See no evil, hear no evil, speak no evil


Shining Light on Our Complicit Behavior

As I traveled across the country in 2016 speaking to nurse leaders, there was agreement on several points addressing disruptive behavior. The nurse leaders estimated that the majority of their nursing staff (85%) demonstrated the practices that align with showing up to work ready and willing to do the right thing. These staff members report to work committed to delivering the same consistent, high quality of care day-in and day-out while maintaining a work atmosphere that is both collegial and civil.

It followed then, that the remaining 15% of their staff members are those who exhibit consistent, disruptive attitudes and behaviors. There was also agreement among these nurse leaders that, of this troublesome 15% of staff members, those considered to be chronically uncivil made up 10% of this number. That left the percentage of disruptive staff members who exhibit actual bullying behavior at 5%.

Conventional wisdom tells us, that as leaders we should be able to get our minds and teams around 5% of any issue or challenge with reasonable effort. If there was a perceived or actual 5% spike in inpatient falls with injuries, avoidable pressure ulcers, or any other nurse-sensitive quality metric, we would have a corrective action plan in place within hours. Why then are we challenged in putting an effective strategy in place when it comes to the 5% of disruptive staff members exhibiting destructive bullying behavior?

The answer to this question has several aspects to it. First, we have incredibly knowledgeable and skilled colleagues that devote their professional energies to the advancement of the care of patients with behavioral health issues. However, given the choice of caring for one emotionally disturbed patient or a busload of multiple trauma patients, most of us are going to choose the trauma patients.

We are not comfortable, let alone as skilled as we need to be, with the management of aberrant behavior. We prefer to address care issues that respond well to antibiotics, chest compressions, or restoring a patent airway. Managing behavior is challenging and time-consuming. It is often unpredictable and can require incredible patience.

Managing aggressive behavior can trigger anyone to feel threatened and at risk. The continuum of responses can range from meeting fire with fire to regression, and peacekeeping tactics. Given the typical workload on any given workday, it is not uncommon for managers and leaders to prioritize addressing staff behavior issues at the bottom of a very long list of things to do. Many leaders will opt out altogether preferring to insist that those involved manage the problems themselves.

However, a significant part of the answer lies in our very caring natures. We are professional caregivers. We are nurses and nurses never admit defeat! There is always one more thing we haven’t tried or a bit more energy we can invest to make a difference. Here is where we become part of the problem instead of part of the answer.

When someone shows us their true colors, we consistently try to repaint them. Have you ever made an excuse for a staff member’s bad behavior? Have you ever told someone on orientation that you are going to buddy them with someone who can be a handful but if they (the orientee) keep their eyes open and mouth closed they can learn a lot? When did public relations manager for disruptive colleagues become part of our ever-expanding role?

A bully (narcissist with a license) is counting on just this kind of ingrained peacekeeping response to remedying an uncomfortable situation. There is a reason why bullying thrives in the industry of healthcare and more specifically, in the caring profession of nursing. Narcissists not only need to surround themselves with willing givers but, they must be around people who are willing to give until it hurts. They need people who can be counted on to move the finish line, explain away, or accommodate the bad behavior.
Acknowledging this excessive caregiving, co-dependent trait in ourselves is the first step to rethinking our approach to managing the toxic 5% of staff.

Excessive caregiving usually appears as the tendency toward being helpful to everyone. We help family and friends often without being asked. We help staff and coworkers even though they can handle a task or situation themselves. We get so caught up in the act of being helpful that we forget that nurses were never intended to fix things. That is not our mission. It is not our purpose to be helpful. Nurses are meant to be therapeutic.

Being helpful promotes dependency, not independence. Our good intentions interfere with a person’s ability to change, adapt, and grow to accept the reality of a situation. When we choose to be helpful instead of choosing to be therapeutic, we begin to flirt with the behaviors of enabling and co-dependency. We keep people stuck. We become complicit.

I have discovered a common thread among those nurses who seemed compelled to try to fix things. Often, they are the firstborn or the second of siblings in a family where the role of the firstborn was essentially abdicated to the second child. It is not uncommon for these nurses to share that they were brought up in a family where there was an abuse of a substance or where one parent was absent or chronically ill. The common thread is this. These nurses were inappropriately asked to step into vacant adult roles and assume
those adult responsibilities at a very early age with absolutely no preparation. They were thrown into the deep end of life, and it was, sink or swim.

They learned, all too young, what it took to get things done while maintaining or restoring a sense of equilibrium in delicate social situations. By the time they were teenagers, they had excelled at it. They essentially behaved in a manner that filled in the maturity gaps for the others in their world who resisted or could not act responsibly. It is no stretch to understand why these nurses would employ a method of maintaining the illusion of peace and stability at work that is dysfunctional. It was a remedy that they believe has always worked for them.

Asking these nurses to change this habitual allowing behavior is like asking them to relearn how to breathe. It is not easy to stand in the realization that your well-meant intentions and actions were enabling individuals to embrace dysfunction rather than growth. But once you understand the reasons why you were prone to fixing (enabling) and reach the realization that your actions were just misguided and not malevolent, it is easier to move forward.

Once we, as nurse leaders, can compassionately accept that, in many cases, we have been complicit and that the goal of peace at any price is far too high a price for the majority (85%) of staff to pay for showing up to work daily. They endure the disruptive behavior, watch our actions, and pray that we will eventually do the right things. They have been patient and disappointed for far too long


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