Combatting Toxic Leadership in Nursing: How Educators Can Play a Role
Maybe it’s a boss who misses an important payroll deadline, or a manager who refuses to step in to solve a conflict between two co-workers. Either way, most employees know toxic leadership when they have experienced it.
In most industries, toxic leadership leads to low employee morale and high employee turnover. But in healthcare—particularly nursing—toxic leadership can actually lead to negative health outcomes and even death.
This is according to Dr. Dan Weberg, PhD, MHI, RN, FAAN. Weberg is an expert on leadership in nursing, having authored several books on the topic, including “Leadership for Evidence Based Innovation, Third Edition” for which he serves as co-author.
We spoke with Weberg on how education can play a role in stamping out toxic leadership by working important lessons in throughout the curriculum. He also offered some dire warnings if toxic leadership is not stamped out in healthcare
Watch his full interview here and read on to learn more.
Toxic Leadership Defined
Toxic leadership in nursing refers to a leadership style that is detrimental to the well-being and performance of nursing professionals. It is characterized by abusive behavior, lack of empathy, micromanagement, and a toxic work environment. This type of leadership can have a detrimental impact on the morale, job satisfaction, and overall mental health of nurses, with cascading effects on patients.
“If those behaviors happen over time, they create a lot of stress for the team in general,” he says. "That team gets distracted and focuses more on the drama every day instead of doing work.”
Leaders often disregard the needs and concerns of their subordinates, which can result in feelings of isolation and burnout. This can have a negative impact on the quality of patient care and the overall well-being of nurses.
Weberg’s work centers on defining toxic leadership first and foremost. “It was hard to put language and evidence around these behaviors,” he says, but it is critical to do so in healthcare.
“Dysfunctional leadership has impact on outcomes,” he says. “On learner outcomes, organizations performance, and in the clinical setting it’s been shown to increase morbidity and mortality in patients.
“People die faster when there’s a toxic leader,” he says.
Effects of Toxic Leadership on Nursing Professionals
Toxic leadership in nursing can have a wide range of negative effects on nursing professionals. These effects can be both emotional and physical, and can significantly impact the well-being and job satisfaction of nurses.
One of the primary effects of toxic leadership is increased stress and burnout among nursing professionals. The constant pressure, fear, and lack of support can lead to emotional exhaustion, decreased job satisfaction, and even physical health problems. This can ultimately result in higher turnover rates and a shortage of experienced nurses.
Weberg provided the following data points from a massive 2018 Harvard Business School study on toxic leadership:
- 12 percent of people who experience toxic leadership will leave their job,
- 63 percent of people report losing time trying to avoid a toxic person,
- 48 percent report decreased work effort,
- 78 percent report decreased organizational commitment.
That’s just the workforce side. Though the clinical side, it is harder to find data, but Weberg said it is widely known that toxic leadership leads to negative patient outcomes.
“We get all focused on these indicators: falls and infections, that kind of stuff, but there’s something we can control in our own behavior in leading teams that is also causing bad outcomes in patients,” he says. “We have to fundamentally address that, we can’t just sweep under the rug.”
Role of Educators in Addressing Toxic Leadership
One of the key roles of educators is to embed leadership into the curriculum where possible and appropriate. There are a handful of opportunities, he says.
“In any of the dynamics where you’re working with a team,” he says. “When your students are going out to clinicals, when their meeting with their preceptors, when you have faculty meetings,” he says.
One area where it does not need to only reside is in the leadership course, he says.
“I think that’s where people tend to stick it,” he says. Leadership material does not focus directly on passing the NCLEX so Weberg acknowledges there may be a desire to bury these lessons, and that students may want to tune them out. But the better practice is weaving it throughout the curriculum. Drip feeding it through simulations is likely the best way to have good leadership practices break through to students, he says.
“You can actually put in sort of these toxic behaviors,” he says.
He gives an example from when he taught at Arizona State University in which he would have an angry physician call in the middle of a simulation making unreasonable demands. He describes another simulation in which there were multiple patients, and he would bring in an actor to inject drama just so students could learn real-world application.
“This stuff is subtle,” Weberg says. “It doesn’t have to be the person running and screaming at the top of their lungs. There are these little micro-behaviors that chip away at people over time.”
Ultimately, the goal of Weberg’s work is to put nurses and healthcare providers in positions to do what they do best: treat patients.
“If you don’t feel safe and content in your role and you’re continually having to navigate interpersonal conflict it distracts from the meaningful work that you signed up to do,” he says. “You didn’t become a nurse to deal with a toxic boss or dysfunctional team member you became a nurse to take care of patients.”
Leadership for Evidence-Based Innovation in Nursing and Health Professions, Third Edition
Leadership for Evidence-Based Innovation in Nursing and Health Professions, Third Edition takes a patient-centered approach, discusses the perspectives on the dynamic of innovation and evidence as well as emerging competencies for leaders of healthcare innovation.
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