Teresa has been a nurse in the Surgical ICU for 45 years. She’s known for her excellent clinical skills, especially when it comes to the sickest of the sick. If a patient becomes critical on the unit, you want Teresa there.
However, Teresa is also known for her sharp tongue, abrasive tone, and drill sergeant style approach towards anyone whom she believes isn’t equally excellent (which is nobody). Many nurses, physicians, and support staff have been seen in tears after an encounter with Teresa.
Some say that Teresa just has high standards. Others say she’s a bully.
How do you know?
Some nurses are extremely competent and possess excellent clinical skills. They are the ones you want present in a crisis situation but not necessarily the ones you want consoling a new nurse after his or her first patient death (Suck it up buttercup).
These nurses treat others like they are beneath them. I’ve heard numerous stories about so called brilliant nurses who won’t help others, act like they’re the only competent humans in the organization and treat others with arrogance and contempt.
I recently had a conversation with a nurse leader who asked for my help. He told me about a nurse, Carol, who had 30 years’ experience, provided the best care of any nurse in his department, was so clinically excellent, but Carol was mean and nasty to others. Carol wouldn’t help the new nurses and instead, would say, “I don’t have time to teach you. You should have learned that in nursing school.” Nurses were constantly in his office in tears about how Carol criticized and embarrassed them in front of others. To make matters worse, Carol was also frequently in his office complaining about how incompetent everyone was.
He was getting attacked at both ends! However, because he knew Carol was soooo excellent, he justified her behavior by saying things like…
…she is very particular…
…gives great patient care…
…don’t take it personally. She just has really high standards…
How many times have you heard someone justify rude and condescending behavior because of someone’s “excellent skills” or “high standards”? Aren’t these folks just a bunch of bullies?
How can you tell?
High Standards versus Bullying
Having high standards is a good thing, especially in healthcare when the stakes are high. However, there is a difference, although sometimes not immediately obvious, between someone who has high standards and someone who is unprofessional, rude, and who may be bullying others. If you’re not sure, consider how you would answer these 5 questions:
- What do they talk about?
Nurses with high standards talk about evidence and best practice. They typically cite studies, recent research, and attend in-services, conferences, etc. without being prompted or paid. They are always trying to improve the care they and others are providing.
Nurses who bully, talk about the way it’s always been done here. When a new nurse mentions best practice or an article they recently read, they are immediately attacked. They are the ones who typically don’t join committees, councils, or attend continuing education opportunities. If they do, they complain about it.
- Do they share their knowledge with others?
Nurses with high standards share everything. When asked questions, they stop and answer, often times going out of their way to help someone learn because they understand that by helping their colleagues, they are raising the standard of their team and improving the quality of care for decades to come.
Arrogant bullies hoard their knowledge and are frequently heard saying, “That’s not my job to teach you. Look it up yourself.” They refuse to help others, even though they could.
- Do they teach others?
Nurses with high standards coach and teach others. They take others under their wing and help others develop better skills. In a code situation, these nurses pull new nurses into the room and say, “Now watch this and we’ll talk about it later.”
Arrogant bullies humiliate and criticize. They make others feel incompetent and are frequently overheard complaining about how “stupid” some people are. Even though they could, they choose not to help others improve their skills.
- What communication style do they use at work?
Nurses with high standards incorporate the assertive communication style at work. They provide honest and respectful feedback to their peers. If someone makes a mistake or forgets to do something, they don’t talk about them behind their backs – they let them know in a respectful manner.
Bullies tend to use the passive-aggressive or aggressive communication style. They may be nice to your face, but they stab you in the back as soon as you turn around. Or, they berate you in front of others; sometimes patients and their families.
- Do they compete or collaborate?
Nurses with high standards are collaborative. They complement others for their knowledge and skills and are frequently the ones who nominate others for awards, will ask to partner with them on projects, and look for opportunities for others to advance.
Bullies are competitive and love to squash their competition. They see the workplace as a battlefield and are always prepared for a fight. If they believe someone is potentially more skilled or knowledgeable, they will spend energy trying to slay them.
I recently saw a meme posted on Facebook from @nursekelsey.
Apparently, she overheard an ICU nurse taking report on an actively coding patient, I’m assuming from a medsurg unit. This ICU nurse was overheard saying to a medsurg nurse, “You’re doing great. I just need the basics. You sound calm. Great job. Deep breath. Bring him down.”
Why should this be so remarkable that many of us felt compelled to share it on Facebook? Because it’s not the norm but it should be!
This is the advice I gave the manager who reached out for help with Carol:
- Engage in honest conversations
Chances are, nobody has ever said to this nurse, “You may be clinically competent but the way you treat your colleagues isn’t okay.” You can’t assume someone knows how they come across and you expect someone to change their behavior just because you think they should. Have the courage to tell them the truth.
- Set clear behavioral expectations with this nurse
When you finally engage in an honest conversation about their behavior, the next step is to tell them exactly how you want them to behavior. For example, say this, “As a competent experienced nurse, I expect you to become the role model for collaborative practice. This means attending in services, helping anyone who needs help, teaching other skills that you have that they may be lacking, etc.”
- Have the legacy talk with this nurse
Say this, “When you leave here (retire), what legacy do you want to leave? What do you want people to say about you? That you were so clinically excellent, but you were mean, didn’t help others, hoarded your knowledge and tried to squash anyone with potential? Or, do you want people to say that you were brilliant and helped them to become a better nurse?
As the leader, it’s your responsibility to cultivate culture where all employees strive for high standards, which can only be achieved when nurses talk about best practice, share knowledge and teach others, are honest and respectful of each other, and collaborate with all members of the healthcare team.
There’s a fine line between competence and arrogance. Bullies cross the line. Don’t let them.