Let’s get rid of the “bad apples”
Submitted by Maureen Kroning, RN EdD
Tags: behavior bullying Incivility Lateral Violence leadership nursing leadership organizational Intervention stress violence
Let’s face it; nursing can be a stressful job. We work often with insufficient staffing, lack of medical supplies, complicated technologies, administrator expectations, high patient acuity, advanced patient ages, patients with multiple chronic illnesses, patient and family demands and the increased demand to document all sorts of things from every imaginable patient assessment there is to do plus documenting: medications, procedures, treatments, transfers, billing codes, education and the list goes on. But, perhaps one of the most stressful challenges of the nurses working environment has become working among our own colleagues. Terms such as “Incivility”, “Bullying”, and “Lateral Violence” are now included among our long list of stressful issues nurses face each and every day. These terms include behavior that is undesirable for any institution and is counterproductive in any environment. Undesirable behaviors can involve not only nurses but any employee in an institution including that administration. The effects it has on nursing can be detrimental to the entire profession and even cause many to leave the profession of nursing altogether.
From 2012-2013, 5,422 nurses have left the profession of nursing, a 26% increase from 2009-2010 (Lintern, 2013). The Director of the National Nurse Research unit, Jill Mahen, states this could be directly related to increased demands on nurses since they are having to work harder, faster and longer to care for patients with greater needs and "you can only do that for so long” (cited in Lintern, 2013). According to Hill (2009) when nurses enter nursing they do so because they feel it is a “calling” to care for others in times of need and one of the reasons cited for nurses leaving their profession is related to lack of support from their peers, healthcare leaders and others within the nursing profession. Furthermore, a study by Laschinger, Leiter, Day et al., (2009) found, working environments with low levels of incivility and burnout were directly linked to nurse’s job satisfaction, their investment to the organization and their desire to stay or leave the profession. But, perhaps one of the most stressful challenges of nurses working environments has become working among our own colleagues. As a nursing administrator, toxic employees or “bad apples” as I like to call them, can create an already stressful environment to one that is unbearable for many nurses. Now, the question is what can we do collectively as a profession, as a vocation to address this issue? If we don’t address this issue right we risk tainting the image of nursing.
According to the Gallup’s annual Honest and Ethics survey “Eighty-one percent of Americans say nurses have "very high" or "high" honesty and ethical standards, a significantly greater percentage than for the next-highest-rated professions, military officers and pharmacists” (Jones, 2005). The ANA president, Karen A. Daley PhD, responded to the Gallup poll results by saying that it consistently represents the fact that people connect and trust nurses to do the right thing (advanced healthcare Network for Nurses online, 2012). While the Gallup poll shows most Americans rating nursing as the most trusting profession, I wonder just how nurses would rate each other.
While researching sites on the internet, I came across a blog titled, “Why do nurses fight so much with one another?” Nurse, bree, posted, “I'm a new nurse and had some clinical rotations where nurses were just vicious to one another. It seemed like every time I came in, there were a few in a bad mood and giving one another the "evil eye" and as crazy as it sounds, this is the part of the job that will stress me the most”. What nurse, bree, was really talking about was something called Lateral Violence (LV), a term that has been getting more attention as of late which is so unfortunate in a profession that is already facing so many stressors. According to Sheridan (2008) lateral violence is aggression which can result in nonverbal innuendos, backstabbing, talking bad about another and verbal affronts to name a few. Lateral violence can be seen as purely bullying another nurse, nurses and even nursing students. This aggression or bullying is really not directed towards the victim but is a response to the nurse’s work environment which he/she views as toxic and since they are unable to confront the oppressor the anger is often directed towards someone they view as safer (Sheridan, 2008).
A Need for Change
According to Randle (2003) nurses who bully each other is common among the profession and the only way to change this is for nurses and educators to transform both the practice of nursing and where the bullying occurs (Randle, 2003). Coccia (1998), published an article titled” Avoiding a “Toxic” Organization” which explained that all organizations are not perfect yet, we need to recognize the personality that dominates the organization. Most healthcare administrators can point out the employees that tend to dominate the areas they work and can even tell you who they consider to be the “bad apples” in their organization. Surprisingly, these employees often remain employed by organizations that have learned to tolerate this type of behavior. Tolerating bad behavior's in an organization occurs for a variety of reasons such as: short staffing issues, union's making it difficult to simply get rid of these employees and failure of management to put acts of incivility, bullying and poor performances in employee files. Healthcare organizations are faced with increase pressure to have positive staff and patient satisfaction ratings which is difficult to obtain if we allow "bad apples" to continue with their counterproductive behaviors. We need to create working environments that do not tolerate and accept acts of incivility, bullying and "bad apples".
