part 3 navigating toxic systems
clearing toxicity: scenarios, insights, and reflections
13.1 Mergers/Demergers
13.2 Easy Change
clearing toxicity: scenarios, insights, and reflections
14.1 Painful Practice
14.2 Family Friction
14.3 Power Trip
14.4 Nurses as Victims
14.5 Challenging Patients
14.6 Stereotypes/Biases Against Patients
15 on the battlefield: nurses under attack
clearing toxicity: scenarios, insights, and reflections
15.1 Physical Attack
15.2 Too Touchy
15.3 All the Wrong Attention
clearing toxicity: scenarios, insights, and reflections
16.1 Burned Out
16.2 Ambitious Attributes
16.3 Organizationally Cynical Energy Vampires
16.4 Special
16.5 Unsupportive Support
16.6 Replaceable
embodying transformational leadership
reflections on authentic leadership
a is your management style causing conflict?
c organizational cynicism self-assessment
d when it’s time to seek outside counsel
introduction
Today’s nurse managers face unprecedented demands in their role as leaders of the largest healthcare workforce in the industry: They must be clinically competent, relationally savvy, and administratively gifted. The lopsided aging of the population has had a double impact: More nurses are retiring from the profession at the same time as elderly baby boomers require increasingly complex and costly care.
Implementation of the Affordable Care Act came with a renewed effort to contain healthcare costs and promote accessible, high-quality care, partially through the use of the electronic health record, which currently consumes half of the work nurses and physicians perform (Brown, 2020). An emphasis on value-based care rather than a fee-for-service model makes a reduction in hospital readmissions vital, even as length of stays dwindle. As healthcare legislation continues to change and evolve, new challenges are sure to be introduced.
Nurse managers are tasked with a wide array of responsibilities, from staffing and budgeting to promoting safe and effective patient care. Ideally, they also work to create and sustain a healthy work environment:
A healthy work environment is one that is safe, empowering, and satisfying, not merely the absence of real and perceived physical or emotional threats to health, but a place of physical, mental, and social well-being, supporting optimal health and safety. A culture of safety is paramount, in which all leaders, managers, healthcare workers, and ancillary staff have a responsibility as part of the interprofessional team to perform with a sense of professionalism, accountability, transparency, involvement, efficiency, and effectiveness. (American Nurses Association [ANA], 2015, p. 21)
Due to a need for filling positions and a lack of succession planning, new nurse managers may not have the training or qualifications to manage effectively, nor the education and support needed to gain traction. Many nurse managers tend to fall into management positions because they have clinical experience or seniority, or perhaps because they are the ones willing to step into such a daunting role. If managers find it difficult to keep their unit staffed, remain within a budget, and maintain low rates of nosocomial infections, then providing support to staff and promoting a healthy work environment are going to feel mightily out of reach. The learning curve for a new nurse manager is steep, and the extended time it may take to train while on the job has the potential to impact negatively on a unit’s culture and morale (Roche, Duffield, Dimitrelis, & Frew, 2015). In a survey of 1,600 nurses, intent to leave their current workplace was closely related to the nurse manager’s leadership characteristics. The nurse manager’s people skills were identified as the most desired characteristic (Roche et al., 2015).
transformational leadership
Transformational leadership is based on five practices that promote “open communication, inspiration, enthusiasm,