Jeremy, an HR business partner to the nursing staff of a medium sized community hospital, arrived at his desk at 8:30am on Monday to a familiar sight. There, sitting on his desk, was yet another resignation letter from a nurse on the 7th floor. Tina’s floor. Over the past 6 months Jeremy had 5 such letters reach his desk. Each one a subtle reminder to him that his organization is dealing face-to-face with the problem with toxic leadership in healthcare.

“I regret to inform you that my last day will be two weeks from today. While I appreciate the friends I have made here and the things I have learned, I nevertheless have taken another opportunity to allow me to grow in my career. Sincerely…”

When confronted about the unusually high turnover in her area, Tina becomes defensive. “This floor has the hardest patients in this hospital,” she replies. “And the pay doesn’t match what nurses are getting elsewhere. You can’t expect to keep good people with these wages.” When asked why nurses on other difficult floors are not leaving at the same rate, she only shrugs her shoulders and tells the HR people that is their job to figure out.

The Research

Much research and many articles have been written on the problem of toxic workplace cultures, particularly in healthcare settings. For example, the excellent article written by George Zangaro, PhD, RN at RN Journal entitled Recognizing and Overcoming Toxic Leadership. In it he writes:

“Toxic leaders can be devastating to personnel at all levels in an organization and can ultimately lead to the dismantling of the organization. Most people have worked for leaders who display some level of toxicity…The purpose of this article is to assist nursing leadership in recognizing a toxic nurse manager and in taking the appropriate steps to reduce the spread of the toxicity in the organization.”

And this problem isn’t exclusively a nursing problem. Far from it. In every segment of every business across the world there are individuals put into positions of power and authority who use their influence and opportunity created by their title and place in the hierarchy to make life miserable for those around them.

Call To Action

In another excellent article published by the American Association of Physician Leadership in the Physician Leadership Journal entitled “Recognizing and Managing a Toxic Leader: A Case Study” the authors conclude:

“Organizations must have a mechanism for identifying, monitoring, counseling, coaching, or even removing toxic leaders. Lack of development of good leaders, dysfunctional teams, loss of productivity, and low morale because of toxic leadership lead to a high burnout rate and turnover.”

It feels like toxic leadership in healthcare is reaching pandemic proportions. Based on the things I see and read online, it certainly isn’t getting any better. I saw a LinkedIn post by a health system yesterday in which they were sharing some of the positive feedback they received from patients. Beneath the post was the disgruntled comment of a current employee stating, in essence, “too bad this company doesn’t care about its workers the way it seems to care about its patients.”


How does this get fixed? It won’t, until those in the highest operational levels of leadership in an organization make it a priority. Until they are willing to address high turnover and low employee satisfaction survey results with tough conversations, this trend will only continue to get worse in my opinion.

In the meantime, those who aspire to a different style of leadership, an approach that emphasizes empathy, compassion, communication, relationships, transparency, principles, ethical behavior, and emotional intelligence, need to band together and work for the greater good. Maybe reading “Letters to a New Manager” might help as well.

If you believe it is possible to be an effective leader, while also caring for your team and their well-being, I would love to hear from you.

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Last modified: July 4, 2023