Addressing the issue
“Bad apples” can be found in every organization, in every healthcare setting and not just within the nursing profession. Typically the "bad apple" is an employee who is rarely smiling or laughing while at work, frequently complaining about: their job, their fellow workers, their patients, leadership personnel and may even bully others in the workplace. The "bad apple" has a way of often dominating the mood on the unit they are working. Recently, when making supervision rounds on a nursing unit, I approached a nurse with a negative attitude and found her colleagues trying to avoid her. One of her colleagues commented to me that, " We all know she is negative and complains but she is great with her patients”. I found it puzzling that the nurse was great with her patients but not great with her own colleagues and nursing leadership.
As a nursing supervisor, unfortunately it is common to have staff feel negatively towards leadership. Staff often express feelings that leadership does not show support, caring and assistance with all the stressors they experience daily on their units. This is the first area that needs to be addressed when looking at a solution for the problem of having "bad apples" in our organizations. As Sheriden (2013) pointed out, the nurse who displays LV or incivility are really angry towards the nursing environment in which they are practicing in. As nursing administrators, we must begin to address this issue with specific interventions and we must do it now for it can and will taint the image of nurses who are smiling at work, providing caring, compassion, and good rapport with their fellow colleagues and have an investment in the organization to do well.
There is an immediate need for interventions to address "bad apples" in the organization and remember this is no ordinary organization it is a healthcare facility, one that provides care to patients, families and their communities. The steps needed include:
- Leadership needs to sit down and admit that there are "bad apples" in the organization
- Identify who they feel are the "bad apples"
- Discuss and develop a corrective action plan
- Communicate to staff that there will be a corrective action plan in place to create a positive change in the organization in order to improve the working environment
- Let staff know managers and supervisors are going to be proactive in enforcing a no tolerance rule for any "bad behavior" throughout the entire organization
- Define what constitutes "bad behavior" so staff can increase their awareness of its occurrence
- Address reasons why bad behavior may be occurring
- Managers need to implement individual and staff meetings to discuss any noted bad behaviors
- All managers need to show consistency throughout entire organization
- Each and every display of incivility, bullying, lateral violence or in other words any and all bad behaviors need to be addressed each time they occur
- Managers and supervisors need to document the warnings in employee records and copies given to the employee
- All leadership need to find ways to show staff that they are supported and cared for
- Find ways for employees to vent their feelings, concerns and issues in productive ways
- Provide safe places for nurses to communicate their frustrations
- Have nurses spend the day in another's persons healthcare role
- Help nurses to recognize the effects of the "bad apple"
- Most importantly, find ways to show that leadership does care and support their employees
As a nurse leader, I empathize with our top administrators who are trying to keep our healthcare facility open. I empathize with our unit nurses and even the “bad apple” and believe the “bad apple” does not have to be just that and can even change and help to make our healthcare setting a better place to work. Administrators need to: recognize what nurses are experiencing daily on their units, be visible on the units, provide supportive personnel, and acknowledge each nurses contribution and the hard work that they do each day. Allowing staff to glimpse a day in the life of an administrator and vice versa the administrator experiencing a day in the life of a staff nurse may just provide a new founded appreciation for the job each one assumes in the healthcare facility. There needs to be a no tolerance rule for “bad apples” on each unit. Managers and supervisors as well as each nurse needs to be accountable to speak up and document any behavior that is not productive in order to create positive work environments. We need to be sensitive and supportive to the feelings of each other and understand that we can no longer tolerate a “bad apple” in the bunch for we may just rot the whole basket.
- Advanced healthcare NETWORK for NURSES (2012). Nurses Remain Most Trusted Professionals in America, Gallup Survey.
- AllNurses.com “Why do nurses fight so much with each other?”
- Coccia, C. (1998). Avoiding a “Toxic” Organization. Nursing Management. 29(5).
- Hill, K. (2009). Why do good nurses” leave nursing? Relfections on Nursing Leadership. 35(3).
- Jones, J. (2010). Nurses Top Honesty and Ethics List for 11th Year. GALLUP Economy.
- Laschinger, S.;Leiter, H.; Day,M & Gilin, D. (2009). Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes. Journal of Nursing Managament 17, 302-311.
- Randle,J.(2003). Bullying in the Nursing Profession. Journal of Advanced Nursing, 43(4),395-401.