Rebuilding a Toxic Unit Culture - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

New managers often ask me if it is possible to remold a culture that has become toxic over time. My answer is always the same. You can rebuild a culture but it will take time and leadership commitment. It will not happen overnight and incremental changes can profoundly improve a culture over time.

Culture has been described as the invisible architecture of an organization or unit. It is a compilation of values, behaviors, actions and group norms that ultimately becomes “the operating system” to use a technology metaphor. How do you know if your culture is toxic? Mike Ganino, a leadership culture expert, provides some telltale signs:

There is lots of gossip and negativity.
There is either poor or disengaged leadership.
There are no definable goals and staff cannot verbalize the success measures.
There is a lack of candor and direct, honest feedback.
There is a lack of psychological safety and staff worry about being thrown under the bus.

Even though leaders may sense issues with the culture, it can be hard quantify how serious the problems may be without conducting some due diligence. One key element to a healthy culture is whether staff promote or discourage others from working in the environment. Ganino recommends conducting a survey to determine this which would include four key questions based on a widely used metric called the NPS or Net Promoter Scale developed by Fred Reichheld. The questions include the following:

How likely are you to recommend our unit as a place to work? This is rated on a 1-10 scale from least to most.
What is the primary reason that you gave that score? This would be a drop down question with multiple options.
What would make you rate it higher? This would also be a drop down questions where you would include multiple options for improvement.
Why didn’t you rate it lower? This would also be a drop down question where you could include some potential bright spots on the unit involving things that are working well.

A second data point to use in evaluating the culture are exit interviews and turnover. It is a lagging indicator but can give you important data about who on the staff has left and possible reasons why. Once you have gained clarity on staff opinions, you can begin constructing an action plan. This often includes redefining mission and values so they are clear to everyone. As a leader, you will also need to be very honest about changes that you need to make in your own leadership behaviors. Trust is the cornerstone of a good culture and leaders must walk the talk.

I remember when I took my first manager role in the Department of Veterans Affairs. My Chief Nursing Officer told me that I needed to think of the unit as a home and I needed to be the one who would set the house rules including the values and behaviors that were expected. Ganino concurs with this philosophy that ultimately leaders drive culture change through their actions.

Unit values and behaviors should be written down and actively promoted. This means that the leader must take responsibility and recognize that excellent transparent communication plays a key role in any change. Employee evaluations need to be built around the values and behaviors. Future recruitment on the unit should be based on congruence with expected values and behaviors. Culture change will not occur without staff development as a strong component of the change. The strongest cultures are built around the learning as being a key value.

The most frustrating part of this process for new managers is that rebuilding a culture does not happen overnight. It takes time to build trust and hard wire values. Too many of us want quick fixes where there are none. When my administration students take on the challenge of managing a troubled unit, I advise that they make at least two year commitment to themselves before giving up. Ultimately, nothing is more satisfying in a leadership career than taking a toxic culture and turning it into an exemplar where everyone wants to work.

References

Ganino, M. (2018). Company culture for dummies. New Jersey: Wiley Publishers.