How Healthcare Leaders Can Spot a Gang in Their Department

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Who would ever think cliques and gangs could actually exist in healthcare, especially in patient units?  Oh, but they do.

In my experience working with healthcare, both as a police officer working in a big city and with Renee as she works to address workplace bullying, incivility, and violence, I’ve seen and heard the good, the bad and the ugly in how nurses treat each other. What I’ve learned is that being a nurse isn’t easy. It’s hard enough for nurses to deal with life and death situations on almost a daily basis…

They should NOT have to deal with the bad behaviors of their co-workers, especially behavior and activities that could be considered gang-like.

In 2007, I was promoted to Detective and assigned to our Criminal Intelligence Unit. This unit’s primary mission was to identify and collect information and intelligence on gangs and gang members operating in the city.

Recently, Renee wrote a blog titled “5 Ways to Protect Yourself from Workplace Cliques” where she discussed the differences between groups of friends, cliques, and gangs. In today’s article, I will take a deeper dive into the mindset of the nurse gang, how it impacts unit culture and patient safety; and then share a few ways to identify and stop them.

In Renee’s article, she told the story of Tarah, a nurse who unwittingly became the target of a nurse gang for wearing a headband that only “gang members” were allowed to wear. This story is a perfect example of gang-like behavior and how it negatively impacts a nursing unit.

But what IS a gang and are nurse gangs REALLY gangs or are they pseudo gangs? How can you tell?

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What is a gang?

In law enforcement, we define a gang as a formal or informal organization, association or group, consisting of 3 or more persons, who can be identified by what they wear and has as one of its primary activities the commission of criminal acts.

I know that definition may sound harsh as it relates to nurses, and I am by no means comparing nurses to street gang member and the level of violence usually associated with them, but you have to admit; the definition seems to fit SOME of the behaviors exhibited by pseudo nurse gangs.

Before we break down the above definition and see if it fits for nurse gangs, it’s important to note that any one element of the definition does not a gang make. It’s when all the elements are present that we may consider the group a gang.

3 Identifiers of Nurse Gangs

Group Dynamics

Nurse gangs tend to always be together, either during work or after, to the exclusion of others. They try to work the same schedules, coordinate care to take breaks together, and work the same holidays. One of the issues affecting patient care is that your unit may have a rule that no more than 2 nurses can be on a break at the same time, but if 3 of the gang members are working, they frequently break that rule, placing undue burden for patient care on the other nurses, ultimately putting the patients at risk.

Note – There is a difference between a group of friends, a clique, and a gang. What makes cliques and gangs different than a group of friends is that a key group dynamic is the use of exclusion.


A gang is typically identified by what they wear, the colors they incorporate into their wardrobe, accessories, or even hair color. In street gangs, tattoos are common as are the colors they wear. Sometimes identifiers change as the trends change, like the long white t-shirts with baggy pants. Red and blue colors are common, as are custom made t-shirts.

In Renee’s story about Tarah’s encounter with a nurse gang, it was headbands. In other organizations it might be a certain type of bracelet or a specific color shoe or socks. Again, the type or color of clothing isn’t as important as the fact that a color or piece of clothing can identify who is a member of the gang

Rule Breakers

Probably the most important element of the gang definition is the existence of criminal activity. A sporting team, for example, has more than 2 players and can be identified by what they wear (their uniforms) but they would not be considered a gang. A group of friends who like to hang out together and wear similar scrub jackets, but who make decisions based on what’s best for patients, is certainly not a gang.

What then distinguishes these folks from gangs?

True gangs break the law by committing crimes.

They burglarize, assault, murder, deal drugs, etc.

In nurse pseudo gangs, they violate your organizational policy or even break the law in the form of harassment, discrimination or in some cases threats of bodily harm.

They may target someone and spread false rumors, set them up to fail, or even sabotage them until it leads to their termination.

For a group of nurses to be considered a gang, they need to violate policy in some way.

Now that you have a better understanding of how to identify a nurse gang, let’s discuss what you can do to stop them.

3 Steps to Deal with Nurse Gangs

Stop denying their existence

In law enforcement, one of the hardest things to deal with is when high ranking police and/or public officials deny the existence of gangs in their jurisdictions. Rather than dealing with the issue, they ignore it in the hopes it will go away or not become a major problem.

In working with healthcare organization to eradicate bullying & incivility, we have seen similar denials. Based on our definition, if you have identified a nurse gang on your unit, but choose to ignore them, you are unknowingly giving them the perception of power. This perceived power is what can lead to some of the most toxic work cultures reported in healthcare.

Identify who they are

One of the most important steps in dealing with nurse gangs is identifying them. Based on what we’ve talked about so far, you would think it would be easy to identify a gang in your unit. However, if you don’t have a speak-up culture, and if nurses are intimidated or even threatened by nurse gang members, it might not be as easy.

Start by paying attention to your cliques.

Have you counseled anyone involved in these cliques for unit or organizational policy violations? Has anyone complained, either formally or informally, about anyone involved in the cliques? If so, you may be dealing with more than a clique.

Intervene quickly

When dealing with street gangs, the National Institute of Justice says that interventions seek to draw gang members and close associates away from the gang lifestyle. Programs are developed to educate gang members and offer them incentives to quit the gang, while still holding them responsible for criminal activity.

Likewise, nursing interventions should start early. Nurses should be taught about cliques, how harmful they could be and how to resist them. It’s also important to set professional standards and assertive communication among your team.  Set expectations for professional behavior early and reinforce often.

In Renee’s book, Do No Harm Applies to Nurses Too! Strategies to Protect and Bully-proof Yourself at Work, she talks about the herd mentality and how some nurses may get sucked into the gang unintentionally.  By intervening early, you can prevent these nurses from joining, thereby enabling the gang to grow.  It’s much easier to address when the gang has only 3 members versus 13.

I understand that referring to caring, compassionate nurses as gang members may sound ridiculous and offensive…  I’m relieved to share that although they do exist, they are NOT common.  However, when leaders fail to recognize just one of these pseudo gangs in their departments, the outcomes can be devastating to their employees and the patients whom they serve.

For more information on how you can cultivate a healthy workforce by eradicating bullying and incivility, contact us at

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