When Staff Align Against Each Other

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BB closer Headshot3:6:2015Although not unique to nursing staff, the consequences of toxic workplace dynamics among healthcare professionals contributes to unsafe care.  Ultimately, changing an organizational culture that tolerates and therefore, perpetuates disruptive behavior will change most effectively when senior leaders make the commitment, designate resources, and practice and enforce respectful behaviors at all levels.  Many progressive leaders are taking steps in this direction already!  This is cause for celebration!

But, what can individuals do in environments where aggressive and passive-aggressive behaviors are so entrenched that this destructive status quo, for whatever reason, seems to be firmly in place? 

It can be tough to work in a culture like this. It can add a huge layer of stress to an already stress-laden work life.  Opportunities for job or shift changes may be limited and feelings of hopelessness and dread may accompany each trip to work.  The toll is monumental in its effect on safety, careers, and costs of care.

As you consider this common example of abuse, keep in mind, there are about 3 million nurses in the US, (12 million worldwide). I believe that most of us want to be respected and respectful and a minority of healthcare professionals  mistreat others.  Nevertheless, abusive colleagues seem to have a lot of power.   Some of this is power we give them when we don’t do anything or worse, join in a destructive dynamic.

Aligning Against Another

Any time two or more nurses are talking about another nurse behind her back in a negative way without skilled, direct and constructive feedback, they are ganging up on her.  This is an example of lateral violence.  Other descriptive terms include passive-aggressive behavior, covert abuse, disruptive behavior, back-biting and horizontal violence.  They all fit!


Carol:  (while rolling eyes, shaking her head and using a negative tone) Kathy should have called the doctor about Mrs. Smith’s respiratory status during the day.  She is slacking off and leaving us to pick up the pieces on evenings.  Now I have to call Dr. Jones at home and he’s going to take it out on me.

Valerie:  I was thinking the same thing.   Last week, I had to call on something she should have addressed.

Carol:  I hate following her.

Valerie:   Me too.


Carol has invited Valerie to join her in an alliance against Kathy and Valerie has agreed. They are assuming that her care is faulty and that have no curiosity about or respect for her decision-making nor any empathy for what her circumstances may have been.  If either of these nurses have a concern about how Kathy is caring for patients, the respectful and safe thing to do is to talk about it with Kathy and, if need be, a supervisor.  In one fell swoop, we manage to disrespect our selves, each other and our profession.

In addition to being disrespectful,  there are several missed opportunities; Kathy doesn’t get feedback about how her decisions affect others, no one’s clinical judgement or knowledge is expanded, and any factors involving workload stress remain hidden.

A Better Way

Our work environments; frenetic, noisy and often relentlessly stressful can pose practical barriers to seeking a higher road.   For me, even as an expert in communication and conflict, there are times when I know it would be much easier to go along with Carol.  I can get some quick validation for my frustrations, I wouldn’t risk any consequences of ownership and I can go along feeling angry and victimized.  However, whether I am facilitating a workshop or providing direct care, the following is what I would challenge colleagues to do and   try to do myself:

Carol:  (while rolling eyes, shaking her head and using a negative tone) Kathy should have called the doctor about Mrs. Smith’s respiratory status during the day.  She is slacking off and leaving us to pick up the pieces on evenings.  Now I have to call Dr. Jones at home and he’s going to ream me out.

Valerie:  You sound stressed.  How can I help?


Valerie:  I was thinking about talking with Kathy sometime soon about some of her clinical decisions.  Do you know when she is working next?

Understanding the Difference

Either or both of the above responses acknowledge Carol’s statement without taking the bait of aligning against Kathy.  Valerie is not shaming Carol for her accusation and this can help preserve their working relationship as it shifts out of an old pattern.   Carol may persist and if this kind of dynamic has been in place for a while, it may take several similar episodes for her to get the message that Valerie isn’t going to jump on the bandwagon.

3945-4-1Carol may learn a new way herself or seek another colleague to try to align with.  As Valerie becomes more skilled and confident in giving direct feedback, she may even talk with Carol about her tendency to talk about others behind their back.

Next time someone tries to align you against a colleague, consider trying one of the above responses or your own variation.  Learn more about communication challenges and solutions: 

 Successful Nurse Communication: Safe Care, Healthy Workplaces, & Rewarding Careers!


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