Recognizing Toxic Nurse Managers 

The use of a 360-degree evaluation is one of the best ways to recognize a toxic nurse manager. A 360-degree evaluation permits the manager’s supervisor to receive input from all individuals in the nurse manager’s sphere of influence (Davidson, 2007). This performance appraisal instrument provides a supervisor with feedback on the nurse manager’s work performance. The evaluation can be given to the nursing staff, unit clerks, patients and any other departments that interact with the particular unit manager that is being evaluated. This approach will permit the nurse manager to see how his or her behavior and leadership style is viewed by others in the organization.
 
Another suggestion is to conduct focus groups with the nursing staff on the unit and other employees who interact with the toxic nurse manager on a regular basis. Focus groups permit the nursing supervisor to obtain in-depth meaning and understanding through the use of probing questions and nonthreatening discussion. A drawback to focus groups is that employees may not be willing to publicly express their concerns in front of co-workers. Individual interviews can be very time consuming, but if a nursing supervisor feels that the staff is not willing to speak publicly, they are an option. Of particular importance in this process is for the nursing supervisor to assess the climate on all shifts, not just the day shift.
 
A nursing supervisor may also track the turnover rate on the toxic nurse manager’s unit. Units with high turnover rates should raise a red flag for the supervisor. When a staff nurse feels that there is no resolution that will occur in a toxic work environment he or she will leave the organization. Turnover is very costly to the organization and disruptive to unit cohesiveness. Additionally, research indicates that increased workplace incivility results in decreased productivity in the health care system (Hutton, & Gates, 2008). Decreased productivity in a hospital represents another significant financial burden for the institution. 

Addressing Toxicity 
Addressing toxicity requires involvement from organizational executives as well as staff nurses. The approaches to be taken by these roles are explored in this section.

Nurse Executive Role

First, the job description should state that the incumbent is required to treat all employees in a respectful and professional manner. It has actually been suggested that the particular behaviors that will not be tolerated by the organization are stated in writing (Flynn, 1999). Second, when selecting the team to conduct the interview the nurse executive should ensure that there are a variety of staff on the team so that diverging viewpoints are represented. This will also increase the odds of identifying a toxic individual in the interview process. Finally, the nurse executive must ensure that he or she clearly communicates the objectives for the interview, rules of engagement and has everyone sign to document agreement to the hiring process. 

During a hiring interview, the nurse executive can attempt to identify a toxic leader through using a behavioral-based interview approach. Behavioral based interviewing is used to determine how an individual has reacted to, and managed prior problem situations (Hoevemeyer, 2006). This interview technique does not focus on what the interviewee might do in a future situation, but rather what he or she has done in a previous situation. For example, the interviewer might ask, “Could you provide me with an example of how you handled a difficult situation with a co-worker?” or “Could you describe a situation where you used appropriate delegation to complete a task?” Behavioral questions will permit the interviewer to determine if the interviewee is the right fit for the job by assessing the skills that are needed to be successful in the new job. Also the leadership should tell the prospective employee they will be evaluated on whether or not they have met these human resource objectives that relate to managing employees in a positive way. The executive must ensure that the prospective employee understands that toxic behavior could end his or her tenure in the organization, but on the other hand nontoxic behavior will be rewarded and recognized by superiors.

Despite the best hiring practices toxic nurse managers will still emerge in the organization. Once a toxic nurse manager has been identified, it is important for the nurse executive to address this toxicity as quickly as possible. The nurse executive should take an identify-verify-rectify approach to address a toxic situation. Begin by investigating the situation, interviewing people close to the situation. Verifying facts will help to determine if this truly is a toxic situation, isolated incident, or the result of a disgruntled employee. If it is determined to be a toxic situation then the nurse executive should confront the nurse manager and rectify this situation as quickly as possible. Nurse executives have the power and authority in the organization to address toxicity issues with a nurse manager. One of the most important issues for the nurse executive is to ensure that he or she is honest with the nurse manager and states things as they are so that the nurse manager gets a clear picture of his or her behavior. When conducting this counseling session be firm, but reasonable in your approach. Always document these types of sessions in the event of future occurrences or if disciplinary action needs to be taken at a later date. The nurse executive may set some reasonable goals for the nurse manager to achieve.

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