Signs of Toxic/Unhealthy Workplaces

Nursing is considered a high stress job, and nurses who work in toxic environments experience higher levels of annoyance, emotional exhaustion, frustration, burnout, and other stressors that eventually affect mental and physical well-being. Here are some signs of unhealthy workplaces.

Updated:  

Signs of Toxic/Unhealthy Workplaces

Toxic workplaces in nursing are not that hard to find. For many reasons, they are all over. Sometimes just one or two units in a hospital are toxic. Specialty units such as cath lab and ICU can be prone to toxic cultures. Sometimes just one shift on a unit is toxic, such as a MedSurg unit with a toxic night shift but a normal day shift. How can you tell if you're in a toxic workplace?

Here are some signs. There's no such thing as a perfect workplace. One sign in and of itself can be just poor management, but a plethora of signs is definitely a red flag.

Hoarding Supplies and Equipment

Lisa is a certified nursing assistant (CNA) new to the MedSurg unit and always has a hard time finding a blood pressure machine and pulse oximeter to use after report. 

Lisa struggles every day to get her vital signs taken on time, while Shelly, another nursing assistant, breezes through her vitals. Lisa sees that Shelly and some other CNAs always seem to have what they need without a struggle. After a while, Lisa notices that the seasoned nursing assistants hide portable pulse oximeters in patient cupboards and blood pressure machines in bathrooms and other creative spots. Night CNAs buddy up with a friend on day shift and pass on equipment.

Lisa becomes angry with Shelly and others. If Shelly wasn't hoarding a blood pressure machine to herself, maybe Lisa would have a chance.

Lisa's anger is misplaced. It's the manager's job to provide employees with what they need to do their job. It's not the employee's job to do so.

Shelly has simply learned to survive in a unit that is short of supplies. Shelly is not taking anything away from Lisa- she's looking out for herself. Units that are always short of commodes, or blood pressure machines, or computers indicate a leadership problem.

Turnover

High turnover is common in nursing. It almost seems the norm. Even so, organizations and units with the worst work environments have the highest turnover. Sometimes a long-standing core group of negative or troublesome employees remain on toxic units while newcomers are run off by lateral violence.

Likewise, when nursing units have a low standard of care, newcomers either sink to the norm or become frustrated and leave.

Leaving begets leaving. Sometimes exiting a unit is contagious, and there is a slow but mass exodus. New grads with six months of experience are put in charge, while travelers and floats staff the unit.

Hospitals that offer too good to be true sign-on bonuses for brand new, graduate nurses when other local hospitals in the area do not are waving a red flag. Steer clear.

Queen Bees

Even otherwise well-run units can have Queen Bees, and it's a sign of weak leadership. Weak managers tend to pair up with strong Queen Bees. Queen Bees are informal leaders of the nursing unit. Queen Bees don't want to run a unit- they just want special privileges, and they want to be seen as important. Typically Queen Bees have clinical expertise and organizational knowledge, which the manager may lack. The Queen Bee may be the one that has all the doctor's cell phone numbers, for example, and has full access to the manager at all times. She has undue influence over the schedule, including holiday times. 

Queen Bees are granted unofficial power by the (usually weak) manager because the manager needs her. The Queen Bee has influence and can persuade her followers to support the manager and inevitable changes.

Favoritism

Closely related to the Queen Bee, the charge nurse gives her BFF the easiest assignment or always gives the float the worst assignment, trying to gain favor.  Again this is management turning a blind eye, therefore condoning the favoritism.

Unaddressed favoritism makes new nurses feel unsafe.

Non-inclusive

A last-minute 5 South Christmas dinner for day shift was held at a restaurant. It was partially subsidized by the hospital and attended by the manager. The next day Melanie, an older and quiet nurse, heard others talking about it. She had not been invited. Small groups of people making plans and excluding others leads to hard feelings and affects teamwork.  It's natural for some people to form friendships outside of work, but if an activity is known to be a work activity, all should be invited.

Mixed Messages

Jason, a new RN, was clearly told by Human Performance in Orientation that he should never work off the clock. If you are working, you are on the clock. Once you clock out, you're done and should leave. "That makes sense, " he thought. He was also told by his manager that no one in Orientation should ever incur edge-of-shift overtime. "There's absolutely no reason for an orientee to work overtime" was the leadership mantra.

In reality, Jason frequently did not finish his charting before the end of shift. His preceptor simply said he had to improve his time management. Jason was confused. It wasn't like the next shift was going to document his assessments. Jason ended up doing what many nurses caught between these conflicting directives do-clocking out at the end of his shift and going straight to his computer to finish charting, often staying up to 30 minutes over and off the clock.

Mixed messages are when leadership says one thing but does not intend to back it up. Essentially management wanted to look the other way, not pay overtime and yet not provide a way for Jason to realistically finish his work.

