My Eclectic Ideations: Nurse Managers: Who is Really Running Your Department?

It was my 1st travel assignment, & I was assigned a preceptor we will call Gertrude. Gertrude sat in her chair all night, &, literally, did nothing productive. She demanded the attention of her co-workers as she talked about her favorite topic: herself, which further lowered productivity. She made derogatory remarks about Human Resources, co-workers, & the Nurse Manager. She was particularly frustrated with HR because they recently figured out she was overpaid, & they lowered her pay to the appropriate level. She acknowledged that she already knew she was overpaid, but she played stupid. She told me just to copy & paste the last nurse's shift assessment in my EMR. I later found out Gertrude had some negative things to say about me, & other staff bought it. In fact, staff seemed to readily adopt any pessimistic point of view Gertrude had about work. I went & spoke to the Nurse Manager in her office the next morning about my performance, & she mentioned that my preceptor, Gertrude, was her strongest nurse on the unit. If she only knew how Gertrude behaved when no one of authority was watching.

rebubble.com

This is a universal problem though, & here is what Nurse Managers need to hear loud & clear. You may be hitting it out of the ballpark on the following:

Strong leadership skills

A strong moral compass
Fantastic clinical knowledge & critical-thinking skills
Education, training, & experience perfect for the job
Compassion for patients & staff alike
An even temperament & ability to remain objective
Emotional Intelligence
High intellectual capacity
Excellent communication skills
Whatever the heck else makes you a good fit for the job

New Orleans Artist Terrance Osborne

However, there is one critical issue, if ignored, will absolutely destroy your ability to effectively lead. IF YOU ARE UNABLE TO DETECT & EFFECTIVELY MANAGE MANIPULATIVE BEHAVIOR AMONG YOUR EMPLOYEES, YOU ARE NOT EVEN IN CHARGE OF YOUR UNIT OR DEPARTMENT. Who is running your unit? Gertrude - & she is undermining everything you are doing to create & maintain a safe work environment.

If you do not recognize & deal with manipulative behavior, it is whatever staff members who have the strongest narcissistic & borderline personality traits that can wreak havoc among other staff. They are running your unit. It will have a detrimental impact on patient care & on the careers of other staff - & possibly your own at some point.

One of my biggest pet peeves, particularly in the workplace, is manipulative behavior. When fresh out of nursing school, I was experiencing frustration with a co-worker with these tendencies. What do I do? I buy a self-help book specifically on the topic of recognizing & managing manipulative behavior at work. Here is the most important lesson I have learned from reading self-help books over the years. YOU CANNOT IMPROVE YOUR INTERPERSONAL SKILLS BY READING A GOSH DARN BOOK. The book did teach me a lot about RECOGNIZING manipulative behavior, however, it did nothing to reduce my frustration or improve my ability to control it. I realized, over the years, that the only way to deal with it is from a position of authority. It requires someone with the ability to discipline & terminate this person to at least subdue these tendencies. If you leave it to your staff, you are leaving them high & dry.

Imgur, 2020

Let me tell you about the worst encounter with manipulative co-workers I have ever experienced. We will call her Katrina because, like a Category 3 hurricane, she appears somewhat manageable. If you are not prepared for her, however, she is going to flood your entire unit - with dirty flood water. Katrina tells lies so far-fetched, that you would assume that any rational human being would second-guess them. WRONG. Katrina has management so wrapped around her finger, & she has mastered the art of manipulation so well, she will have management saying & doing things as bizarre as her. Otherwise intelligent & rational human beings will band together behind Katrina to take out whatever "terrible" person she convinces them has wronged her. It got to the point that I am worried she is going to convince these people to storm the walls of the capitol & steal Nancy Pelosi's laptop or form a legitimate gang in which everyone wears the same color, packs heat, sells illicit drugs, & uses their designated gang hand signals. Even worse, they have reported false statements to the Board of Nursing on behalf of Katrina. They are seriously lying to a regulatory board & wasting the BON's time fighting for whatever cause Katrina invented. It is the most insane form of groupthink I have ever witnessed in a work environment. Following behind Katrina & banded together, their behavior becomes less & less rational or logical. These are managers putting their own careers at risk because the levy that should have prevented her from flooding the unit was broken. In other words, management lacked the foresight to recognize & manage her manipulative behavior.

I lived in New Orleans, LA in 2005, until 2 weeks before the hurricane hit. I moved to Baltimore, MD to start nursing school, as fortune would have it. It hit the day I started school, & I shed tears the whole week for the city I loved. Katrina ran a lot of good people out of NOLA, just like the Nurse Katrina runs off good employees. She also lowered morale, which led to looting & violence, just like Nurse Katrina managed to increase incivility & bullying at work. Local, state, & federal politicians & organizations were often at odds with each other instead of working together because of the mastermind Katrina. Nurse Katrina works in such a way as well, & this lowers the quality of care & causes patient safety issues. Worst of all, Katrina wreaked havoc on the weakest & most vulnerable of the city; they were defenseless, which made it so easy for Katrina to cause destruction in their lives.

I am going to stop speaking in metaphors & similes & spell out what behaviors to expect from a manipulative employee.

Dr. Ann Brown, 2017

Any time I must deal with a co-worker who is both manipulative & covertly or overtly aggressive, I see the same set of behaviors.

1. Nurse Katrina will engage in rude & disrespectful behavior, &, if a co-worker attempts to stand up for themselves, Nurse Katrina will try to convince others she is the victim in the situation, rather than the perpetrator.

