16 Signs You're in a Toxic Work Environment as a Nurse and How To Overcome

In our LinkedIn Group "Career Resources For Nurses," our Moderator Ayla Roberts, MSN, RN conducted a poll asking "Have you ever been in a toxic work environment?" 100% of respondents answered "yes."

So, today, we're sharing advice from seasoned nurses who have been there, too. Diana Page, ACNP-BC wrote the following article about toxic work environments in nursing. Wali Khan shared his personal story of working in a toxic environment and how he overcame his struggles.

16 Signs You’re in a Toxic Work Environment as a Nurse

By Diana Page, ACNP-BC

As nursing professionals, it is our responsibility to care for patients but it is also the duty of our employers to ensure we are working in safe, supportive, empowering environments that are free from toxicity and lateral violence.?

The World Health Organization (WHO) defines a healthy environment as a place of “physical, mental, and social well-being,” supporting optimal health and safety. Does your work environment reflect that??

My own burnout stemmed from a solidly toxic workplace but at the time I had no idea. I had no frame of reference and I thought it was “just the way it was.” The environment plus my people-pleasing tendencies and lack of boundaries was a recipe for disaster and I slowly become more and more resentful and burned out. My colleagues and I used our voices but nothing ever changed. There was an illusion of “we want to make things better,” but in my world actions speak louder than words. Eventually, I decided to save myself and moved on.??

This experience, as horrific and disappointing as it was, helped me hone in on what truly wasn’t working, what aspects of the environment were truly problematic, and what I had control over when it came to my mindset and my actions. Through that reflection, I was able to identify what kind of job and environment would be more supportive of my goal of living a healthy life both as a human being and in my role as a nurse. Ultimately once I had that clarity, I took the leap.?

So, I’m sure you have a few questions, the first and probably most important, how do you know if you are in a toxic work environment? Sometimes it is insanely obvious. Other times we are either in denial or we really haven’t figured out why we aren’t happy. Or honestly, maybe we are scared out of our minds and not sure what to do to make it better…so in an effort not to rock the boat, we do nothing. But here is some guidance.

1. Are you happy? Be honest with yourself. If the answer is no, ask yourself what is contributing to your discontent. Ok now look around you, are people smiling? Are other people happy? How is morale? If the people around you seem unhappy and the environment is one of poor morale and dissatisfaction you may be dealing with toxic workplace culture.
2. Lack of positive feedback for a job well done but readily available negative feedback even for the slightest misstep can be a sign something is off. Are there instances where the punishment doesn’t fit the crime? Is there favoritism from leadership??
3. Dishonesty, inconsistency, and lack of transparency. Does leadership tell the truth? Do they follow through on their word??
4. Bullying, microaggressions, or lateral violence between coworkers. This is unfortunately quite common and can lead to decreased self-confidence, anxiety, burnout, and depression. Just remember bullies thrive on control and enjoy seeing others squirm. Try to maintain the moral high ground and choose mature professional communication. This may help disarm them or keep the incident from escalating while you involve leadership.
5. Is there adequate value placed on work-life balance and personal needs? This is huge. Staff needs to be able to “unplug” and remove themselves from the workplace when at home. Do you feel taken advantage of? Are the work commitment expectations reasonable?
6. Failure of leadership to manage unmotivated staff who aren’t pulling their weight. This fosters a culture where high performance isn’t valued and fuels resentment among staff members. This makes the people working hard to excel and contribute feel disillusioned. If you see this it may be a sign of poor leadership and toxicity.?
7. Is there reactivity and defensiveness when having conversations versus listening and providing constructive feedback? Is there a willingness to take action or create change and how willing are others to hear other people’s opinions??
8. Leaders who play favorites (or discriminates in general), are never happy with a project, micromanage, or are a poor communicator who is upset you couldn’t “read their mind,” or a leader with narcissistic tendencies who may have a “do as I say, not as I do” approach.
9. Staff members throw others under the bus without a blink of an eye, a lack of community, and poor support among colleagues. Colleagues are “out to get” other colleagues.?
10. High turnover and absenteeism: This is an indication morale is low and people are unhappy. Again…BIG red flag.?
11. People who complain ALL the time. This is an indication people aren’t happy and morale is low. It is not uncommon to see people complaining here and there but if it is a daily thing this is an indication of deeper toxicity. Keep in mind it may not be overt with people talking at the water cooler. It may be through social media, chat features online, texting, etc. Regardless…Yuck. Try not to engage and set up healthy boundaries.??
12. A workplace culture of humiliation, intimidation, or harassment.
13. Little to no feedback about your performance and solely negative feedback when you do get reviewed.?
14. Other people take credit for work you have done, especially if it’s your boss. Yikes.?
15. Infighting, gossip mills, paranoia about other staff members, and the formation of cliques. If the workplace feels like high school… it’s probably dysfunctional.
16. Sexual harassment, discrimination, and workplace violence - keep in mind that this treatment is 100% NOT OK AND ILLEGAL.?

