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toxic nursing SECOND EDITION

managing bullying, bad attitudes,

and total turmoil

cheryl dellasega, PhD, RN, CRNP

Copyright © 2021 by Sigma Theta Tau International Honor Society of Nursing

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____________________________________________________________________________________

First Printing, 2020

Publisher: Dustin Sullivan Managing Editor: Carla Hall

Acquisitions Editor: Emily Hatch Publications Specialist: Todd Lothery
Development Editor: Meaghan O’Keeffe Project Editor: Meaghan O’Keeffe
Original Cover Designer: Alan C. Berry Copy Editor: Todd Lothery
Second Edition Cover Designer: Rebecca Batchelor Proofreader: Gill Editorial Services
Interior Design/Page Layout: Rebecca Batchelor Indexer: Larry D. Sweazy
dedication
To all the nurses out there who strive to make nursing the very
best profession it can possibly be: You are appreciated.
acknowledgments
This is my fifth time collaborating with Sigma, and so they’ve begun to
feel like family: Emily, Carla, and Todd, it has been a pleasure to work
with you. Your patience, vision, wise edits, and suggestions have made
this a better book.
Development editor Meaghan O’Keeffe also contributed signifi-
cantly to the second edition of this book and was so helpful as the new
version was crafted. Although she chose not to continue as co-author, I
would be remiss if I did not acknowledge the contributions of Rebecca
Volpe, who helped write the first edition, thereby creating the founda-
tion for this one.
Finally, thanks to all the commentators and future readers who are
taking action in different ways to improve the nursing workplace.
about the author
Cheryl Dellasega, PhD, RN, CRNP
Cheryl Dellasega is a Professor in the Department of Humanities at
the Penn State College of Medicine and a nursing research consul-
tant to Penn State Health. She obtained her RN at Lancaster General
Hospital, her BSN at Millersville State University, her MS and CRNP
at the University of Delaware, her PhD from Temple University, and
her MFA from Rosemont College. She is the award-winning author of
the nonfiction books Surviving Ophelia, Girl Wars, Mean Girls Grown
Up, The Starving Family, Forced to Be Family, and When Nurses Hurt
Nurses, now in its second edition. Her current clinical work is with
adolescent girls through her programs Club and Camp Ophelia. Her
research on geriatric nursing, psychosocial aspects of health, and rela-
tional aggression has been widely published and presented to interna-
tional audiences.
commentators
G. Rumay Alexander, EdD, RN
Clinical Professor and Director–Office of Multicultural Affairs,
University of North Carolina at Chapel Hill School of Nursing

Lori S. Bechtel, MSN, RN

Nurse Manager, Neuroscience Critical Care Unit,
Penn State Milton S. Hershey Medical Center

Peggy Ann Berry, MSN, RN, COHN-S, SPHR PhD

Candidate
University of Cincinnati

Robert E. Boesch, DNP, RN, CNML

Vice President Surgical Services, Penn State Health

Beth Boynton, RN, MS

Organizational Development Consultant, Speaker, and Author,
Beth Boynton, RN, MS Consulting Services

Theresa Brown, BSN, RN, OCN

Staff Nurse and Writer, Urban Teaching Hospital; The New York Times

Cheri Clancy, MSN, MS, RN, NE-BC

Director of Ambulatory Nursing, St. Christopher’s Hospital for
Children
BSN Leadership Instructor, University of Medicine and Dentistry of
New Jersey, School of Nursing

Janet Passley-Clarke, DNP, MS, CRNP, PMH-BC

Advanced Practice Manager–Psychiatry, Penn State Health,
Pennsylvania Psychiatric Institute
 commentators | vii

Katherine M. Curci, PhD, CRNP, CNM

Assistant Professor, Department of Family and Community Medicine
Co-Medical Director, Penn State Hershey Medical Group at Fishburn

Deana Deeter, CRNP, CHPPN, CPON

Hummingbird Program Manager,
Penn State Milton S. Hershey Children’s Hospital

Cheryl Dellasega, PhD, RN, CRNP

Professor of Humanities, Penn State College of Medicine
Professor of Women’s Studies, Penn State University

Kelly K. Dineen, RN, JD

Assistant Dean for Academic Affairs, Instructor of Health Law
Saint Louis University School of Law

Jared M. Dougherty, MBA, MSN, RN, CCRN, CNML

Manager of Cardiovascular Services, Clinical Services Group,
HCA Healthcare

Laura Dzurec, PhD, PMHCNS-BC, ANEF, FAAN

Senior Scholar, Boston College Connell School of Nursing

Cole Edmonson, DNP, RN, FACHE, NEA-BC, FAAN

Vice President, Patient Care Services; Chief Nursing Officer,
Texas Health Presbyterian Hospital Dallas
Robert Wood Johnson Foundation Executive Nurse Fellow

