Changing the Culture - Pipe Dream, or Possibility?

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Specializes in ED, TNCC.

Hi All!

I work at a large ER with a pretty big culture problem. Bullying and hazing runs rampant. (E.g.: Giving heavy, over-the-top assignments to nurses who aren't in the "in crowd," drawing resources away or flat out denying them to "drowning" nurses, snide comments, eye rolling, etc.) The average newly hired nurse leaves by the 6-month mark, and I've heard from many of these nurses that the culture is a major reason why they're leaving. Others leave because they are not afforded the same opportunities as others, because they're not "in the clique." A nurse can be cross-trained into other areas (triage, trauma, fast-track, etc.), "after working there for a year" (per preceptors/managers). However, a well-respected, good nurse with 2 years in this department and a whole alphabet soup after her name (TNCC, CCRN, CEN, CFRN) was passed over for a new grad with 3 months of experience. But, this new grad had friends in the "in crowd." It's been very frustrating for many of my friends and coworkers, and I've watched several really great nurses leave as a result.

My questions are these: Is it possible to change this kind of culture? What does it take? How would you go about doing it? Have you seen it work in your ER? Or is this all "Pie in the sky" thinking on my part?

Thanks in advance!

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Sure, if they fire the whole "in crowd" clique...

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Specializes in ED, Critical care, & Education.
Hi All!

I work at a large ER with a pretty big culture problem. Bullying and hazing runs rampant. (E.g.: Giving heavy, over-the-top assignments to nurses who aren't in the "in crowd," drawing resources away or flat out denying them to "drowning" nurses, snide comments, eye rolling, etc.) The average newly hired nurse leaves by the 6-month mark, and I've heard from many of these nurses that the culture is a major reason why they're leaving. Others leave because they are not afforded the same opportunities as others, because they're not "in the clique." A nurse can be cross-trained into other areas (triage, trauma, fast-track, etc.), "after working there for a year" (per preceptors/managers). However, a well-respected, good nurse with 2 years in this department and a whole alphabet soup after her name (TNCC, CCRN, CEN, CFRN) was passed over for a new grad with 3 months of experience. But, this new grad had friends in the "in crowd." It's been very frustrating for many of my friends and coworkers, and I've watched several really great nurses leave as a result.

My questions are these: Is it possible to change this kind of culture? What does it take? How would you go about doing it? Have you seen it work in your ER? Or is this all "Pie in the sky" thinking on my part?

Thanks in advance!

You have a challenge on your hands but no challenge is too great with the right mindset and passion. Sounds like either your organization and/or department needs a focus on nurse bullying/horizontal violence/burnout etc...

I would encourage you to check out Renee Thompson of RT Connections. Nurse Bullying is her passion and she is working hard to eradicate it. This type of behavior is not okay, should not be tolerated by management, and definitely not by nurses. Go to www.reneethompsonspeaks.com. If you like what you see I encourage you to connect with her.

So, you need money to get Renee to your organization. Just thinking ahead here. Organization says no way, can't pay for that (been down that road with another hot topic). Consider writing a proposal to the hospital administration and/or Foundation asking for funds to support this endeavor. I don't know the statistics but I bet less bullying will lead to better teamwork, happier staff, less attrition, increased quality of care, better patient satisfaction scores etc... Do your research and sell your point.

I just wrote a blog post on building relationships. It sounds like that isn't what you need…but maybe some of your peers!

https://allnurses.com/general-nursing-discussion/5-things-i-1085789.html

I admire your quest. Hang in there.

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Specializes in ER, ICU.

Culture change must have new leadership, and separation of the worst offenders. The most obvious change is a new manager, who will have to fight the old culture. Some staff may get fired, but hopefully most will leave. But sometimes the staff is entrenched, circles the wagons, and frags the new manager. I was told by a manager once, flat out, that she was at war with the old guard, who liked their power and culture, and were complaining to the director (waging a smear campaign) against her. She told me she was actively looking for a new job and would bail at the earliest opportunity. For her to be so frank was amazing, and showed the level of rancor. Each situation is different. Change can occur, but sometimes it can be very difficult. The fact that the director tolerates, or can't do anything about it is telling. If they don't know, they are incompetent. Either way, unless you can get the manager job, and the support of higher leadership, it is probably worth it to move on. Good luck.

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Specializes in Nephrology, Cardiology, ER, ICU.

Management needs to change. Doubt the "suits" like the turnover either.

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