Toxic Nursing, 2nd Ed. Cheryl Dellasega
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Название: Toxic Nursing, 2nd Ed
Автор: Cheryl Dellasega
Издательство: Ingram
Жанр: Медицина
isbn: 9781948057608
isbn:
Although many people might not think of nit-picking, fault-finding, and criticism as forms of bullying, they are, in fact, behaviors called relational aggression (RA), which uses words and behavior as weapons. RA can be linked with all kinds of adverse physical and psychological outcomes. RA has sometimes been called “female bullying” because while males tend to aggress physically (or through war), women have a long history of using more covert, relational ways to express conflict.
It is the nurse manager’s responsibility to create a climate of cooperation and respect on the unit. First, and perhaps most importantly, the nurse manager needs to role model the kind of behavior(s) employees are expected to adopt. Next, each person must recognize that he or she has the potential to act out the behaviors of being too aggressive, too passive, or standing by while another person is being bullied. Identifying specific situations that may provoke each type of behavior will help stimulate a discussion of helpful alternatives. As with most things, initiating a frank conversation on the unit about bullies, victims and silent observers is a good place to begin.
There are, however, nurses who are always on the attack, stuck in the “RA Rut.” No matter what the situation, this nurse is in aggressor mode, ready to humiliate, intimidate, or manipulate. The nurse manager should make use of careful documentation and confrontation when aggressive behaviors occur so there is a record of either improvement or continued mistreatment of peers.
Finally—just remember that we are all human. We all have good days and bad; we all have deep dark stories that cast light on why we are the way we are. We’re all dysfunctional in some way. It’s important to hold people accountable and take action to try to make things better. But, it’s also important to remember that there is usually a (relatively compelling) story behind toxic behaviors.
Fostering Cultural Change
Before taking the quiz, read the following:
The “super nurse syndrome” (Dellasega, 2009) occurs when one nurse believes he or she is automatically a better nurse and more skilled than everyone else. Are there super nurses in your hospital? On your unit? By any chance could you be a super nurse?
Answer the following questions to explore further.
Use a scale of 1–10 with 10 as “agree as much as possible” and 1 as “disagree as much as possible,” respond to the following:
• I believe that I am a very skilled nurse.
• My supervisors and other administrators consider me a good nurse.
• I am the best nurse in my organization.
• The feedback I get from my coworkers about my nursing abilities makes me feel as confident as possible.
• I am more skilled than most of my coworkers.
These questions are meant to prompt reflection on how you view your own competencies in comparison to those of your colleagues. You could also use them in a meeting of either colleagues or staff and start a dialogue on the “super nurse syndrome.”
This is an unvalidated quiz meant to prompt self-assessment and reflection. Once you have rated each item, add your score. If you got a high score on items 1, 3, and 5, you may be projecting a super nurse persona and not recognize it—or you may truly be a confident and skilled nurse. Scoring high on items 2 and 4 could mean you feel a need for external validation of your skills.
Look at the items individually and determine whether a high score on one or more individual items aligns with feedback you have received.
4 | gossip and trash talk
In their 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the Institute of Medicine (IOM) committee on the Quality of Healthcare in America noted that improving our health system depends in very large part on trust. In particular, the IOM indicated that healthcare professionals must feel that their team members, leaders, and organizations are trustworthy (Institute of Medicine, 2001). LoCurto and Berg (2016) define trust as “an expectation that the other person will behave in a way that is beneficial, or at least not harmful, and allows for risks to be taken based on this expectation” (para. 1). Happily, emerging evidence indicates a moderate to high level of trust among healthcare providers, although Sangaleti et al. (2017) note that it is perceived as a process rather than an outcome.
One threat to the development and maintenance of trust in a clinical setting is gossip. Waddington (2016) cautions administrators not to dismiss gossip as idle talk but rather to consider it a harbinger of deeper discord. Buldik, Ozel, and Dincer (2016) concur after surveying 268 nurses from four different acute care hospitals. They call gossip a “social virus” that has the potential to negatively impact patient care.
So what makes us gossip? Traditionally, researchers have thought that rumors spread because of the “three Cs”: conflict, crisis, and catastrophe. But marketing professor Jonah Berger has another idea: What about mere physiological arousal? Berger designed a study in which he placed people into two groups. One group experienced heightened levels of physiological arousal (their autonomic nervous system was activated, which affected bodily functions such as heart rate and perspiration), and the second group did not.
He found that situations that increase arousal spark information sharing—even if the arousal is entirely unrelated to the content of the information being shared (Beilock, 2011; Berger, 2011). That means after you take a jog around the neighborhood, you probably shouldn’t stop to chat with your neighbor because you might accidentally share the news of a friend’s pending divorce. It also means that as a nurse, after you’ve just participated in a code, you’re more likely to mention that piece of office gossip you had been keeping to yourself. More recently, Brondino, Fusar-Poli, and Politi (2017) discovered a connection between biologic measures and gossip, with oxytocin but not cortisol levels increasing in 22 females randomly assigned to gossip vs. non-gossip conversations and then a follow-up neutral conversation.
A situation that may promote gossip is institutional change. Commentator Donna Kandsberger notes,
When communication is not provided until decisions are finalized, unofficial information will certainly spread and fill in any gaps. Typically, due to the anxiety associated with change and unknown outcomes, the scenarios that staff imagine and circulate through the ‘grapevine’ tend to be more negative and alarming than the actual situation.
Sharing gossip may not always be a bad thing, especially since there is more than one type of gossip. In fact, authors distinguish between what they call “positive gossip,” which serves a bonding/sharing purpose, and “negative gossip” (the latter sometimes referred to colloquially as “trash talk”). Jolly and Chang (2018) suggest that there may be benefits to gossip, such as when one coworker tells another coworker that a third party had a really hard patient, prompting others to provide more support. But of course, the bottom line is that when most folks think of gossip, they think of the negative exchange of sometimes-false information about someone else.
In a healthcare setting, there are clearly a number of different professional groups: nurses versus physicians, day shift versus night shift, leadership versus bedside nurses, full-time versus part-time, men versus women, junior versus experienced—the list goes. Gossip can occur between groups—where, for example, workers on the day shift gossip about СКАЧАТЬ