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Workplace toxicity is a frequent topic discussed among nurses, whether on social media, in blog posts, on podcast episodes, or in day-to-day conversations at work. Bullying, incivility, harassment, and aggressive behavior can be found in many American healthcare workplaces, and nursing can sadly be a profession overrun with toxic behaviors. We found in Vivian’s recent workforce survey that 76.4% of healthcare professionals feel morale in their hospital had gotten worse since this time last year.
Since so many nurses face these types of situations on a daily basis, nurses need to practice advocating for themselves and finding ways to feel empowered when faced with toxic workplaces, and managers. After all, it’s hard to have a satisfying nursing career if you don’t feel safe.
Pushing Back Against Bullying
Self-advocacy means speaking up for yourself and making your needs, opinions, and feelings known. In your work as a nurse, your self-advocacy may look like going toe-to-toe with a nurse bully, communicating clearly with a toxic manager who seems hell-bent on making everyone’s life a living hell, or meeting with your hospital’s administration to discuss the latest evidence on safe staffing and how nurse-patient ratios on your unit are damaging patient outcomes.
If you’re being harassed, intimidated, or poorly treated by one or more colleagues, you’re not alone, and advocating for yourself is paramount. According to Our Own Worst Enemies: The Nurse Bullying Epidemic, a 2019 article published on the website of the National Library of Medicine, studies show that high numbers of both nursing students and working nurses experience bullying or other negative behavior, including up to 60% of nurse managers and executives, and 78% of students.
According to Dr. Renee Thompson, one of the country’s leading authorities on incivility in healthcare and nursing, there are specific actions a nurse can take in order to advocate for themselves in the presence of toxicity and bullying. First, negative behavior has to be documented in a formal way, and if someone can get witness statements in writing, even better. Second, if you can link a bully’s behavior to compromised patient safety, it is more likely to catch leadership’s attention.
A strong form of self-advocacy, when confronted with bullying, is having the courage and sense of personal power to call the bully out on their behavior. Bullies thrive on perceived weakness or vulnerability, so showing them the opposite can stop them in their tracks.
Stating what you see and how it doesn’t fit with the work environment can demonstrate your unwillingness to be a target. For example, you could say, “Rolling your eyes when I ask a question and making fun of my shoes and scrubs in front of colleagues and patients isn’t how we do things here, and I have no problem documenting what happened. I want you to know that I won’t accept being on the receiving end of such rude behavior, nor will anyone else.”
The Toxic Manager
A toxic boss is a human landmine that nurses may need to deal with in order to simply do their jobs. Gallup reports that, of more than 7,000 workers surveyed, 50% had left a job to get away from a bad manager.
If a toxic nurse manager or supervisor is the issue, they may show any number of behaviors, including, but not limited to:
- Taking credit for successes that they had nothing to do with
- Playing favorites, speaking negatively about certain staff members, and creating division and cliques through gossip and scapegoating
- Micromanaging
- Giving unhelpful, blaming criticism without constructive feedback
- Putting blame on others without taking personal responsibility
- Gaslighting
- Passive-aggressively ignoring or neglecting staff
When you have a toxic manager on your hands, there are options in how you can respond, keeping in mind that the power imbalance between you can often stand in the way. However, these strategies are worth a try:
- Talk openly with your manager and explain how their behavior is negatively impacting your work and morale; appeal to their humanity
- Don’t ignore the behavior; your silence can be seen as acceptance of their bad behavior
- Ask for positive, constructive feedback—and point out if the feedback is not actionable or helpful
- Find ways to be supportive and create a positive working relationship
- Just as with a bully, document incidents in a detailed manner, including witness statements, if possible
- Study and learn skills related to emotional intelligence (EI) and Non-Violent Communication (NVC)
- Have clear boundaries and maintain emotional distance by always being professional and courteous
- Bring your complaints (and documentation) to Human Resources
- Resign if necessary and seek a healthier work environment
- Most importantly, don’t blame yourself
Self-Advocacy Matters
Sticking up for yourself in the face of toxicity is necessary, but can be very difficult. But, the choice to avoid or ignore toxic behavior can often backfire, leaving you even more exposed to bullying and intimidation, not to mention burnout, compassion fatigue, and deep unhappiness and dissatisfaction.
If you focus on clear communication, strong personal boundaries, emotional intelligence, and protecting yourself, you can go far in helping your current workplace feel safer. You also might become very clear that you need to move on to a healthier environment in the interest of your mental health, your professional development, and the success of your nursing career.
Toxicity in the workplace will never be completely gone, but you can empower yourself to say no to toxic supervisors and environments. You’re a hard-working healthcare professional and you deserve better.