2. Nurse Katrina will upgrade to a Category 5 hurricane if someone insults her fragile ego, over even the smallest slight that your average joe may not even notice.

3. She will gather up troops by manipulating other people (both co-workers & managers) into joining her in destroying people. Some co-workers who can see through it may comply with them anyway to avoid becoming her next target. As the army grows, as in most groupthink behavior, they become less rational & increasingly aggressive, as if their frontal lobe is no longer functional.

4. There is no limit to how far Nurse Katrina is willing to deviate from the truth to build a case against someone she is after, & there is no limit to who she is willing to flood with outright falsehoods, managers, HR, BONs, the Pope, the President of China, whatever.

5. There are 2 types of co-workers Katrina targets: the "easy" targets who have some sort of weakness that makes it easy for her, or someone who has a strength that makes her feel threatened. Katrina must eliminate any threats to her power & control.

6.
The managers are usually the last people to figure out that a staff member like Katrina is causing problems by engaging in the disruptive behavior because they experience a completely different version of that Katrina. She can be charming, persuasive, & seemingly harmless if that is what the situation requires to gain or maintain control. They may see Nurse Katrina or Gertrude as one of their top performers or even a good friend.

Clark, 2011

What covertly or overtly aggressive & manipulative behaviors am I talking about?

1. Speaking to her target in an accusatory or condescending tone in front of patients & other staff to discredit & shame you. She may make you feel like a misbehaving child.

2. Making negative remarks or making fun of you to others as you walk away, possibly hoping you will overhear.

3. Withholding information necessary to do your job.

4. Shutting you out of conversations with other staff in attempt to alienate you from others.

5. Questioning your clinical competency, sanity, or whatever else she can think of to convince others you are an unreliable simpleton with a screw loose who cannot be trusted to perform well or deliver accurate information to others.

6. ANA on Incivility: Incivility can take the form of rude & discourteous actions, of gossiping & spreading rumors, & of refusing to assist a coworker. All of those are an affront to the dignity of a coworker & violate professional standards of respect. Such actions may also include name-calling, using a condescending tone, & expressing public criticism (Andersson & Pearson, 1999; Read & Spence Laschinger, 2013). ANA Position Statement

7. ANA on Bullying: Actions may include, but are not limited to, hostile remarks, verbal attacks, threats, taunts, intimidation, and withholding of support (McNamara, 2012). Such actions occur with greater frequency and intensity than do actions described as uncivil.

Frandsen, 2015

Nurse Katrina is obviously capable of other equally disruptive behaviors, which you can review in the resource links below. The bottom line is that it is up to people capable of setting expectations & enforcing consequences to deal with manipulative staff: Management & HR. Outside of work, years of intensive therapy may help, but your staff, no matter how adept at reading Katrina, are unable to control her behavior; it is up to you. Unaddressed, the consequences are significant. From an individual perspective, every Nurse Katrina I have encountered is always the main factor in the workplace that just seems to suck all the joy out of nursing. Please, Nurse Managers, deal with Katrina in a way that allows you to truly be the leader on your unit & allow for a safe, peaceful work environment for your hard-working, dedicated staff who want to focus on their patient care & career growth instead of Katrina's never-ending storm. Your staff deserves you, the qualified, designated Nurse Manager, as their leader.

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ADDENDUM: All humor aside, this is coming from someone who went through some very painful experiences as a younger, naïve nurse. In today’s climate, &, in light of a heartbreaking, global pandemic, it is more crucial & necessary than ever that we protect & support these newer, younger nurses on the frontline of this war. All healthcare disciplines & all staff, from the bottom to the top of the food chain, should hold themselves accountable for ensuring that our less seasoned nurses are given what they deserve, which is nothing less than respect.

Resources

ANA https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence/

NSO https://www.nso.com/Learning/Artifacts/Articles/Create-effective-anti-bullying-policies

JCAHO https://www.jointcommission.org/resources/patient-safety-topics/sentinel-event/sentinel-event-alert-newsletters/sentinel-event-alert-issue-40-behaviors-that-undermine-a-culture-of-safety/

Nursing Management: Journal of Nursing Excellence in Nursing Leadership https://journals.lww.com/nursingmanagement/fulltext/2016/01000/decreasing_workplace_incivility.8.aspx

AANAC Workplace Bullying: The Signs and What To Do By BETTY FRANDSEN, RN, NHA, MHA, C-NE/MT

The Psychology of Mob Mentality https://www.psychologytoday.com/us/blog/facing-trauma-together/202101/the-psychology-mob-mentality

9 Classic Strategies of Manipulative People https://www.psychologytoday.com/us/blog/in-flux/201610/9-classic-strategies-manipulative-people

DSM-V Borderline Personality Disorder Traits: https://www.medscape.com/answers/913575-165741/what-are-the-dsm-5-diagnostic-criteria-for-borderline-personality-disorder-bpd

DSM-V Narcissistic Personality Disorder Traits: https://www.medscape.com/answers/1519417-101764/what-are-the-dsm-5-diagnostic-criteria-for-narcissistic-personality-disorder-npd

In Sheep's Clothing https://www.amazon.com/Sheeps-Clothing-Understanding-Dealing-Manipulative/dp/1935166301

What Can Organizations Do to Tackle Workplace Bullying? https://www.psychologytoday.com/us/blog/what-doesnt-kill-us/201605/what-can-organizations-do-tackle-workplace-bullying