Communication Challenge for Healthcare Professionals #1

Frustrated Nurse Manager Wants Help with Passive-aggressive Behaviors

Here are my initial thoughts for the nurse manager:

Dear Frustrated Nurse Manager,

Thanks for this great albeit difficult situation to discuss.  Ultimately, it is your decision how to proceed and I offer the following comments for you to consider as you develop your strategy.

This nurse’s behavior has become a chronic problem and one which seems to be tolerated thereby giving her permission to continue. It is always hard to change boundaries and will likely be a tricky and stressful process for you, her and anyone else involved. If it isn’t addressed, however, it will likely continue and who knows the extent of damage this is causing in terms of quality, safety, morale, etc.

A two pronged approach should be considered i.e. one which addresses the culture of the unit and one which addresses the individual.

Addressing the Employee

Addressing the employee should include direct feedback. Think carefully about how you can frame this feedback from a kind and helpful way. Be clear in your own mind and heart. Would you want anyone to treat her the way she is treating you?  Would you intervene on her behalf?  She likely has an invaluable skill set in addition to a long committed career both of which deserve lots of respect.  Finding ways to help her be more successful in her interpersonal work relationships or happier at work could be helpful frames.

'I' Statements with a true spirit of ownership can be especially effective given the subtlety issue. You have a right to your feelings regardless of her intention or cleverness in disguising comments/gestures.  An example might be, “I feel frustrated when you roll your eyes and make inaudible comments with the tone you just used.  It makes me feel like you don’t respect me or what I am saying.  I’d appreciate it if you would find a more respectful and constructive way of offering your feedback.” 

I wonder if you have honored the shift in your relationship somehow. Changes in power dynamics are tough even in the healthiest of cultures. This doesn't need to be a big deal.  “Sometimes it is hard for me to be in this supervisory role and I miss our former relationship. I am committed to my new role though and I hope we can find a way to have a more respectful dynamic between us.  Keep in mind that you cannot insist on her respecting you, but you can expect to be treated respectfully. If this is not successful or you do not feel safe, or she refuses to listen to feedback, then you may want to consider a progressive disciplinary approach.

Addressing the Unit Culture

At the same time, it is important that the unit begin the process of setting clear standards for interpersonal behavior. This would include creating or recreating norms and considering any training required to ensure ALL staff have the skills to practice them. This might include a variety of communication workshops. A plan for enforcing and monitoring new behaviors must be part of the process as well. It is helpful if the organization has consistent norms to fall back on.

I think it is critical to touch base with your supervisor somehow. Leadership commitment for any culture change is essential.  You don't need to talk about why she didn't address the situ, but rather get her consent for you to. If she wants to address it, fine but this is about moving forward and we are ALL learning. Another reason to talk with her about it is to consider what support you might need. You can role model an assertive approach here too. Even if she is 'hands-off' in a general way, this may be an opportunity for her to actively support you and you can consider what this might look like. A dry run though, a debriefing session after you have a conversation with the employee, a job coach, (if she isn't willing/able to play this role) or maybe just asking her to check in with you every couple of weeks for a few months to discuss progress. Another thought would be to get help/support in development of a clear expectation and how that may fit in with performance issues. At any rate, think about what YOU need from her and then ask for it. 

 
Finally, it is important to realize that those who are offering excuses for her are also tolerating the behavior. You will be role modeling for them too that you expect to be treated respectfully. And that you

expect EVERYONE on the unit to treat each other respectfully. The favoritism you mentioned when you were peers is probably another side of this dynamic. Perhaps there are some ways for you to get staff buy-in by asking what they need in order to get to a place where respectful verbal and non-verbal communication is the norm. In bullying school programs there is often a guideline: "No Innocent Bystanders".

Good luck, this crucial work will take time and persistence. 

Beth

What do you think of this advice?  I’m always interested in feedback so feel free to send me an email. 

In my podcast on this same topic, I offer more coaching support for a similar situation.   Also, don’t forget to check out my book     

Confident Voices eNewsletter Archives

Beth’s Home Page