Toxic Nursing, 2nd Ed. Cheryl Dellasega
& Prado-Inzerillo, 2018, p. 39). These practices are defined in Table 0.1.
table 0.1 transformational leadership practices
| practice | application |
| Modeling the way | Showing others by providing open communication and embodying enthusiasm for nursing excellence, thereby promoting trust, respect, and a sense of team. This can be achieved through: • Participation in daily rounding • Multidisciplinary debriefings for sentinel events in a timely manner • Consistent follow-up with staff regarding concerns • Transparency in positive and challenging situations |
| Encouraging the heart | Welcoming contributions and accomplishments from all employees, as well as key input in decision-making. This can be done through: • Rewarding staff (publicly or privately, depending on the individual’s needs) • Relating with staff on a personal level • Making connections with staff during positive and difficult times |
| Inspiring a shared vision | Co-creating a vision and then communicating that vision in a way that invokes excitement and enthusiasm Identifying any desired purposes and actions that will make a difference in the work environment or in patient care |
| Enabling others to act | Creating a sense of trust and empowerment by providing new opportunities and collaborative activities. This can be accomplished through: • Advocating for resources to accomplish goals on both the unit and the organizational level • Enabling mentorship and leadership development • Focusing on succession planning • Providing an open environment for employee input on implementation of new initiatives |
| Challenging the process | Using creative solutions to challenge the status quo. This can be achieved through: • Taking risks and experimenting with new ideas • Learning from mistakes to identify new opportunities for positive change • Working to influence organizational policy • Using data to make decisions and initiate organizational change |
But nurse managers need transformational leadership support too. In a systematic review of nurse leader retention, support from a transformational leadership team was identified as an important factor in a nurse leader’s decision to stay in the role (Vitale, 2018). The Organization of Nurse Leaders in New Jersey (ONL NJ) was created to address lack of succession planning within organizations by focusing on providing meaningful mentorship opportunities.
The ONL NJ includes participation from more than 90% of New Jersey hospitals with a workforce of 116,000 nurses (clinical and academic; Vitale, 2018). The program has evolved over time and now includes:
• Pairing of mentorship teams
• A one-day educational session focused on mentorship and networking
• An evidence-based toolkit to provide guidance in a year-long mentor and mentee relationship (includes phases of the relationship, role exploration and definition, goal setting and assessments, and evaluation)
• Check-in points with mentorship committee members
As of 2018, a total of five cohorts of mentor/mentee pairings (over 100 nurses) have been through the program. A limited number of participants did not establish an effective mentoring relationship, but most report an increase in confidence and skill-building, and personal and professional growth.
organizational support
As nursing workforce retirements increase, a continued push for effective leadership will be critical to healthcare outcomes in the coming decades (Vitale, 2018). As workforce shortages continue, it will be critical to educate managers who can advocate for, support, and empower staff. Healthcare organizations have a duty to provide nurse managers with the tools and support needed to manage effectively. Recommendations for organizational support include (Vitale, 2018):
• Clear aims and roles of the nurse manager to prevent ambiguity and lack of authority
• Strategic succession planning: identifying potential managers well in advance to allow for mentorship, formal education, and leadership development
• A focus on the interpersonal skills required to lead and manage people in the workplace
In addition, healthcare organizations need to support an approach to leadership that is aligned with the concepts related to the transformational leadership model. Transformational leadership is a core component of the Magnet Recognition Program® (ANA, 2015) and is based on a foundation of practices and behaviors that promote organizational outcomes such as:
• Improved job satisfaction
• Organizational commitment
• Productivity
• Turnover
managing conflict and addressing toxicity
Conflict in the workplace—which can be transient or ongoing, intense or mild, personal or professional, and overt or covert—challenges nurse leaders, particularly on the management level of administration. Although few managers receive education on conflict resolution, most confront it on a daily basis in one form or another.
Conflict exists on many levels and for many reasons. Tension may trickle down from the top or bubble up from below, and while it is individually defined, a nurse manager must have the capacity to handle conflicts that can create a toxic work environment. Johansen (2012) links the ability of nurse managers to address inter- and intra-personal stress among coworkers with the quality of patient care.
Valentine (1995) found that nurse managers often rely on “compromise” to address conflict. I maintain that a range of skills is required to fully address nursing conflicts and the adverse outcomes that can result. Communication (real-time and virtual), problem-solving, support measures, reframing, education, and awareness raising—as well as assessment, consultation, and collaboration—are all behaviors identified by experts as key across different areas of conflict.
Although intended for nurse managers specifically, it is my hope that nurses in other positions will find the content in this book useful. Continued personal and professional growth and improvement lead to a goal valued by all nurses: the best possible patient care.
methodology for this book
Prior to the printing of the first edition of Toxic Nursing, my coauthor and I conducted a Google search using the terms “nurse bullying” and “nurse conflict and cynicism.” This resulted in 6,300,000 hits for “bullying” and 10,200,000 for “conflict.” A review of the top 100 sites for each category of the two searches revealed that blogs on bullying evoked many more responses, with only one blog specific to conflict and chaos.
To better offer an understanding of conflict management in the nursing workplace, we conducted a review of problems reported in the scholarly literature. Then, to explore nursing perspectives more intimately, we selected narratives for analysis rather than research or anecdotal articles. Specifically, we used blogs as a source of stories shared by nurses.
To identify blogs that would provide content on common nursing conflicts, we used the following criteria. First, they had to be about nurses in practice, not students. Second, there needed to be more than three posts from different posters featured on the blog. Third, the blogs had to refer to nurses or situations related to the nursing profession within the United States. Finally, they had to be written in English. Using these guidelines, we identified 21 usable blogs.
The number of posts on the 21 blogs ranged from three to 431. All were signed anonymously,