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Stomp out horizontal hostility

Nurse Leader Weekly, November 16, 2005

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It can be the unit secretary, a nurse aid, a nurse, or even a charge nurse who spreads negativity throughout your organization.

With bad attitudes and continuous complaining, such employees taint what should be the healthy, collegial working environment you try to create and maintain for all staff.

So what can you do to stop the toxic personalities in your organization from stunting the personal and professional growth of other staff? Refuse to tolerate toxic behavior, says Regina L. Phelps, MN, PhD, RN, CNAA, BC, director of education services at Centra Health in Lynchburg, VA.

The term "horizontal hostility" has been coined to label the growing problem of nurse-to-nurse animosity. Horizontal hostility negatively affects the nurses involved as well as staff and managers who may be caught in the middle, and it puts patients' safety at risk.

Phelps teaches managers the warning signs of a toxic personality/situation and the strategies for properly handling such people/situations.

As part of her program, Phelps teaches staff the following:

• Do not tolerate toxic behavior from one another
• Hold each other accountable for poor behavior
• If you are unable to hold someone accountable due to intimidation, talk to your manager. Hold managers accountable for handling toxic personalities/situations; if negative behavior continues, follow the chain of command

Handle toxic personalities

Deal with staff who constantly naysay (standard behavior of a toxic personality) by practicing the following:

- The broken record technique. When a naysayer gives you excuses as to why he or she cannot comply with a policy or procedure, simply repeat-and continue to repeat as necessary-the action or behavior you expect.

- Accountability. Hold staff accountable for their behavior. For example, if you receive a complaint from a nurse that suggests that a charge nurse unfairly assigns the more difficult patient cases to him or her, tell the charge nurse that you've received complaints about the way he or she assigns cases, and ask to see the assignment sheets for the week. Then continue to monitor the assignment process.

- Monitoring behavior. After setting the expectations, monitor the results. Set the expectation for improved behavior by giving a date by when you expect to see improvement (immediately is a deadline). Then monitor the results and set a clear expectation to maintain the improvement.

- Document the process. Ensure you properly document everything, just in case employee termination becomes necessary.

Warning signs of toxic behavior

To help managers recognize toxic behavior, Phelps suggests monitoring the following:

• Turnover rates. By keeping an eye on the turnover rates of individual shifts, managers can find problem areas that staff may be uncomfortable discussing with them.
• Call-in ratios. Look for call-in patterns to see if staff call in more frequently when a particular staff member is scheduled.
• Orientation dropouts. If you have a large number of new nurses leaving the organization, find out why.

Editor's note: This article is adapted from The Staff Educator, October 2005, HCPro, Inc.

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