When niceness becomes toxic, <i>or</i>, how niceness effectively silences nurses and maintains the status quo in nursing
Debra Jackson
Abstract
Niceness has been referred to as our ‘most fundamental social dysfunction’ (Summers, 2005) and in nursing, niceness can be (and often is) toxic and disabling. Niceness is powerfully reinforced in nursing by spoken and unspoken discourses that control who can speak and when, and how that voice will be heard and responded to. Niceness is not to be confused with attributes such as collegiality or friendliness because unlike these qualities, niceness has very real malignant and malevolent connotations that act to silence and oppress those caught in its web and to strongly maintain the status quo. A ‘caring’ nurse who is always ‘nice’ to people is not likely to be an agent of conflict and change, of critique and opposition. To engage these activities means ‘rocking the boat’, ‘making waves’, ‘speaking out’ and not necessarily ‘being nice’. Thus the ‘tyranny of niceness’ masquerading as ‘caring’ often severely disables a nurse in securing the material and social conditions her (sic) work requires. It also renders her (sic) ‘docile’ and submissive; it makes her (sic) a compliant and willing agent for domination. A ‘good’ nurse, a ‘nice’ nurse, does as she (sic) is told and seldom questions the authority of others (Walker, 1997:8). As Walker (1997) notes, the desire to be nice means that people remain silent when they should speak out. It also means that when people do show courage and speak out, they can be silenced by others who (in enacting their own ‘niceness’) may be uncomfortable with authentic communication or with the issues being raised. In environments shaped by niceness, speaking out can involve considerable personal risk, because in environments of niceness, any speaking up that can be perceived as challenging in any way is likely to be taken as a breach of the code of niceness. Breaches of the niceness code do not come without consequences. In cultures shaped by niceness, those nurses who will speak up and raise issues can come to be cast as a ‘problem to be managed’ (Jackson et al., 2013:577) and themselves become the focus of scrutiny and even investigation up to and including disciplinary action. This means those raising issues are quickly silenced, often with accusations they are unprofessional, unsupportive, negative, splitting the profession, breaching codes of conduct, breaching confidentiality or similar (Jackson et al., 2011). Once this happens, the initiation of measures designed to silence the dissenting voice is justified, as are any actions needed to restore and maintain the organizational status quo (Jackson et al., 2013). The flow-on effects can also mean that others who witness the fallout from speaking up will likely be dissuaded from doing so. Literature suggests cultures of niceness affect people from minoritized groups more than those from the dominant group. Amongst other things, being nice means avoiding conflict (Walker, 1997) and in ground-breaking work on racism in the United States nursing, Barbee (1993) linked entrenched and continuing racist practices and behaviours in nursing to a culture of conflict avoidance (Barbee, 1993). Writing more recently, Perlow (2018) argues that niceness is not harmless or benign—rather, Perlow positions niceness as a racialized and gendered tool used to disguise power relations and a powerful means to silence and oppress people of colour. This should be evident to many of us in nursing, because despite the mantras of diversity, equity and inclusion that are often prominent in the mission (and other guiding) statements of most nursing organizations, we still see widespread inequity and lack of inclusion. We still have way too many (so-called) peak nursing bodies that are monocultural, with only minimal (if any) engagement with any persons from minoritized or marginalized communities. For many years there has been increasing recognition of the need for nurses to speak up and speak out. Despite the general acceptance that nurses should speak up to raise concerns, or to challenge various behaviours and actions, even very contemporaneous research suggests that nurses can perceive speaking up as a ‘challenging behaviour’ and that nurses may remain silent, ‘even when speaking up is needed for patient safety’ (Lee et al., 2022). The importance of nurses speaking up is recognized as so crucial to safe and affective health care that there is increasing awareness of the need to foster ‘speaking up’ skills in undergraduate student nurses (Fagan et al., 2016). Speaking up should be ‘business as usual’, but it actually requires considerable confidence and enormous courage (Lee et al., 2022). Yet speaking up reflects exactly what we want from nurses—we want and society needs nurses who are critical thinkers, change agents, problem solvers—politically astute advocates who will stand up and speak out for social justice. We need nurses to speak up and speak out right from the bedside to broader more societal-level advocacy and active political engagement. In order to speak up and speak out; however, there is a need to contravene the niceness agenda and raise issues that we ourselves, and others may find uncomfortable. If we want nurses and students of nursing to speak up and speak out, we really must eradicate disabling cultures that are underpinned by toxic forms of niceness. Niceness is strongly entrenched and harmful. It does violence to any who are seen to breach the powerful discourses of niceness. Disabling toxic niceness acts to continue to oppress and silence nurses and in turn, short-changes those we serve. Nurses need to be able to exchange information, ideas and raise issues in climates and with colleagues who are willing to authentically engage with relevant information and issues, and with new and different ideas. Instead of enculturating our colleagues and our students into niceness, lets model and create healthier cultures that are underpinned by collegiality, friendliness and authentic, respectful communication that welcomes and actively listens to dissenting or seldom heard voices. These courageous and important voices are the very voices that we need, to ensure that nursing can fulfil its social imperative and maximize the contribution of nursing to human health and well-being. Because without these voices, nothing will ever change. Editorials are opinion pieces. This piece has not been subject to peer review and the opinions expressed are those of the authors. Debra Jackson is Editor-in-Chief of JAN. The author does not have relevant political or other affiliations to declare.