Recognizing and Overcoming Toxic Leadership 

Submitted by George A. Zangaro, PhD, RN, FAAN

Tags: behavior leadership managers nurse toxic work environment workday

Recognizing and Overcoming Toxic Leadership 

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Author’s Affiliations: Assistant Professor (Dr. Zangaro), Student (Ms. Yager), Professor (Dr. Proulx), Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD.

Correspondence: Dr. Zangaro, University of Maryland Baltimore, 655 West Lombard St Suite 465, Baltimore, MD 21201-1579


Toxic nurse managers are detrimental to organizations, diminishing staff morale, thwarting creativity, and creating unnecessary job stress. Toxic nurse managers can also negatively affect an organization’s bottom line as staff absenteeism may increase, job satisfaction and critical thinking may decrease, leading to turnover and complicating innovation, decision making, and problem solving. The authors discuss the signs of toxic nurse managers and strategies for addressing their impact on organizations.
It was difficult for the novice nurse, a cheerful and competent practitioner, to get out of bed. That queasy, nauseous feeling had already begun, and she knew that the headache would not be far behind. What was this, some sort of infectious process or a virus perhaps? Could this dread of getting up and going out to work, possibly be related to something on the job? Indeed it was, and the “infection” had to do specifically with a toxic leader. 

Toxic leaders can be devastating to personnel at all levels in an organization and can ultimately lead to the dismantling of the organization. Most people have worked for leaders who display some level of toxicity. The following provides some examples of toxic behaviors. The purpose of this article is to assist nursing leadership in recognizing a toxic nurse manager and in taking the appropriate steps to reduce the spread of the toxicity in the organization.

The nurse manager who

  • has a staff meeting and spends thirty minutes talking about how wonderful he or she is, and during the process takes credit for others’ accomplishments.
  • blames the staff nurses when discharge times have increased on the unit over the past 3 months.
  • shares information with the inner circle of loyal followers but not with others.
  • refuses to consider a staff nurses idea for a new way to give report to oncoming nurses during shift change, stating that the current way works fine and no change is needed.
  • is easily annoyed by simple requests from the staff, is not engaged in conversation with the staff or does not listen to their concerns.

Impact on Nursing

The U.S. health system continues to struggle with a critical shortage of nurses. It is anticipated that there could a shortage of approximately 500,000 nurses in the U.S. by 2025 (Buerhaus, Staiger, & Auerbach, 2008). Due to the challenges with the U.S. economy, hospital administrators are requiring significant contributions from leadership at all levels, specifically from the nurse managers on inpatient units. Nurse managers are expected to ensure a positive work environment that fosters satisfaction and retention of nurses. With the shrinking pool of registered nurses, it is becoming increasingly difficult to recruit new nurses. 

Effective hospital leadership at the executive level as well as at the unit level is crucial in today’s unstable economic environment. Studies have identified a significant relationship between effective leadership and job satisfaction (Laschinger, & Finnegan, 2005; Upenieks, 2003; Wilson, 2005), commitment (McGuire, & Kennerly, 2006) and intent to stay (Force, 2005; Johnson, & Rea, 2009). Each of these outcomes contributes to a healthy and productive work environment. In today’s market there is a high demand for leaders who serve as coaches, empower staff, and inspire staff to excel. To be successful in these difficult times a nurse manager must value the staff and make staff members his or her top priority. Unfortunately, there are nurse managers in organizations today who demoralize staff, promote their personal agendas, and go out of their way to protect their reputation regardless of the negative impact to the organization. They are known as toxic leaders.

Toxicity is defined as “the degree to which a substance can harm humans or animals” (Webster’s, 2009). Repeated exposure to a toxic organism can have long lasting effects on an individual. Staff members who are repeatedly exposed to a toxic nurse manager will either accept the leadership style and adapt to toxic behaviors, or will reject it and leave the environment. In a hospital setting, the effects of toxic management can spread rapidly through a nursing unit if the culture of the unit supports it. The effects of toxicity can have a significant impact on the individual employees on the unit and the organization. 

