1. Cox, Sharon MSN, BSN

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Q As a manager with a new assignment, I'm currently dealing with several challenging personalities. I'm a good manager, but everything I've tried so far hasn't worked and I don't feel confident in my ability to fix these longstanding issues. Any advice?

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Start by changing your self-talk to reframe this concern so you have energy. Instead of thinking of conflict as an Achilles heel, understand that dealing with challenging personalities is a skill set you can learn. Framing these situations as an opportunity for personal growth, problem solving, and fostering accountability on your unit will help you feel more proactive.1


Part of being proactive is to tap your resources so you aren't handling this alone. Reach out to a colleague in behavioral health or a peer who handles conflict well, such as a human resources or organizational development team member, for coaching on "crucial conversations." And get to know your employee-assistance program staff members because you may also need their advice and counsel.2


Set yourself up for success by making your expectations clear. Have team agreements or ground rules in place based on staff responses to the question, "What do we need from each other to work well together?" Discuss the top three needs during staff meetings to measure progress and change them as things improve. You can reiterate these needs when reinforcing your expectations, and always tie what you're doing to patient safety, quality, retention, and/or teamwork. Identify behavior patterns rather than focusing on a given situation because this makes a stronger case and will keep you from getting caught in "he said/she said" arguments. Deal with the most problematic person first and that will send a message to others.


Use cognitive rehearsal to script yourself so you can stay focused and consistent.3 An easy acronym to use for behavior change is DEAF:


* Describe the behavior; don't attack the person.


* Explain the impact; the more honest the better.


* Ask for what you need instead.


* Follow through with a "thank you" or consequences for dropping the ball.



Plan for different situations so you don't get caught up in the emotion of the moment. For example:


* Set limits for manipulators. "In fairness, I'll be holding you to the same expectations everyone else meets and you'll need to decide if you can do that consistently. The decisions you make will then determine the decisions I need to make."


* Confront passive-aggressive employees. "When you have a problem with me, I want to be the first to know it" (covert) or "Rather than all the nonverbals, you can speak directly to me because I would rather you say it than share it" (overt).


* Set limits and clarify consequences for bullies. "Your pattern of incivility has no place in our team environment and has been mentioned in exit interviews, costing us almost $150,000 in employee departures. I can no longer afford you regardless of your clinical skills. Take the weekend to develop your plan for turning this around or turning in your resignation because your behavior simply isn't acceptable."4



It's beneficial to ask yourself what the situations may be trying to teach you. Maybe you're learning that "you get what you tolerate" or "we teach people how to treat us." Learn these lessons now or they'll likely show up in your path again. Also, keep in mind that underlying all difficult behavior is low self-esteem. Help the employee's self-esteem and you may diminish the challenging behavior.


Whatever you choose to do, remember that quality, safety, and teamwork, as well as your credibility, will be positively impacted by stepping up to this challenge. Taking it on will allow you to grow and go from being good to great in your leadership role.




1. Cox S, Beeson G. Getting accountability right. Nurs Manage. 2018;49(9):24-30. [Context Link]


2. Cox S, Cohen S. Essential Skills for Nurse Managers. Danvers, MA: HCPro; 2015: 40-42. [Context Link]


3. Longo J. Cognitive rehearsal. Am Nurse Today. 2017;12(8):41-42,51. [Context Link]


4. Porath C. Mastering Incivility: A Manifesto for the Workplace. New York, NY: Grand Central Publishing; 2016: 155-159. [Context Link]