Ep #19: Navigating Toxic Work Environments with Diana Page

Welcome to Becoming a Stress-Free Nurse Practitioner, a show for new NPs and students that want to pass their board exam the first time and make that transition from RN to NP as seamless as possible. I’m your host Sarah Michelle. Now, let’s dive into today’s episode.

Hey friends, you guys know how much I believe finding fulfillment in not only your career but also your life is so incredibly important. And when I met our guest today a couple of weeks ago, I truly felt that Diana had the exact same mission and purpose and felt she could bring so much value to the show and ultimately to you.

Every day I see her actively teaching so many concepts that are vital to your ability to not just survive, but truly to thrive in this profession. From work life balance, to self-care, to burnout, she really covers it all in hopes of helping others in our profession find their path through both mentorship and support.

Today, we’re going to be covering a topic that we feel is pertinent to many of you out there, no matter where you are on your nurse practitioner journey, which is workplace toxicity and how to manage that. And spoiler alert, we’re going to offer you a bonus freebie at the end of this episode to tie it all together that will be available to you in the show notes.

Sarah: So welcome, welcome, welcome to the show. Let’s just start by giving the listeners a little introduction to you and your life as a nurse practitioner currently.

Diana: Thank you so much for that lovely introduction. You’re so sweet. So I’m Diana, my Instagram is @catalystforselfcare. And yes, I am like the burnout boundaries self-care guru. So it really started as a passion project after I had my kids. So I have two toddlers, I’m a neuro NP, and now I’m also a nurse, nurse practitioner mentor, which I’m absolutely in love with doing.

But the reason I started my burnout education, I guess you’d say, on my page was because I actually went through burnout myself in my first NP job. It really took me by surprise, I don’t think I realized it at the time until like years had gone by and I knew I felt miserable, but I didn’t really know why.

I actually almost left the profession because I thought maybe it was just being an NP. You know, maybe I just wasn’t kind of “cut out for it” which looking back is really sad, you know?

Sarah: That like makes my heart ache.

Diana: I know, right? So I’m so glad I didn’t and for any nurses, nurse practitioners out there that feel that way right now, like just know that you’re not alone. And, you know, hopefully you’ll get some clarity from this discussion today and also just the resources on our pages and things.

But burnout is definitely not normal, you know, and toxic work environments, which is what we’re going to talk about today can be really bad. I mean, it can be really, really bad. The things, you know, I hear from nurses out there, and the things that I’ve experienced, you know, luckily, I haven’t had too, too much. But it can be really devastating and make you feel really terrible and like you’re not good enough and all those things. You know, it can really make you question things.

So my burnout was awful. And then I had kids and then I decided, I kind of looked around after I had kids and I was like, “Like all my friends are burning out, what is going on? This is crazy.” And this was like pre, you know, 2020. So I just decided to start a blog and just put out resources hoping that it would help other people in the healthcare world keep burnout at bay. I just felt like we could do better talking about it, because I didn’t, I still don’t think we talk about it enough. I think we’re getting better though.

And so I started a blog in my Instagram account, and I’ve just been kind of cranking out stuff there on the Instagram account pretty much daily. There’s a ton of like free resources there. And then I started my mentorship. I agonized about it for like eight months, as I’m sure you know the feeling. Like, “Should I? Shouldn’t I? Should I?” But I did it. I launched that and now I have a thriving group of mentees. And we just started our round just last week.

Sarah: That’s amazing.

Diana: Yeah. So yeah, it’s been a wild ride. You know, I also got divorced when I was in NP school.

Sarah: You’ve done all the things.

Diana: I did all the things. Like I checked all the boxes, like schooling, get the internship, do the job, you know, like I did everything right, you know, except the whole divorce thing. But school and career wise I really checked all the boxes, but I just didn’t feel good. You know, I didn’t feel fulfillment. And there were things that I realized, which again, we’ll talk about that were really drivers of my burnout. One of which was toxicity in the workplace for sure.

Sarah: And I 100% think even just the awareness piece is so important because I was very much in a toxic workplace in my first nursing job. And I just felt so alone, I’m like, “Nobody out there is going through what I’m going through right now.” And I wish I’d had the perspective to know like, number one, I’m not the only person, but number two, like there are things I can be doing about this as well.

Diana: Mm-hmm. Yeah, and you feel kind of hopeless, you know? It’s like you feel isolated and you feel almost like you don’t want to say anything to anyone because you’re going to be viewed as this like incompetent human being. Like somehow, you’re deficient, which is completely false, you know.