One of the greatest challenges in addressing toxic leadership in an organization is simply that it is widely tolerated by employers (Flynn, 1999; Kimura, 2003; Padilla, Hogan, & Kaiser, 2007; Reed, 2004).  Flynn (1999) reports that apathy leads to the organizational culture that makes toxic leadership acceptable, while other researchers state that workers eventually accept the situation of poor leadership as normal. Poor interpersonal skills also play a role in this problem.  Too often, belittling, embarrassing, yelling, and blaming become the main forms of communication (Kimura, 2003; Reed, 2004).  This leads to controlling information and the isolation of workers, which can escalate the problem (Wilson-Starks, 2009).  

Symptoms of a Toxic Nurse Manager

Toxic nurse managers are not always easy to identify. A toxic manager is defined as “the manager who bullies, threatens, yells. The manager whose mood swings determine the climate of the office on any given workday. Who forces employees to whisper in sympathy in cubicles and hallways. Call it what you want—poor interpersonal skills, unfortunate office practices—but some people, by sheer, shameful force of their personalities, make working for them rotten” (Flynn, 1999, p.40). Behaviors displayed by toxic managers include:


Self-centered toxic nurse managers are focused on advancing their careers and exhibit little concern for staff morale or professional growth and tend to ignore the organization’s vision. They are rigid in their thinking and hide their weaknesses and failures from their own supervisors (Kimura, 2003). When interacting with a self-centered manager he or she will use “I” when speaking about accomplishments on the unit and not give credit to the staff who were responsible for the accomplishment. Self centered nurse managers typically place blame on and complain about the staff on the unit. The self-centered toxic manager will search for followers who will do exactly what they request and these individuals will become the manager’s “inner circle.” These staff members will likely adopt the toxic behaviors displayed by their leader.

Exploiting others

Toxic nurse managers will take credit for successful initiatives on a unit, but give no credit to the nurse(s) who initiated, planned and executed them. More importantly, when a problem occurs with a particular initiative on the unit, the toxic nurse manager will blame the staff nurses and accept no responsibility for the problem.  

Controlling behavior

The toxic nurse manager must be in control of every aspect of the unit at all times. In order to maintain control, toxic nurse managers withhold information from the staff, are secretive, and give very little, if any, autonomy to the staff. This behavior results in stagnation or a lack of progress on the unit. The controlling nurse manager will eventually create a culture on the unit that is resistant to change. 

Disrespecting others

The toxic nurse manager who yells, bullies, threatens and speaks to staff in a condescending tone is demonstrating a broad lack of respect. This may occur in a person-to-person contact or in coercive emails. As an example, a new staff nurse fresh from orientation has made a medication error and must complete an incident report. The toxic nurse manager decides to discuss the error with the new staff member, instead of this being a private counseling session the nurse manager ridicules the staff member in front of her peers. What should have been a positive learning experience for the new staff nurse turned into a humiliating experience for the staff nurse.

Suppresses employees’ innovation and creativity

Nurse managers who suppress employees’ innovative thinking and creativity are not permitting the employees to “think outside of the box.” He or she controls all information and forces employees to follow the manager’s vision for the unit. The toxic leader has staff convinced that he or she can guide them to accomplish unrealistic goals as long as they follow his or her vision. This behavior leads to employees feeling unappreciated.

Inadequate emotional intelligence

Emotional intelligence is defined as “the ability to manage ourselves and our relationships effectively.” It consists of four fundamental capabilities: self-awareness, self management, social awareness, and social skill (Goleman, 1998). Nurse managers who lack emotional intelligence can be described as those who yell at staff, make irrational decisions, lack self-awareness of one’s emotions, or are unable to control disruptive impulses. The nurse manager who displays some or all of these characteristics on a busy chaotic nursing unit is the one to avoid. 

Recognizing Toxic Nurse Managers 

The use of a 360-degree evaluation is one of the best ways to recognize a toxic nurse manager. A 360-degree evaluation permits the manager’s supervisor to receive input from all individuals in the nurse manager’s sphere of influence (Davidson, 2007). This performance appraisal instrument provides a supervisor with feedback on the nurse manager’s work performance. The evaluation can be given to the nursing staff, unit clerks, patients and any other departments that interact with the particular unit manager that is being evaluated. This approach will permit the nurse manager to see how his or her behavior and leadership style is viewed by others in the organization.

