The following scenario highlights how to address a serious problem with a toxic staff member. This is the second article in a two-part series. In the first, a positive connection is what was needed to begin a better relationship with a toxic employee. Note this is a different situation, not one that would usually follow the first example.

In this case, Nurse Toxic is coming to work daily and spreading hate and discontent. Again, every manager has seen one, and most have supervised one of these team members at some point. In this second example the situation is much more serious than simply improving the relationship between the leader and Nurse Toxic.

The facility’s leader is constantly “under siege” by their entire team with comments like, “You have to do something about Nurse Toxic.” These comments should always begin with a conversation. A good leader knows her team members are aware of what she is thinking because they tells her. The absolute worst thing a leader can say or think is, “Oh, Nurse Toxic must know how we feel,” or “Nurse Toxic has to know this or see this.” But surprisingly, it is not uncommon that the nurse in question is quite oblivious. Several suggested steps follow.

New versus Seasoned

Is this a fairly new team member or one who has been developing and displaying this negativity over some time? If the team member is new (say six months or less), the leader should observe interactions with his teammates and get a sense of how he fits in with his shift. Then the leader should speak to residents who are cared for by Nurse Toxic to get a feel of how the residents perceive him when they are delivering care.

Once the facts are established, the leader is ready to meet with Nurse Toxic and let him know how he is viewed by his peers and residents.

The same fact gathering applies for a longer-term Nurse Toxic. If this is new or uncharacteristic behavior, the meetings outlined below will help determine if there is a problem or issue with him either professionally or personally.

One easy solution might be to provide a “free help day” where the unit manager/leader or director of nursing (DON)/assistant director of nursing (ADON) helps or shadows Nurse Toxic for her shift. The goal of this “help” is to try to identify if an assignment or other factors on the shift are adding to the behavior and attitude issues. If the workload is the concern or the cause, sometimes assignment or shift changes can make huge differences in team members with less than positive attitudes.

Looking Out

There is a danger, especially for new leaders, to be “taken in” by those who want to be seen as “being very close” to the leader. They are the first to report to the leader with every (alleged) negative comment made about them in the breakroom or out on the smoking block. New leaders (and indeed all leaders) should be very wary of those who attempt to curry favor by flattery, being a snitch, or having a “You know I’ve got your back” attitude.

As this applies to Nurse Toxic, it is very important to make sure there isn’t someone else “sabotaging” him. Sometimes, as outlined above, there could be another team member who is creating an illusion of toxicity to advance their own cause.

Starting Right

The best beginning step is a frank and very open conversation between the leader and Nurse Toxic. Again, the first conversation should have an emphasis on honesty and be a bit less hung up on the organizational chart hierarchy. There is a much better opportunity for success with just a discussion between the leader and Nurse Toxic. That way, Nurse Toxic does not feel “ganged up on.” This initial conversation is held in a nonthreatening or punitive way (for round one). It is not uncommon for a newer Nurse Toxic to be a little surprised if not shocked to hear how she/he is perceived in the building or the vibes that co-workers are putting out to others. So be prepared.

Listen Up

During the initial conversation, it is best if the leader can get Nurse Toxic to do most of the talking. The leader opens the conversation with concerns about Toxic and expresses a desire to simply achieve quality care under an environment of great teamwork. This is a perfect time to teach and be firm about the fact that the spirit of the leaders and team dramatically affect all caregivers.

Negative spirit coming out of the stand-up meeting has nowhere to go but down the hall and then, through the caregivers, directly into the residents’ room. All team members need teammates who care about each other as much as they care about the residents to create an environment that produces great quality care. 

As much as an individual might like to think they can conquer the world just using their individual abilities and talents, they must recognize that unless they can encourage others to help, they cannot be effective and great care cannot be accomplished.

Start and End with Praise

Nurse Toxic might just be toxic because he feels that no one has truly asked about him, inquired as to his experience to date, or their frustrations. Often, he just wants to be heard or get a chance to vent. By using open, honest communication, it is possible to find the underlying cause of why Nurse Toxic is acting this way. As with any coaching, this conversation should start and end with praise for the talents that have been already mentioned: great clinical skills and dependability. 

Look Deeper

The theme of this initial conversation, with every effort being made to get Nurse Toxic to talk, should be to educate and explain expectations, while giving specific examples (facts, not rumors) of his poor attitude and team spirit. This is the time to ask the honest question, “Is there something underlying causing this toxic attitude?” Is there a problem at home, is there something going on at work the leader is not aware of?

While obviously the need for this to change must be expressed, it is very important for this two-way conversation to determine root cause and provide potential solutions rather than the “hammer drop.” This is the time for the leader to be sure to convey the effects that Toxic’s behaviors are having on others.

This may be a great opportunity for the leader to use a personal touch early on, before the effort may get to a forceful level. The leader could even have lunch with Toxic to attempt to get to him better on a different level, possibly leading to more insight and potential solutions.

Aim for Understanding

Now with (one hopes) a more complete understanding on both sides, it is time to watch the progress, or lack thereof. Positive interventions still might include teaming Nurse Toxic with one of the team’s more positive and energetic leaders. Or this might be an opportunity to have both of them head up a project to attack a serious problem in the building (such as a falls program, wounds, walk to dine, etc.).
The combination of Nurse Toxic’s clinical skills and knowledge with a high-energy nurse might make for a winning combination. The good attitude and teamwork of the positive nurse may rub off on Nurse Toxic if they spend enough time together. This is happening while Nurse Toxic is seeing his skills and talents finally being appreciated. It is also possible to learn, in the first conversation or further along in this process, that Nurse Toxic felt he was constantly being overlooked whenever there were growth opportunities with the company, and this has led to bitterness.

