Toxic Nursing, 2nd Ed. Cheryl Dellasega

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СКАЧАТЬ Over time, it will affect the ability of the group to function as a unified staff.

      –Melissa Snyder

      Just as with younger girls, those who control the flow of information often perceive themselves as having a sense of power. Knowing the latest tidbits about classmates or coworkers and selectively sharing them (or not) can seem to bestow status and even popularity, but this tactic may misfire.

      As a manager, I would engage the entire OR staff in some way to raise awareness about the separation between personal and professional lives. Yes, it’s nice to have colleagues who care about you and your well-being, but the place to address those concerns is almost always face to face—not through an intermediary or third party. Depending on the severity of the problem, there might need to be a more systematic ongoing program to educate everyone on respect and civility.

      Distortion of information can also lead to serious misunderstandings about important topics. At a staff meeting, I would want everyone to use more caution in what they share about coworkers; the OR is a small community in and of itself where rumors can fly quickly. At the same time, I would indicate my approval of those nurses who use discretion and understand that when something comes their way, it should be kept confidential or at least not shared more widely.

      Lastly, I would have a conversation with Liz and Penny individually to try to gauge their time management, their job performance, and their professional development. If loose lips are causing problems with work, they need feedback on that. As well, given Liz and Penny’s ability to share information, I might invite them to develop a newsletter or some other form of communication to be shared by all OR personnel.

      –Cheryl Dellasega

      reflections 4.1

      Do certain nurses in your unit share personal information about coworkers with third parties? Do you? If you’re being honest, the answer to this question is ‘yes.’ It’s normal to talk about our friends and colleagues; the problem arises when we’re malicious or cruel.

      One critical question to consider is whether the gossip is disruptive to the unit’s cohesion. The question then becomes: what can you as the nurse manager do about it?

4.2 Out of Context

      scenario

      One busy evening, Liandra—who has worked in the ER for many years—makes a medication error, which is quickly caught and corrected by one of her coworkers. Despite the self-limiting nature of the medication mistake, Liandra is consumed with guilt. She can’t stop retracing her steps and trying to figure out what led her to give the wrong dose of medication.

      Carrie, Liandra’s coworker, works a double on the night after the mistake is made. She tells the entire night shift about Liandra, implying that the nurse manager is ready to take further action. By morning, the night shift workers are convinced Liandra nearly killed a patient and will suffer serious repercussions.

      One of them calls Liandra to console her and discovers the incident has been blown out of proportion. This is not the first time Carrie has been caught exaggerating at the expense of a coworker.

      nurse leader insight

      When things go wrong within a clinical setting, it is important to have established a culture in which the error is reported rapidly and the focus is not on blaming the person who made the error but on exploring why the error occurred and preventing future errors. In this scenario, Carrie has created a culture of blame through her exaggeration of the error made by Liandra.

      The focus is now on correcting the misinformation and negative feeling created by this exaggeration. As the manager, it would be important to directly address this issue with Carrie and help her understand how her actions have created an environment that is not only problematic for her colleagues but also shifts the focus from prevention of these errors to seeking blame for an error that anyone could make—again. The manager should work with the staff to create a culture of trust that encourages the staff to report errors quickly and accurately without fear of repercussions from other staff. And when errors like the one in this scenario occur, the approach should be to seek opportunities for new learning at all levels.

      –Melissa Snyder

      My first concern in this situation would be Liandra’s well-being—assuming, of course, that the patient has been taken care of. I would act quickly to address the situation by reinforcing the process to be followed when mistakes are made, stressing that patient safety comes first. With Liandra, I would try to identify factors that may have contributed to the mistake in case system issues need to be corrected.

      Next, I would have a unit-wide discussion on errors. This would provide an opportunity for all ER personnel to discuss how we as professionals address mistakes. It would be helpful if others volunteered ahead of time to share incidents in which they have made errors and how they dealt with both the ethical and emotional aspects. This might be the venue to further examine the damage done when negative talk occurs around a coworker’s performance.

      Finally, I would want to check back with Liandra and make sure her professional self-esteem is back on track. If she continues to feel guilty and unsure of herself, the likelihood of future mistakes will increase. Other senior nurses could also be encouraged to be supportive of Liandra and check in with her from time to time.

      –Cheryl Dellasega

      reflections

      Most of us played the game “telephone” as kids, where a message begins with one person and is slowly—and reliably—distorted as it makes its way from one person to the next. As the nurse manager, what can you do when this type of thing happens on your unit? If gossip is just part of human nature—and we won’t be able to eliminate it—what can we do to constructively manage it?

      In the case above, Liandra makes a mistake. When errors occur on your unit, how does the staff react? Does the person who made the error feel free to report it? Are others in the unit emotionally supportive of the nurse who made the error? In short, what type of environment has been cultivated on your unit? Are you satisfied with it?

4.3 Secrets

      scenario

      For several months, Maggie has been trying to get pregnant. She and her husband, a resident in the same hospital where she works, have gone through several special treatments to try and have a child. When she finally conceives, she tells only Alice, another nurse supervisor with whom she is close.

      “Please keep it to yourself,” Maggie says. “I’m worried something might go wrong, and anyway, I’m applying for that new position in nursing education. If they know I’m pregnant, I might not get the job.”

      Alice tells Maggie she will keep her secret, but over coffee with Donna, she hints about some big news that is about to break. Donna, who knows Maggie, guesses at the secret, which Alice refuses to confirm with anything more than a smile. Donna then progresses to tell two other people who “promise” not to reveal what they know, and so on. Eventually, Maggie learns about Alice’s betrayal and confronts her—so angry that the relationship is permanently damaged.

      nurse leader insight

      In this scenario, Maggie has not directly contacted the nurse manager. However, it is safe to assume that the nurse СКАЧАТЬ