Healthy Workforce

The Case of the Abrasive Perfectionist

Is that nurse a perfectionist with high standards or a bully?

Liz was thrilled when she accepted a job in the medical ICU (MICU) at a large Level I trauma center. However, it wasn’t long before she wondered if she had made the right decision. Liz’s preceptor, Clare, a 30-year MICU veteran, was not what you would call warm and fuzzy. She didn’t smile and had a drill sergeant’s demeanor, becoming abrasive any time Liz made a mistake (even a minor one) or admitted not knowing something.

While Clare was well known for her excellent clinical skills and ability to quickly act in a crisis situation, many nurses and physicians were somewhat afraid of her. Clare ran a tight ship whenever she was in charge, but no one wanted to get on her bad side, which was all too easy to do. Some said that Clare was just a perfectionist with very high standards. Others said she was a bully. Liz wasn’t sure what to think.

Wanting to be as competent as humanly possible is usually a good thing, especially in healthcare, where the stakes are high. However, wanting and expecting the best from yourself and others is one thing; being a bully is another matter.  Unfortunately, when someone is highly skilled, we often justify or rationalize their uncouth behavior by saying things like:

“She’s just very particular.”
“He’s an excellent nurse as long as you don’t get on his bad side.”
“Don’t take it personally. She has impossible standards. She’s like that with everyone.”

Perfectionism vs. Bullying

Where do we draw the line between brusque perfectionism and bullying? Ask yourself these questions:

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WHAT DO THEY TALK ABOUT?

Perfectionist nurses are always focused on providing the very best possible care to patients. These nurses talk about evidence-based practice, cite studies, attend in-services and participate in conferences. They’re passionate about their work and look for opportunities to do better. Bullies hate being challenged, even when their ideas are outdated or wrong. They talk about the way things have always been done. If a new nurse mentions some best practice or new article they recently read, the bully immediately attacks. Bullies aren’t interested in new ideas, and if they have to join a committee or attend a conference or in-service, they complain about it.

DO THEY TEACH OTHERS?

Perfectionist nurses want others to do better. If they call out another nurse for making a mistake, their goal is to help them develop better skills or practices. If the perfectionist takes over in a code situation, they will tell their less-experienced colleagues, “Watch and learn — we’ll review later.” Bullies like to humiliate and undermine others. They make others feel incompetent and ashamed for simple errors. Even when not directly berating colleagues, nurse bullies are frequently overheard complaining about how “stupid” some people are.

DO THEY COLLABORATE OR COMPETE?

Perfectionist nurses love to collaborate with other professionals who share their commitment to top-quality care. They compliment others for their knowledge and skills and treat their peers with obvious respect.  Bullies love to squash anyone they see as competition. If they believe someone is potentially more skilled or knowledgeable, they will spend a lot of energy trying to crush them. They see the workplace as a battlefield and are always prepared for a fight.

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Taking Action

How can you deal with a nurse whose perfectionism makes them a bear? Try these two strategies:

  1. Engage in honest conversations.

    Since people are often reluctant to confront nurses who do their jobs well, it’s quite possible that nobody has ever said to this nurse, “You may be clinically competent, but the way you’re treating me isn’t okay.”  You can’t assume someone knows how they come across. Have the courage to tell them the truth. If they’re really a perfectionist committed to being the best nurse they can, they’ll take it to heart.

  2. Ask for their help.

    If a nurse is a perfectionist, her intentions may be pure and good. She may actually want to see others learn and grow. If you’re a new nurse, try saying something like this: “You’ve been a nurse for a long time. I’m sure you could teach me a lot of things that they don’t teach you in school. Will you help me?” She may take you under her wing, and you may both benefit from it!

All healthcare employees should strive for high standards and best practices, which can only be achieved when nurses share knowledge, are honest and respectful of each other and collaborate with all members of the team. Perfection should be a common goal, not an excuse to drag others down.


Renee Thompson, RN, DNP, CMSRN, CSP, is an author, speaker and consultant. To learn more about how you can eradicate bullying and incivility in your workplace, check out the resources at www.healthyworkforceinstitute.com.

Illustration by Jasmin Mora – www.jasminmora.com


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