Learn more about nurse advocacy in our related article, The Nurse as Patient Advocate, which explores vital nursing skills and how they can be used through patient education and beyond the bedside.
Unfortunately, the toxic culture usually starts with the “top brass”. I’m a nurse manager and have one employee who is relentlessly toxic. They believe they should be in the role, but do not have the degree required. It’s nothing they should feel bad about, but they project those feelings onto me. Getting everyone in the work place involved in petty drama. Spending more time looking for anything to go to my boss about, who entertains petty gossip (even contributes to it), but ignores my patient safety and staff safety concerns. She has a huge ego. Great nurse, just not qualified for the role she wants. I spoke up…and the investigation was one sided. Not objective. People who speak up for themselves get labeled as being “difficult” for advocating not only for themselves, but for a safer, better work environment for patients and staff. If your admin doesn’t take these types of things seriously, which is often the case, nothing will improve with that person at the top. That’s just the story of every nurse and nurse manager i know. It’s extremely difficult to try and delegate or give constructive feedback to your colleagues.
Thanks for your advice r/o toxicity at work
I work at a facility where the nurses take anywhwere from 7-10 patients. To who do I report this unsafe practice? You mentioned gallup, what other avenues are out there, JACHO, the Board nursing ect?
Thanks for reaching out, Lisa. Start with your State Board of Nursing to see what they suggest. You can also leave a review if you’d like at https://www.vivian.com/facilities/.
Wow, I can’t believe that I too a 10% pay cut to get away from a toxic manager form 114,000 per year to 104,000. I am in a better place, but I am upset that I worked so hard for my pay just to have it swiped away.
At least my anxiety has improved.
Great article! I just finished a travel assignment and was bullied. This article raised a lot of great points.
I had for many years a toxic administrator so I was able to relate to ALL your signs listed. Unfortunately I needed to stay at my location for family reasons. I worked in fear of retaliation at any moment all my years. Thankfully she just retired but I explained to new administrator I have PTSD from working under her reign and he has heard so many stories already shockingly. I definitely was not alone with this feeling. All the surgeons were great, not a mean one in the bunch – they & immediate coworkers made work tolerable. So I need to work out my issues from the old regime and accept the positive new administrator. It’s been 15 years of abuse so it won’t happen overnight.
Not helpful when you’re a new hire and a large number of nurses are unfriendly from day one. Feeling ignored when I speak, people speaking over me, they not making room in the changing area, and are just plain unfriendly, what do I call them on? It’s vague and the response I get from a manager is “they’re just like that”, or they don’t believe me. If I say, “Please say hello back to me because I’m offended when you pretend you didn’t hear me”, it will be more of a problem. Managers can’t change a culture. She may want to speak to one offender, that’s if they want to get involved and that’s really really iffy. They have more important issues to deal with. After 35 years I’ve learned speaking up always backfires usually by retaliation. Ultimately it’s just better to leave. Being a nurse is a tough gig mostly because of the culture. The job itself is really rewarding when you work with kind and supportive people who like what they do
Thank you! It is so difficult to know exactly how to handle workplace abuse. I am currently dealing with a difficult situation at work. I am being ignored(snubbed) and it has been going on long term. It can’t go on because we have to work as a team and we can’t do it without effective communication. That example of what to say in the face of that is so empowering! I would rather give other party a chance before involving Human Resources.
Thank you so much for this article!!!
Thank you for this message. I’ve experienced many forms of a toxic workplace throughout my entire 40 years of nursing, a career I’ve always wanted! Such an awesome thing to endure. I don’t feel things would have turned out any different, if I chose another solution. For me, once there was one individual to name as a cause, it was always others involved. “Birds of the feather flock together.” It was like, the entire workplace became toxic. The only thing left to do was to resign. This happened several times in different environments. Either I was terminated for speaking out, and deemed as the bad wolf; or I decided it was time to leave on my own. Some nurses are their own worst enemies. I’ve learned to speak up when it compromises patient safety. And when a patient is potentially at harm or risk, it’s time to make a decision; especially if management does nothing.
It is hard to push back when the bullying goes all the way up the food chain in management. You have the director, the unit manager, even the administrators not doing their job to help with that situation
Thank you for this 🌷
This seems to refer to bullying by co workers in the form of peer pressure. However, I personally think that the current bullying problem is administration to staff. Please address that. It’s why conditions are unsafe and unfair. Mistakes can be criminally prosecuted. The environment has been made toxic for patients and nurses by corporate Healthcare. ( an oxymoron)
I don’t understand why “leave the position” is basically everyone’s advice. There is no real advice that works and job hopping decreases your credibility, while also losing seniority and long term benefits. I want to know how to truly cope with a babyish, bully manager and coworkers who discriminate against older coworkers.
Great Article I’m going through something like this in my workplace