The book, which some may find mildly offensive, uses the word in part because Sutton felt “safe” words like jerk, tyrant and bully were just euphemisms that didn’t pack the appropriate wallop in describing the true nature of these people.
Title aside, it was a groundbreaking book as it was truly the first that collected qualitative and quantitative data regarding the subject and set criteria determining who is or isn’t an a–hole.
Albeit Sutton admits that we’re all a–holes from time to time, he also submits it’s the chronic ones that wreak havoc.
As you might suspect, Sutton’s research finds that a–holes cost their employers thousands, if not millions, of dollars a year, due to their propensity to increase turnover, lower morale and productivity, and/or lose customers and future sales.
Some profit-driven organizations, such as Google, Mozilla, and Gillette, have begun implementing policies to protect themselves from these corrosive employees and their nefarious exploits.
Healthcare’s Tolerance. What gives?
In healthcare, we haven’t yet banished these troublemakers, nor does it seem like we will anytime soon.
At any given time, they safely roam hospital halls with impunity, disrupting productivity, annoying clients/patients, and/or spurring turnover.
The culture of healthcare permits, and expects, nurses to eat their young.
Likewise, we largely tolerate physician abuse because we collectively suffer from some sort of battered nurse syndrome.
As an industry, we’re deluged with a–holes.
Now, let’s talk about what makes them. In his book, Dr. Sutton lists 12 common actions used by jerks.
They are, as he puts it, the dirty dozen.
- Personal insults
- Invading “personal territory”
- Uninvited physical contact
- Threats and intimidation
- “Sarcastic jokes” and “teasing”
- Withering email flames
- Status slaps intended to humiliate
- Public shaming or “status degradation rituals”
- Rude interruptions
- Two-faced attacks
- Dirty looks
- Treating people as if they are invisible
Typically, I see about half of these rules employed on the floor, some more than others.
It isn’t uncommon for me to see number one, as I’ve seen physicians, nurses, and nursing assistants barb one another publicly and privately; number seven, especially physician to nurse, nurse to nursing assistant; number nine, usually physician or physicians interrupting nurses midway through report or assessment; number ten, a tactic used by passive-aggressive nurses to malign the reputation of a coworker; and, finally, the most common of all, number 12.
Typically, this passive-aggressive tactic is deployed by all members of the healthcare team, especially in a self-constructed hierarchical type of way.
Usually, for whatever reason, this tactic is used to dehumanize, projecting the victim with a sense of inferiority.
In the end, what’s more insulting: a caustic barb or someone believing they’re so superior to you that they consider you invisible?
How to survive
Surviving isn’t always easy, especially if you can’t escape them.
In fact, when possible, you should stay away from these morale-sapping vampires at all costs, as anything good seldom comes from them.
In an a–hole rich environment, I’d suggest disassociating.
If you can consciously alter your mental state and conclude that your colleagues don’t define you as a person, you might be able to weather the storm.
As a last resort, other than quitting, you may find it beneficial to confront them with a nonviolent, no holds barred approach.
Although this no holds barred approach may work in some situations, I don’t recommend it, unless you’re a master communicator with a finely tuned conflict barometer and someone who can remain calm, cool, and collected amidst a verbal skirmish.
In the end, there are many different strategies to manage caustic a–holes.
If you can, ignore them, if you can’t, confront them. Usually, we can tolerate repeated minor offenses, but we’re not emotional punching bags.
If you can’t control them, counter them, and if you can’t counter, avoid them.
As nurses, we can switch specialties, move to a different floor, or change hospitals.
If you’re miserable, leave. It’s okay to be happy and dream big, even when the dream is an environment free of a–holes.
- Note from Mighty Nurse – We encourage open and honest discussion of all aspects of nursing career and lifestyle. Let us know what you think about this issue, or submit your own story.
Robert I. Sutton (2008), The No A–hole Rule: Building a Civilized Workplace and Surviving One that Isn’t, Business Plus, ISBN 978-0-446-69820-7