We’ve all either heard it or said it; she’s a great nurse but she’s toxic. Or, a great physician, but… Why is it that we won’t tolerate someone’s poor performance in healthcare (think incompetence) but we turn a blind eye to poor behavior? I’ve even heard it said about some people that they are just “too good” to fire!
I recently shared on social media a resource I created that described the 5 Worst Mistakes Leaders Make When Addressing Bad Behavior. Based on our research at the Healthy Workforce Institute, we’ve worked with thousands of front-line leaders who share common mistakes. One of them is tolerating bad behavior just because someone is excellent at their job.
What I wrote was, “Another mistake leaders make when addressing bad behavior is ignoring bad behavior because the employee is excellent. So, what SHOULD you do?”
This post generated a lot of comments surrounding the term “excellent” for nurses, physicians, executives, etc. even though they behave badly. They basically said that it’s impossible for an employee to be considered excellent if they exhibit bad behavior, yet we say it all the time. That we tolerate toxicity just because of the amount of revenue they bring into the organization or that they’re “a body” (think nursing shortage), or that they are just too “good” to fire.
Here are a couple of the comments:
“Help me understand how an employee with bad behavior is an excellent employee?!”
“No bully is an excellent employee. That is an oxymoron”
If we all agree that you can’t be called “excellent” if you’re toxic, why do we do it? Could it be because we’re really not sure?
How can you tell if someone is excellent but toxic?
Tara has been working as an ICU nurse for decades and has a reputation for eating students, new nurses, and new physicians for breakfast! When healthcare professionals are hired, they are often warned about Tara. When they get pulled into the ICU, they are warned about Tara. When there is change in leadership in the ICU, guess what? They are warned about Tara.
Tara is a toxic employee, and everyone knows it. New healthcare professionals drop like flies and experienced ones somehow find ways to transfer to other units. Turnover is high and staff morale is low.
Why is someone like Tara allowed to continue working if she is so toxic?
Tara remains employed for 1 primary reason: Tara is considered an “excellent” clinician.
She is the one you want to work with when a patient codes and the one you want caring for your mother. She has saved numerous lives and prevented numerous errors (by both physicians and nurses). Tara never seems to get tired or burned out and therefore works as much overtime as needed. Everyone, even the leadership team, tolerates Tara.
Is Tara then too good to fire?
Healthcare professionals share their horror stories about the meanest, nastiest nurse (like Tara) who is somehow allowed to continue wreaking havoc on their unit without fear of discipline from the manager. Although at times, complaints may be filed against this person, the leadership team typically responds in one of 4 ways:
- Deny (I can’t believe she would really do that…)
- Minimize (how bad could she really be?)
- Rationalize (you know, her life really hasn’t been easy…)
- Intellectualize (but she’s such an excellent nurse. The physicians love her!)
Tara was so hypercritical, unapproachable, and evil to her co-workers (oh, but her patients LOVED her!). When a complaint was filed against her by a group of her peers, the solution “brilliantly” thought up by management was to send the entire unit, all 75 of them, to a 4-hour workshop on how to deal with negative co-workers. Seriously? Imagine the cost to the unit in terms of dollars AND morale. Basically, what management was saying was that the staff was helpless to do anything about it. No wonder the nurses were leaving in droves.
But with the COVID-19 pandemic adding more staffing issues to an already high demand profession, how can any healthcare organization afford to fire ANYONE?
Why you need to fire your excellent but toxic employees
According to Mike Irvine, LinkedIn Talent Blog, “The Most In-Demand Jobs Right Now,” registered nursing was the fifth most in-demand job. By 2030, it is projected that a whopping 1.2 million new RNs will be needed to address the shortage we are experiencing now.
So again, I ask-how can you fire any healthcare professional right now, no matter how unprofessional they are?
Instead of justifying toxic behavior, leaders need to realize that nobody, no matter how clinically excellent they are, is too good to fire!
Nobody is too good to fire
I don’t care if the nurse is brilliant or can hold her bladder for 24 hours. If she is a bully and you’ve told her to stop, she needs to be fired! Ignoring bad behavior because it’s “a body” is really a short-sighted strategy. Wouldn’t you rather be short-staffed with amazing healthcare professionals than fully staffed with a bunch of mean and nasty ones?
- 23% of nurses considered quitting because of incivility by healthcare professionals (Maxfield, et al., 2005).
- In a study in 102 hospitals with 4,530 participants, 67% agreed that intimidating behaviors were linked with adverse effects including 27% stating this resulted in patient death (Rosenstein & O’Daniel, 2008).
- In an emergency department, 70% of errors were associated with bullying, and uncivil behaviors (Schaefer, Helmreich, & Schedieggar, 1994).
Trust me. Keeping toxic employees in your organization is a mistake! Nobody is too “good” to fire.
How to stop tolerating toxic employees
Stop allowing your toxic employee to remain employed just because he/she is a good clinician or works as much overtime as you need!
Stop making excuses and justifying their behavior!
Stop protecting ONE toxic employee at the expense of the remaining 75+ good employees.
Start advocating for the rest of your employees by taking action against bad behavior no matter what. Adopt a philosophy that to remain employed, employees have to be clinically AND professionally competent.
As Perry Belcher said so well, “Nothing will kill a great employee faster than watching you tolerate a bad one.”
What we ignore, we condone. What we tolerate, we become. Bullying and toxicity undermine a culture of collaboration, a healthy work environment and patient safety – period. Got a bully? They need to go no matter how “excellent” they are.