3 Ways to Turn Around a Toxic Nursing Department (Without Replacing the Whole Team)
Because there’s a better way than just letting people go.
By Elizabeth Later, BSN, MHA, RN, CENP, CPPS
“We need to blow it up and start over.”
The words I heard carried the weight of frustration and fatigue. I had just finished a conversation with the executive leader of a team who was visibly discouraged by what he was witnessing in one of his departments—disengaged nurses, inability to meet quality performance indicators, tension, and constant drama. The department had a history of cycling through multiple leaders and the team had become fractured and reactive. They undermined any leader put into place, and the cliques that had formed participated in gossip and criticism. Many solutions had been tried - without success -leading to the only solution on the table (as if it was even possible) which was to start over—to rebuild the team from scratch.
However, here’s what experience has taught me: most toxic cultures aren’t born from bad people—they're the result of chronic instability, ineffective systems, and leaders who have run out of tools and time or don’t have the skills they need to turn things around. Replacing the leader and “holding everyone accountable to standards of behavior” might feel like the only options, but they’re not the most effective or sustainable path.
In many cases, we can shift the culture—not by starting over, but by asking better questions.
1. Start by Seeing What’s Strong—Not Just What’s Broken
One of the most overlooked steps in transforming a struggling team is intentionally looking for what is still working, even when it feels like everything is unraveling. I often begin with a simple Appreciative Inquiry exercise that invites the team to reflect on a moment when they felt proud to be part of their unit. In one Cardiac Wellness department, nurses shared stories of the feelings they had when they saw patients meeting goals that were set, then wanting to celebrate those achievements with the care team. These stories weren’t just nostalgic—they were a reminder that commitment to high standards and patient-centered care still existed within the team’s DNA.
Appreciative Inquiry doesn’t ignore the problems; it reorients the conversation toward possibility. It takes disenchantment with the past, confusion about the present, and concern about the future and reframes the conversation to be more about what’s possible. When that happens, solutions and ideas that weren’t obvious before suddenly become apparent, and by naming and amplifying what’s working, we create a sense of shared ownership and begin to build trust from the inside out.
This strengths-based approach has repeatedly proven to be the first spark that reignites teams that have gone dark.
2. Support Nurse Leaders in Looking Inward—Before They Reach Their Breaking Point
Toxic environments don’t form overnight, and healing them requires courage, consistency, and respect—especially from those in leadership. Reflective Nursing Practice offers a structured and compassionate space for nurse leaders to pause and examine their own patterns, blind spots, and stress responses. This is not about blame—it’s about understanding the human side of leadership.
I once coached a highly respected nurse leader who had experienced a deeply personal crisis—a painful divorce that left her emotionally raw and physically exhausted. Although she insisted on continuing her work as a distraction, her team began to notice the shift. She was present at work, but not present in her work. Issues went unaddressed, communication became inconsistent, and morale plummeted. Through guided reflective practice and targeted coaching, she began to reconnect with her values and regain her leadership voice. The transformation wasn’t just hers—the team followed her lead, and with the help of a facilitated Appreciative Inquiry session, the metrics reflected it.
Engagement scores tied to mission alignment soared from 68% to 91%. Team members reported feeling more heard, and what began as a personal unraveling became an organizational turning point.
3. Rebuild Systems That Make It Safe to Speak Up and Ask for Help
Culture isn’t built in grand gestures or mission statements—it’s built in the everyday decisions that shape how people treat one another, especially under pressure. When teams become toxic, one of the first casualties is psychological safety. People stop asking for help, stop offering feedback, and begin to withdraw into cliques where they feel safe.
On that same unit, the team brainstormed and introduced a simple triage communication system that allowed nurses to discreetly signal when they needed immediate support from a colleague. It was a small change with a profound impact. Instead of powering through until they were overwhelmed, nurses had permission—and a mechanism—to speak up early. This led to a shift in how the team viewed one another, from isolated individuals to an interdependent network.
The results were undeniable. In the next employee engagement survey, perceptions of adequate staffing improved 78%.
A Culture Isn’t Rebuilt by Force. It’s Rebuilt by Trust.
When a nursing team is in distress, it’s tempting to believe that replacing people is the only way forward. But most of the time, the team and the leader you have are probably capable of far more than what they’re currently showing. Exploring that is so much more meaningful and humane than just firing people.
Ready to Begin?
If you’d like to bring evidence-based structure and more humanity to leadership so your teams can recover, re-engage, and thrive, you can connect with me directly to talk about how we can turn things around—without starting over.