Another suggestion is to conduct focus groups with the nursing staff on the unit and other employees who interact with the toxic nurse manager on a regular basis. Focus groups permit the nursing supervisor to obtain in-depth meaning and understanding through the use of probing questions and nonthreatening discussion. A drawback to focus groups is that employees may not be willing to publicly express their concerns in front of co-workers. Individual interviews can be very time consuming, but if a nursing supervisor feels that the staff is not willing to speak publicly, they are an option. Of particular importance in this process is for the nursing supervisor to assess the climate on all shifts, not just the day shift.
A nursing supervisor may also track the turnover rate on the toxic nurse manager’s unit. Units with high turnover rates should raise a red flag for the supervisor. When a staff nurse feels that there is no resolution that will occur in a toxic work environment he or she will leave the organization. Turnover is very costly to the organization and disruptive to unit cohesiveness. Additionally, research indicates that increased workplace incivility results in decreased productivity in the health care system (Hutton, & Gates, 2008). Decreased productivity in a hospital represents another significant financial burden for the institution.

Addressing Toxicity 

Addressing toxicity requires involvement from organizational executives as well as staff nurses. The approaches to be taken by these roles are explored in this section.

Nurse Executive Role

First, the job description should state that the incumbent is required to treat all employees in a respectful and professional manner. It has actually been suggested that the particular behaviors that will not be tolerated by the organization are stated in writing (Flynn, 1999). Second, when selecting the team to conduct the interview the nurse executive should ensure that there are a variety of staff on the team so that diverging viewpoints are represented. This will also increase the odds of identifying a toxic individual in the interview process. Finally, the nurse executive must ensure that he or she clearly communicates the objectives for the interview, rules of engagement and has everyone sign to document agreement to the hiring process. 

During a hiring interview, the nurse executive can attempt to identify a toxic leader through using a behavioral-based interview approach. Behavioral based interviewing is used to determine how an individual has reacted to, and managed prior problem situations (Hoevemeyer, 2006). This interview technique does not focus on what the interviewee might do in a future situation, but rather what he or she has done in a previous situation. For example, the interviewer might ask, “Could you provide me with an example of how you handled a difficult situation with a co-worker?” or “Could you describe a situation where you used appropriate delegation to complete a task?” Behavioral questions will permit the interviewer to determine if the interviewee is the right fit for the job by assessing the skills that are needed to be successful in the new job. Also the leadership should tell the prospective employee they will be evaluated on whether or not they have met these human resource objectives that relate to managing employees in a positive way. The executive must ensure that the prospective employee understands that toxic behavior could end his or her tenure in the organization, but on the other hand nontoxic behavior will be rewarded and recognized by superiors.

Despite the best hiring practices toxic nurse managers will still emerge in the organization. Once a toxic nurse manager has been identified, it is important for the nurse executive to address this toxicity as quickly as possible. The nurse executive should take an identify-verify-rectify approach to address a toxic situation. Begin by investigating the situation, interviewing people close to the situation. Verifying facts will help to determine if this truly is a toxic situation, isolated incident, or the result of a disgruntled employee. If it is determined to be a toxic situation then the nurse executive should confront the nurse manager and rectify this situation as quickly as possible. Nurse executives have the power and authority in the organization to address toxicity issues with a nurse manager. One of the most important issues for the nurse executive is to ensure that he or she is honest with the nurse manager and states things as they are so that the nurse manager gets a clear picture of his or her behavior. When conducting this counseling session be firm, but reasonable in your approach. Always document these types of sessions in the event of future occurrences or if disciplinary action needs to be taken at a later date. The nurse executive may set some reasonable goals for the nurse manager to achieve.

Nurse managers are often selected from within the unit and promoted quickly to a new role that he or she is not ready for. For many of these nurses who are unprepared for a managerial role toxic behavior tends to be displayed as a defensive or survival mechanism. In these situations, the new nurse mangers are taking an autocratic type approach to leadership to ensure compliance from the staff (Kerfoot, 2007). In this case it would be appropriate for the nurse executive to take a mentoring or coaching type role and assist the new nurse manager in being a successful leader. The nurse executive may provide the nurse manager with an effective leadership style to emulate and also offer educational classes to ensure success. 

