How do you manage the highly skilled, toxic nurse?
I'm the nurse manager of a 28-bed medical-surgical unit that employs 22 clinical nurses, three monitor technicians, and 10 nurse technicians. Staff members typically work three 12-hour shifts per week, which is inclusive of interaction with physicians, ancillary staff, family, and patients. Advanced technical skills are a must, superb synergy is a definite, and treating each other with dignity and respect is an uncompromising expectation. I review and discuss our hospital's mission and core values during team and individual meetings. Additionally, as a leader, I model the ideal behaviors that employees should demonstrate as they care for patients and interact with their coworkers.
Each member of my staff has unique skill sets, qualities, and personalities. One nurse has 45 years of experience and serves as a preceptor to several generations of new nurses. Although highly skilled and proficient in delivering excellent patient care, this nurse lacks the level of compassion, hospitality, and respect necessary to engage and retain new nurses on the unit. The most recent example of her behavioral performance deficiency involves being extremely rude to two members of the new nurse cohort, speaking to them in a demeaning tone about a skill set that was challenging for them. She told them, “It's no surprise, given the nursing school you graduated from.” This is in direct violation of the hospital's policy concerning acceptable behavior, which is to be professional, considerate, and positive.
A review of the employee skills and engagement quadrant provides insight for identifying employees' performance and engagement levels. (See Figure 1.) As we consider this nurse and her disregard for the hospital's core values, the quadrant validates that she's a “type 3 employee,” demonstrating sound technical competencies but deficient in exhibiting acceptable cultural behaviors.
Situations concerning this type of nurse are complicated because the nurse manager respects the employee's organizational intelligence, technical proficiency, and years of tenure. However, being mindful of the fear this nurse elicits in other employees, particularly new nurses being precepted, the nurse manager in this scenario decided to develop and execute a plan to improve the nurse's behavior.