EP 74: Building Stronger Nurse Leaders: Addressing Conflict, Respect, and Team Dynamics

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Dr. Renee Thompson:
Plants thrive and grow in a peaceful, nourished environment, right? Well, it's the same with human beings. But what if that environment is not so peaceful? What if it's toxic? Welcome to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. In this podcast, you'll get practical, evidence-based strategies to help you cultivate and sustain a healthy and respectful work culture by tackling an age-old problem in healthcare: bullying and incivility. I am your host, Dr. Renee Thompson.

Dr. Renee Thompson:
Hi, everyone! Welcome back to another episode of the Coffee Break Podcast. Okay, once a month, I get to actually provide our listeners with practical solutions to common situations, and these situations I really gather and have been gathering for years from some of the nurse leaders who reach out to me from some of the conversations I have with leaders during our coaching calls, we do a lot of coaching calls. We also do a monthly live culture call with leaders from across the country. These are our clients, and they, part of that is Q&A. And then also when we host a webinar or I'm doing a live virtual event or in person. These are some of the questions that leaders have asked me. And so I pulled out a few of them to share with you today. Now, please note I am changing some of the details because I want to maintain confidentiality. However, trust me, these situations are real.

Dr. Renee Thompson:
All right. First up, a leader reached out to me, and she said one of her new nurses told her that one of their physicians was incredibly rude to her and berated her in front of other people. This new nurse was very upset, and first of all, the leader acknowledged that she was glad that this new nurse told her about it because a lot of new nurses would have just thought, well, that's just part of the job. So, the fact that she spoke up, even though she didn't say anything to that physician, she did say something to her manager, which was great. So the manager said to me that she met with that physician, and she basically told him what had happened, and she told that physician, you need to apologize to this new nurse. And he did, okay, but after she said to me, one of her colleagues said, I would have never done that. I would never make somebody apologize. And so she asked me, then what should I do? Should we force somebody to apologize?

Dr. Renee Thompson:
Okay. I have a very strong opinion about this. I'm the oldest of five kids. My brother Jerry is only ten months younger than me, and then Eric and Tina came along a couple of years later, and then Amy was the baby. We picked on my siblings all the time as kids. And my sister Tina would run to my mom and tattle on us, and my mother would say, no, you go and apologize to your sister. And so, of course, I'd walk over to my sister, and I'd say, I'm sorry. I wasn't sorry. Okay, I was just mad that I got in trouble. I never forced someone to apologize because I don't want an insincere apology. However, what you can say to someone is the right thing to do is to was to apologize, but that's up to you.

Dr. Renee Thompson:
Okay, now, I do want to add something else here that has shown up over a period of time. So many times, let's say this physician does apologize to that new nurse. And I think he did, but I don't know how she responded. I cannot tell you how many times, and I'm guilty myself, somebody apologizes to you, and you say, don't worry about it. It's okay. No problem. When you do that, you actually lose a little bit of credibility, and you almost make it okay that they treated you that way, okay? You almost negate the fact that they treated you in a way that was very disrespectful. They apologized like, don't worry about it. Makes them think, oh, I guess I wasn't that disrespectful. Here's what you say instead when someone apologizes to you, you just look them in the eye and say, thank you for apologizing. Because that means that you value yourself and don't expect to be treated that way from anyone. But you know, when we say don't worry about it, it really minimizes the situation. Instead, when you say thank you for apologizing, that's right. It's like you saying, that's right. You treated me this way. You should apologize. So think about that the next time somebody treats someone else on your team with disrespect. Again, I never force someone to apologize because, many times, what you end up with is an insincere apology. However, the right thing to do is to apologize.

