As I
used to say back 38 years ago at the beginning of my career, when I found
myself in the most violent locked so called "back ward of the back wards" of a classic
insane asylum in Saint John, New Brunswick ....... that "The
only way you can tell who the staff are from the patients... is who has the keys". The staff were indeed as violent as the residents. They hid behind their 'keys', now armed with their self-righteousness, and sanctioned by society, now protected to indulge in all manner of sadistic pleasures on the helpless and the voiceless.
Fast forward to
the end of my 38 year career in Mental Health in 2017. The exact same dynamic and level of toxicity remains. Although I would give out the sickest, and most disturbed award to the managers and all their minions of the present day, the In-Patient Units of our city. They are still as cruel and violent towards patients and staff alike as they were at
the beginning of my career. Only a very few in society really care about the mental health consumers. All you will
ever get from their spokespersons is
deceit, deception, and lies. The helpless Joe and Jane public are being devoured by these hospital units. Only God is merciful and loving of these
vulnerable souls.
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NURSING ECONOMIC$/July-August 2007/Vol. 25/No. 4 233
Executive Summary
Nursing organizations and hospitals are not
immune from the ravages of incivility.
Toxic behavior can range from the very serious
bullying and sabotage of very destructive people
to the annoying and hard to cope behavior of just
plain jerks.
When a unit does not have a clearly defined “No
Jerk” rule and infrastructure to support healthy
behavior, communication suffers and errors occur.
Nurse leaders have the opportunity of changing
the self-interest behavior of jerks in our communities
of caring.
Leadership, Civility, and the ‘No Jerks’ Rule
doesn’t have to be that way. For example, Dan
Wilford, the former CEO of Memorial Hermann
Healthcare System in Houston, explained to this
author that he believed in the “No Jerks” rule. This
meant that he didn’t hire jerks; and if they were discovered,
appropriate action would be taken. It was his
ethical belief that the work of health care could not be
accomplished with jerks overpowering the good work
that needed to be done. To that end, he established the
“Institute for Spiritual Leadership” with required
courses and other programs to support the leadership
and staff in the organization to lead in healthy, fulfilling
ways.
Defining Jerks
Frost (2007) defines “toxic employees” as those
who are rude, temperamental, abusive, spread gossip,
create factions, distort communications to their ends,
and sabotage work processes, colleagues, and managers.
Eventually, organizational performance suffers.
Staff may become distracted by this behavior and
withdraw to protect themselves from these people.
Sutton (2007) lists 12 characteristics (The Dirty
Dozen) which includes personal insults, invading
personal territory, uninvited physical contact, threats
and intimidation, sarcastic jokes and teasing, toxic email,
humiliation, public shaming, rude interruptions,
two-faced attacks, dirty looks, and treating people
as if they are invisible. He describes two tests for
spotting these people: (a) does this person create a
feeling of oppression, humiliation, de-energizing and
make one feel worse; and (b) does the person target
others less powerful? Sutton points out the damage
done to the victim, to the innocent bystander, to the
perpetrator, and the cost to the organization in performance
and managerial, legal, and human resources
costs. The price to the organization is significant and
cannot be ignored.
Toxic behavior can range from the very serious
bullying and sabotage of very destructive people to
the annoying and hard to cope behavior of just plain
jerks. While the behavior of jerks might be less
destructive than the very toxic, aggressive behavior of
bullies and saboteurs, it can be just as difficult to cope
with in the work environment. The preceptor who
talks down to the orientee, who reiterates that nursing
schools don’t teach as well as they did when the preceptor
was in school, and who blames versus creates
a learning environment when the orientee makes a
mistake are common examples of jerks that new grads
commonly encounter. This behavior doesn’t qualify
as bullying but it is equally dehumanizing and difficult
for a new grad to handle.
HOSPITALS AND HEALTH CARE
organizations are a reflection
of the culture of our
country. Many authors
decry the state of declining civility
in our society and in our organizations.
Carter (1999) writes
that the barbarians are truly at our
doors and that the ability to create
a functional life in a community
is being taken over by the emphasis
on one’s own self-interest and
individual rights. He also believes incivility is being
fueled by the violent metaphors allowed in our language.
Forni (2003) also notes that civility is rapidly
turning to incivility in our culture. His view is that
civility is part of an ethical code that we must live by,
and the breakdown in these codes of ethical behavior
has allowed incivility to grow and flourish. He writes
about 25 rules that can bring a framework for civil and
ethical behavior back into the workplace. And while
civil behavior is desirable in the workplace to create
the healthy environment we all want to be apart of,
Gonthier (2002) notes that the effect on employee
energy and productivity of the individual and the
organization is a very serious problem. Civility is not
just a nice concept to have at work. It is necessary for
the orderly functioning of our organizations.
Incivility in Hospitals and Health Care
Nursing organizations and hospitals are not
immune from the ravages of incivility. However, it
KARLENE M. KERFOOT, PhD, RN, CNAA, FAAN, is Principal,
Kerfoot & Associates, Indianapolis, IN; and a Nursing Economic$
Editorial Board Member. Comments and suggestions can be sent to
karlene@indy.com
Copyright ©2007 Nursing Economic$.
