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Nurses suggest favouritism is common in healthcare settings and can lead to a difficult workplace culture, not to mention concerns about patient care
Does one colleague always seem to be allocated the best shifts, have their pick of the most desirable annual leave slots or have a less demanding workload than the rest of the team?
Nursing Standard. 38, 3, 22-25. doi: 10.7748/ns.38.3.22.s12
Published: 01 March 2023
Or perhaps they get first pick on the case load, eased into a new job or indulged in other ways to make their working life that little bit easier?
These are some of the issues nurses raised when asked if they had seen or experienced favouritism at work.
They told Nursing Standard that favouritism is something they witness and endure at work regardless of the healthcare setting, and it can lead to a difficult atmosphere for the rest of the team.
Favouritism is the unfair support shown to one person or group, especially by someone in authority.
One community nurse described how a colleague, who was a ‘favourite’ of the manager and was not a permanent member of staff, was allowed to work from home for eight weeks on full pay while they settled in a new pet. But, in contrast, another colleague had to use a day’s annual leave to be at home when their child was injured at school. ‘It’s been going on for a long time and lots of very good nurses left due to this manager,’ she said.
‘Favouritism can be quite subtle and often arises when managers are not experienced’
Nurse in Northern Ireland (name withheld)
‘The culture was so bad that if you did not become part of it, you were bullied and given a very hard time. The trust has admitted bullying and that it was a toxic environment.’
Senior nurses and psychologists say it is a well-established problem in nursing teams, and much of it begins with nurses who are newly promoted to managers.
A nurse in Northern Ireland who has worked in a number of different settings says she has seen it often, and it can be hard to pin down and provide evidence of what is happening.
‘It can be quite subtle,’ she says. ‘It often arises when managers are not experienced.’
Some inexperienced managers, she suggests, can see team members who disagree with them as a challenge to their authority.
‘The manager tends to avoid communicating or engaging with those people and everything will be directed towards someone else who always agrees with them,’ she says. ‘The person who is perceived by the manager to be supportive then becomes the favourite.’
Such behaviour leads to divisions in a team, as the nurse, speaking on condition of anonymity, explains: ‘Somebody may make a joke about someone being the golden girl, but it is a joke with an edge. There may be back chat, but often the issues are not really dealt with and just ignored, or some other pressure comes along that is more pressing. But favouritism can be very visible and difficult to watch.’
Favouritism covers a spectrum that can cross over into the territory of bullying and discrimination. The RCN says that bullying and harassment are ‘behaviour from a person or group that is unwanted, unacceptable and has a negative impact on your emotional well-being’.
There is no legal definition of bullying, but it is generally unwanted behaviour that can include offending, persecuting or excluding someone – which can include some elements of favouritism.
If a nurse feels the behaviour is related to their age, disability, gender reassignment, race, religion or belief, sex or sexual orientation then it is discrimination, according to the RCN.
‘What we see so often in nursing is a manager put in a position with limited training on how to manage’
Iwan Dowie, head of adult nursing, University of South Wales
Favouritism can be difficult to raise and resolve, according to RCN health, safety and well-being national officer Kim Sunley.
‘Nursing staff need to be treated fairly wherever they work. Favouritism of one colleague over another, such as unfair shift allocation, could be a form of bullying. This can be difficult to challenge, especially where there is perception that favouritism is connected to friendships outside of the work environment.’
Ms Sunley says that nurses should establish if there is a pattern and keep a diary of what happens and when it takes place.
‘Nurses should raise it with their manager if they feel safe to do so and/or a trusted colleague or their union rep. If the situation continues, they should seek further advice.’
Research and reports into failures of care have previously highlighted the damaging effect that poor leadership in nursing can have.
A recent independent review of leadership across health and social care in England highlighted the need to improve the skills of managers in nursing.
General Sir Gordon Messenger, who led the review, said he found that leadership could have a huge impact on the quality of services, but that the development of quality leadership and management was not ‘adequately embedded or institutionalised’ in healthcare.
The report highlighted ‘poor behavioural cultures and incidences of discrimination, bullying, blame cultures and responsibility avoidance’, saying there were ‘too many reports’ of such issues to be ignored.
Research is fairly limited, but suggests favouritism is damaging to nursing teams and can make nurses want to quit.
One survey completed by more than 450 nurses in Australia found their trust was undermined if their managers did not have consistent relationships with their teams, and increased a desire to leave.
‘A willingness by the supervisor to come to their nurses’ defence and having a consistent standard of relationship quality is likely to improve nurse retention,’ according to the 2016 study.
Nurses and other experts who spoke to Nursing Standard agreed that favouritism was often able to develop when people were over-promoted.
The chronic nursing shortage across the UK means that there are tens of thousands of unfilled posts and recruitment can be difficult. This has exacerbated the problem of inexperienced or inappropriate people being put in positions of power, often with little support, nurses suggested.
Iwan Dowie, head of adult nursing at the University of South Wales, says putting an unsuitable person in a leadership role is a mistake he has seen repeatedly in nursing.