But I know that that’s definitely a feeling I had. Like that imposter syndrome kind of creeps in and you just think like, “I’m just not a good nurse, you know, I’m just not a good NP. I can’t hack it.” Which, no, you’re being set up to fail, you know?

Sarah: You’re in a bad environment.

Diana: Yeah, like there’s things that are contributing to that. But sometimes it’s hard to know, especially when you’re new and they don’t talk about this in school, you know? They don’t give you like, “Hey, this is normal, this is not normal. Like if this happens, then that happens.” You know?

So I think it’s great that you’re talking about this because it is important for everyone to kind of know the red flags to look out for and what it feels like and what they can do.

Sarah: Yeah, I think like nursing and nurse practitioner wise like you’re done with school and you’re just kind of thrown out there. They’re like, “You have the knowledge now, you can do it.” And I’m like, “But what about like, all these other things that I’m going to be encountering?” I wish there was just like a crash course to how to survive life as a new nurse or a new nurse practitioner.

Diana: Mm-hmm. Well, and that’s why like I think mentorship is great because it really is, like I have some new nurses in my session now and it is really- I say to them all the time like, “I’m so proud of you for doing this now because these tools are things that you use your whole life.” You know, like navigating workplace issues like this, it’s not something they teach you in school, you know? And it’s something that you don’t necessarily know to do unless you burn out and you’re like, “Oh shoot, I should have like had that information ahead of time, that would have been helpful.”

Sarah: Yeah, absolutely. Can you kind of maybe like walk us through a little bit of the ins and outs of what workplace toxicity looks like? And the reason I ask this is because I feel like it can be a little bit more subtle than what people might imagine. And it’s also not just like I had one bad day, like this whole place is toxic, either.

Diana: Totally. Yeah. So yes, I think either extreme is tricky. Like the whole like I had one bad day doesn’t equal like you’re in this terrible workplace. Like it just means you had a bad day, we all have bad days. But also sometimes it’s so bad that like you just need to run.

So I think one thing that I always encourage people to do, especially when you interview is to just look around. Like are people happy? Are people miserable? Like are people smiling? Do people look like they’re just not in a good place? If people look unhappy, they probably aren’t happy. And if they’re unhappy, they’re probably unhappy for a reason. So that’s like, one thing.

I mean, I think also like talking to people. Like as a new NP when I interviewed, I asked to speak to the NPs and asked them like what is the culture like? You know, what is leadership like? You know, asking those kinds of questions is really important.

I think if you’re in a workplace and you’re kind of looking around, is turnover really high? If turnover is high and people are leaving in droves, that’s a huge red flag. A lot of times that’s either because like the culture is super toxic, or leadership is super toxic, or the workload demands are just like unrealistic, and people are burning out.

Sarah: Or all three.

Diana: Yeah, or all three, which would be a nightmare, then you run. But I think that, you know, if people have been there for 15, 20 years, or five years, whatever, if people have been there for a while, that’s usually an indication that the culture in the workplace is pretty sound. But if people are, you know, there for a year-

You know, I was in a workplace once where we joked like, “Oh, you know, like they’re probably not going to be here in six months because it’s so bad.” You know? And it’s terrible, but it was the truth. Like, it literally was just like, turn around, turn around, turn around, it was so toxic. And only with like more drastic changes within the structure of the practice did that change. Which fortunately it did change, but it took some pretty drastic action by higher leadership, by leadership.

So I think also looking for like the churn and burn culture. You know, is it that they’re just like- You know, as NPs it’s like numbers, numbers, numbers. You know, is there any value placed on work life balance? Like if you have a family, are they family friendly? You know, are they okay if your kid gets sick?

You know, like these sorts of things matter because ultimately you want to feel supported. And you want your work life balance to be supported, you don’t want to live at work. You want to work and like do your job well, but you need to have, you know, a reasonable workload and you don’t want to be there every hour of the day. You need to be able to leave work and leave work at work when you do leave work, you know?

And then leadership, you know, having leadership that’s not dishonest, that you know, has your back, that’s transparent with you, that communicates with you. Like if you see leadership kind of showing favoritism or, you know, the gossip mill can be a really big red flag. You know, if there’s a lot a lot of gossip and, you know, people throwing each other under the bus that can be very, very toxic.

Sarah: I really like the point you brought up of talking to people too. Like if you’re going to take a job somewhere you should be shadowing there. You should be getting to know these people and getting a feel for this atmosphere before you ever get into it.