Kaylie listened closely when her nurse manager said in a staff meeting that they were to give bedside report 100% of the time and to include the family when possible. On her next shift, she took a report from two nurses, each of whom stood steadfastly in the hall over their computers. She looked up and down the hall and saw everyone was giving report in the hall as usual. The charge nurse said nothing, and of course, the manager was not around at 0700. Kaylie, being new, was not about to rock the boat.

FACT: Mixed messages teach new and experienced nurses alike that the appearance of good patient care is more important than good patient care.

To be fair, most nurse managers receive zero training. Some are managers just because they were willing and were selected because of their clinical skills. Never trained in the required skills, they manage as they were managed. On top of that, they are limited by their own Directors, unrealistic budgets, and out-of-touch higher-ups.

It's no surprise that so many nursing units have issues. Maybe it's surprising that nurses manage to do so much good work every day, despite the stress and obstacles.

Do any of these signs sound familiar? What are other signs of a toxic workplace?

7
Up Vote Up Vote ×
Nurse Beth

About Nurse Beth, MSN

Career Columnist / Author

Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development, and am a blogger and author.

145 Articles   4,099 Posts

Share this post

Share on other sites
Specializes in ER.

You nailed it!

Regarding bedside report though, it's another gimmick that got handed down from up high as the latest and greatest. Anyone who has attempted to do it knows that some things need to be said out of earshot of the patient.

8
Up Vote Up Vote ×
Specializes in Gerontology.

I retired about 6 months ago. My unit suffered from favouritism, non inclusiveness and some Queen Bees.

All played a part in my decision to retire.

5
Up Vote Up Vote ×
Specializes in Gerontology.

Another example of non inclusive.

The charge nurse and her friends all take the same break. Even if it leaves the floor short. You can hear them laughing and giggling in the break room. 
And while on break the CN updates her friends about any changes in policies, procedures, etc. But conveniently forgets to updates other people.

4
Up Vote Up Vote ×

I know a troubled unit when I float there and the majority of other nurses are floating there from other units too or are new graduates, travelers and one or two experienced nurses are holding the place together. 

5
Up Vote Up Vote ×
11 hours ago, Pepper The Cat said:

And while on break the CN updates her friends about any changes in policies, procedures, etc. But conveniently forgets to updates other people.

This is textbook bully behavior. She is withholding information you need to do your job. This is reportable to HR as it puts patients at risk. Pro-tip: HR doesn't care about your feelings so don't even bother with that. 

Also to the Queen Bee reference. I think that there needs to be some clarification. You can have a senior, experienced nurse with clinical/organizational expertise who is a leader on the unit and has the ear of the manager because of said characteristics without them being a "Queen Bee" or the manager being weak. I think you tread into "Queen Bee" territory when you expect special privileges because of your status or you manipulate the manager. 

6
Up Vote Up Vote ×
Specializes in Med-Surg.
8 hours ago, Wuzzie said:

Also to the Queen Bee reference. I think that there needs to be some clarification. You can have a senior, experienced nurse with clinical/organizational expertise who is a leader on the unit and has the ear of the manager because of said characteristics without them being a "Queen Bee" or the manager being weak. I think you tread into "Queen Bee" territory when you expect special privileges because of your status or you manipulate the manager. 

I agree.  I was once accused of being my manager's "Golden Child" by one coworker because my manager and I go on so well.  She had hired me about 20 years prior and we knew each other well and I had her ear.  But I never took advantage of it and the manager was very fair and equal in her treatment of us.  

 

4
Up Vote Up Vote ×
Specializes in Med-Surg.

I've been at the same facility for 30 years and thankfully don't find it toxic although I have dealt with some situations such as RN/CNA dynamics that were unpleasant, as well as some issues with coworkers, and chronically short staffed but I've been able to ride it out.  I've been on the same unit now 13 years and we recently switched managers and it's going well.  Hopefully in five to seven years I can retire.  

I think it is important to recognize toxicity and decide what to do about it and when to leave.

I think management here gave up on bedside report and now say that we at the very least have to introduce the next shift's RN to the patient after getting report.  

 

5
Up Vote Up Vote ×
Specializes in Gerontology.

To me a QueEn Bee has experience and knowledge but takes great joy in selecting who she shares that knowledge with. For example, she knows how to used a new piece of equipment but will watch someone struggle to use it for several minutes until she decides to share her knowledge.

5
Up Vote Up Vote ×
Specializes in ER.

The Queen Bee is an information hoarder who likes to protect her turf. 

8
Up Vote Up Vote ×
Specializes in Home Health,Peds.

I am on break right now but for scenario 1, how is it not Shelly’s fault for hiding BP and pulse oximeter machines? Isn’t that creating a hostile environment?

The machines do not belong to Shelly. It is hospital equipment. 

1
Up Vote Up Vote ×
37 minutes ago, Googlenurse said:

Isn’t that creating a hostile environment?

Unfortunately no. A "hostile work environment" is applicable only if the person involved is part of a protected class. That's not to say it wasn't hostile but from an HR standpoint it does not apply.

1
Up Vote Up Vote ×
+ Add a Comment