How to survive a toxic manager

It is important for nurse executives to foster a culture in which the staff nurse feels safe and is comfortable approaching a nurse executive for advice or assistance when dealing with a toxic nurse manager. The following depicts behaviors that are recommended for a staff nurse to practice when confronted with a toxic nurse manager. These behaviors are suggested to assist the staff nurse to understand how to best approach a toxic situation. Even though the nurse manager possesses positional power and authority on the unit, as a staff nurse you can quietly lead from the middle and be just as effective. Leading from the middle can be accomplished by working with the other staff nurses to make subtle changes that are satisfying to the staff, but not contributing to the toxicity on the unit.  
 
 
The staff nurse should:

• never approach a toxic nurse manager alone, always seek safety in numbers and confront the manager as a group (Lipman-Blumen, 2005).
• align themselves with other nurse managers or executives for appropriate support.
• never lose control of your emotional intelligence when interacting with a toxic nurse manager.
• not get frustrated and feel like it is a hopeless situation.
  attempt to develop ways to exert a positive influence on the nurse manager by remaining professional and calm in difficult situations.
• avoid condemning or criticizing the nurse manager and spend your time more wisely by developing a strategic plan to overcome the adversity the toxic nurse manager is spreading on the unit.
  Figure 2. Suggested staff nurse behaviors when confronted with a toxic nurse manager

Implications
 
The literature demonstrates that the implications of toxic leadership on the nursing profession are very costly in terms of staff turnover.  There are many contributing factors to this problem.  Among the most commonly mentioned problems are the lack of leadership training and professional development activities offered for nurses in leadership roles (Kerfoot, 2007).  Very often, a person has had only “field-specific” training, as opposed to managerial or leadership training (Flynn, 1999).  Furthermore, findings have shown that a major barrier in obtaining leadership training is the current work schedule and job demands of nurses which lead to them being unable to get away to attend training and workshops (O’Neil, Moorjikian, & Cherner, 2008).  

The impact of toxic leadership on the nursing profession is substantial.  Combining toxic leadership with the stressful nature of the job itself leads to lackluster work, poor morale, decreased productivity, increased absenteeism, and high turnover (Dyck, 2001; Kimura, 2003; Pearson, & Porath, 2005; Shirey, 2006; Wilson-Starks, 2009).  Employees begin to feel cynical and frustrated, leading to decreased energy, enthusiasm, and self-esteem (Lencioni, 2007).  Both physical and psychological problems such as hypertension, ulcers, headaches, anxiety, depression, and anger also occur due to the stress of poor leadership (Dyck, 2001; Sutton, 2007).  In addition to these physical symptoms, toxic leadership causes de-motivational behavior, which affects a nursing unit’s morale and general culture (Reed, 2004).  This organizational stress places the purpose of the organization in jeopardy (Padilla, Hogan, Kaiser, 2007; Reed, 2004). Unhealthy work environments created by organizational stress may produce bad outcomes for both the staff and patients. 

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