There's hope for healing unhealthy relationship with manager

Dear Joan,
I am a nurse at a major hospital. I love nursing, but I find it emotionally draining to work in an environment where managers act like power-hungry autocrats. They make up unwritten rules of silence so the people at the top never learn the truth about how most hospital units are run. Fear of losing our jobs and shame about imperfection are the management tactics that are used to keep us silently compliant.

On my unit, the manager condones vicious, even libelous gossip and withholds praise for good work if she finds you too outspoken. She gives unequal work assignments and refuses to take responsibility for unsafe staffing ratios.

The outspoken nurse is floated to other units when it’s not her turn, refused shift requests and denied the same salary increases that other, less verbal nurses are receiving for meeting the same evaluation criteria.

The nurses I talk to at lunch, at seminars and at nursing organizational meetings all tell me the same stories. One nurse was given a three-day suspension without pay by her manager because a patient’s family member perceived the nurse as being too hurried and unfriendly. The nurse had just finished coding [the heart stopped] a 57 year old man before entering the room of the patient with the complaining family. The manager never attempted to explain the situation to the family.

At a recent workshop I attended, a nurse told me about being verbally abused by a physician. He shouted out that he thought the nurse was incompetent and would make a better checkout girl in a local supermarket. He did this in the middle of the nurses’ station, with co-workers present. It turned out that the doctor had failed to read the patient’s chart and he, in fact, was responsible for the error. The doctor was never told to apologize to the nurse…but the nurse was told her raise was contingent on reestablishing friendly relations with the doctor involved.

I don’t want to leave a profession I love. I have been a nurse for over fifteen years and find patient care very rewarding but I can’t stand the unhealthy environment any longer. I’m too aware of the injustices to remain silent. Can you help me?

Your situation goes beyond the world of health care. There are poor managers in every industry; however, it may seem more incongruous in health care, since it is supposed to be a caring, healing environment.

Pressures in your industry have made things worse. I hear from my health care clients that the pressure for cost containment has made the environment feel more like a bottom line business, something that many health care professionals disdain. Rather than filling beds, hospitals now want to get people out of the hospital as quickly as possible. Staffing levels are watched closely. Full-time staff is pared down and replaced with contract staff, in an effort to stay lean. Low unemployment has made recruiting and retention issues worse. Mergers are wreaking havoc on once stable cultures. Some physicians are frustrated by the loss of independence and earning power they once had.

On one hand, your manager sounds so unfair and retaliatory that I’m inclined to tell you to go find a new manager to work for. But I think it’s also worth pursuing both sides of this situation. Some of these realities aren’t going away any time soon, no matter what job you take in health care, so let’s look at some things you can do.

Make sure your suggestions and feedback are perceived as constructive.
Tact and neutral language will go a long way. For instance, how do you define "outspoken"? I have been involved in situations with clients where the employee called his or her own communication style "open and honest" but I would have called it out of line. If an employee attacks the manager with anger, sarcasm or accusations, they aren’t going to be heard. These are often the same employees who are complaining to everyone else about how horrible the manager is, rather than going to the manager and talking in a civil tone about what is troubling him or her. The delivery style is just as important as the content.

Take a big picture view.
Read everything you can about the changes going on in health care. Ask questions of senior managers about the changes that are happening and why. Often, a situation (such as staff allocation) can appear to be irresponsible or even retaliatory, when, in fact, it is being dictated by someone above the manager. Often, knowing the end goal will spur a team into a more creative solution, such as finding ways to cut costs instead of head count.

Develop mutually respectful relationships with physicians and other technical professionals. However, don’t become a compliant punching bag. Stories about arrogant, abusive physicians are nothing new. What is new is the labor shortage. I have several colleagues who tell me they are having a tough time finding staff who want to work with these doctors. In addition, some senior administrators are intervening in cases like this, but unfortunately, it is the exception, rather than the rule.

Focus on good examples instead of dwelling on the bad.
It’s tempting to want to gather evidence that supports your own feelings of injustice, but it will only become a black hole of negativity that will rob you of a balanced perspective and suck you dry. I suspect there are many good managers, respectful physicians and happy teams in your organization and others.

In the final analysis, if you are taking these positive steps and you feel that your manager is unfit to work for, you can talk to a neutral party such as Human Resources, or you can take your talents to a different department or organization where you will be treated with the respect and dignity you deserve. Where there are managers this bad, there are often managers above them who are worse. They allow behavior like this to go on, because it’s easier than doing something about it. If that’s the case, you can find a new environment without giving up the profession you love.

Joan Lloyd is a Milwaukee based executive coach and organizational & leadership development strategist. She is known for her ability to help leaders and their teams achieve measurable, lasting improvements. Joan Lloyd & Associates, specializes in leadership development, organizational change and teambuilding, providing: executive coaching, CEO coaching & leader team coaching, 360-degree feedback processes, retreat facilitation and presentation skill coaching and small group labs. Contact Joan Lloyd & Associates at (414) 573-1616,, or 
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