‘What we see so often is a manager put in a position with limited training on how to manage. These are nurses who have been in a team for years, have the right qualifications, and are similar to the people above who are recruiting them, and then are put into management roles as people don’t like to have a lot of change.
‘[Recruiters] want someone who supports their views, not someone who asks if they have thought about doing things differently. What it means with a lot of managers is that they are not good when it comes to leading.’
» Check local policy Employers should have a policy on how to deal with problems that come under bullying and harassment, including informal and formal action and who to go to for help
» Keep a diary It is crucial to keep a detailed written record of incidents. The RCN has an interactive diary that nurses can use that will provide vital evidence if they decide to make a complaint. Complete this as soon as possible after the event, excluding patient names and referring to colleagues by their initials
» Speak to the person directly The RCN suggests considering speaking to the person directly, by themselves or with a colleague. Their behaviour may be unintentional and they may stop if they are made aware of the effect it is having. The college recommends a calm but firm approach and make a note of everything that is said, either at the time or immediately afterwards
» Talk to others Speak informally to friends, family, trusted colleagues or a workplace counsellor. This is one way to clarify that you have a genuine problem. You can also contact occupational health or employee assistance support
» Mediation can sometimes help If this does not work, a formal complaint may be needed, following the employer’s policy
» Union members can contact their union for more advice and support
Source: RCN bullying advice bullying help
Mr Dowie says part of the skill of leadership is developing other people, being open to listening to other ideas and allowing people to express themselves. But someone without these skills can see people with ideas as a threat, which can lead to favouritism, he says. Such managers ‘favour those less likely to challenge their own perceived authority’, he adds.
Sir Cary Cooper, professor of organisational psychology and health at the University of Manchester, agrees favouritism is a problem of leadership.
‘What we need is people with more emotional intelligence who are socially and interpersonally sensitive, who recognise what is going on in a group and how an individual is feeling.’
He says that favouritism affects all sectors, but is especially worrying in healthcare. Anything that can hinder good communication, such as a divided team, could compromise patient safety, Professor Cooper points out.
‘If a nurse feels the behaviour is related to their age, disability, gender reassignment, race, religion or belief, sex or sexual orientation, then it is discrimination’
RCN nursing workforce standards
‘The value derived from managers’ recognition is going into one person and we get resentment emerging from the team. Those people who feel excluded can work together in a way to punish the manager indirectly and undermine them and then they don’t do the things they would normally do in a thriving team,’ he says.
‘This can be very dysfunctional and create poor performance. They may not communicate then to fellow nurses or the manager and communication is important for patient care. It is not a good scenario.’
Experienced nurses on an endoscopy unit in the north of England were waiting eagerly for a trainee nurse endoscopist role to be advertised so that they could apply. This band 8a post offered an exciting career opportunity for whoever secured the job.
But Sofia Khan (not her real name), who had worked on the unit for some time, said it became clear that even before interviews had taken place, there was a favoured applicant.
‘I heard the rumour that another nurse, who had no endoscopy experience and worked in a different part of the hospital, was going to get the role,’ Ms Khan says.
‘The first sign that something was happening was the job description, which was very open. It was more basic than descriptions I have seen for band 5 roles, which meant that anyone could apply, and endoscopy experience was listed as desirable rather than essential.’
‘It left me feeling rubbish and damaged my confidence, but I felt powerless to do anything about it’
Nurse (name withheld)
The interview included a presentation and was a time-consuming process for those short-listed.
At the end of the interview process, the ‘favoured’ applicant was appointed.
‘I feel he was earmarked for the job from the beginning, and somebody was keeping him informed behind the scenes. We see it all the time, the wrong people are given positions and they are somebody’s friend or relative.’
She has since left and will be taking up a role as a clinical nurse specialist in cancer care. The new job has boosted her self-esteem, which was shattered by the previous experience.
‘It left me feeling rubbish and damaged my confidence,’ says Ms Khan. ‘But I felt powerless to do anything about it.’
Everyone will come across people at work who they get on better with than others. But someone with more emotional intelligence will recognise that and not treat people differently, Professor Cooper says.
When it comes to addressing this, he acknowledges it is not easy. The best approach is to choose a person with good communication skills who is neither a favourite or the least favoured, to sit down and discuss it with the manager. Unfortunately, those who most need to hear it are those likely to be least receptive.
‘These managers are more likely to be insecure and have really low self-esteem and gravitate to those who give them constant reinforcement. That person is going to be very difficult to deal with in terms of giving them feedback in a sensitive way.’
gov.uk (2022) Leadership for a Collaborative and Inclusive Future inclusive leadership
gov.uk (2023) Workplace Bullying and Harassment
RCN (2022) Bullying and Harassment
Rodwell et al (2016) The impact of characteristics of nurses’ relationships with their supervisor, engagement and trust, on performance behaviours and intent to quit.
RCNi (2022) Compassionate leadership in nursing: how to make it a reality. rcni.com/compassionate-leaders
