Managing the Toxic Leader

Managing the Toxic Leader
Read the Managing the Toxic Leader Case Study Scenario from the perspective of the chief nursing officer (CNO) or director of nursing (DON) who supervises 3 West, inpatient psychiatric unit
Design a performance improvement plan (PIP) for Jackie. The audience for the PIP is Jackie and your organization’s human resources department. Key components of the PIP should include documentation of performance issues and development of an action plan.
Cite 5 sources of credible scholarly or professional evidence to support your plan.
Performance Improvement Plan Development
Note: The requirements outlined below correspond to the grading criteria in the Managing the Toxic Leader Scoring Guide. Be sure that your performance improvement plan addresses each point, at a minimum.

• Evaluate Jackie’s performance as a leader.
 Provide examples of Jackie’s performance from the scenario.
 Identify at least two standards of professional performance that Jackie is violating.
 For the purposes of the performance improvement plan, document the performance issues.
• Determine the implications of Jackie’s behavior for organizational mission, vision, and goals.
 Review the organizational mission, vision, and goals of your own organization, or those of another health care organization you are familiar with.
 Connect your employee performance expectations to the goals of the organization.
 Explain how Jackie’s behavior affects the organization’s ability to achieve its mission, vision, and goals.
• Develop an action plan to improve leader performance.
 Clearly identify professional performance expectations.
 Explain how improvements in Jackie’s performance can improve health care delivery and patient outcomes.
 You may wish to refer to the About TeamSTEPPS resources (linked in the Suggested Resources) to connect the action plan to more effective teamwork and improved outcomes.
• Support your main points, claims, and conclusions with credible scholarly or professional evidence, correctly formatting citations and references using current APA style.

Suggested Resources
Patient Safety
• Jarrett, M. P. (2017). Patient safety and leadership: Do you walk the walk? Journal of Healthcare Management, 62(2), 88–91.
o A checklist to help health care leaders take a proactive approach to patient safety.
• Pettit, A. M., & Duffy, J. J. (2015). Patient safety: Creating a culture change to support communication and teamwork. Journal of Legal Nurse Consulting, 26(4) 23–26.
o Addresses various aspects of communication as a barrier to good care and describes the use of TeamSTEPPS as an evidence-based practice for improving patient safety.
Leadership and Communications
• Agency for Healthcare Research and Quality. (2017). About TeamSTEPPS. Retrieved from
o Describes TeamSTEPPS teamwork system and provides links to TeamSTEPPS resources.
• Cianelli, R., Clipper, B., Freeman, R., Goldstein, J., & Wyatt, T. H. (2016). The Innovation Road Map: A Guide for Nurse Leaders [PDF]. Available from
o An infographic presenting key concepts in innovation for health care leaders. This resource will be useful for all of the assessments in this course.
• Moosey, M. (2016). Communicating difficult and taboo information: A how-to guide for commanders. Military Medicine, 181(1), 40–43.
o Addresses the challenges of communicating difficult information in a gender-integrated setting.
• Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating Lewin’s theory with Lean’s system approach for change. Online Journal of Issues in Nursing, 21(2), 1–13.
o Illustrates how multiple disciplines are able to utilize a common framework for leading and sustaining change.
• American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author.

Kyle is a BSN-prepared psychiatric nurse who has two years of nursing experience and is viewed by peers as being a senior nurse. Currently, he attends a graduate program part-time to earn his MSN degree, with hopes of being a manager of an inpatient psychiatric unit. Whenever Kyle is on duty, he is always in charge of the 12-bed, inner-city psychiatric unit. He works on 3 West, caring for young adult patients who suffer from developmental disabilities.
Every Tuesday and Thursday afternoon, the unit participates in patient care conferences. The purpose of the conference is to discuss patients who represent a challenge for staff, or someone who has behaviors that require interdisciplinary collaboration in order to provide a safe and therapeutic milieu. In order to maintain compliance with the Joint Commission, the psychiatrist, nurse manager, pharmacist, psychologist, and representatives of nursing, social work, and recreational therapy are expected to attend. Jackie, the nurse manager, is the chair of the patient care conferences.
The psychiatric unit follows a primary care nursing model, and Kyle is the primary nurse for K. C. Kyle reflected that just two days prior to the scheduled care conference, K. C. was verbally threatening to staff and patients. Additionally, he stopped eating and was banging his head on the wall. On the day of the patient care conference, K. C. had physically assaulted another patient. Kyle, having just two years of nursing experience, was having difficulty managing K. C.’s disturbing behavior. Kyle acknowledged that K. C. was a danger to himself and others, and Kyle was looking for guidance and support from the health care team.
Thursday at 2 p.m., Kyle entered the conference room as expected, only to find that he and the recreational therapist were the only staff present. This was not unusual, because when Jackie, the unit manager, sporadically attended rounds, she was often late. Ten minutes after the meeting was supposed to start, Jackie passed by the conference room while talking on the phone, and asked the person she was speaking with to hold on for a minute. As she hurriedly walked away, Jackie told Kyle and the recreational therapist the meeting was cancelled and asked, “Didn’t you get my email?” Kyle was speechless. He had not received an email from Jackie, and was disappointed as yet another patient care conference went unattended by the management team.
In the meantime, Kyle was at a loss for how to positively manage the care for K. C. The unit was getting out of control, as K. C. was becoming more aggressive with other patients. On the afternoon of the cancelled meeting, Kyle saw Jackie and asked for a moment of her time. Jackie stated that she was late for an appointment as she briskly walked toward the door. She asked Kyle to email her so they could set up an appointment for a more convenient time. Immediately, Kyle sent an email to Jackie stating that he was accessible anytime, even on his days off. Days went by and Kyle never received a reply.
On Kyle’s next shift, he patiently waited for his unit manager to arrive. He needed to discuss the care of K. C. with her. When Jackie finally arrived at work, she was wearing a too-short sequined dress, large gold hoop earrings, and three-inch heels. As she had entered the psychiatric unit, Kyle noticed that she was hanging on Martin’s arm and giggling flirtatiously. Kyle remembered that Martin was complaining earlier that morning that he had scheduled a meeting with Jackie to discuss a staff squabble. To make matters worse, Martin, who was a younger and less senior nurse, followed Jackie into her office and slouched comfortably into the leather chair across from her desk. Jackie hurriedly ran into her office and closed the door.

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