Toxic Nursing, 2nd Ed. Cheryl Dellasega

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СКАЧАТЬ example, one bedside nurse talking about another bedside nurse. The gossip that occurs between groups may serve to reinforce dividing lines that separate one group of people from another. As these battle lines become more entrenched, it can become harder and harder for groups to work together. Although gossiping about someone outside your group with a member of your group can reinforce your group bond, the net effect is negative because it alienates you further from out-of-group colleagues. Too often, the latter is the case—and make no mistake, gossip is often a source of verbal abuse (Dellasega, 2009).

      Almost everyone reports experiencing some negative gossip, or peer verbal abuse, at work. Diane Ceravolo and her colleagues did a study on the frequency of verbal abuse for nurses before and after an intervention workshop series (2012). At baseline, they found—in line with other studies—that 90% of nurses reported experiencing peer verbal abuse in their workplace. After their workshop intervention, the level of verbal abuse decreased to 76%—still quite high.

      A 2019 survey published by American Nurse Today showed that of the 35% of respondents who experienced verbal assault by a healthcare provider in the last two years, two thirds reported the incident to a manager (Spader, 2019). This number has increased from a study conducted in 2012, which stated that less than one-third of those who had experienced verbal abuse reported their concerns (Ceravolo, Schwartz, Foltz-Ramos, & Castner, 2012). However, although more nurses reported the incident in the 2019 survey, 75% of those who did were dissatisfied with how the situation was resolved.

      This is significant. If the vast majority of nurses experience verbal abuse, and the vast majority also believe that talking with their manager won’t help resolve the problem, the obvious question is, what now? What should nurses do when they experience verbal abuse? What should managers do when their nurses report that they have experienced verbal abuse, or that gossip is getting out of control?

      Because it doesn’t seem realistic to try to change the foundational sociology of human relations by asking employees not to talk about third parties, managers must find another way of dealing with this problem. One approach might be an in-service event to educate nurses about the IOM report on errors, which indicates that many medical mistakes occur due to breakdowns in communication (Institute of Medicine, 1999). Another might be to maintain an open-door policy so that employees can talk to you easily—and to let them know that the conversation will be treated with respect and not held against them. Since several of the studies reviewed suggest gossip can be connected to wanting more information about an individual or institution, yet another option would be to schedule open Q&A forums where uncertainties and fears about hospital issues can be openly addressed. Times of transition and insecurity (such as a proposed merger or expansion) can often lead to a gossip volcano.

      If you’re dealing with gossip about institutional change, commentator Donna Kandsberger suggests the following:

      Initiating communication early along with regular updates can help staff feel included in the overall goals and mission of the work unit or organization and thus increase their feeling of being respected members of the organization. It must be clearly communicated and understood, in order to avoid the perception of indecision or confusion on the part of the organization’s leaders, that early information will be accurate at the time of presentation but is subject to revision over time as plans and decisions evolve. With early and ongoing communication, opportunities for staff to comment or ask questions can increase their feelings of inclusion and empowerment as well as give leaders valuable insights into the ‘word on the street’ or ‘grapevine’ of information and perception that is circulating among the staff.

      The bottom line is that it’s unlikely that gossip and trash talk is going to vanish from our workplace, so we need to find constructive ways of managing its negative consequences.

      Commentator Melissa Snyder articulates three approaches a nurse manager can take to address this type of inappropriate communication:

      First, the nurse manager must consistently work at establishing professional relationships between all employees based on trust and integrity. Without these core values, relationships cannot grow and mature, and the cohesiveness of the work team is constantly challenged. In a busy, stressful healthcare environment, nurses must feel supported by and confident in the abilities of their colleagues. Each of these scenarios betrays this sense of trust and support in both personal and professional ways. To establish trust, nurses must be empowered to share their thoughts and feelings regarding situations in a professional way.

      The second approach in dealing with gossip and trash talk is to foster a professional work environment that extends beyond the boundaries of a particular unit. Professionalism must be modeled consistently by the nurse manager and other expert nurses. In addition, all nurses should be supported in their socialization to the professional role with frequent opportunities to practice these skills and to gain new knowledge through professional development programs. Over time, this combination creates an expectation of professional behavior that guides how nurses behave at the bedside but also permeates all other aspects of their lives.

      The final approach is the need to address the role of technology and social media with all nurses. Nurses need to know that these technologies can be very useful but can also be very detrimental if not used with caution and consideration. Nurses need to know what the expectations are for their use of social media, and, if possible, there should be a clear policy indicating how these technologies can be used.

clearing toxicity: scenarios, insights, and reflections

4.1 Indiscretion

      scenario

      Liz is an OR nurse known for her love of “sharing” information about her coworkers. During her shift, she often goes from one nurse to the next, prompting them with “Did you know . . . ?” or “Have you heard the latest?”

      Most of the other nurses know what Liz is up to and have learned to deflect her. Even so, her constant desire to spread negative news creates friction in the OR—especially when Liz repeats information about one nurse to another. She is a master at taking tidbits of conversations out of context and sharing them with a person they are likely to upset.

      Penny, an OR tech, is good buddies with Liz and often collaborates with her to spread rumors. Between the two of them, Liz and Penny stir up lots of drama in the OR. One day, Liz and Penny suggest that Tara, a nurse who has been having marital trouble, has filed for divorce from her abusive husband. Within hours, everyone in the OR thinks that Tara’s marriage is on the rocks, and, when one nurse comes up to console her, Tara becomes upset. She goes to the manager and insists that something be done to curtail Liz and Penny’s “loose lips.”

      nurse leader insight

      The manager of the OR should go directly to the source of the rumor mill and confront both Liz and Penny about their actions. It is possible that the pair may find this to be a harmless activity or that they are really unaware of the way their actions are affecting others. This direct confrontation may be enough to curtail their desire to share rumors—especially if they are informed of the negative effects this behavior is having on other staff members.

      Sometimes, simply recognizing the problem is enough incentive to end the behavior. However, the manager should also speak with the staff as a whole. In this exchange, the staff should be empowered to speak up when they are uncomfortable with information that is being shared by their colleagues.

      Without a willing audience, the rumors cannot be spread—and this may be the most effective way of resolving the problem. In a unit such as the OR, where everyone must work together as an orchestrated team, integrity and trust are core values that are essential to building a cohesive work group. The СКАЧАТЬ