments personally, but to be willing to dig deeper into what is causing her to act in this manner. Trying to get to know Maureen as an individual on a level of colleagueship rather than “upsmanship” could help to lessen her anxiety and help her relax to the point where she can share in a more authentic manner. It is entirely possible that when she feels more comfortable and less on edge about how she has to “perform,” she will openly share her concerns and be willing to learn from the experienced crew, who can teach her a lot of what she needs to know.

      It is also important for the unit manager to review the orientation program for new nurses to a specialty unit. There is a great deal to absorb, and the support, coaching, and reinforcement of how the team works and how she can move comfortably into the team is a critical area of such an orientation.

      The support role of the manager of the unit is critical to Maureen’s success. Weekly meetings to explore how things are going, to formally review her behavior, and to coach her on alternatives could be very helpful to Maureen as well. She is clearly a babe in the woods on the way to Grandma’s house. The senior nurses can either be the big, bad wolf and eat her up over time or take her under their collective wing and smartly show her the way to a satisfying career on the MICU. It is a choice; if the outreach is successful, the entire team will benefit and grow in the process.

      In healthcare, working harmoniously with others is a challenge at every level, from staff nurse at the bedside to nurse executive in the boardroom. At every turn, there are difficult and demanding people whom you must “win over” to a healthier approach to communicating and engaging in the work at hand. Team development, positive reinforcement, and celebrating success go a long way to developing a culture where people are more willing to play together in the sandbox. It is a challenge and why nursing is a “practice” profession. We learn and grow every day.

      –Nancy M. Valentine

      That big “S” on Maureen’s chest may stem from competition, insecurity, or even social exclusion by peers. Have coworkers constructively given her feedback on her behavior or silently witnessed it? They may have talked about Maureen’s behavior among other nurses or have started to avoid talking or working with her. As the nurse manager, you may have seen her display the behavior or seen her peers scatter at her approach, which can and does affect patient and nurse safety.

      Begin by documenting what you observed or heard her say. Start a private conversation with Maureen in your office to initiate coaching. Gently determine what the main issue is for her behavior. Coaching may be effective in eliminating Maureen’s behavior, but it might not change coworkers’ attitudes toward her. All staff must be educated on negative behaviors in the work environment and what professional behaviors are expected. As with Ron, if the behavior does not abate, begin additional disciplinary action.

      We all need to be mindful of our behavior and reactions toward each other. Educate staff on appropriate responses to the perpetrator based on the behavior immediately, constructively, and assertively. If the power balance is apparent, the nurse manager must address the issue. Educate on assertive communication to stop the behavior before the cycle of disrespect, conflict, and bullying escalates. Speak to and post expected professional behavior and empower nurses to use the chain of command to help change the nursing culture.

      –Peggy Ann Berry

      reflections

      First, put yourself in Maureen’s shoes. From a 10,000-foot perspective: How do you think she became the person she is today? Is it possible her behavior stems from insecurity? What can you, as the nurse manager, do to try to support the super nurse so she doesn’t feel the need to crow about how much better than everyone else she is?

      Next, think about the colleagues Maureen is chronically standing up. What can you do to support them? How must they feel? The nurse managers’ challenge in this situation is to support these nurses without deepening the divide between colleagues.

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