Because that was one of the biggest mistakes I made with my first nursing job actually. Like I think if I had spent any amount of time there, I would have known that job was not for me. But I was like so excited about the environment I was getting into. I was like, “Gosh, like pediatric oncology. Like I cannot even imagine a better fit for me.” And then I got into it, and I was like, “This is not what I thought it was. Like this whole thing is not what I thought it was.”

Diana: Yeah, oh shadowing is huge. Yeah, I definitely recommend that to anyone looking at switching to a new job. I’ve always shadowed and of course that’s only, again, one day, one day in the life. But it gives you an opportunity to talk to people, just to see the flow, the workflow, if it seems reasonable. And again just seeing if people feel like they have a life outside of work. You know, just kind of talking to people, like sussing it out.

Sarah: And seeing if it’s a good fit for you too. Because we idealize what these things might look like, and then we can end up in a toxic workplace because of that too.

Diana:  Yeah.

Sarah: So how do you feel like this impacts not only your work life, but also your personal life? Because I really see it as kind of expanding all the way across with workplace toxicity.

Diana: Yeah. Well, you know, I think that the biggest thing is, you know, when we’re feeling that toxicity at work it does contribute to a level of burnout for sure. And I think burnout in general, you know, not only just makes you feel kind of disillusioned and disconnected from your role, but also it can make you really irritable. Like I know I was no fun to be around when I was burning out. It’s like sorry everybody.

But yeah, I think, you know, it can affect you in the sense of causing physical symptoms too. You know, like trouble sleeping and nightmares or, you know, people obviously now are suffering from trauma related to what they’ve seen in the field. You know, GI upset, not having an appetite, or eating too much or, you know, drinking too much and kind of self-medicating with food or substances and things like that.

I think like definitely headaches, muscle tension, all those things can happen. Like there’s a lot of physical things that can happen when you’re feeling high levels of stress, anxiety, and burnout.

But it can also affect relationships. I really do think that it can affect your relationships with your friends, with your colleagues. You know, people, especially in toxic work environments if there’s a lot of gossiping or, you know, people sort of talking behind each other’s back. Sometimes that can cause a lot of unrest in the workplace that can then stem out of there through like texting and gatherings where people aren’t, you know, included or what have you.

So I think it really can be all encompassing, I agree with you a million percent.

Sarah: Yeah, I think when I was working that first nursing job, I must have been like the worst person in the world to be around. Because I was just, I was so miserable at work that it was almost like there was no way for me to not also be miserable at home. And like me, and he was my then boyfriend now husband, like we would go out to dinner, and I would just be like, “I feel so awful. Like I don’t want to go into work tomorrow. Like I don’t want to do this.” And so it really started at a certain level to impact everything. And I was like, “I’ve got to get out of here. Like I got to go.”

Diana: Yeah, and when you find that you’re like venting all the time to your significant other they’re like, “This is like not fun.” Like going out to dinner and just like, “Oh, work this, work that.” Like that shouldn’t be your date night, that should be [crosstalk]

Sarah:  He’d be like, “Can we talk about anything other than work?”

Diana: Anything else?

Sarah: I’m like, “I’m trying. I’m trying so hard, but I got to get this off my chest. You know, like this has got to go, like it just feels like so much pressure.”

Diana: Right, which is fine but like set yourself a timer for like three minutes, five minutes and then like nip it.

Sarah: I got my five minutes for support and then we’re moving on.

Diana: Exactly.

Sarah: Do you feel like there’s any like skills or tactics that nurse practitioners can like have in their emotional toolbox so to speak, if they’re experiencing some of this workplace toxicity?

Diana: Yeah, I mean, I think it’s really important to know who your allies are and like not being afraid to self-advocate. I think in my first nursing job, well nurse practitioner job I like was really terrified to set boundaries. I don’t even know if I knew what a boundary was to be honest, like looking back. But I definitely didn’t self-advocate. I was very much like a yes person, like a people pleaser. Like I wanted to do all the things and help all the people and wanted people to think I was doing a good job.

So I think like when we’re new, I think just recognizing that you are a human being, you can have limits, you can say no to things.

You know, when it comes to boundary setting, I think it’s really important just to remember that when we say yes to something we’re always saying no to something else. And whether that be a date night with our partner, or you know, time for ourselves to read a book, or, you know, doing something that you wanted to do, like reorganize your closet, whatever it is.

So I think like boundary setting is a big one. I think just like the self-esteem and knowing that, you know, you’re worthy of a break and you don’t have to say yes all the time is really, really important.

And just having the confidence at a place where you feel you can say something to your allies when you feel you’re in kind of a tricky situation where you need a solution. And it’s really about going in with some ideas for that solution and what the problems are. Not just kind of going and complaining. But those are big things.

