You may wonder if your workplace is unhealthy or toxic or if it’s just you not being able to deal.
“I don’t have any time to spend with my patients. I throw meds at them and every day just pray I don’t make a mistake today. I’ve been crying almost every night and I’m so anxious before I come to work. I never know if I’ll get floated and I’m terrified to go to ICU. People call in sick all the time. The manager’s nice, but she lets the charge nurses run the floor and every charge nurse has different rules.”
Here are 5 indicators of unhealthy practice environments.
Poor Work Organization
There’s a chronic lack of supplies. Staff hoard supplies and if you don’t know where the pulse oximeter is and where any extra pillows are hidden, you’re out of luck. There’s little support from supervisors, who have an “that’s the way it always is around here” attitude.
The left hand never seems to know what the right hand is doing. You talk to one pharmacist who tells you it’s OK to run an Amiodarone drip on Tele, and another pharmacist who says it’s not.
Soiled linen is covered with Chux. Patients on bedrest are not turned. Vital signs may or may not be accurate. IV tubings may or may not be changed.
Staff feel forced to falsify information because the emphasis is on defensive charting and not on actual care.
Patients are not respected and not treated with dignity
Nurses want to do the right thing but the right thing is not only not rewarded, it is punished. Taking the time to sit and give a patient thorough discharge instructions using teachback which delays bringing up an ED admit is called a time management performance issue on your part.
Nurses who use workarounds and falsify documentation are praised as being efficient. Being dishonest and betraying your ideals leads to moral distress.
Staff do not take pride in their work. Aides are unapproachable and insubordinate, and some of the worst ones have been there several years.
Lack of Teamwork
In an unhealthy or toxic practice environment, it’s each man is for him or her self. It’s sink or swim and no one is going to help you. Coworkers won’t make eye contact with you, for fear you may expect something from them.
You might see a couple of coworkers team up to help each other, but they don’t really help others. It’s survival, not teamwork. You also see staff scatter when there’s a new admit or a when a patient needs to be cleaned.
Organization is Always in Survival Mode
Over the last few years there have been a series of short-lived CEOs and CNOs. The organization never stabilizes and accountability drops each time there’s a gap in leadership, as everyone waits to see what the new boss will deem important. Staff are jaded and skeptical of administration.
Absenteeism is always high and you are asked to stay over frequently. Turnover is higher than like facilities in the community, and there is a lack of collective organizational knowledge. Employees have job insecurity because layoffs and firings are capricious.
There are frequent visits from the state Department of Health, surveys, corrective plans of action, and re-surveys. Everyone is afraid of getting in trouble but not sure just how to do that.
Lack of Policies
Everyone is vague about the actual written policies and policies seem to be whatever the charge nurse on duty says. For example, you may have been told that the doctor must explain the risks and benefits before a surgery or procedure, but you observe nurses obtaining consent and the charge nurse says, “That’s how we do it. The doctor will talk to them in Pre-op but you have to send them with a signed consent”.
Nurses are confused about when the rules for changing IV tubing or the IV site. Eventually staff become accustomed to doing things the wrong way, and comfortable with normalization of deviance.
To Leave or Not to Leave
If you are in a practice environment like this, you need to plan your exit strategy.
If it’s your first job, don’t judge all of nursing because of this experience. This does not represent nursing as a profession, it represents low standards and faulty management. When facilities or businesses are struggling just to survive, it’s a jungle.
It’s not to say there are not toxic practice environments in larger, financially stable, established organizations, but there are some positive balancing aspects, if only more resources.
When you know your license is at risk and you are miserable, there is no justification for staying. You will spend more time at work than at any other single daily activity during your life. It’s just not worth it to be miserable when there are other options.
If you’ve decided to leave, first get another job. It may be challenging if you are within your first year, but it will be more challenging to land another job if you are unemployed. When asked about your short tenure, simply say, “It wasn’t a good fit. I look forward to working here where the mission and values match mine”.
Employers do understand that sometimes nurses have to jump ship not because they are unreliable, but because some practice environments are simply unsafe. Never say anything negative about a previous or current employer in a job interview.