United, nurses can change blame and toxic-centred cultures

Toxic and blame-based emergency department cultures can make nurses feel unsafe and bullied, but professional unity can challenge and change such cultures

Illustration showing five nurses with their arms linked in a show of strength and unity
Picture: iStock

If left unchallenged, toxicity and blame-based cultures can emerge and take hold of once healthy working emergency department (ED) environments.

In a similar way to how EDs have become increasingly unsafe for our older and vulnerable patients – who instead of being admitted to wards are placed in areas undesignated for care – they are also becoming unsafe for nurses due to the proliferation of toxic cultures centred on cost efficiencies and the achievement of operational targets.

Our analysis article, Toxicity in the ED: how to change a culture of blame and shame, discusses how nurses can feel undervalued and experience a lack of respect, while trying to deliver care in challenging environments.

What does good NHS leadership look like?

I have had the fortune of working alongside many inspirational and caring leaders and their commonality is a determination to support their teams to deliver quality care through innovation, role modelling and the introduction of evidence-based healthcare practices, supported by policy and process to guide decision making.

There is a wealth of literature exploring the concept of leadership in the NHS, detailing what good looks like and how leaders can develop services to improve morale and instil a sense of purpose and direction.

Examples include the NHS Leadership Academy’s Healthcare Leadership Model published in 2013, which embraced the values of the NHS Constitution and paved the way for many leadership courses.

‘It is essential that nurses support colleagues and advocate for patients by raising concerns and challenging poor decision making or leadership’

With all this information freely available, I find it hard to understand how and why blame and toxic-centred cultures emerge, unless the short-term gains resulting from bullying and harassment are valued clandestinely.

Be prepared to raise concerns and challenge poor decision making or leadership

As professionals, nurses can unite and use the Nursing and Midwifery Council code to challenge poor decision making, harassment and the absence of policy that enables the irrational and subjective practices underpinning toxic cultures to take hold.

Professional unity and well-articulated challenge are the adversaries of such cultures.

It is essential that nurses support colleagues and advocate for patients by raising concerns and challenging poor decision making or leadership.

This will promote the integration of evidence-based emergency nursing practices in healthy working environments, which are proven to deliver improved patient outcomes.

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