How to Tell Your “Best” Nurse She is Toxic

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Have you ever worked with a nurse who was so brilliant, had a remarkable mind, and knew everything there was to know about saving lives, but who was a toxic force in your department?

I have too.  If I’ve heard this once, I’ve heard it a thousand times, “She’s a great nurse, our best, but she’s not a very nice person” or “He’s our best nurse but doesn’t like people very much.” How on earth can you be a great nurse and not like people?? One nurse even described her coworker as “beastly on a good day.”

The problem is that because these nurses are so competent, we tend to rationalize, justify, or just ignore their behavior. We say things like, “Just ignore him like everyone else does” or “That’s just the way she is. Don’t take it personally.” I recently talked with a manager who said that when his toxic nurse is in charge, he knows everything will run smoother because she is SO efficient. But within the same breath, said that he is losing new nurses because of her.

If you find yourself saying, “He’s a great nurse BUT…” then he’s NOT a great nurse!

Why oh why do we keep toxic humans around just because they are good at what they do? It’s because we are so afraid that if we fire them, the unit/department will fall apart. After all, who will be in charge, manage the difficult physicians, manage the codes, etc.? So often I’ve heard managers defend why they keep toxic employees. It’s usually out of fear of who will do the work once the “awesome”, clinically competent nurse leaves.

Well guess what?

By keeping this “great” nurse, you’re preventing the would be and could be nurses from becoming great.

To be a GREAT nurse, you MUST be clinically AND professionally competent! You can’t have one without the other. But too often that’s exactly what we see in our healthcare organizations. Not okay.

Can your toxic nurse be saved? My best answer is this – I don’t know. However, I do know that you have an ethical responsibility to at least try. This is why I’ve constructed 3 ways to save your toxic nurse.


Chances are, nobody has actually told this toxic nurse that she’s toxic!! Don’t assume she knows. She may have received so many accolades for her performance that she doesn’t even realize there’s a problem.  You can’t fix something if you don’t know it’s broken. Tell her.

Schedule a meeting with her. Tell her that you want to talk to her about something that is uncomfortable for you to say and may be uncomfortable for her to hear. Tell her that you need to be honest with her about her behavior. That although she is clinically competent, the way she treats people is not okay.

In your conversation, use key statements such as:

  • It’s not okay the way you’ve been treating your coworkers.
  • You are incredibly competent, and I also need you to step up and act in a professional manner.
  • This is a professional environment yet you have not been treating your coworkers professionally.

Communication is key here. Let her know how her behavior impacts the work, patients, and her coworkers.  Give examples and be as specific as possible. 

For example: Yesterday when Mr. Rossi coded, you pushed Sarah out of the way and said, “Oh please, like you know what you’re doing (sarcastically), let ME handle this if you want him to live.”  This was a missed opportunity for you to support and coach Sarah – not criticize and humiliate her. I’ve seen you treat your coworkers like they were incompetent many times before.


Setting expectations is an essential part of creating a professional workplace. Ideally, leaders should be setting those expectations right from the beginning – immediately upon hire. However, in situations where someone’s been wreaking havoc on the unit for decades but nobody’s ever addressed it, then you start now. As the Chinese proverb states so eloquently, “The best time to plant a tree is 20 years ago. The second best time is now.”

Set behavioral expectations now.

First, get very clear about her behaviors and why everyone considers her toxic or “beastly”.  

Make a list of everything she does that you believe is unprofessional and inappropriate. For example:

  • Yells at someone for sitting in “her” chair
  • Refuses to take report from certain nurses that she feels are beneath her
  • Changes assignments if she doesn’t like hers
  • Openly criticizes her coworkers in front of others, even in patient’s rooms
  • Uses profanity in the nurses’ station, hallways, and break rooms
  • Sets new nurses up for failure by giving them the worst assignments

Then tell her you never want to witness these behaviors or hear about them ever again. Tell her how you expect her to behave and what the consequences are if she doesn’t comply. Remind her that although you will give her the time to adapt her behavior, you’re going to need to see immediate improvements.

Then tell her, “This is how we treat each other in THIS SPACE” and be specific.

I expect you to…

  • Treat all chairs, computers, workstations, etc. as shared property
  • Take report from every nurse because patient’s lives depend on a thorough report
  • Accept the assignment you’ve been given without causing a scene
  • Refrain from yelling, openly criticizing, or berating your coworkers in any public area
  • Avoid using any profanity in this organization
  • Support new nurses as they learn and grow by setting them up for success

Now, you may need to elaborate on these expectations a bit but you get the point. Tell her the behaviors you no longer want to see AND the behaviors you want to start seeing. You have to spell it out so that she can’t say she didn’t understand.


You had the honest conversation with your nurse about her behavior and set behavioral expectations.  At this point, I guarantee, one of two things are going to happen. She is going to step up and do the right thing or she is going to step out – either by quitting or by getting fired.

That means you need to be willing to let her go if she doesn’t step up.

According to Robert Sutton’s book, The No Asshole Rule, once you make the courageous decision to terminate a toxic employee, the remaining employees initially act as though they’ve just come out of 10 years of solitary confinement.  They’re not sure what that big bright light is in the sky; they meander around not really knowing which direction to go. However, once they realize they’ve been released from their prison, they step up and, like marshmallows in a cup of hot cocoa, rise to the top.

Stop rationalizing, justifying, and ignoring toxic employees no matter how “great” they are! You will never create a nurturing, supportive, and healthy workforce until equal weight is given to BEHAVIOR.

Take care. Be kind. Stay connected.

Helping you cultivate a healthy happy workforce,

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