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Physical effects of toxicity in the workplace

Not only can a toxic workplace lead to dissatisfaction when it comes to your job and career choice but it can also contribute to physical symptoms. Many of these are triggered by the stress associated with the environment but any of these can be a sign you are in a toxic situation. Oftentimes these are felt on the way to work or on the night before your workweek starts:

1. GI upset, nausea, lack of appetite, or emotional eating
2. High anxiety, heart palpitations
3. Depression
4. Insomnia or nightmares?
5. Feeling on edge or panic-stricken
6. Lack of appetite or weight loss
7. Headaches and muscle tension
8. Agitation, irritability, restlessness

At the end of the day sometimes these types of environments are able to be navigated through self-advocacy, leveraging effective leadership, and systems change.?But other times it may be beyond repair and it's okay to save yourself. You are number one. You are never stuck and your mental health matters. Being healthy in all aspects of your life matters.?

Recall that a healthy nurse as defined by the ANA:?

?“One who actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, financial, personal, and professional wellbeing”.?

For a list of some ways to overcome a toxic workplace head to THIS nurse.org blog post by Wali Kahn and as always visit www.selfcarecatalyst.com for more support, and free resources, or head to Instagram @catalystforselfcare for more burnout-repellent tips!?

You aren’t meant to do life or nursing alone.

Lateral Violence: 18 Steps To Overcome A Toxic Workplace

By Wali Khan

Follow Wali on Instagram @wali_khann

I’m hiding in the restroom. It is peaceful here. I’m by myself. My shift just started and I know my patients need me - I’m supposed to be there to protect them.?

But, who’s protecting me from the attack I feel by my coworkers and how did it come to this??

That scene was my real-life. I once worked in a toxic environment and was plagued with feelings of confusion and anxiety. I failed to see the warning signs and thought everyone I worked with felt just as genuine about caring for strangers as I did. I was wrong.?Not everyone feels the way I do.?

Nursing school didn’t prepare me for the sabotage, bullying, and workplace harassment I faced early in my career. Is this what a veteran nurse meant by “nurses eat their young?”??

Though it took me a while to realize it, I now know that there is no reason why anyone should feel attacked at work. I refuse to stand down and hide my experience anymore. This is how I decided to stand up for what was right and make a positive change in my work environment.??

Work Negatively Affected My Personal Life

While reflecting on my workplace, I realized that the treatment was negatively affecting not only my professional life but, my personal life as well.??

• I was more agitated at home,
• Felt more fatigued,?
• Experienced more headaches,?
• Lost weight,?
• Completing a simple task felt daunting so I left a lot of tasks unfinished which only caused anxiety.?

I remember coming home after a long shift and venting to my loved one about the troubles at work. “Then do something about it,” they responded. My initial response was one of anger. As if what I had to say wasn’t important.?

Then it hit me - how did I allow my work to affect my home life??

My loved one's response was my source of empowerment. Those words redirected my focus from drowning in my problems to coming up with solutions to fix those exact problems.?

I couldn’t be pessimistic anymore - I had to be optimistic, my career and honestly, my mental health depended on it.?

At the time, I didn’t realize that I was stuck in a downward spiral and had lost focus on some of the most important things in my career. Volunteering in my community,?participating in quality improvement programs, and teaching were activities that once brought me great joy.?

Having an outlet to talk about what I was experiencing at work without the fear of retaliation helped relieve stress, for the moment. Eventually, though, my next shift would come and I’d return to the toxic work environment that would wreak havoc on my home life.?

Until finally, I made a promise, to myself that I would no longer let my toxic work environment poison my life.?

Here are 18 steps I took to overcome my toxic work environment,

1. Acknowledge your feelings. The most important step is to acknowledge your feelings, be honest with yourself, and others, openly explain how you are feeling and how someone else’s behavior is making you feel.?

2. Interpret your feelings before confronting those that are responsible for contributing to your negative feelings. Did you know feeling numb belongs to the root emotion anger? Did you know the feeling of being isolated belongs to the root emotion of sadness? Explore the feelings wheel for a deeper understanding of what your feelings mean and how they may be controlling your emotional health.?

3. Start an emotional intelligence journal and start recording your feelings.?Record how certain feelings affect your ability to cope with stressors and your readiness to address the cause of those feelings. Acknowledge that hurt people hurt people. By understanding your own feelings you will understand why those around you may be responding negatively.?

4. Develop an action plan to help you deal with negative feelings as they arise, don’t ignore your feelings, don’t downplay how your feeling, be open and honest with yourself and those around you.?

