Stop Tolerating Bad Managers

“What should we do with a manager who screams at employees in the hallways, gossips, and has poor people skills?”

When asked this question at a recent HCPro event, I wanted to respond, “Fire him or her immediately.” In any other industry, the simple answer would be to terminate the manager. Such outrageous behavior is unacceptable from professionals.

In nursing, however, this behavior is too often overlooked when exhibited by managers, when the truth is that bullying and unpleasant behaviors are more common in the manager group than staff nurses. The person who asked the question posed it as a desperate plea for help with a horrible situation. Imagine what the nurses on that unit feel as they go in to work each day, knowing the manager may berate them publically if anything goes wrong.

What is wrong with nursing that we allow this to happen? Similar situations occur every day. Bad managers damage retention, morale, performance, and patient care—so why are there so many of them in nursing and why are they allowed to get away with it?

Ineffective and aggressive managers are tolerated in the culture of healthcare, says nursing communication expert Kathleen Bartholomew, RN, MSN. “It is considered ‘normal’ in healthcare for people to act out and behave badly every once in a while,” she says. Because managers are difficult to hire, a warm body is better than no body. In addition, as long as a manager is within budget, random outbursts are tolerated.

Healthcare organizations historically have made excuses for bad behavior from nursing managers:

• She has stuff going on at home
• He worked a double shift last night
• It was a difficult case
• That’s just the way she is, and has been like that for 20 years

“Hospital leaders are overwhelmed just trying to stay financially viable, so they are myopically focused on the bottom line on which their very survival depends,” says Bartholomew. “If they could only see the impact that these disruptive behaviors have on that bottom line, they would act with the urgency of a code.”

Poor nurse managers don’t simply produce turnover, which is easy to quantify. They have a deeper effect on softer measures, such as teamwork, engagement, and accountability. A manager who exhibits toxic behavior begets the same from his or her employees. This damages efforts to improve patient care and poses a hazard to patient safety. Bartholomew says managers are the culture carriers of an organization. If they demonstrate hostility, then what you see is what you get.

To transform hostile nursing managers, the culture of healthcare needs to change, Bartholomew says. And for that to occur, executive leadership must focus on specific behaviors and better language.

“These two things have historically been considered soft stuff or human resources or personality problems not worthy of attention,” she says. “It is a longstanding bias that must be changed in order to keep our patients safe.”

There are three steps executive leadership can take to change a culture. These steps set behavioral expectations not only for nursing managers but for all employees.

1. Create a foundation of trust 

“The first responsibility of healthcare leaders is to create conditions for trust,” says Bartholomew. “This can only happen when all staff are held accountable to the same rules.” A hospital’s culture will change only when everyone sees that the same rules apply to everyone, from the housekeeping staff to nurses to managers to surgeons.

Explain what behavior is acceptable and what is not, from shouting to gossiping. Don’t limit only to what is said out loud. “Ninety-three percent of all communication is non-verbal,” says Bartholomew. “Call out all non-verbal behaviors.” This includes eye-rolling, sighing, making faces, and ignoring, which can be as damaging as something said out loud.

Give nurses the language skills they need to respond to bad managers and to communicate effectively with them. Bartholomew recommends investing in confrontation education for managers and for staff, staging communication workshops, creating written standards of behavior that include examples and which everyone must sign, and holding role-playing workshops where people get to practice good behavior and how to confront bad behavior.

By doing so, leadership can “change the culture from fear to peer,” says Bartholomew.

I say it’s time to end this nonsense. Everyone has the right to be treated respectfully. Managers who can’t follow the standards of behavior should shape up or be shown the door.