1. Lockhart, Lisa MHA, MSN, RN, NE-BC

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Q: What's a toxic workplace culture?

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A: We've all heard references to "toxic culture" when discussing an unfavorable place to work, but what exactly does this mean? It simply means unhealthy. A toxic culture is one that prevents growth-individually, professionally, and organizationally.


According to Forbes, there are five signs to look for: narcissists at the top, commiserating employees, lack of transparency, a changing rulebook, and the place (people) is literally sick. The latter refers to employees frequently calling in sick or working while sick and frequent turnover. Although many articles are related to nonhealthcare businesses, the warning signs are similar and the results, the same: high turnover, low satisfaction, and poor outcomes.


For nurse leaders, watch for these 10 signs of a toxic culture:


* top-down leadership


* an inequitable system of reward and recognition


* abuse of position and power


* lack of respect


* unmotivated and disengaged staff


* tolerance for antisocial behavior


* poor mentoring and coaching


* lack of honest transparency in communication


* no value placed on work-life balance and personal needs


* reactivity not proactivity.



Poor leadership is at the forefront of a toxic culture. Poorly prepared or trained leaders possess "skilled incompetence." Either consciously or unconsciously, those who follow the mantra "do as I say, not as I do" exhibit a narcissist approach to leadership. In this case, we see that decisions are made without consulting the people who do the work and without actual understanding of what it takes to perform the work required. This is one of the biggest drivers of the inevitable turnover that occurs in a toxic environment. High leader visibility; rounding with purpose; staff-led committees; and open, trusting dialog are the ways to manage this issue.


Unprofessionalism, which may be displayed as low engagement, poor communication, gossip, rumor mongering, discrimination, and favoritism (real or imagined), is also rampant in toxic cultures. Communication of the mission, vision, and strategic plan are crucial when addressing this. The communication must be direct, transparent, and frequent. In townhalls, newsletters, and open forums, respectful, interactive, and mutually appreciative communication is vital. Professionalism must be shown by example and addressed as a minimum expectation in the culture.


An organization that utilizes a top-down hierarchy instead of a more collaborative, horizontal approach creates an environment in which trust becomes an issue. This lends itself to the next area of concern: abuse of power. Here, leaders see themselves as the ultimate authority and employees as expendable. When leaders fail to address bullying, harassment, destructive gossip, retaliation, and intimidation, it sets an overall negative tone and organizational culture.


Leadership tips to combat this include recognition, first and foremost, and listening, engaging, interacting, rounding, and sitting one-on-one with employees. What are staff members feeling? Take concerns seriously and remember to listen to understand. Educate staff members at all levels regarding zero tolerance for antisocial behavior and retaliation. Lead by example, creating a healthy work environment and a just culture that engages staff at the point of care, not just top-down directives.


Just as leaders must understand how to promote healthy, creative, and supportive work environments, employee involvement in decision-making is also needed for success. Empowerment, communication, and visibility are the keys to a healthy work environment.




Aries E. 5 signs you're in a toxic workplace.


Porter-O'Grady T, Malloch K. Quantum Leadership: Creating Sustainable Value in Healthcare. 5th ed. Burlington, MA: Jones & Bartlett; 2018.


Sherman RO. Signs of a toxic culture.


Zhu P. Five characteristics of a toxic workplace.