Signs of Toxic/Unhealthy Workplaces

Nurse Beth, MSN

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?