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Recognizing and Overcoming Toxic Leadership

by George A. Zangaro, PhD, RN
Kelly Yager, MS, RN
Joseph Proulx, EdD, RN

Author’s Affiliations: Assistant Professor (Dr. Zangaro), Student (Ms. Yager), Professor (Dr. Proulx), Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD.

Correspondence: Dr. Zangaro, University of Maryland Baltimore, 655 West Lombard St Suite 465, Baltimore, MD 21201-1579

 
Abstract

Toxic nurse managers are detrimental to organizations, diminishing staff morale, thwarting creativity, and creating unnecessary job stress. Toxic nurse managers can also negatively affect an organization’s bottom line as staff absenteeism may increase, job satisfaction and critical thinking may decrease, leading to turnover and complicating innovation, decision making, and problem solving. The authors discuss the signs of toxic nurse managers and strategies for addressing their impact on organizations.  
 
 
It was difficult for the novice nurse, a cheerful and competent practitioner, to get out of bed. That queasy, nauseous feeling had already begun, and she knew that the headache would not be far behind. What was this, some sort of infectious process or a virus perhaps? Could this dread of getting up and going out to work, possibly be related to something on the job? Indeed it was, and the “infection” had to do specifically with a toxic leader. 

Toxic leaders can be devastating to personnel at all levels in an organization and can ultimately lead to the dismantling of the organization. Most people have worked for leaders who display some level of toxicity. The following provides some examples of toxic behaviors. The purpose of this article is to assist nursing leadership in recognizing a toxic nurse manager and in taking the appropriate steps to reduce the spread of the toxicity in the organization.

The nurse manager who

• has a staff meeting and spends thirty minutes talking about how wonderful he or she is, and during the process takes credit for others’ accomplishments.
• blames the staff nurses when discharge times have increased on the unit over the past 3 months.
• shares information with the inner circle of loyal followers but not with others.
• refuses to consider a staff nurses idea for a new way to give report to oncoming nurses during shift change, stating that the current way works fine and no change is needed.
• is easily annoyed by simple requests from the staff, is not engaged in conversation with the staff or does not listen to their concerns.

Impact on Nursing 
The U.S. health system continues to struggle with a critical shortage of nurses. It is anticipated that there could a shortage of approximately 500,000 nurses in the U.S. by 2025 (Buerhaus, Staiger, & Auerbach, 2008). Due to the challenges with the U.S. economy, hospital administrators are requiring significant contributions from leadership at all levels, specifically from the nurse managers on inpatient units. Nurse managers are expected to ensure a positive work environment that fosters satisfaction and retention of nurses. With the shrinking pool of registered nurses, it is becoming increasingly difficult to recruit new nurses. 

Effective hospital leadership at the executive level as well as at the unit level is crucial in today’s unstable economic environment. Studies have identified a significant relationship between effective leadership and job satisfaction (Laschinger, & Finnegan, 2005; Upenieks, 2003; Wilson, 2005), commitment (McGuire, & Kennerly, 2006) and intent to stay (Force, 2005; Johnson, & Rea, 2009). Each of these outcomes contributes to a healthy and productive work environment. In today’s market there is a high demand for leaders who serve as coaches, empower staff, and inspire staff to excel. To be successful in these difficult times a nurse manager must value the staff and make staff members his or her top priority. Unfortunately, there are nurse managers in organizations today who demoralize staff, promote their personal agendas, and go out of their way to protect their reputation regardless of the negative impact to the organization. They are known as toxic leaders.

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