Toxic Nursing, 2nd Ed. Cheryl Dellasega

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СКАЧАТЬ and she just walked away from me.

      –Anonymous BSN, RN-BC

      nurse leader insight

      In this situation, it is right to be concerned about the RN’s pattern of aggressive behavior toward the aging and possibly slower LPN. Any time such behavior is tolerated, it is given silent permission to continue. The message goes to all stakeholders that such behavior is OK.

      The most effective and direct way to address the incident would be for the concerned nurse to intervene while the hostile behavior is happening. In a clear and firm voice that everyone involved can hear, say, “Stop yelling at her right now. Your behavior is inappropriate!” In this case, the offending RN, LPN, and volunteer all get the same message about the behavior. This type of intervention gets easier, although not necessarily easy, with practice and a supportive organizational culture. Later, take a quick, private moment with the LPN and volunteer to see if they are OK, and convey the message that no one deserves to be treated like that.

      A private moment with the offending RN later in the shift would also be necessary. If the concerned nurse is a colleague, she might say, “I’ve been concerned about your yelling at the LPN for a while. It is harmful to all of us. If you continue, I am going to talk with the unit manager. If there is some way that I can be helpful, please let me know. If you have concerns about her performance, maybe you should talk with her or the unit manager. Do you understand what I am talking about?”

      If the concerned nurse is a supervisor, a more authoritative tone and approach are warranted. She might say, “Yelling at the LPN is inappropriate. I am aware that I have tolerated your behavior for a while and I was wrong to. I’m sorry if I have given you any ideas that abusive behavior is OK. It is not. Beginning now, I am going to call you on it and document it in your record. Do you know what I am talking about? Is there something that you need from me to behave more respectfully?”

      Given the ongoing pattern of behavior witnessed by staff, patients, and volunteers, the nurse manager should be concerned about the organizational culture on the unit. This pattern of behavior includes multiple missed opportunities for the concerned nurse to give constructive feedback to the offending RN, LPN, or nurse manager and the LPN’s unhealthy coping pattern of just walking away (a passive-aggressive action in its own way). In addition, there is the possible question of the LPN having performance issues. All these issues should be addressed.

      –Beth Boynton

      In this situation, the LPN who had been bullied by the RN is not spunky enough to stand up to the perpetrator. Although the LPN was warned by another nurse who witnessed the bullying, she still did not have the courage to stand up or even discuss the matter with the third person. I believe that by staying indifferent to her perpetrator, the LPN strengthens the RN’s hand, which makes things even more miserable. In this case, the best thing is to inform the superiors and administration about the situation by a petition. That being said, the attitude of the administration is highly important to prevent these hostile behaviors. If the administration is determined enough to solve the LPN’s problem, they will also prevent future bullying episodes.

      –Dilek Yildirim

      reflections

      Think about the “civility quotient” of your unit—what behaviors do you observe, and how does your team rate? Are they more or less civil than others within the institution?

      How far should a nurse manager go in intervening with interpersonal communication problems? Is it your job to make sure everyone on your unit “gets along,” or are there times when employees need to figure things out for themselves?

1.2 Rude Docs

      scenario

      Hector, a nurse on the rehabilitation unit, graduated from school the week before he started work. He is well received by his nurse coworkers, but the physicians give him a hard time. “You new nurses are all the same. No common sense!” fumes one doctor, Dr. Monroe, when Hector doesn’t realize he is supposed to have his patient in bed when the physicians make rounds.

      “If you had half a brain, you’d know that it’s your job to make sure these patients take in enough calories to help them get through rehab!” says another doctor, Dr. Carter. “It’s hard work to go through therapy all day.”

      Hector feels totally incompetent, even when the other nurses reassure him and try to run interference with the physicians.

      nurse leader insight

      In this example, at least two doctors are known on the unit for berating new nurses. Sadly, many of us have experienced a transitional shock coming from a rigorous academic environment with a sense of accomplishment, excitement, and commitment to practice to this hostile and disrespectful “welcome” to the real-world nursing environment.

      Stopping this disruptive behavior is crucial for collaborative, safe care and for rewarding, long-term careers. Ideally, the nurse manager would have spoken with these physicians individually prior to Hector’s starting on the unit. A quick chat in private about the expectation of respectful behavior, sentinel event data related to poor communication, the cost of recruiting and retaining qualified staff, and an invitation to look at teaching opportunities as they arrive may be all that is needed. Because that didn’t happen, the nurse manager should speak with Hector privately and explain that she is working on addressing this behavior with the physicians, that Hector should try not to take it personally, and that she would like to help Hector be assertive with these doctors the next time an incident occurs. They could use a scenario to role-play a response.

      This would provide Hector with language and leadership support for the next time he is attacked by these doctors. Using a clear, firm voice and confident body language, Hector might say, “Dr. Monroe, your comments about all nurses lacking common sense are offensive. My goal is to work with you collaboratively for the safest and best care of our patients. I am happy to hear feedback on your preferences and concerns, and I expect you to treat me with respect. Can I count on you for this?” Or, “Dr. Carter, your insulting language is inappropriate. I agree that nutrition is an important factor of caring for our patients. There are many challenges associated with feeding patients, including their willingness to eat, the food, and the time and staff available to help. Let’s schedule a meeting with the unit manager to discuss our concerns and address this issue.”

      Finally, the nurse manager should be aware that supportive staff “running interference” may be contributing to an unhealthy alignment of us versus them with the physicians.

      –Beth Boynton

      While the claims of the physicians might be correct, the way they expressed them was inappropriate. Given the way the information was presented, the physicians’ rudeness could be considered bullying. Either way, I believe that Hector should talk to the physicians and tell them he was frustrated not by what they told him, but by how they told him.

      –Dilek Yildirim

      reflections

      Are physicians expected to demonstrate respect for the skills of nurses in your organization and vice versa? What behaviors show respect or diminish it? Can you identify situations where rude interactions disrupted the workflow or caused emotional distress?

      What is the difference between physicians who connect well with the nursing staff and those who do not? СКАЧАТЬ