And then just having like a really good way of taking care of yourself outside of work. You know, I know that people are- It’s so cliche to like self-care and health care, but it’s not just about like face masks and bubble baths. I mean, if you like that, which I totally love a good face mask, that’s great. But it’s also about just like making sure you’re planning out your week so you’re not feeling overwhelmed and you’re not taking on too much. And like setting those boundaries, even with yourself if you’re, you know, whatever.

So it’s partially like that nurturing yourself and partially like putting these tools into place.

Sarah: Yeah, I think something really that I had to work hard to wrap my head around like pampering and self-care are not synonymous. Like they are not exactly the same thing. Even though like some pampering items can make me feel better. But like true self-care is like I’m doing something that will actively contribute to my life.

So for example, like at the end of a shift like I might sit and journal for a little bit about the patients I saw, so that way I can disconnect when I go home. And that is how I care for myself so when I’m home, I can be home and talk to my husband about things other than work, right?

Diana: Yeah, yeah. Oh yeah, being present is a great self-care technique. I mean, doing a post shift reflection is something that I very much value. I think for my own journey when I was burned out, that was huge for me. Like I went from crying in my car after my shift to like really processing the day to like go home and really kind of cut the cord and transition.

It’s just like when you transition into work, it’s just kind of transitioning out of work. But even if you just ask yourself a few simple questions, you know, even informally and not writing it down, I think that could be really a great form of self-care.

Sarah: And you’re setting a boundary with yourself too. Because, you know, people are always like work life balance, work life balance. But I think at the end of the day it really just boils down to work life boundaries and the things that you set for yourself so you can have that disconnection.

Diana: Yeah. Oh exactly, I mean, exactly. I agree.

Sarah: Now, what are some things that the listeners should avoid doing that might perpetuate an atmosphere of workplace toxicity? Maybe not even like they intended to do it, but they’re doing it?

Diana: Well, first of all, if you’re a bully, stop it.

Sarah: Please don’t be a bully, God bless.

Diana: Please don’t be a bully. I actually had one person once respond to an Instagram post that I had done about bullying like, “I think that’s me.”

Sarah: Oh no.

Diana: I was like, “Oh geez, okay, we need to talk.”

Sarah: Right now, today.

Diana:  Yeah, seriously. So okay, yes, if you’re the toxic person and you recognize that, you need to like get it together. If you’re not the toxic person and you’re in a toxic work environment, it’s really about not engaging in those toxic behaviors too.

You know, I think sometimes people can get wrapped up into the gossip mill or workplace drama or whatever. Really try your best not to do that because the conversations you have with someone when you’re gossiping could really be affecting somebody else in a very toxic negative way.

But I also think that there’s times that we say little things when we are really stressed out that kind of come across more as like a microaggression where it’s like this very like naggy little comment to someone when you’re irritable that can really be damaging.

So I think just like being aware of how you communicate with your peers. I think, you know, with nursing a lot of times there’s this, you know, nurses like competing with each other sometimes or like the nurses eat their young sort of thing. And, you know, I think that culture is shifting, I really do. I think that nurses are more, like I mean the community that I have on Instagram, it’s a great community. Like I haven’t seen any bullying, not like I would tolerate it anyway, but maybe that’s why no one does it.

But yeah, just I think, you know, being a sounding board for people that you care about. You know, if you see that someone’s having a really bad day, be their ally, you know, and they’ll be your ally when you need it. If you see things that are really wrong happening, even approach the person and say like, “Man, are you okay? Like let’s talk about this. Like who do we need to talk to?”

Know your resources, know your employer’s grievance policy. Know about your EAP, the employee assistance program, if there’s issues that you’re having, or you need support.

But I think it’s really just using those tools we talked about but, you know, not getting roped into some of those toxic behaviors. And if you are a leader or get transferred into like a leadership role, then that’s when you can like really plow forward and help create some really positive changes, you know?

Sarah: I think a lot of this if you’re accidentally perpetuating workplace toxicity comes from a place of fitting in too. So don’t feel like you have to fit into that culture and that environment. You could be the first person who says, “How about we do this differently? Like why don’t we all just support one another?”

Diana: Exactly.

Sarah: Like that is what we should actively be doing as nurse practitioners. And beyond nurse practitioners, like business owners as well. I feel like there’s a lot of competition between business owners, when really if we all like supported one another and worked together, all of our businesses would grow as a result of that.

Diana: Oh definitely. A million percent. I mean, women, especially like women supporting women businesses, man, I’m all about it.