Karlene M. Kerfoot
Karlene Kerfoot
234 NURSING ECONOMIC$/July-August 2007/Vol. 25/No. 4
When You Have to Work With Jerks
There will always be situations where there are
jerks. You can become the brunt of their nasty e-mails,
sabotage, and negative behavior. Several strategies
will help you deal with jerks.
1. Take care of yourself. Emotionally, it is important
that you do not personalize the attacks, although
this can be very difficult. Professionally, you need
to keep documentation of the incidents in case the
behavior escalates to bullying. Consult with your
boss and others and develop a plan.
2. Always take the high road. At no time should you
ever allow yourself to drop down to the same
level of behavior. This means never answering
hostile e-mails with anything other than grace and
dignity. It means keeping your own counsel and
not discussing the situation with anyone except
the appropriate people in the organization.
Everyone has a dark side and events like this can
precipitate anger, vengeance, or depression.
Retaliating with behavior that is inappropriate is
absolutely unacceptable.
3. Assume that a workable relationship can be established.
Withdrawal from the person is probably
the most natural reaction. Withdrawal makes it
easier for the person to continue the behavior
because, as Carter (1999) explains, it is easier to be
hostile to someone you do not know well. Forni
(2003) notes that incivility thrives among
strangers and rudeness is often halted when people
get to know each other. The game is often over
when the person develops a relationship with you
and mutual areas of concern and collaboration are
found.
4. Reach out to experts when all else fails for advice
and counsel. This is no time to go it alone. When
one is in a difficult situation such as this, thinking
can be distorted. Reality checks from mentors and
experts will help guide you.
Summary
There are jerks in this world. There are jerks at
work. As managers and leaders we are obligated to
insure that people have a healthy environment in which
they can be nurtured and grow. Patient safety cannot be
compromised because we allow jerks to create chaos.
This is a serious issue that is very expensive in terms of
the toll it takes on people, patients, and the organization.
However, there are solutions so we must act. Jerks
don’t need to be a part of the culture of nursing.
Incivility does not need to exist in hospitals and health
care facilities. As Carter (1999) notes, the barbarians are
truly at the door and this is true of hospitals and of nursing.
However, we have the opportunity to change the
self-interest behavior of jerks in our communities of caring.
That is what leadership is all about.$
Why Are There Jerks?
There can be two very divergent explanations for
this behavior. The first is that the person has that kind
of personality and will inevitably act that way. When
this person fails at creating chaos, he/she will move on
to another venue to keep acting out this behavior.
Another explanation is that a toxic environment creates
toxicity in individuals and a failure of leadership allows
this behavior it to exist (Frost, 2007). Probably both
explanations are viable and the accuracy would depend
on the individual and the situation. We know there are
nurses who always have to be “super nurse” and need
to portray others as stupid. These nurses, traditionally
labeled the “Queen Bees,” became this way because of a
variety of reasons. Whatever the explanation, we know
that we are obligated to create healthy environments in
which the patients can be assured of safety. The behavior
of jerks cannot be allowed.
Developing a No Jerk Culture
In health care, we are dependent upon collaborative
relationships to create safe outcomes for our
patients. When a unit does not have a clearly defined
“No Jerk” rule and infrastructure to support healthy
behavior, communication suffers and errors occur.
Poor communication is the leading cause of reported
sentinel events, according to the Joint Commission.
We cannot afford distractions from the work of patient
care that dysfunctional members of the health care
team can cause. We can learn from other organizations
that have developed the rule of not allowing toxic
people to poison their workplace.
It is important to clearly define the behavior that is
not allowed. Sutton (2007) describes companies that
have clearly articulated this stance. Southwest Airlines
not only supports a jerk-free staff, but is also very
aggressive in not letting any passenger who is a jerk
abuse their employees. Barclays Capital has clearly
articulated a “No Jerk” rule. The Men’s Warehouse in
their philosophy states that they will respond immediately
to anyone regardless of position who is degrading
another. We in nursing can look at “best practice” outside
of health care to build the best programs possible.
Once the philosophy and behavioral expectations
are clearly established, the next step is to hire against
that philosophy and to internally implement the standard
with educational and support programs to help
everyone achieve the standard. Monitoring the effectiveness
of the interventions is necessary.
A leader or manager might want to ignore the
problem and hope it will go away. Or the person
might feel she does not have the skills to intervene
correctly. This is the time the leader/manager must
reach out for help. The costs of ignoring this problem
are enormous both from a patient safety stance and in
the very high cost to the organization from productivity
and litigation.
references continued on page 227
NURSING ECONOMIC$/July-August 2007/Vol. 25/No. 4 227
REFERENCES
Carter, S. (1999). Civility. New York: Harper Perennial.
Forni, P. (2003). Choosing civility: The twenty-five rules of considerate
conduct. New York: St. Martin’s Griffin.
Frost, P. (2007). Toxic emotions at work. Boston: Harvard Business
School Press.
Gonthier, G. (2002). Rude awakenings: Overcoming the civility crisis
in the workplace. New York: Kaplan Business.
Sutton, R. (2007). The no asshole rule. New York: Warner Business
Books.
On Leadership
continued from page 234
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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