It is not easy to change a culture. At times, it feels like I’m swimming against a strong current. I can get pretty maudlin and discouraged trying to decrease hostility and build a healthy work environment. The moments that rejuvenate me, however, are the precious conversations I have with staff—in just one meaningful interaction with a staff member, I realize again that we are all caught in this undertow of emotions. Every day, the pressures of our job and horizontal hostility take our profession way off course.
I once asked a peer how she was coping with the increased workload, hoping to hear some solutions I could apply myself. “I ask staff to fill out their own performance evaluations, and then I just sign them. I don’t have time to meet with them,” she said. I was really concerned. Had the demands of our jobs gotten to the point that we could not have just one conversation a year with our staff?
Performance evaluations are a golden opportunity to connect with a staff member on a more meaningful and deeper level that we ever could in a conversation on the floor. If this connection is compassionate, they in turn bring that compassion and understanding to the unit. The quality of relationship that we develop and demonstrate with staff becomes the standard for the unit and decreases horizontal hostility, one nurse at a time. Here is an example:
Audrey is the sweetest person on our floor. She is consistently pleasant, is clinically competent, and is a team player who steps up to the role of relief charge when needed. What more could I possibly say?
A section of our performance evaluations is marked “goals.” I asked Audrey what she thought of the goal I had written on her performance evaluations: “Do not stand by and say nothing while staff is gossiping. Either walk away or point out that it is gossip and then walk away.” She paused and responded thoughtfully, “That would stretch me… a lot.”
Aware of the fact that Audrey herself would never gossip, I asked that she take a stand. Rather than be a silent witness to the drama, I asked that she deal with negative comments made about others in an assertive manner. Then came her questions.
“How do you do that? What do you say?” she asked.
We role played some scenes she has witnessed and discussed some scripts. The essence of the conversation was that it would take a lot of courage for her to actually say something or walk away. But the effects of “just standing by” and listening to negative comments were not benign. I focused on what emotions listening to people being criticized brought up for her. Then I asked how she would feel if she had walked away or told others how badly the negative gossip affected her. The feeling of self-respect that came with speaking her truth won by a long shot.
Kathleen Bartholomew, RN, MN