For example, while giving a report to an oncoming nurse she/he repeatedly interrupts and rudely comments “is that all, are you done?” Don’t react, calmly be firm and explain how their behavior is making you feel. Reinforce that the patient is the center of attention and that their negative behavior is not acceptable and will be reported. Keep calm and don’t argue. Ask if you can resume where you left off. Report the incident to management and provide pertinent facts involving the incident and refrain from providing personal opinions.?

5. Be realistic. With yourself.

6. Ask yourself hard questions.?

• Are you ready to confront what/who contributes negative behavior to your workplace?
• Have you conformed to and/or contribute to your workplaces negative behavior? (Gossip, blame others for poor work performance or lack thereof, bully, fail to assist a coworker that is in need of help) The saying goes, “If you can’t beat em, join em”.?This goes back to the saying hurt people hurt people.?If you engage in negative behavior in your own toxic workplace then it is only fair to say that you’re just as responsible and have to be part of putting a stop to it.??

Most individuals that lack emotional intelligence are prone to behaving in the same way as their abusers.?As a defense mechanism victims will act like their abusers to take the attention off of them but stand back and watch others as they are victimized. Start by putting an end to gossiping, bullying, and set an example for others to follow.?

7. Redirect negative behavior using a non-judgmental approach. Help others find the positive in a situation or change the subject of conversation and focus on positive information.??

Image courtesy of @wali_khann Instagram

8. Identify what/who is contributing to negative behavior and making your work environment toxic.?

• Is the behavior a secondary outcome of an ineffective system??
• Are roles and responsibilities clearly documented, communicated, enforced, and understood by all employees?
• Does management encourage staff to communicate issues that may negatively impact practice in the workplace??
• Are those in management readily available when issues arise??
• Are their roles and responsibilities clearly understood by staff and is there a chain of command to follow when escalation is required?

9. Open lines of communication. Become the leader of change. Share your opinions amongst staff and ask for their views/opinions/ideas on how the system could be improved. Value everyone’s input and thank them for their feedback and be sure to follow up once issues/ideas/recommendations are shared with management. Employees that feel involved in improving their workplace are more likely to work as a team, morale improves and research has proven that when morale is up customer service scores improve too.?

10. Are those in positions of Leadership contributing to your toxic work environment?

• Does management hold everyone accountable for following rules, protocols, and policies???
• Does management treat everyone fairly? Is punishment transparent and unbiased?
• Can the person assigned as a leader be trusted amongst staff, are they respected, valued, and accountable?

Toxic leaders can plague systems and destroy working relationships that took years to forge. This discussion within a group can be difficult because of the fear of retaliation. If a toxic leader is the primary cause of your toxic environment then more than likely others will have made comments about interactions/concerns/problems they may have experienced too.?

Encourage others to provide feedback but set limits and discourage gossiping before engaging in conversation. Record facts and identify common complaints/concerns. Be sure staff feels comfortable disclosing information and if necessary keep anonymous.?

11. Prioritize and summarize concerns addressed by staff. Ask particular leaders for a meeting and explain that you will be representing your team (have a witness present) and have some suggestions for improving your work environment.?

• Be non-judgmental, open and honest with concerns addressed by staff and refrain from placing blame inside.?
• Involve the leaders in being part of an action plan to improve the work environment from which they lead.?
• Be sure to thank the leaders for their time and ask if a follow-up meeting could follow and set a target date for when you believe this should occur. If the leader is not willing to be part of a resolution and resistance is met make sure to document what was discussed during the meeting and forward it to both the leaders and to the next person in the chain of command, start a paper trail.
• Involve co-workers in each step of the way and ask for recommendations, valuing everyone’s input.?

12. Know your employer's grievance policy.

13. Reassess your feelings/progress.

14. Return to your journal and review your input regularly. Address feelings that have a negative impact on your emotional health. Find someone you can trust within your work environment. Explain that you value their honesty and support. Ask if they can help you debrief when necessary and be there for them too. Make a pledge with this person that what is discussed will be kept private and will not be shared with others at work.

15. Accept that you cannot change anyone but yourself. Be conscious of your actions, set an example of healthy behavior. Lead by example and others will follow.?

16. Avoid taking responsibility for anything you did not do and do not place blame on others. If you are responsible for a problem then provide an explanation for your involvement. Provide facts and ask for recommendations to prevent from making the same mistake twice.

17. Try your best then move on. If you have made a conscious effort to help improve your work environment and feel like no progress has been made, or your emotional health has not improved then it is okay to say you have tried your best and move on. Your emotional health is more important than continuing to be part of a negative work environment.?

18. Share your story with others. On the other hand, if your commitment to leadership has proven to be effective then share with others the skills that you used to help improve your work environment so they will use these skills too.?

• Follow up with your co-workers often and address issues immediately as they arise.?
• Keep a record of dates, issues, ideas, progress and resolution for staff to review so progress can be measured and modifications added to plans as appropriate.?

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