Are You an Apple Eater or an Apple Polisher? Cultivating Staff without Being a Bully to Increase Satisfaction and Safety

Purpose:
The purpose of this presentation was to assist our staff in identifying the problem of Toxic Behavior, understanding the difference in overt and covert behaviors, assist them in becoming good leaders, giving them tools to overcome obstacles and how Team Nursing creates a positive work environment.

Significance:
Toxic behavior is seen in every aspect of our profession. Studies show that ¾ of those bullied have some form of post-traumatic stress disorder, decreased productivity, lack of respect for each other and management, and decreased quality patient care. Ultimately it was the patient who lost.

Strategy and Implementation:
Our creative program starts with a simple title, “Are you an Apple Eater or an Apple Polisher”, the program then introduces the problem of Toxic Behavior. The program begins with an introduction to the undermining subtleties of overt and covert behaviors of the Apple Eaters (the bullies) and the strengths and qualities of the Apple Polishers (the leaders). We focus on the idea of a “Just Culture” where Team Nursing is at the forefront showing them that the power of the Team enhances Patient Satisfaction and Patient Care. We present a case study that illustrates the problem, and then open the room to discussion. Nurses are able to talk freely, without fear of retaliation, of events that have occurred on their units or to them. They gain insight and ideas about how to overcome the obstacles of creating a team environment. Providing them with the ideas and the tools (their own behaviors) to eliminate Toxic Behaviors they then are able to return to their units as leaders.

Evaluation:
Our findings are still on-going at this time. We have seen in the past months our patient and satisfaction scores increasing. Every unit in the hospital has been receptive to this program and our staff is open to change in bringing about an environment of a “Just Culture.”

Implications for Practice:
The cost of bad behavior causes increased turnover and lower productivity which ultimately hinders a culture of safety. By calling out the “Apple Eaters” and becoming “Apple Polishers”, you can increase patient & staff satisfaction, decrease turnover rate & ultimately increase quality patient care.