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Battling Bullies: How to Take on Nursing Cliques and Gangs (and Win)

How to survive and fix a toxic workplace

On the first day of her clinical hours for her undergraduate degree in nursing, Emily noticed that some of the unit’s other female employees wore hair bands. Although it wasn’t part of the dress code on that notoriously tough and cliquish unit, she decided that she would tie up her long hair in a similar style.

In the locker room the next morning, Emily was confronted by one of the hair-band-wearing nurses, who demanded, “Who gave you that?” “Nobody,” Emily replied. “I noticed other girls wearing one, so I wore one too.” “You don’t wear a hair band unless we give you permission to wear one!” the other nurse retorted.

She then snatched it off of Emily’s head, leaving the nursing student mortified and speechless.

There is nothing new about bullying and incivility in the nursing profession. “Nurses eat their young” is an adage that has survived many generations. It’s a common and costly problem: Some studies estimate that bullying and incivility are responsible for 60 percent of the new graduate nurses who resign within the first six months of employment, and for more than 20 percent of nursing turnover overall.

A study of horizontal violence and new nurses, published in the journal Creative Nursing in 2011, found that up to 34 percent of nurses consider leaving the profession because of bullying. Even for those who stick it out, a toxic workplace may haunt a nurse throughout his or her entire career. One in five nurses who have been bullied suffer from post-traumatic stress disorder (PTSD).

Social Bonding Gone Bad

We are born as individuals, but we survive and thrive in groups. You can blame oxytocin: When we bond with another human, our brains release small amounts of oxytocin, often referred to as the cuddle hormone, which compels us to seek out other people for love, companionship and protection.

People with strong personal bonds tend to be healthier, live longer and feel more joy. Many nurses spend more time with the people they work with than with their own families and friends. Therefore, to enjoy a long, healthy and satisfying career in nursing, it’s important to seek out positive work relationships.

Unfortunately, nurses are notorious for cliquishness, and when a group becomes a clique or a gang, it can promote disruptive behaviors in the workplace. To avoid this, it’s important to understand the difference between a group of friends (healthy, positive) and a clique or gang (unhealthy, destructive).

Cliques: Who’s In, Who’s Out

So, what is a clique? Cliques are groups of individuals who share similar interests, spend time together — and make it clear to others that not just anyone can join the group. Membership in a clique usually provides some special privileges denied to outsiders, even if it’s as simple as being allowed to sit at a particular table during meal breaks.

Cliques are commonplace during adolescence — think of the high school cliches about jocks, greasers, preppies and so on — but they can continue into adulthood. In a 2013 survey conducted by CareerBuilder, 43 percent of employees reported that their workplaces are populated by cliques.

Exclusion is a central part of any clique; they use it as a weapon. Clique members stick together and tend to shun people who aren’t in the group, which can make going to work a stressful and unpleasant experience. Did you know that when people feel excluded, the pain centers of their brains light up? It’s painful to feel left out of a social group. Cliques know this and use it against others. The result is unnecessary drama and distraction.

Nursing Education

People in cliques also exhibit pack-like behavior: They hoard resources, don’t readily share with others outside of their clique and may actually harm outsiders to protect their own. Like packs, cliques also expect members to put the group first, seldom tolerating individuality.

Gangs: Breaking the Rules

Cliques that become entrenched and powerful can sometimes develop into something worse: gangs. Law enforcement typically defines a gang as a formal or informal organization, association or group of three or more persons whose membership can be identified by what they wear and who have as one of their primary activities the commission of criminal acts.

That definition may sound harsh, and I am by no means accusing nurses of the level of violence and criminality associated with street gangs. However, if you think about the behaviors exhibited by disruptive or hostile workplace groups, you’ll have to admit that the definition sometimes fits. Nurse gangs sometimes even have initiations.

For a group of nurses to be considered a gang, the group needs to violate policy or break the law in some way. This might include violating your organization’s policies and/or committing unlawful acts such as harassment, discrimination or threats of bodily harm. If a nurse gang targets someone, members might spread false rumors about that person, sabotage them in an attempt to get them terminated or even physically assault them.

Gangs also tend to actively undermine the workplace’s normal management structure. For example, the gang might try to dictate when nurses are allowed to take breaks or even who gets promoted and who doesn’t. A key difference between a clique and a workplace gang is that while cliques usually try to maintain some level of popularity, gangs operate mostly on fear. They want others to be afraid of them. This includes members who try to leave the group!

 

Columns about Groups of Friends versus Cliques versus Gangs

 

What Can You Do to Help Create a Healthier Workplace?

If your workplace is beset by cliques and/or gangs, you might feel compelled to get involved, seeing it as the only way to get ahead or telling yourself, “If you can’t beat them, join them.” However, make no mistake about it: Joining a clique or gang is a career-destroyer. But, what do you do if a clique or gang has targeted you? Here are five ways you can protect yourself.