Patricia Artley Hart, MS, RN, CPN, NE-BC

Director of Nursing Children’s Hospital and Women’s Health,
Penn State Hershey Medical Center

Kathleen Merrill Jackson, DEL, MSN, RN

Doctoral Fellow and Consultant,
Mountain State University and ITT Educational Services
 viii | toxic nursing

Susan Johnson, MN, RN

Instructor; Doctoral Student, University of Washington

Mary Lou Kanaskie, MS, RN-BC, AOCN

PhD Candidate; Clinical Nurse Educator–Oncology Nurse Residency
Program Coordinator
Nursing Education and Professional Development, Penn State Milton
S. Hershey Medical Center

Donna Kandsberger, MSN, RN, CPHON, PCNS-BC

Clinical Nurse Specialist, Pediatric Hematology/Oncology, Penn State
Hershey Children’s Hospital
Clinical Instructor, Department of Pediatrics, Penn State College of
Medicine

Monica Kennison, EdD, RN

Susan V. Clayton Nursing Chair and Professor, Berea College

Karlene Kerfoot, PhD, RN, NEA-BC, FAAN

Kerfoot & Associates, Inc.

Jonathon A. Koob, MHA, BSN, RN

Director of Critical Care Services, Lafayette General Medical Center

Sherry Kwater, MSM, BSN, RN

Chief Nursing Officer,
Penn State Milton S. Hershey Medical Center

Mary T. Meadows, MS, MBA, RN,

CENP Director, Professional Practice, AONE Executive Director,
AONE Foundation

Eric R. Messner, PhD, FNP-BC

Assistant Professor, Department of Family and Community
Medicine, Penn State Milton S. Hershey Medical Center,
Penn State College of Medicine
 commentators | ix

Robin Elaine Murray, DNP, RN

Assistant Professor of Nursing and Associate Dean,
Missouri Baptist University

Victoria Schirm, PhD, RN

Director of Nursing Research,
Penn State Milton S. Hershey Medical Center

Shellie Simons, PhD, RN

Associate Professor, Department of Nursing,
University of Massachusetts Lowell

Melissa J. Snyder, DEd, CRNP

Campus Coordinator of Nursing Programs,
Penn State Harrisburg

Whitney Staub-Juergens, DNP, MSN, RN,

CCRN, NE-BC
Director of Care Delivery, Clinical Services Group,
HCA Healthcare
table of contents
about the author........................................................v
commentators...........................................................vi
introduction............................................................xvii

part 1 the relational nurse manager....1

1 incivility.......................................................3
clearing toxicity: scenarios, insights, and
reflections.................................................................. 6
1.1 Too Loud...................................................6
1.2 Rude Docs................................................8
1.3 Putdowns.............................................. 11
1.4 Cynical Character.................................. 12
summary................................................................. 15
2 the newbie: mistreatment of new nurses....17
clearing toxicity: scenarios, insights, and
reflections................................................................ 20
2.1 The Battle of Degrees............................ 20
2.2 The Right Kind of Experience............... 22
2.3 Not So New........................................... 25
2.4 Popularity............................................. 27
2.5 Trial By Fire............................................ 29
summary................................................................. 31
3 the know-it-all/criticism queen....................35
clearing toxicity: scenarios, insights, and
reflections................................................................ 37
3.1 Extreme Criticism.................................. 37
3.2 Passing Judgment................................ 41
3.3 Anything You Can Do, I Can Do
Better..................................................... 45
summary................................................................. 48
 xii | toxic nursing

4 gossip and trash talk...................................51

clearing toxicity: scenarios, insights, and
reflections................................................................ 55
4.1 Indiscretion........................................... 55
4.2 Out of Context....................................... 58
4.3 Secrets................................................... 60
4.4 Rumors................................................. 62
summary................................................................. 64
5 cliques, campaigns, and high-school
drama........................................................67
clearing toxicity: scenarios, insights, and
reflections................................................................ 70
5.1 Ganging Up.......................................... 70
5.2 Witness................................................. 72
5.3 Energy Vampire.................................... 74
5.4 Two Faced.............................................. 76
5.5 Green-Eyed Monster............................. 78
5.6 Who Gets Who...................................... 79
5.7 Favorites................................................ 81
5.8 The In Crowd......................................... 83
summary................................................................. 84
6 competition and credit................................87
clearing toxicity: scenarios, insights, and
reflections................................................................ 90
6.1 Taking Credit......................................... 90
6.2 Thief...................................................... 92
6.3 The Biggest Contest ............................. 94
6.4 Overdrive.............................................. 96
summary................................................................. 98
7 nurse managers as the problem................101
clearing toxicity: scenarios, insights, and
reflections..............................................................105
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