We've all been there before. Working for a lousy boss can make a great job unbearable. Not a day goes by without a dreaded encounter with the "evil" boss. Since many healthcare jobs place employees in a team situation, which functions much like a family, team members spend lots of time together and come to learn a lot about each other. It's not surprising how often the workplace mirrors a dysfunctional family.

Negative relationships and poor communication are two of the most destructive forces found in the modern healthcare team. Whereas technology and ongoing change present tremendous challenges in the workplace, it is often the inability to relate to the boss and others in a positive way that causes the most intense stress and burnout. It's often this stress, not the rigors of a fast-paced work environment, that hastens the departure of an employee looking for greener pastures.

Difficult relationships between staff and management can not only be intimidating, but also damaging to patient safety. "Abusive, demeaning or intimidating language and other disruptive physician behavior is a recognized barrier to good patient care," says Jess Driver, JD, chief risk officer of Beth Israel Deaconess Hospital in Boston and president-elect of the American Society for Healthcare Risk Management (ASHRM).

It's most insidious when allied staff are reluctant to tell physicians important observations about patient status. Patient care is jeopardized when therapists concentrate on getting supervisors under control rather than watching patients at critical moments.

This situation is not limited to healthcare. In a survey by a Denver-based executive coaching firm, 67 percent of respondents said their company does not deserve their loyalty, due to "lousy manager syndrome." Some supervisors micromanage, disregard feedback, set employees up to fail or "manage" others through intimidation. Dealing with these issues can be frustrating; however, by taking proper steps you can often improve or begin to establish positive relationships, which can make the workplace enjoyable again.

Step 1: Assume Responsibility

Talk with your boss and engage in an honest, open conversation, taking responsibility for establishing a positive relationship. Rather than an interaction where both parties are acting on a hidden agenda, the employee should assume responsibility for relating in a candid manner. Although the difficult relationship may be the result of the boss's behavior, a positive relationship cannot be developed without assuming responsibility to bring about change. Sometimes managers are new, or you are new, and both can negatively affect the relationship. And some bosses find themselves in an impossible situation created by the upper management.

It is important to act respectfully and to take notes before and after on what was said. Sometimes writing things down has the additional benefit of making them clearer and will enable you to understand what is desired and thus improve the employee-boss relationship.

Step 2: Assess Vulnerability

Another important step is to assess your own susceptibility. For example, if this is your first position, you may be sensitive to criticism. If you are having personal difficulty at home, stress at work can seem extra traumatic. When things go wrong, it is easy to blame the boss. In some cases the relationship with the boss may mimic another problematic relationship. For example, the employee who struggles in a marriage for an equal partnership rather than an authoritarian-dependent relationship may react quickly to a boss who acts in a condescending manner.

Criticism is common in many healthcare settings where stress is high and tempers flare. It is important to assess personal vulnerability and to practice self-control. Once personal anxiety about criticism has been reduced, action can be taken to manage the interaction and to move it in a positive direction.

Step 3: Think Before You Speak

It is essential to take the necessary time to plan what you are going to say. Timing is important for correcting negative communication patterns or for responding to the difficult boss. Timing involves carefully selecting the most opportune moment to speak while not acting prematurely.

When a situation is potentially negative, it is especially important to think before speaking. Although resolution of issues should not be put off indefinitely, waiting for a cooling-off period can facilitate problem resolution. When interpersonal issues are concerned, it is important to practice patience. A controversial matter should not be approached when there is inadequate time for discussion or when one of the individuals involved is rushed or tired.

The quickly constructed e-mail can lead to disastrous results. When situations are stressful it is particularly important to stay away from the computer and to avoid the hasty e-mail that cannot be recalled after real damage is done.

Step 4: Strategies for Reconciliation

There are strategies that can encourage a resolution no matter how complicated the situation. Using a suggestive approach may be helpful. For example, an employee may say, "I've been wondering if you would consider trying to help us work together better." A suggestive approach provides some direction to the conversation while allowing the other individual to take action and feel in control.

Using body language and behaviors that promote conversation is wise. For instance, a posture that promotes openness and receptivity should be used rather than a stance that appears to disregard the other individual. Eye contact, facial expression and the position of fingers, arms and head are all important and should be assessed to assure open, positive communication, professionalism and personal confidence.

Step 5: Select Other Options

If steps to correct the situation are unsuccessful, evaluate alternate methods. Some experts recommend talking to your boss's boss. Usually you are better off talking to human resources or employee assistance first.

Try to focus on your job and shine despite the resistance put in your path; other managers and supervisors will notice. And if it does come down to a legal dispute, continued good performance is a great shield against the dirt that will be thrown your way.

In most cases problematic relationships can become more positive. Misunderstanding and lack of open communication often enables bad attitudes whereas working together in a spirit of cooperation can cause even the most damaged relationship to mend. 

Ruth Davidhizar, RN, DNS, CS, FAAN, is dean of the division of nursing at Bethel College, Mishawaka, Ind. Steven B. Dowd, EdD, RT(R)(M)(CT)(MR)(QM), is an associate professor at the University of Alabama in Birmingham.