Sarah:  I’m all about it.

Diana: It’s good stuff. But yeah, you know, I think a lot of it comes from fear.

Sarah: Absolutely.

Diana: You know, people want to be liked and especially when you’re new and you’re in a new work environment you want to be liked. I definitely felt that when I was new. I don’t know if you felt that way.

But, you know, that’s kind of where that yes, yes, yes, yes, yes comes from and then you’re like, you know, drowning in things and it’s hard to kind of backpedal. But people are going to like you for you. I mean, you’re an awesome person, regardless of whether you gossip about people. It’s like you’re a better person if you don’t.

Sarah: Yes.

Diana: Yes, I agree. Just, you know, having the courage to do that and to say that it’s hard. But once you do, I really think people tend to follow you and look at you as a leader versus, you know, someone who is maybe not someone they can trust.

Sarah: Yeah, I definitely feel that. I desperately wanted to be liked in that first job. I was like trying so hard. I’m like, “Oh gosh, please, everybody like me. I’m so excited to be here.” And I was like, “It doesn’t matter what I do here, this is not going to work.” Not to like drone on and on about my first job but it was not a good one.

Diana: No, no, and hey, but you switched it up.

Sarah: Yeah.

Diana: And that’s another thing, it’s like sometimes no matter what you do, you know, a lot of times toxic work environments, like they can’t- Like I’ve been in one where, you know, it did turn around and it was way better eventually.

At the same time, I have also been in toxic work environments where it wasn’t and I did end up leaving, which was a good decision looking back. I don’t regret that decision at all. In fact, I probably should have done it sooner.

But the point is, is like you don’t have to necessarily feel like you have to fix it. It’s like a malignancy, you know, it’s like if it’s just terminal, it’s terminal and you can move on and it’s okay.

Sarah: It just is what it is.

Diana: Sometimes you have to save yourself. Your mental health is paramount and, you know, it’s really important that you maintain like a healthy mental and physical balance within yourself. And if your work environment is really that damaging to you it’s okay to say, you know, this isn’t for me.

Sarah: Yeah, and your top priority always has to be you because how are you expected to go out there and care for patients in the way that you want to if you’re not actively caring for yourself first?

Diana: Amen, firm believer in that.

Sarah: So tell us a little bit more about your freebie. And not only that, but how can my listeners get into contact with you too?

Diana: Yeah, so I put together this little freebie for your peeps.

Sarah: And it’s amazing by the way.

Diana: Thank you.

Sara: It’s absolutely amazing, I was looking at it earlier and I was like, “Oh my gosh, there’s so many goodies in here.”

Diana: Yeah, so it’s really just putting together like how to identify- It’s all about toxic work environments and like boundary setting and how to have difficult conversations. And some stuff about like bullying and identifying bullies and how to deal with them.

But it’s really just a PDF that they download, it’s free, about navigating toxicity in the workplace, how to identify it, how to handle it, sort of what it looks like, what it feels like. And then really like step by steps of how to have difficult conversations. Because I feel that when you’re setting boundaries and navigating these types of things, you’re typically having those conversations that make you want to vomit.

Sarah: Over and over, yes.

Diana: So there’s some tips for that. I have a totally separate like boundaries freebie that I’ve done. That’s on my page in the link in my bio. But this is really predominantly all about the toxic workplace stuff. So that’s for them, for your people and anyone who wants it.

And then I’m on Instagram @catalystforselfcare. My blog is selfcarecatalyst.com. And there’s a bunch of, I haven’t really kept up with it recently, but most of the stuff like the daily content all that stuff is really on Instagram. And there’s a ton of free stuff on the link in my bio that people can look through like a post shift reflection if they want it, whatever. There’s a bunch of stuff there.

Sarah: There’s so much good stuff and so many good reels too. If any of y’all out there are into reels, Diana has some of the best reels. I’m always like scroll, scroll, scroll.

Diana: It’s fun.

Sarah: Well, thank you so, so much for coming on the show. I so appreciate it.

Diana: Oh my gosh, you’re so welcome. This was a blast.

Sarah: And to everybody out there listening, I’ll talk to you guys next week.

As an extra bonus, friends, if you’re looking for support no matter what phase of your nurse practitioner journey that you’re currently in I have communities available for both students and new nurse practitioners. In these communities we work to uplift one another and grow this profession together every single day. Links to join will be included for you in the show notes.

Thanks for listening to Becoming a Stress-Free Nurse Practitioner. If you want more information about the different types of support we offer to students and new NPs, visit https://www.npreviews.com/resources. See you next week.