Dr. Renee Thompson:
Okay, here's another situation. Somebody reached out and said there's someone on her team who constantly argues about everything. And apparently, there was a situation where she had to go over a report with her. So this was somebody in a leadership role? I think she was an assistant nurse manager. She had to go over a report with her. And the report showed some deficits in her charting. Okay. I think it was her documentation. And as she's going through this because, well, first of all, let me just step back. I used to be a stroke coordinator, and we had to follow the Joint Commission's get with the guidelines documentation. You had to make sure all these things were documented in the chart. So, did they have DVT prophylaxis? Did they get there was a gosh, I swear 37 things that we had to go through the charts to make sure we're done. And if a patient who had a stroke, if those 37 things weren't done, we would send a report to that nurse to say, hey, you didn't do this. Hey, you didn't do that. So they hated us, okay. Saying us, it was me and one other person. It's like we're the police. And I was like, okay, we need to figure that out. So that's a whole other conversation. But this was similar where she was sitting down with this person and she was going through some deficits, some things that she missed in her documentation. And this assistant manager told me this nurse kept interrupting her. Yeah, but this and what about that? And just kept interrupting, defending herself, being argumentative to the point where this assistant nurse manager lost it on her. She reacted. She lashed out. They got into this big argument, and then she felt bad. She's like, that's not who I want to be as a leader. I shouldn't have lashed out at her. And she kind of beat herself up, and so we talked through this a little bit, and this is what I shared with her. And this is something that I think can really help you too. We all have triggers, okay? We all have triggers. And a lot of these triggers. It's not like somebody does one thing, and it triggers us. But in this case, this nurse kept interrupting her, and that was a trigger. And one time, we can usually overlook it. But when it keeps coming, that trigger keeps hitting us. That's when we lose the ability to think logically, be rational, and then our amygdala takes over, and the amygdala says, clobber the guy, and you clobber the guy. And that's what happened to her. When I talked to her about was the fact that when we all get triggered, all human beings go through this. Your body tells you you're being triggered. Okay. And what's helpful is just to pay attention. Have you ever had a conversation with someone, and they say something that rubs you the wrong way? Where do you feel that? For me, I feel it in my gut. I get this little pinch in my gut. Some people feel it in their chest. Some people feel it in their head. Okay, you have to pay attention to where are you feeling those triggers. And what I said to her was, the first time she noticed that feeling that she was being triggered, that's when to act. Because your prefrontal cortex is still in control, if you let those triggers keep happening, you're going to get to the point where amygdala takes over.

Dr. Renee Thompson:
And here's a situation I shared with her. And I've shared this before. So you may have heard this. There was one time I needed an emergency haircut. Okay. I travel a lot. My hair was really bad. I even said to my best friend Kimmy, I said, Kimmy, how bad is my hair? Like, I'm going to be traveling. I'm going to be speaking. How bad is it? She'll tell me the truth. It's like, yeah, you need a haircut. I'm like, all right, that means I need to get a haircut because she will always tell me the truth. But I couldn't get in with my hairstylist, so I had to go to a random place. Oh, my gosh, a random place to get a haircut. And I found a place at the mall, and there was a young man who was cutting my hair. I'd say within the first five minutes, he dropped the f-bomb just in casual conversations. And if you've heard me talk before, you know I don't curse. And I actually don't appreciate when people curse in front of me, okay? It makes me uncomfortable. I never grew up with that. I never heard my parents curse. Other people, that was common language in their homes, but not for me growing up. So when I hear something like that, especially, I don't even know him. It's a little jolting for me. I'm like, what? I always let the first one go. Okay, well, then he did it again. And then I was really triggered. And that's when I said to myself, okay, I'm being triggered here. It's going to affect me. What am I going to do? I don't want to get to the point where I am rude to him. So I said to myself, the next time he drops the f-bomb, I'm going to say something to him. And this is one of my strategies. Just name the behavior. And sure enough, he dropped the f-bomb. And I said, excuse me. This is the third time you drop the f-bomb while you've been talking to me. I'm actually offended by that language. And I said it just like that. Like I didn't make a big deal about it, and he's like, oh my gosh, I'm so sorry. Like. Thank you. Okay, thank you for apologizing. And then he finished cutting my hair, and, but I never went back to him. Well, because then I went back to my regular person, and the haircut was okay.

