Signs of a Toxic Culture - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

I was recently asked by a leader how to identify whether you are in a toxic culture. She had recently joined a new organization, and was having growing concerns that she had made a serious mistake by not doing more due diligence. The fact that she was asking the question is probably a strong indication that the culture was not a positive one. There was no overt yelling or screaming but what she did see were subtle signs that deep damage was occurring and the staff was feeling the fallout.

Tim Porter-O’Grady and Kathy Malloch in their book Quantum Leadership present a model that nurse leaders can use to evaluate organizational toxicity. They identify the following 10 sources of organizational toxicity that together can form a syndrome of organizational pathology. These sources/indicators include the following:

The organization has a vertical authority structure – when decisions are top-down driven with little collaboration across the organization, this leads staff to believe that there is a lack of trust and a desire to defend the status quo.
Inequitable rewards and recognition practices – when there are wide gaps between what staff earn and what leaders earn, this can lead to feelings of inequity. If the wages of long-term staff are compressed but newer staff are brought on at higher salaries, this leads to distrust as does inequitable recognition practices.
Abuse of power – when leaders abuse their power and are allowed to remain in their positions – staff will run out of patience and many will end up leaving. Interesting, this is rarely reported or asked on exit interview.
Lack of respect for the workforce – some leaders view staff as being expendable and do little to retain them.
Failure to manage unmotivated employees – although finding the time and energy to discipline unmotivated staff is challenging, failure to do to it can result in toxic work environments where excellence is not seen as a value.
Tolerance of antisocial behavior – bullying, gossiping, sexual harassment and other deviant behaviors impact everyone in the work unit. A failure to deal with these problems leads to toxicity in the environment.
Toxic mentoring – when a preceptor or mentor is not constructive in guiding the growth of another, it can result in a toxic situation which sometimes leads to the exit of the staff who is being mentored.
Inconsistency and Dishonesty – when leaders don’t follow through with promises or are dishonest in reporting outcomes, this causes toxicity in the environment.
An Imbalance Between Work and Personal Life – too much focus on work at the expense of the lives of employees is extremely damaging in the long run. An expectation that no one will “unplug” is unrealistic.
Advocacy Gone Awry – Doing too much care in a reactive manner has caused toxicity in many healthcare environments today.

Very few organizations have all 10 sources of toxicity but most probably have at least one or more. Without strong leadership to directly address these behaviors, even strong cultures can evolve and become toxic in a relatively short period of time. My colleague mentioned above has an important choice to make – does she stay and try to be transformational or does she leave. There is no right or wrong answer here and her decision will likely be made after she evaluates her potential for success in this environment.

Read to Lead

Porter-O’Grady, T. & Malloch, K. (2018). Quantum Leadership: Creating Sustainable Value in Healthcare. 5th Edition. Burlington, MA: Jones & Bartlett.