Healthy Workforce

The Case of the Negative Newbie

Positive, constructive feedback is necessary to improve behavior

Gretchen is an experienced orthopedics nurse who is currently precepting new grad nurse Tammy. Although she is progressing well clinically, Tammy has a condescending attitude towards the support staff. She makes negative comments about them in the break room and rolls her eyes when they ask questions.

Once, when another nurse asked for Tammy’s help in cleaning a patient, Gretchen overheardTammy say, “Get the CNAs to do it. They’re used to the dirty work.”

We often associate workplace incivility with established cliques and hostile old hands, but it sometimes starts with the arrival of new nurses with bad attitudes. If not corrected, this negativity can lead to a toxic work environment.

What should be done to set a nurse like Tammy on the right path?

 

Take Responsibility

Although many nurses believe it’s the manager’s responsibility to address personnel problems, any staff member who witnesses negative or disruptive behavior (e.g., yelling, cursing, derogatory comments, gossiping) should speak up. In the case described on the facing page, the preceptor, Gretchen, witnessed Tammy’s unprofessional comments. However, so did the nurse who asked Tammy for help. If Gretchen didn’t intervene, that other nurse had a responsibility to address Tammy’s rude comments.

Prepare a Script

When they witness disrespectful or disruptive behavior, many nurses don’t know what to say, so they say nothing. It’s easy to get caught off-guard in the moment, so the key is to have simple, powerful “scripts” prepared ahead of time. What could Gretchen have said when she overheard Tammy’s comments about “dirty work”?

Hiring Now

A good response would have been to immediately interrupt her and say, “Time out. What you just said is not okay. I need to speak with you privately.”

This statement includes three important elements. First, it interrupts the behavior so that it doesn’t continue. Second, it says unequivocally that the behavior will not be tolerated. Third, it continues the conversation in private. (The goal is to correct negative behavior, not to compound it with a humiliating public reprimand.)

Possible scripts for private conversations:

• “Can you help me understand why you think it’s okay to treat our support staff in this manner?”
• “Every person on this team is valued.”
• “Our core principles are …” followed by relevant organizational or unit values or principles such as kindness, integrity, compassion and respect.
• “I want you to treat our support staff as colleagues, not as servants or second-class citizens.”

Each of these scripts firmly but respectfully sets expectations for appropriate behavior.

Give Honest Feedback

Anyone may behave in a disrespectful manner when in a stressful situation. However, some nurses demonstrate a consistent pattern of such behavior and will not change until it is brought to their attention. For example, Gretchen might say to Tammy, “I’m not sure you’re aware, but I’ve noticed you can be condescending towards the CNAs. When you treat anyone on our team that way, it disrupts the way we work together.”

The Friday Newsletter

Lively career advice, nursing news and the latest RN job openings delivered to your inbox every week. Feel inspired by your work.

View Sample

Whatever the specific words, the feedback should be clear and honest; it should describe specific, observable behaviors; and it should explain the impact it has on the workplace, particularly as it affects patient care. (A nurse who doesn’t care about the impact of his or her actions on patients shouldn’t be a nurse!)

Document Behavior

Tammy’s behavior is very concerning because it indicates that she sees herself as better than others. Negative behavior that stems from a nurse’s personality traits or core beliefs (rather than an overreaction to stress or simply being unaware) is harder to fix and may indicate that a nurse is not suited for the team or organization — or even the profession. For this reason, it’s critically important to document such behavior and all future incidents.

Documentation should include:
  • The date, time, location and any witnesses.
  • An objective description of the incident, recording actions or statements as close to verbatim as possible.
  • Notes that align the negative behavior with relevant patient safety, quality, satisfaction or team communication issues. If the nurse who documents the incident is not a manager, they should alert their manager to these concerns, provide a copy of the documentation and note the possibility of a pattern of behavior. Nursing leadership should take immediate action to address the problem.

Resolution

In the case described above, Gretchen did ask the manager for help in addressing Tammy’s behavior. Tammy apologized and promised to change. This story has a happy ending: Tammy completed orientation and a year later started precepting new nurses herself. She frequently shares the story of how Gretchen called her out on her behavior and what a gift that intervention turned out to be.


Renee Thompson, RN, DNP, CMSRN, CSP, is a speaker, author, consultant and founder of The Healthy Workforce Institute – www.healthyworkforceinstitute.com –  whose goal is to eradicate nurse bullying and incivility.

Illustration by Jasmin Mora – www.jasminmora.com


In this Article: , , ,

Latest Articles