1. Act with confidence

Remember that cliques and gangs rely on instilling fear and insecurity in others. They enjoy watching someone cringe with fear as they walk by. It’s all the worse if members are in positions of actual power; receiving reports from a nervously squirming non-member probably gives them joy.  You can take that joy away from them by standing tall, shoulders back, and communicating with confidence. It makes you less of a target when you act as though they can’t scare you.

When she was hired as a new nurse, Bonnie was warned about the “power clique” on her oncology unit. On her first day, one of the power clique nurses walked by and remarked, “New nurses never last here, and I can tell you won’t either.”

Deciding not to let the clique intimidate her, Bonnie walked right up to the other nurse with her head held high and said respectfully, “Excuse me. Why would you say something so cruel to me on my first day of work?” The clique nurse looked at Bonnie in shock, walked away and never said anything unprofessional to her again. Bonnie had demonstrated that she would not be an easy target.

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2.  Be the consummate professional

Yes, even towards the clique members. This is not to say that you go out of your way to be nice to them, but you should treat them just as you would treat any professional colleague. By doing so, you’re role-modeling the behavior that they should be displaying while sending a message that you’re not going to let them influence your behavior.

Any time Miguel was in charge, he gave the easy assignments to the friends in his clique and the worst assignments to outsiders like Jess. One day, Jess was in charge and had the opportunity to saddle Miguel with a complicated patient with extensive neurological issues, newly transferred from the ICU. Rather than assign the challenging patient to Miguel just to watch him struggle, Jess gave the task to the unit’s certified neuro nurse, who had prior ICU experience.

Although Miguel was shocked that Jess hadn’t zinged him back when she had the chance, Jess told him simply, “I made the decision based on what was best for the patient.”

3. Avoid gossiping about the clique

Although you may be tempted to gossip about them in the break room with other non-clique members, resist the urge! Sometimes, nurses who are not confident in themselves or can’t deal with the pain of exclusion eventually join a clique. Think about how it would play out if this week you were gossiping about clique members to your colleague and the next week that same colleague joined them.

When Lindsey walked into the break room, she saw several of her colleagues sitting around gossiping about their department’s all-female clique. Lindsey was surprised to see Tammy, whom she thought was friends with one of the clique members, sitting at the table too. Lindsey decided to walk out of the break room instead of joining in the discussion. The next day, she overheard Mila, the clique’s leader, yelling at one of the gossiping nurses for talking about her behind her back. Lindsey quickly realized that Tammy had told Mila about the gossip. Lindsey was relieved she left the room when she did!

4. Strip away their power

One common reason why cliques and gangs grow and thrive is because their leaders are in management roles — e.g., charge nurse, coordinator or the person who sets the schedule — that they can abuse for social power.  If you’re in a leadership role, remove their power! If they’re in a charge role, take them out of it; if they’re preceptors, don’t let them precept. Delegate easily abused tasks, like scheduling, to someone else who won’t use that responsibility as a cudgel.

An ICU director reached out to me for help in handling a charge nurse she described as a “toxic force” in her department. Although this nurse gave the worst assignments to people she didn’t like, openly criticized nurses and physicians and even called staff members stupid in front of patients, she was very competent in her role, so everyone just excused or worked around her toxicity.

My recommendation was that she be removed from the charge role immediately because she was using this power to lash out at anyone she didn’t like. The director reluctantly demoted her, which completely changed the dynamics of the department. Team morale greatly improved.

5. Report the gang

Remember, by definition, the behavior of workplace gangs violates policy and may cross the line into criminal behavior. If you have a nurse gang on your unit or department, your patients are at risk. Document all incidents of disruptive behavior and report them immediately to your administration.

After Cindy recovered from the initial shock of having her hair band literally ripped off her head, she reported the incident to her instructor and to the nurse manager. When she returned to the unit the next week, the bullying nurse was no longer there. The manager had suspected this nurse was the ringleader of a gang that was routinely terrorizing the staff and violating several policies, but other nurses had been afraid to report her behavior.

With Cindy’s report and the previous concerns about the nurse’s disruptive behaviors, the manager was finally able to terminate her. Some of the remaining nurses thanked Cindy for speaking up!

It’s no exaggeration to say that the future of nursing depends on our ability to meaningfully address this problem within our profession. As nurses, we have tremendous moral responsibility for our patients and their families. The only way we can fulfill that responsibility is by caring for each other rather than tearing each other down.


Renee Thompson, RN, DNP, CMSRN, CSP,  is a speaker, author, consultant and founder of The Healthy Workforce Institute (www.healthyworkforceinstitute.com).


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