Dr. Renee Thompson:
So this is what I said to her. You have to decide at what point you're going to say something instead of waiting until your amygdala takes over. So, in this case, she said, well, yeah, probably the third time. I love the number three. The brain loves the number three. Okay. Every single day, I have three priorities. I have three secondary priorities. You know, three personal priorities. The brain loves three. So, for me, it's like three strikes. And then I said to her, okay, go back to that situation because all we can do is learn from situations like this so that we can be better the next time. So she said, all right. The third time, she could have said to her, this is the third time you've interrupted me while I've been talking to you. Are you willing to just let me finish? And then we can sit down, and I'll give you an opportunity to explain, to discuss, I'm happy to do that, but I'd really appreciate it if you'd let me finish first, and so we talked through that. Now, that's something you might have to practice. But again, it's all about paying attention to your triggers. This can actually help the opposite.

Dr. Renee Thompson:
Let's say you have, because here's another story. Charge nurse is fine all of a sudden, stressed out about something. And then she lashes out at people, okay. She gets triggered, and then she's fine, and then she lashes out. So, it was a situation that a manager shared with me every six weeks. She acts out, and then she's okay for a while. So, I asked her to have that same conversation with that charge nurse. What triggers you when you're in those situations? And she didn't even know. She couldn't even really think. But, and it's not for the manager. It's not for you as the leader to tell them what their triggers are. Let them figure that out. And so the next time it happened, and this is what she said to her, I want you to pay attention. The next time you get yourself worked up to the point where you're yelling at people, can you catch yourself before you get to that point? What's the trigger? And sure enough, she did. And this charge nurse was able to identify a few of her triggers. And then, here's the key. When you feel yourself triggered, what can you do instead of lashing out? And she came up with it, and she said, I'm just going to step off of the unit for five minutes. I'm going to tell people, hey, I'm going to step off the unit for five minutes. But you can empower your employees, who tend to be quiet, they may freak out, okay? You can encourage them by having to manage themselves, by having that trigger conversation. It's like emotional intelligence starts with self-awareness, but then it's all about self-management. So, me personally, oh, I am full of self-awareness. But sometimes, I have trouble managing my emotions, managing my reactions. It's something that I'm still working on, but the key is helping your team, helping yourself become aware of things that trigger you so you don't get into that situation where you're lashing out.

Dr. Renee Thompson:
Okay, all right, we've got one more to discuss. And oh my gosh, this is so common. So, so common. So here's the situation. There was someone who was a staff nurse. She was promoted to manager of an ICU. Okay, she had been a staff nurse in that ICU. Their previous manager, okay, so who she replaced got promoted to the critical care director. The previous manager, so now the current director, was beloved by the staff. It was really difficult decision for her to make, to step out of the manager role and into a director role, because she had such a great relationship with her staff. The staff loved her. So now what's happening is the staff are not going to the manager to solve problems, to ask questions, to resolve issues. They're going to the director to handle them. And guess what? The director is handling them. Big mistake. Okay. Very common. I had a CNO, one of my clients, who did the exact same thing. She was all about being there for her people. If anyone in her organization would text her at 8:00 at night, she would text them back. She would answer phone calls. She always wanted to be there for her people. And I get that. Wow. Let's just say we've had conversations. I just did a webinar and setting boundaries with people. Okay. But that's a different conversation. But what would happen was these people would contact her and they would ask her, hey, is it okay if we put this person in this department or move people around and the CNO? Yes, absolutely. But what ended up happening was then she'd get a phone call from the night supervisor saying, why would you tell them that? I already told them that they couldn't do that. And the bottom line with this, I want you to think about where it starts. The intent is pure and good. This director now wants to feel that she's helping, and when her staff come to her, and they asked for her help, of course, she wants to help them. Okay, so you have to think she's not deliberately undermining this manager. She's undermining the manager. Absolutely. But she's not doing it on purpose. Okay, she's not realizing the negative ripple effect her helping is having on the manager's credibility and the department. It's just like classic, you go to mom, says no, you go to dad, dad says yes. It's the same situation because there were times where they would go to the manager, and basically, the manager would say no. They'd go to the director, and the director would say, yes. So what do you do?

