Karlene M. Kerfoot

Leadership, Civility, and the 'No Jerks' Rule

Executive Summary• Nursing organizations and hospitals are not

immune from the ravages of incivility.• Toxic behavior can range from the very serious bul-

lying and sabotage of very destructive people to theannoying and hard to cope behavior of just plainierks.

• When a unit does not have a clearly defined "NoJerk" rule and infrastructure to support healthybehavior, communication suffers and errors occur.

• Nurse leaders have the opportunity of changing theself-interest behavior of jerks in our communities ofcaring.

HKarlcnc Kerfoot

lOSPITALS AND HEALTH CARE

ürganizations are areflection of the culture

'of our country. Manyauthors decry the state of declin-ing civility in our society and inour organizations. Carter (1999)writes that the barbarians aretruly at our doors and that theability to create a functional lifein a community is being takenover by the emphasis on one's

own self-interest and individual rights. He alsobelieves incivility is being fueled by the violentmetaphors allowed in our language. Forni (2003)also notes fhat civility is rapidly turning to incivilityin our culture. His view is that civility is part of anethical code that we must live by, and the break-down in these codes of ethical behavior has allowedincivility to grow and flourish. He writes about 25rules that can bring a framework for civil and ethicalbehavior back into the workplace. And while civilbehavior is desirable in fhe workplace to create thehealthy environment we all want to he apart of,Gonthier (2002) notes that the effect on employeeenergy and productivity of the individual fmd theorganization is a very serious problem. Civility is notjust a nice concept to have at work. It is necessary forthe orderly functioning of our organizations.

Incivility in Hospitals and Health CareNursing organizations and hospitals are not

immune from fhe ravages of incivility. However, it

KARLENE M. KERFOOT. PhD. RN. CNAA. FAAN, is VinePresident/Chief Clinicai Officer, Atirora Health System,Milwaukee, WI: and a Nursing Economics Editorial BoardMember. Comments and suggestions can be sent toKarlene.Kerfoot@aurora.org

Copyright ©2007 Nursing Economics.

doesn't have to be that way. For example. DanWilford, the former CEO of Memorial HermannHealthcare System in Houston, explained to thisauthor that he helieved in the "No Jerks" rule. Thismeant that he didn't hire jerks; and if they were dis-covered, appropriate action would be taken. It washis ethical belief that the work of health care couldnot be accomplished with jerks overpowering thegood work that needed to be done. To that end, heestablished the "Institute for Spiritual Leadership"with required courses and other programs to supportthe leadership and staff in the organization to lead inhealthy, fulñlling ways.

Defining JerksFrost (2007) defines "toxic employees" as fhose

who are rude, temperamental, ahusive, spread gos-sip, create factions, distort communications to theirends, and sabotage work processes, colleagues, andmanagers. Eventually, organizational performancesuffers. Staff may become distracted by this behaviorand withdraw to protect themselves from these peo-ple. Sutton (2007) lists 12 characteristics (The DirtyDozen) which includes personal insults, invadingpersonal territory, uninvited physical contact,threats and intimidation, sarcastic jokes and teasing,toxic e-mail, humiliation, public shaming, rudeinterruptions, two-faced attacks, dirty looks, andtreating people as if they are invisible. He describestwo tests for spotting these people: (a) does this per-son create a feeling of oppression, humiliation, de-energizing and make one feel worse; and (b) does theperson target others less powerful? Sutton points outthe damage done to the victim, to the innocentbystander, to the perpetrator, and the cost fo tlieorganization in performance and managerial, legal,aud human resources costs. The price to the organi-zation is significant and cannot be ignored.

Toxic behavior can range from the very serioushullying and sabotage of very destructive people to theannoying and hard to cope behavior of just plain jerks.While the behavior of jerks might be less destructivethan the very toxic, aggressive behavior of bullies andsaboteurs, it can be just as difficult to cope with in thework environment. The preceptor who talks down tothe orientée, who reiterates that nursing schools don'tteach as well as they did when the preceptor was inschool, and who blames versus creates a learning envi-ronment when the orientée makes a mistake are com-mon examples of jerks that new grads commonlyencounter. This behavior doesn't qualify as bullyingbut it is equally dehumanizing and difficult for a newgrad to handle.

UROLOGIC NURSING / April 2008 / Volume 28 Number 2 149

Why Are There Jerks?There can be two very divergent explanations for

this behavior. The first is that the person has that kindof personality and will inevitably act that way. Whenthis person fails at creating chaos, he/she will move onto another venue to keep acting out this behavior.Another explanation is that a toxic environment cre-ates toxicity in individuals and a failure of leadershipallows this behavior it to Rxist (Frost. 2007). Probablyboth explanations are viable and the accuracy woulddepend on the individual and the situation. We knowtbere are nurses who always have to be "super nurse"and need to portray others as stupid. These nurses, tra-ditionally labeled the "Queen Bees," became this waybecause of a variety of reasons. Whatever the explana-tion, we know that we are obligated to create healthyenvironments in which the patients can be assured ofsafety. The behavior of jerks cannot he allowed.