Ways Forward

Other ideas as the path continues for Nurse Toxic might include, after an in-depth discussion, moving him to another position. Examples could include a quality assurance (QA) position, reporting directly to the DON. This could minimize Nurse Toxic’s contact with the rest of the nursing team, but it will still use those strong talents to the benefit of the mission of the organization. Nurse Toxic might make a great Minimum Data Set (MDS) nurse, functioning in a position where he isn’t directly supervising others. Maybe he would be a good wound nurse, working much more on his own. The effort to recondition Nurse Toxic is also an opportunity to grow other new leaders, and a positive individual could be given the opportunity to coach Nurse Toxic through this.

Time for Hardball

If after all this positive energy—and trying a few of the solutions offered above—the situation with Nurse Toxic is still very poisonous, the time for playing hardball has arrived. Using the organization’s standard evaluation form, the team meets with Nurse Toxic and clearly outlines all the issues that cannot continue. During this open and honest conversation, Nurse Toxic is told that his employment will be terminated in a maximum of four weeks unless a dramatic improvement in his team skills occurs.

Every week on a set date for the next four weeks, a new up-to-date evaluation is given to Toxic. This must happen like clockwork. Each week gives the opportunity to praise areas of improvement, stress items that have not improved, and bring up any other issues that are headed south.

By the end of the four weeks, and following standard Human Resources procedures, Nurse Toxic will have 1.) improved to an acceptable level; 2.) recognized that he just cannot do this and resigned; or 3.) know that termination of his employment is imminent. The work on the weekly evaluations must be both timely and thorough. It is critical that all the facts are gathered, including information from teammates and residents to monitor for improvement, especially regarding team engagement.

Moving Along

In the end, all of the above suggestions should be moved through fairly and honestly but quickly. Nurse Toxic may be so toxic that he should not be part of the team. Every effort has been outlined above to make this process “fair” to Nurse Toxic. But it is also critical that the organization and its mission are always fair to the residents (the negative spirit that pervades the building with Nurse Toxic present) and the poor folks who have to work with him every day.

At this point, an organization must move to defend the team and spirit of the building. To do less than that is unfair to all, and it goes against the goal of quality care. Or, as a wise man once said, “One cannot get clean drinking water until one gets the hogs out of the creek.”

A Bigger Problem

A final example will address a situation where an entire nursing leadership team is toxic. The nursing managers are in complete team chaos. They do not work well together, do not support each other, and even seem to try to make the other team members’ jobs more difficult. In this example, the organization has a wound care nurse, QA nurse, MDS Coordinator, two unit managers, and a DON.

The administrator sits this team down in the conference room and goes person by person, telling each of them what great skills and talents they possess individually. This is immediately followed by telling them that together, they make a terrible team and their attitude and failure to support each other is having a tremendous negative effect on quality care.

Each nurse is then given a blank sheet of paper and told to write their current job position. The administrator then outlines to the group all the responsibilities and the dedication it took to be in each of the different roles present at the table. As the next step, each is asked to secretly write out the words “If I could do anything other than my present position, I think I would be the best at ___________________.” The administrator then asks for all papers to be left with her so they could set up individual discussions.

Switching Jobs

After they all return to work, the administrator calls each one back in individually for a discussion of why they think they can achieve their absolute “best” at the new job written on the paper, and how they could develop the team moving forward in a way that strongly supports the other members.

This suggestion is based on an actual event. In that instance, the process worked out wonderfully. Everyone gained a new position—one that they chose—and then each succeeded in their new spot because it was their idea and their plan to make teamwork into a reality.

The wound care nurse wanted to be the MDS nurse. This nurse became the best MDS coordinator in the company and has trained new staff at several different locations in the organization. She still works with the organization, now as an ADON, and also helps with MDS work. The QA nurse wanted to be the wound care nurse, and she performed well at that position until her retirement. The MDS coordinator became the unit manager for the second unit and then went on to become a DON at a local assisted living facility.

Of the final two nurses, one moved from the unit manager position to the QA nurse, and the second one moved to the opposite side unit manager spot. They both worked at the facility and worked as a team until they retired.

This last solution might not always work out as well as it did in the example above. But an organization can seldom go wrong when it works to get folks in the spot where their passion is. Their drive and happiness will always be much stronger when they are in the spot of their dreams.

Keep Team Building

Finally, preemptive methods can also be effective tools in dealing with toxic team members. It is never a bad idea to do solid, well-thought-out team building exercises twice a year. Full day fun exercises can really pay off if even a few of the problems mentioned above can be avoided. If Nurse Toxic just has a temper, anger management techniques or training could be useful. In the end, the facility is there to provide quality care. Anything that helps to make the team positive just makes the quality better. 

Unfortunately, the reverse is very true as well.

Greg Dowdy is the chief operating officer for American HealthCare, which has 17 facilities in Virginia. He has been doing this job for 37 years, in which time he may have accidentally learned a thing or two. For this article he engaged his entire operations team to provide multiple options and angles to this common problem. Dowdy can be reached at Please also view his Provider LED Talk posted on ProviderTV.