Dr. Renee Thompson:
We're going to talk about this from the perspective of you're the manager, who your director is unintentionally undermining you, and then I want to talk about if you're the director, and this happens, how you can prevent this situation from happening. All right. So if you're the manager and this is happening, I want you to have an honest conversation with the director, okay? Or if you're the house supervisor on his conversation with the CNO, you might even want to sit for coffee and basically say this. I want to talk to you about something that's been happening a lot. And it's about when my staff come to you to help solve problems, answer questions. You probably don't realize this, but in many of those cases, they've already asked me. And whether they didn't get the answer that they wanted, or if there's some other reason, then they go to you. And when you solve the problem or you tell them what to do, I feel like it's undermining my authority, my credibility as their manager. And I get it. You were their manager just a couple of months ago. Like, I totally get it. The next time somebody from my department reaches out to you because of a situation in the department, can you please just respond by saying, well, what did Tina say? Okay. Tina's manager. What did Tina say? Because I want to feel that you're going to back me up, okay? And here's the thing. If you're that senior leader, that's exactly what you need to do. You need to say. What did Tina say? Even if you disagree, even if that's not a decision that you would have made, if you're the senior leader, you need to back up your manager no matter what in front of the staff. Because again, if not, that manager is going to lose credibility with their team. And that's a terrible way to start a new role in the department. Now, there are a couple of things that you can do too, if you disagree. Well, that's part of your coaching that you're going to do with that new manager. Okay. There's you could that's where you can use this as an opportunity for coaching. Okay, walk me through the decision that you made and the reason that you made that decision because there may be some things that they're not considering. This is your opportunity, if you're a senior leader, to actually coach them and help develop them. We have a leadership development shortage right now, and one of the studies we did, I think it was about two years ago now, showed 50% of the leaders out there right now in healthcare have less than two years experience. And at the time, many of them learned how to be leaders during COVID, when everything was a crisis. There was no time for development. And we get into these situations without even realizing the negative ripple effect that this has on, again, the manager's credibility, the team morale, cohesiveness of the team. Because if I think I can always go above you and go to my former boss, I might be inclined to do that, especially if I'm not getting what I want. I'm not saying it's right, but I'm saying it's happening. So I just want to reinforce it's important. Let's say you're in the situation right now. You're like, oh, I just took the manager role, and the manager is now the director. Oh, please have this conversation now. Have the conversation before you get into that situation. Like, hey, I get it, you were their boss. They came to you for everything. Now you're in a director role. I need them to come to me. And if I'm not sure, I will have, I'll reach out to you for help, okay? If I'm not sure the best answer, I will come to you. But if they come to you, please send them back to me, okay? Because it's just not healthy when you have that sort of triangulation.

Dr. Renee Thompson:
Okay. Well, those are three common situations. I hope that if you're in these situations in the future, you now feel equipped with practical ways that you can actually handle these situations. And as we wrap up here, I just want to thank you for listening, or if you're watching, thank you for watching. We have important work to do in healthcare. And human behaviors are so complex. It's not easy. But just with a little bit of practice, a little bit of strategy, some scripting, I love my scripts, we can start tackling these issues, even if it's just one at a time, so that you can do the important work that you need to do as a leader.

Dr. Renee Thompson:
Again, thank you for being here. If you like this podcast, please do me a favor and review it. We are trying to get more reviews because I don't know if you realize this, how we get out there letting people know, like how this podcast gets shared, is really by the number of reviews that we have. Okay, if not, Apple Podcast keeps it kind of buried. So, if you can post a review, if you can rate it, and share it with others, it's so funny. I'm always saying, please review it, please review it. And I listen to podcasts all the time. And the podcast host says the same thing and I thought, wait a minute, I'm asking people to review my podcast. When was the last time I reviewed someone else's podcast that I listened to? So, I made the commitment that when I listened to a podcast, if I haven't already reviewed it, I'm going to review it. It's just the right thing to do if you like it. I guess you can review it if you don't like it, but I'd really be grateful every time we get a new review. My whole team, like if we had a bell, would ring the bell. We'd get really excited about it. So again, thank you for being here, and we'll see you soon. Take care.

Dr. Renee Thompson:
Thank you for listening to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. If you found this podcast helpful, we invite you to click the Subscribe button and tune in every week. For more information about our show and how we work with healthcare organizations to cultivate and sustain a healthy work culture free from bullying and incivility. Visit us at HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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