Two Stories

The stories start with two nurses.

They are both 30ish, well educated with over 5 years experience in hospital nursing. They both obtained new jobs in a hospital when their families relocated.

They brought attitudes to work they share with most other health care professions:

  • They want to belong to an effective team that makes a difference.
  • They want a place where they feel safe and supported.
  • They want to give patients excellent care.
  • They found themselves in work settings that, although similar in many respects, had vastly different social dynamics.

Remedial Setting

Betty landed in a bad situation. Although everyone at the hospital knew this ward to be a toxic work environment, no one mentioned that during the hiring interview. It didn’t take long to discover what was happening.

Betty’s introduction to the unit was abrupt. The greeting she received when she arrived on the unit was short. The other nurse did not look at Betty while pointing out what was where. Saying, “Okay, now go see what room 210 want; that buzzing has been going on long enough,” she was gone.

A few days into the position, it became clear that people were not working together. The only form of humor was a sarcastic put-down. Any expression of enthusiasm met with disdain. Nurses would never ask one another for help. The docs moved through the unit focusing on their charts and minimizing any contact with the nurses. The unit manager was rarely on the unit

Occasionally nasty things happened. Betty was updating charts when a senior nurse loudly criticized a newly graduated nurse who had recently started on the unit. It’s was embarrassing to watch. She certainly wouldn’t want to be on the receiving end of that.


Caitlin began her new position on a unit two floors below Betty’s unit. Although the views out the windows were similar, they were in completely different worlds inside.

She felt welcomed from the beginning. The unit manager assigned Caitlin to a senior nurse who mentored her through the initial weeks on the unit. The became familiar with the team’s patient centered treatment philosophy as well as the nitty-gritty of equipment and supplies.

What impressed Caitlin the most was that others listened to her. They expressed a genuine interest in Caitlin’s previous job experience. She was accepted as a valuable and knowledgeable member of the team.

That message of respect was consistent among members of the team. When someone did become snappy and abrupt under pressure, others came together to help one another. The unit manager attended carefully to the group. When a patient’s spouse spoke rudely to one of the nurses, the unit manager promptly arrived, supported the nurse in resolving the situation. She then said to the patient’s spouse that the nurses put a top priority on the patients’ wellbeing and that there was no need for harsh words. She delivered that message firmly and with respect.

Developing as a Team

Both units have potential to grow. The Growth unit is ready to address major challenges, such as a new model of care or innovative collaboration with other health care professionals in the community. The Remedial unit has potential to grow, but requires serious attention to the rudiments of teamwork. Team members need to refine their interactions with one another; the unit manager must convey a new culture of respect through her interactions with everyone on the unit.

Both groups could benefit from a process of reflection, recognizing that their current state determines where they begin that process.

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