When a Toxic Culture Exists, Alignments Become Integral and Dangerous to Collaborative Efforts!

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From Miriam Webster online dictionary:


 verb \kə-ˈla-bə-ˌrāt\

: to work with another person or group in order to achieve or do something

: to give help to an enemy who has invaded your country during a war

Interesting distinction, don’t you think?

nurses 4Alignments can be insidious in healthcare teams and can confuse leaders because they can lead to really good outcomes.  SOMETIMES!  But they are symptoms of dysfunction and should not be taken lightly or interfere with an organization’s efforts to develop healthy workplace cultures!

We know that a healthy workplace must engender open, honest and respectful dialogue among all healthcare professionals in order to provide safe, quality care.  When skills, leadership commitment, and/or clear expectations are lacking, a toxic culture is likely present and the implicit norms for getting along have disturbing ramifications.  Confirming symptoms include: mixed messages, controlling management, and double standards.   Add in a power dynamic where nurses may be on the lower end and these toxic cultures promote dangerous relationships. Instead of forming the healthy and respectful relationships that are necessary to collaborate for patient care, staff form alignments that are more about survival.

In nursing this manifests like these examples which may be overt or covert:

  • If you work this Sunday for me, I’ll take care of our problem patient, Mrs. Smith today.
  • If you go to lunch with the new nurse, don’t expect me to cover your break.
  • I’m not going to show her how to use the new IV pump.  She didn’t bring me back any hot packs from the stock room.

Rather than the give and take based on ownership, limits, and respect that is necessary for collaborative teamwork and safe care, nurses take sides and make deals in order to navigate staffing shortages, management mandates, and constantly shifting and urgent patient needs. They help some nurses get through the shift alright, and patients MAY receive very good care, but where are the opportunities to problem solve with Mrs. Smith, support new staff, and ensure training is effective and supplies are readily available for all staff?  These things may remain hidden or provide conflicting information.

It is very hard to practice respectful communication in a culture that doesn’t support it and is doc nurse handshakea much longer conversation.  Nevertheless,  I believe that nurses can and will form healthy relationships when they receive the support they need to do so!

If  you understand systems thinking and the importance of relationships in complex adaptive systems you’ll understand why emotional intelligence, effective communication,  and respectful behavior are absolutely critical to safe, quality care.

Properties of Complex Adaptive Systems & Relevance to People Skills- Part I-Adaptability

Properties of Complex Adaptive Systems & Relevance to People Skills- Part II-Butterfly Effect 

Properties of Complex Adaptive Systems & Relevance to People Skills: Part III-Emergent Behavior

Are you a staff nurse or nurse leader?  Do you know what I am talking about here?

Beth Boynton RN, MS is a national speaker, organizational development consultant, and the BB closer Headshot 1-13 Cherationsauthor of the award-winning book, “Confident Voices:  The Nurses’ Guide to Improving Communication and Creating Positive Workplaces”.  She specializes in communication, collaboration, & emotional intelligence for healthcare professionals and organizations and is trained in the Professor Watson Curriculum for Medical Improv through Northwestern University Feinberg School of Medicine. She offers medical improv training for communication, emotional intelligence, culture change, and teambuilding efforts. Her video, “Interruption Awareness:  A Nursing Minute for Patient Safety” and blog, “Confident Voices in Healthcare” have drawn audiences from all over the world.  She is currently writing a core text with F.A. Davis Publishing Co. tentatively titled Successful Nurse Communication:  Safe Care, Positive Workplaces, & Rewarding Careers, practices as a Per Diem RN in a LTCF for folks with dementia, and a student of improv.  Her complete CV is online.




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One Response to When a Toxic Culture Exists, Alignments Become Integral and Dangerous to Collaborative Efforts!

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