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Stop Tolerating Bad Managers

Rebecca Hendren, for HealthLeaders Media, October 11, 2011

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.”

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4 comments on "Stop Tolerating Bad Managers"


Jennifer (10/30/2011 at 12:02 PM)
I found this article and response comments frustrating on levels. There are those managers who continue fail to meet performance expectations and they should be coached and counseled appropriately up to and including exiting the organization. I have fortunately met very few of those people as a staff member or a leader but they are frequently the ones the physicians like and go to bat for. There is more to explore when discussing "bad managers". Executives who have bad managers might need to look no further than in the mirror. Lack of support, lack of mentoring and failure to communicate and set expectations is a commonly voiced frustration of front-line managers. Combine that with a huge workload including productivity, documentation,risk,financial/regulatory audits,multiple performance reviews and working with staff who frequently make more money for much less accountability. Its not surprising nurses are not interested in leadership roles given what the job entails. Management is the art of getting work done through the contribution of others. Managers are often told by senior leaders; its their responsibility to "get staff" to do things. Many of us know how effective those kinds of directives are. To really change the culture of healthcare executive leadership could start investing in manager selection, development and performance management. Look realistically at span of control and workload for managers and consider flexible schedules and other creative ideas for salaried managers to increase their satisfaction and retention. Managers are employees too- take the time to find out why they are failing, what motivates them and the tools they need to be successful.We might have less "bad managers" out there than we think.

Darlene Hall (10/13/2011 at 1:15 PM)
Too often, as with poor patient satisfaction surveys, staff nurses are blamed for the low scores rather than the managers themselves who are not part of direct patient care. The new healthcare reform has changed healthcare reimbursement based upon patient satisfaction/experience thus causing a decrease in nursing workforce in some instances. This in turn, leads to a top heavy facility with managers that try to create nurses who are completely submissive, afraid, and are controlled. Unhappy nurses leads to unhappy patients.

John J Simon III (10/12/2011 at 12:27 PM)
I understand that this is a nursing site but I think all patient care leaders need to be strong representatives of compassion not only towards their patients but also to each other. We need to have those crucial conversations while creating the atmosphere of trust. Bad behavior on the part of authority can be a safety issue. If an employee sees something at the initial point of being potentially unsafe and does nothing for fear of reprimand we might be performing RCA's.