It is interesting that so often in articles of this nature a prescription is given that should “cure all ailments.” In this discourse, however, the goal will be to offer the reader a variety of options. As the first article in a two-part series, this article outlines Option 1.

A Toxic Personality

The situation is a common problem: One facility, or sometimes even an entire organization, is held hostage by one person with a toxic personality, meaning a personality that is very harsh, malicious, or harmful. Every manager has seen one, and most have had one in their center.
For this example, the individual (Nurse Toxic) is a very talented nurse with great clinical skills. She has almost perfect attendance, so she is extremely reliable, but her personality is toxic. Quite frankly, almost no one in the organization likes working with her.

It is critical to remember that a “troublemaker” can often be a leader. They are, very simply, leading in the wrong direction. Therefore, in turning this negative individual around, it is possible to have a strong new leader to help with the cause. Solving this problem may reap unexpected benefits.

One possibility that may occur in the less severe situations is where the leader simply has a poor relationship with the toxic individual. For reasons that may be unclear, the nurse does not care for the leader, and, honestly, the leader really doesn’t like the nurse very much either. There is a simple plan to resolve this issue, one that has been around for years, and works equally well with nurses, certified nurse assistants (CNAs), and, in truth, almost all positions in an organization.

The plan walkthrough follows.

Make a Non-Work Connection

The leader decides one Monday to change this situation. Walking down the corridor, she spots Nurse Toxic alone at the end of the desk. With a smile, the leader strides over and says hello. Nurse Toxic grumbles but does not look up. Having previously done her research, the leader plows on. “Toxic, I understand you have a pug, what is your pug’s name?” she asks.

Now, when asked about their kids or pets, almost everyone will come to life. After a much more upbeat response from Toxic, the leader follows with a story about a relative who has two pugs, how funny and loving they are and so on.

To the surprise of both, this was the best encounter ever between the leader and Nurse Toxic. When the leader closes this discourse pleasantly, with no mention of work or work issues, and walks off, Toxic is left quite puzzled. She is very sure the leader is up to something, but she is not sure what that something might be. The trick here is not an underhanded one. The only goal is to repair a relationship.

Follow Up with a Personal Touch

On the following Monday, the leader again finds Toxic, this time returning from lunch. The leader opens with, “Nurse Toxic, I know you lost your mother this past year to cancer, and I can’t imagine how hard that must have been for you. There is a cancer walk this Saturday, and my family and I are walking. Would it be OK with you if we made our walk and donation in your mother’s honor?” the leader says.

Again, the leader has touched the nurse in a positive, personal way. She may even join the leader and their family on the walk, giving an opportunity for further bonding. But, at a minimum, the nurse is now quite sure something is up. However, she really can’t help but feeling better by now regarding the leader, even with those misgivings.

Bring Them Back In the Fold

Three is often the magic number. So, about a week later, the leader again spots Toxic alone at the end of the desk. By now they may have already noted a slight improvement with Nurse Toxic in the target areas of team spirit and attitude. Despite Toxic’s suspicions, nothing is really up. The leader is simply trying to positively bring Nurse Toxic back into the fold and inject some positive energy.

In the final encounter the leader finally crosses the line into work. “I can’t help but see every day how strong your nursing skills are, and we know we can count on you being here every day,” says the leader as they open the conversation (praising work strengths). The leader concludes the opening with, “I’d like to ask you for a favor.” Now, being suspicious from the very beginning, this is just what Nurse Toxic suspected all along.

Tap Strengths

But the conversation then takes a very different direction than what she suspected. The leader goes on to explain that there has been a constant problem on this unit, and as smart and skilled as Toxic is, the leader is quite sure she has some really good ideas to fix this problem and provide better resident care. The leader closes with the suggestion that Toxic think about this problem tonight while driving home, and tomorrow while driving in (so as not to take any family time away tonight).

Toxic will almost always come in the next day with a suggestion. The leader must then make every effort to try her solution, even if just part of it. Toxic could even head up the committee to solve the problem.

So, in the previous example, in less than a month, the leader may have both improved a relationship and found new energy to attack a serious problem. Note that there has been nothing disingenuous about this process. The goal is to connect or reconnect with a talented team member to improve the quality of care.

This is good for all involved.

Person First

In the end, people will always work harder on their idea than that of their leader, so one shouldn’t be surprised when the problem gets solved. Team members also respond much better when they know the leader is making an effort to care about them as a person, not just as a worker.

It should be clear that this method would work just as well with CNAs and other team members. In fact, the further away on the organizational chart the leader is from the team member, the more effective “being heard and asked to help solve a problem” might be.

This is the first of a two-part series on suggestions about how to deal with toxic team members.
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 on