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What to do if hostile, rude or negligent behaviour from colleagues or a manager is affecting morale and patient care – and how to challenge it
Team working is essential for delivering good care, and in challenging times we need the support of colleagues more than ever. When someone does not pull their weight or behaves in a hostile way, the atmosphere can feel negative and tense, and you may feel dragged down by it and lose motivation.
Nursing Standard. 38, 3, 19-21. doi: 10.7748/ns.38.3.19.s11
Published: 01 March 2023
This behaviour might be the manner in which a colleague speaks to others, or could be non-verbal aggression such as eye-rolling or ignoring someone. On Nursing Standard forums and elsewhere, nurses report encountering unacceptable behaviour at work ranging from colleagues shouting at each other and skipping routine tasks, to displays of outright hostility.
Negligent behaviour can include not responding in an appropriate manner to patients – ignoring call bells, for example – and carelessness in documenting actions and observations on care plans.
University of East Anglia professor of work psychology Roberta Fida has studied the impact of workplace aggression.
She says: ‘We know that the more nurses work in a stressful context, the more they will experience negative emotions, such as anger and frustration.
‘This can lead to what we term “moral disengagement”, where someone starts to justify sliding professionalism, for example by saying, “Well, it’s okay, because everyone does it”.
‘One study showed how nurses who have been the target of aggression or bullying at work can morally disengage and become clinically negligent themselves.’
While all this may sound gloomily familiar, evidence suggests this negative spiral can be stopped.
‘Reflecting on what happened is important,’ says Professor Fida, and she cites research showing that nurses who do this are more able to regulate their behaviour and less likely to morally disengage.
‘It’s important to try to understand what the triggers are and reduce stressors where we can,’ she says.
Speaking to your supervisor is often the best first step if you are concerned about a colleague’s behaviour at work and its impact on patients. If you have tried this previously and felt fobbed off, then try again. You could choose a different time to raise them, provide some fresh examples or evidence, and say something like, ‘I still feel uncomfortable and want to discuss this with you’.
Professor Fida says that if someone upsets you, speaking directly to them can be effective. ‘Stay calm and simply explain that what they did is unacceptable and ask them to stop doing it. Remember, their behaviour may be unintentional.’
Sleeping during shifts, watching Netflix and not responding to call bells were some of the accusations that a care home nurse faced in an employment tribunal earlier this year.
The nurse is no longer allowed to practise due to strong and detailed witness statements provided by five of her former colleagues at the care home,
A Nursing and Midwifery Council fitness to practise panel heard that she had used force when dealing with patients, shouted and sworn at them and called them abusive names, and failed to take action when a patient’s condition deteriorated.
The panel said: ‘Nurses must act with integrity. They must make sure that their conduct at all times justifies their patients’ and the public’s trust in the profession.’
Maguire Communication Skills Training Unit senior trainer Ali Franklin, based at the Christie NHS Foundation Trust, says: ‘Think about colleagues’ behaviour as you would your patients: if they are angry, ask yourself why they might be feeling like that.’
She suggests that rather than labelling behaviour as rude or aggressive, describe it in a factual and specific way.
‘The Code actively encourages nurses to raise concerns in a professional way and escalate them where needed… It confirms that no one should be obstructed when raising a concern’
Geraldine Walters, NMC executive director of professional practice
‘So, rather than say, “You were rude to me”, you might say, “Earlier, when I asked you for help with patient A, you turned your back on me”.
‘Most people, when tackled like this, will acknowledge the behaviour and may say something like, “Oh, I know I was short with you, I was having a bad day”.’
A similar approach may be needed if you feel a colleague is neglecting their duties.
‘Arrange a time to talk, focus on what you want, have evidence ready to support your points, describe specific behaviours and use neutral language,’ advises Ms Franklin.
For example, say something along the lines of ‘The nighttime meds were not given out and I’m concerned because patients are waking up in pain’.
At the end of the conversation, agree what is going to happen and use collaborative language. For example, say: ‘How about we monitor it over the next two weeks and then look at it again?’
If you have to repeat the conversation, once again be specific and factual, and bring evidence. You might say, for example: ‘I’m still concerned about this. Last night, four patients woke up in pain.’
If the person you have an issue with is your manager, it can feel difficult to challenge their behaviour, but sticking to these principles and explaining how you feel can be effective.
If you have repeatedly tried to tackle a problem with a colleague or supervisor, it may be time to escalate the issue. Do not be afraid to use your organisation’s formal processes. These are in place to protect healthcare staff as well as patient safety. Speak to your manager. If you do not feel listened to, speak to HR or your line manager.
Nursing and Midwifery Council (NMC) executive director of professional practice Geraldine Walters acknowledges that speaking up takes courage. She advises nurses to start by looking at the NMC’s code of professional standards.
‘The Code actively encourages nurses to raise concerns in a professional way and escalate them where needed. Nursing managers and leaders can help as they’re also bound by the Code. Importantly, it confirms that no one should be obstructed when raising a concern.’
The NMC’s Caring with Confidence animations show how the Code can help to guide decisions and actions in difficult situations.
If you are a manager dealing with issues in your team, it is vital to be consistent, considerate and open to others’ comments.
‘If you feel that your supervisor is listening to you and taking appropriate actions to support you, then you’re less likely to experience emotional exhaustion,’ says Professor Fida.
But what happens when, as a manager, you too feel overstretched and unable to solve your team’s issues?
‘The most powerful thing you can do as a manager is to listen to someone and fully acknowledge what they’re saying about a situation and the impact it has on them,’ says Ms Franklin.
‘Show that you understand by saying something like, “I get it, you are up against it and it’s draining you”.’
As a manager, you will not be able to fix everything and – just as when you have to break bad news to patients and families – it is best to be honest about what you can and cannot do.
Having fully acknowledged team members’ issues, use collaborative language to bring the focus back to team solutions, such as: ‘We’re in a difficult situation – what, if anything, can we do to make this more manageable?’
Encourage the team to come together at the beginning and end of a shift. ‘A few minutes talking over things is valuable,’ says Ms Franklin.
If you feel you are being repeatedly targeted at work, the RCN advises that you write notes about what is happening, recording the details in a bullying and harassment diary.
RCN members can contact the college’s advice team for support, while the NMC has guidance on raising concerns.
But remember that your employer has a duty of care to provide a safe working environment and should have a policy on what to do if you feel you are being bullied.
As a nurse, caring for patients is your primary concern, but how effective you are at dealing with colleagues, patients’ relatives and the stresses of working life has a big impact on your ability to do your job well and to gain fulfilment from it.
A study co-authored by Professor Fida found that when nurses are confident in dealing with colleagues and managers, their experience of incivility is greatly reduced. And understanding and managing your own emotions as well as those of others can form a buffer against the damaging slide into bad behaviour and disengagement.
Evidence suggests that during the COVID-19 pandemic, nurses who were confident in their own capabilities to deal with work tasks and manage their own emotions experienced fewer mental health issues.
As well as trying the tips here, find out from your manager or HR department if there are any training courses you can do to develop your confidence in communication.
The Christie NHS Foundation Trust runs communications skills courses for healthcare professionals.
Strategies for dealing with rude colleagues who ruin your day rcni.com/rude-colleagues
The Christie NHS Foundation Trust: Maguire Communication Skills Training
NMC Caring with Confidence animations Code animations