Nurse executives are encouraged to obtain mentors for leaders who have been identified as toxic. The mentor can guide the nurse manager into creating a common vision on the unit that encourages participation by all staff. This vision should be developed by the manager and staff on the unit. This strategy has been identified as one that generates cohesiveness and increases communication and employee pride (Burritt, 2005; Failla, & Stichler, 2008; Huston, 2008). In doing this the nurses will become re-energized and empowered (Burritt, 2005; Failla, & Stichler, 2008).  Empowering the nursing staff, creating a strong sense of community and instituting changes that will inspire confidence, excite the nursing staff, instill creativity and autonomy, and stimulate personal growth results in a healthy work environment (Failla, & Stichler, 2008; Gratton, & Erickson, 2007).  

How to survive a toxic manager

It is important for nurse executives to foster a culture in which the staff nurse feels safe and is comfortable approaching a nurse executive for advice or assistance when dealing with a toxic nurse manager. The following depicts behaviors that are recommended for a staff nurse to practice when confronted with a toxic nurse manager. These behaviors are suggested to assist the staff nurse to understand how to best approach a toxic situation. Even though the nurse manager possesses positional power and authority on the unit, as a staff nurse you can quietly lead from the middle and be just as effective. Leading from the middle can be accomplished by working with the other staff nurses to make subtle changes that are satisfying to the staff, but not contributing to the toxicity on the unit.

The staff nurse should:

  • never approach a toxic nurse manager alone, always seek safety in numbers and confront the manager as a group (Lipman-Blumen, 2005).
  • align themselves with other nurse managers or executives for appropriate support.
  • never lose control of your emotional intelligence when interacting with a toxic nurse manager.
  • not get frustrated and feel like it is a hopeless situation.
    attempt to develop ways to exert a positive influence on the nurse manager by remaining professional and calm in difficult situations.
  • avoid condemning or criticizing the nurse manager and spend your time more wisely by developing a strategic plan to overcome the adversity the toxic nurse manager is spreading on the unit.


The literature demonstrates that the implications of toxic leadership on the nursing profession are very costly in terms of staff turnover.  There are many contributing factors to this problem.  Among the most commonly mentioned problems are the lack of leadership training and professional development activities offered for nurses in leadership roles (Kerfoot, 2007).  Very often, a person has had only “field-specific” training, as opposed to managerial or leadership training (Flynn, 1999).  Furthermore, findings have shown that a major barrier in obtaining leadership training is the current work schedule and job demands of nurses which lead to them being unable to get away to attend training and workshops (O’Neil, Moorjikian, & Cherner, 2008).  

The impact of toxic leadership on the nursing profession is substantial.  Combining toxic leadership with the stressful nature of the job itself leads to lackluster work, poor morale, decreased productivity, increased absenteeism, and high turnover (Dyck, 2001; Kimura, 2003; Pearson, & Porath, 2005; Shirey, 2006; Wilson-Starks, 2009).  Employees begin to feel cynical and frustrated, leading to decreased energy, enthusiasm, and self-esteem (Lencioni, 2007).  Both physical and psychological problems such as hypertension, ulcers, headaches, anxiety, depression, and anger also occur due to the stress of poor leadership (Dyck, 2001; Sutton, 2007).  In addition to these physical symptoms, toxic leadership causes de-motivational behavior, which affects a nursing unit’s morale and general culture (Reed, 2004).  This organizational stress places the purpose of the organization in jeopardy (Padilla, Hogan, Kaiser, 2007; Reed, 2004). Unhealthy work environments created by organizational stress may produce bad outcomes for both the staff and patients. 

A final implication of toxic leadership is that in toxic environments employees have to decide to conform to the current work environment, transfer to another unit or to leave the organization entirely. Unfortunately some employees are not maneuverable due to a lack of education, or they just simply cannot afford to change jobs because they are economically dependent on their current job. As a result, many employees accept toxic leadership, willingly conform to this leadership style and become the next generation of toxic leaders (Sutton, 2007; Wilson-Starks, 2009).  In the current economy nursing executives cannot afford to allow this toxic cycle to continue and spread into the next generation of future nursing leaders. Toxic leadership will spread and produce systematic damage in an organization.


Toxic managers do not save the organization money rather they cost it money in recruitment fees. They have infectious, devastating cumulative effects on the person, unit and organization. Nurse executives are in the position to stop this toxicity in the workplace and create healthy work environments for nurses. There is not a shortage of great leaders in nursing, but we need them to mentor and coach new nurse managers to help eliminate toxic behaviors. Let’s remove toxic managers, empower nursing staff, and create good leaders for the next generation of nurses to emulate.


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