Developing a No Jerk CultureIn heaith care, we are dependent upon collabo-

rative relationships to create safe outcomes for ourpatients. When a unit does not have a clearly defined"No Jerk" rule and infi:astructiu:e to support healthybehavior, communication suffers and errors occur.Poor communication is the leading cause of reportedsentinel events, according to the Joint Commission.We cannot afford distractions from the work ofpatient care that dysfunctional members of thehealth care team can cause, We can learn from otherorganizations that have developed the rule of notallowing toxic people to poison their workplace.

It is important to clearly define the behavior thatis not allowed. Sutton (2007) describes companiesthat have clearly articulated this stance. SouthwestAirlines not only supports a jerk-free staff, but is alsovery aggressive in not letting any passenger who is ajerk abuse their employees. Barclays Capital has clear-ly articulated a "No Jerk" rule. The Men's Warehousein their philosophy states that they will respondimmediately to anyone regardless of position who isdegrading another. We in nursing can look at "bestpractice" outside of health care to build the best pro-grams possible.

Once the philosophy and behavioral expecta-tions are clearly established, the next step is to hireagainst that philosophy and to internally implementthe standard with educational and support programsto help everyone achieve the standard. Monitoringthe effectiveness of the interventions is necessary.

A leader or manager might want to ignore theproblem and hope it will go away. Or the personmight feel she does not have the skills to intervenecorrectly. This is the time the leader/manager mustreach out for help. The costs of ignoring this problemare enormous both from a patient safety stance andin the very high cost to the organization from pro-ductivity and litigation.

When You Have to Work With JerksThere will always be situations where there are

jerks. You can become the brunt of their nasty e-

mails, sabotage, and negative behavior. Severalstrategies will help you deal with jerks.1. Take care of yourself. Emotionally, it is important

that you do not personalize the attacks, althoughthis can be very difficult. Professionally, youneed to keep documentation of the incidents incase the behavior escalates to bullying. Consultwith your boss and others and develop a plan.

2. Always take the high road. At no time shouldyou ever allow yourself to drop down to thesame level of behavior. This means neveranswering hostile e-mails with anything otherthan grace and dignity. It moans keeping yourown counsel and not discussing the situationwith anyone except the appropriate people inthe organization. Everyone has a dark side andevents iike this can precipitate anger, vengeance,or depression. Retaliating with behavior that isinappropriate is ahsohitely unacceptable.

3. Assume that a workable relationship can beestablished. Withdrawal from the person isprobably the most natural reaction. Withdrawalmakes it easier for the person to continue thebehavior because, as Carter (1999) explains, it iseasier to be hostile to someone you do not knowwell. Forni (2003) notes that incivility thrivesamong strangers and rudeness is often haltedwhen people get to know each other. The gameis often over when the person develops a rela-tionship with you and mutual areas of concernand collaboration are found.

4. Reach out to experts when ail else fails for adviceand counsel. This is no time to go it alone. Whenone is in a difficult sittiation such as this, tliink-ing can be distorted. Reality checks from men-tors and experts will hülp guide you.

SummaryThere are jerks in this world. There are jerks at

work. As managers and leaders we are obligated toinsure that people have a healthy environment in whichthey can be nurtured and grow. Patient safety cannot becompromised because we allow jerks to create chaos.This is a serious isstie that is very expensive in terms ofthe toll it takes on people, patients, and the organization.However, there are solutions so we must act. Jerks don'tneed to be a part of the culture of nursing. Incivility doesnot need to exist in hospitals and health care facilities.As Carter (1999J notes, the barbarians are truly at thedoor and this is true of hospitals and of nursing.However, we have the opportimity to change the self-interest behavior of jerks in our commimities of caring.That is what leadership is all about.S

REFERENCESCarter, S. (1999). Civility. New York: Harper Perennial.Fomi. P. (2003). Choosing civility: Tbe twf>nty-five rules of consid-

erate conduct. New York: St. Martin's Griffin.Frost, P. (2007). Toxic emotions at work. Boston: Harvard Business

School Press.Gonthier, G, (2002). Ilude mvnkemngs: Overcoming the civility crisis

in the workplace. New York: Kaplan Business.Sutton. R. (2Ü07). The no asshole rule. New York: Warner

Business Books.

150 UROLOGIC NURSING / April 2008 / Volume 28 Number 2