Q&A With Nurse B: We Used To Work Together But Now I'm The Boss!
Beth Boynton, RN, MS specializes in communication, collaboration, and workplace culture. She offers advice on how to navigate common conflicts in nursing and healthcare with an eye towards shared accountability and co-creative solutions.
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I’m a nurse manager on a med-surg floor and was promoted from my staff RN position about six months ago. I’ve been on this unit for three years and started out as a graduate nurse. One of the full-time RNs who reports to me now – let’s call her Naomi – was my preceptor during my first six months.
Naomi’s clinical skills are superb and I owe a lot of my professional growth and confidence to her. We got along pretty well during my preceptorship, even though sometimes I felt she was a little negative. Now, as a manager, I’m becoming worried about how some of her behavior affects me, the team, and our patients. She has a tendency to groan when she gets her assignment, sighs heavily during report, and sometimes rolls her eyes during morning rounds.
We’ve also had a lot of change and turnover lately, and I suspect Naomi is creating more tension for everyone. I know I should address this but I dread it, partly because some of her behaviors are so subtle that they’re hard to recognize. The previous manager ignored her behavior, and if I’m completely honest, I ignore it too. The other day I was asking her to help another nurse with a complicated dressing change, and she walked away from me as if she hadn’t heard me; I felt disrespected but said nothing! I don’t want to be enemies.
Tension is Mounting
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Dear Tension is Mounting,
Thanks for sharing this difficult situation! It’s your decision how to proceed, but I have some thoughts about addressing the conflict with Naomi and the culture of the unit.
It sounds like Naomi has an old pattern of behavior that has been ignored. While it isn’t fair to dredge up old situations, you can find a starting place for providing constructive feedback1; the feeling you felt when she walked away from you the other day provides a perfect opportunity. Think about a good time and place for talking privately, be kind and helpful, and show ownership for your feelings. Also, give her a clear expectation about how you expect to be treated.
Once you are sitting down together you might start out the conversation like this: “Yesterday, when I asked you to help another nurse with wound care, you walked away from me while I was talking, and I felt disrespected. I want you to know that I expect to be treated with respect. Do you know what I’m talking about?”
There is no guarantee that she meant to or will own up to being disrespectful; that uncertainty is part of why giving this kind of feedback is hard. If she agrees that she misbehaved, she’ll hopefully apologize and perhaps give some sort of explanation; perhaps she was feeling overwhelmed with work or a problem at home. In any case, your feelings will be out in the open, and even if she didn’t mean to be disrespectful, she now knows that walking away from you during a conversation is likely to have such an impact on you and possibly others. Maybe she’ll reflect on that.
If things proceed cooperatively, you might use the opportunity to honor the shift in your relationship; this doesn’t need to be a big deal. For instance, you might say: “Sometimes it’s hard for me to be in this supervisory role and I miss our former relationship; you have so much knowledge and clinical experience to share. I’m committed to my new role, and I hope we can build a positive working relationship.”
Whether she grows from the feedback or not is up to her; in any case, there’s a good chance that she’ll think twice before doing it again. You might still address the change in your relationship even if the emotional tone is cooler.
Addressing the unit culture
It is also important to promote a a health work environment. 2 Naomi’s behavior has been tolerated over the years; consequently, she and all who work with her have been given the message that groaning, eye-rolling, and related behaviors are okay. They are not!
Your next task is starting the process of setting clear standards for respectful interpersonal behavior on the unit; this includes creating explicit norms about respectful behavior and considering any training required to ensure all staff have the skills to practice respectful communication. A plan for enforcing and monitoring new behaviors should be part of the process, and gaining leadership support can be helpful. You might ask for support from your supervisor that could include coaching regarding your talk with Naomi, clarification of organizational values that should be consistent with team norms, and keeping your leader aware of the initiatives you are taking on in your new role.
Good luck on taking these tough steps toward improving your relationship with your staff and the culture on your unit. If readers have other ideas that might help this nurse manager, please let us know your thoughts.
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Beth Boynton, RN, MS specializes in communication, collaboration, and workplace culture. She is a Medical Improv Practitioner and author of Confident Voices (CreateSpace 2009) and Successful Nurse Communication (F.A. Davis 2015). Her third book, Medical Improv: A New Way to Improve Communication is scheduled for release in 2017.
1. Boynton, Beth, RN, MS. (Retrieved Jan. 30, 2017) “Giving/Receiving Feedback” Pedagogyeducation.com, n.d. Pdf.
2. Longo, J., (Jan. 31, 2010) “Combating Disruptive Behaviors: Strategies to Promote a Healthy Work Environment” OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 1, Manuscript 5.