Toxicity is defined as “the degree to which a substance can harm humans or animals” (Webster’s, 2009). Repeated exposure to a toxic organism can have long lasting effects on an individual. Staff members who are repeatedly exposed to a toxic nurse manager will either accept the leadership style and adapt to toxic behaviors, or will reject it and leave the environment. In a hospital setting, the effects of toxic management can spread rapidly through a nursing unit if the culture of the unit supports it. The effects of toxicity can have a significant impact on the individual employees on the unit and the organization. 

One of the greatest challenges in addressing toxic leadership in an organization is simply that it is widely tolerated by employers (Flynn, 1999; Kimura, 2003; Padilla, Hogan, & Kaiser, 2007; Reed, 2004).  Flynn (1999) reports that apathy leads to the organizational culture that makes toxic leadership acceptable, while other researchers state that workers eventually accept the situation of poor leadership as normal. Poor interpersonal skills also play a role in this problem.  Too often, belittling, embarrassing, yelling, and blaming become the main forms of communication (Kimura, 2003; Reed, 2004).  This leads to controlling information and the isolation of workers, which can escalate the problem (Wilson-Starks, 2009).  

Symptoms of a Toxic Nurse Manager

Toxic nurse managers are not always easy to identify. A toxic manager is defined as “the manager who bullies, threatens, yells. The manager whose mood swings determine the climate of the office on any given workday. Who forces employees to whisper in sympathy in cubicles and hallways. Call it what you want—poor interpersonal skills, unfortunate office practices—but some people, by sheer, shameful force of their personalities, make working for them rotten” (Flynn, 1999, p.40). Behaviors displayed by toxic managers include:

Self-centeredness

Self-centered toxic nurse managers are focused on advancing their careers and exhibit little concern for staff morale or professional growth and tend to ignore the organization’s vision. They are rigid in their thinking and hide their weaknesses and failures from their own supervisors (Kimura, 2003). When interacting with a self-centered manager he or she will use “I” when speaking about accomplishments on the unit and not give credit to the staff who were responsible for the accomplishment. Self centered nurse managers typically place blame on and complain about the staff on the unit. The self-centered toxic manager will search for followers who will do exactly what they request and these individuals will become the manager’s “inner circle.” These staff members will likely adopt the toxic behaviors displayed by their leader.

Exploiting others

Toxic nurse managers will take credit for successful initiatives on a unit, but give no credit to the nurse(s) who initiated, planned and executed them. More importantly, when a problem occurs with a particular initiative on the unit, the toxic nurse manager will blame the staff nurses and accept no responsibility for the problem.  

Controlling behavior

The toxic nurse manager must be in control of every aspect of the unit at all times. In order to maintain control, toxic nurse managers withhold information from the staff, are secretive, and give very little, if any, autonomy to the staff. This behavior results in stagnation or a lack of progress on the unit. The controlling nurse manager will eventually create a culture on the unit that is resistant to change. 

Disrespecting others

The toxic nurse manager who yells, bullies, threatens and speaks to staff in a condescending tone is demonstrating a broad lack of respect. This may occur in a person-to-person contact or in coercive emails. As an example, a new staff nurse fresh from orientation has made a medication error and must complete an incident report. The toxic nurse manager decides to discuss the error with the new staff member, instead of this being a private counseling session the nurse manager ridicules the staff member in front of her peers. What should have been a positive learning experience for the new staff nurse turned into a humiliating experience for the staff nurse.
 
Suppresses employees’ innovation and creativity

Nurse managers who suppress employees’ innovative thinking and creativity are not permitting the employees to “think outside of the box.” He or she controls all information and forces employees to follow the manager’s vision for the unit. The toxic leader has staff convinced that he or she can guide them to accomplish unrealistic goals as long as they follow his or her vision. This behavior leads to employees feeling unappreciated.

Inadequate emotional intelligence

Emotional intelligence is defined as “the ability to manage ourselves and our relationships effectively.” It consists of four fundamental capabilities: self-awareness, self management, social awareness, and social skill (Goleman, 1998). Nurse managers who lack emotional intelligence can be described as those who yell at staff, make irrational decisions, lack self-awareness of one’s emotions, or are unable to control disruptive impulses. The nurse manager who displays some or all of these characteristics on a busy chaotic nursing unit is the one to avoid. 

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