October is National Bullying Awareness Month. Bullying can occur in places other than on the schoolyard or in the school hallways. Bullying in the workplace is a very real occurrence that happens on a daily basis. Nurses can be victims of a bully in several ways: horizontal (from upper level management - charge nurse, supervisor, manager, etc), vertical (nurse to nurse), or even from patients. This article will focus on bullying from coworkers.
I was caring for my 16 month old patient who had a drain from her skull as a result of neurosurgery the day before. The surgeon had come in to remove her drain and she was having a scant amount of drainage from her site. The father wanted to hold his daughter, so I gently placed some gauze on her site and taped the gauze into place. At this point, the charge nurse walked in and became verbally aggressive in saying that the surgeon would not want gauze placed on the site, and then began to criticize other aspects of my care for this patient - including the temperature! I was taking a temp with the manual temp instead of the monitors - I had my reasons! The father immediately lost all trust in me caring for his daughter. I had not done anything wrong in my care for this patient, and I had already talked with the surgeon outside of the room and he said I could put gauze on her if she was draining some.
This is an example of nurse bullying. The Department of Labor (DOL) identifies bullying as a behavior that creates defenselessness or demoralizes the victim's right to dignity in the workplace (2006). Furthermore, bullying involves verbal abuse, humiliating or intimidating behaviors, threats, or behavior that interferes with the job performance (Center for American Nurses, 2007). Murray (2009) cites ten tell-tale signs of workplace bullying. Included in these 10 signs are: the inability to please a supervisor, undermining of an employee who is trying to do their job, accusations of incompetence of a previously proved area of excellence, yelling or screaming at others in order to make them look bad, degradation of the employee in front of others, and inability to get help despite requests by the victim for interventions, thus leaving the nurse to be filled with dread and stress.
The effects of bullying in the workplace should not be taken lightly. Bullying has become an increasing factor of job dissatisfaction, work related injuries, absences from work, decreased productivity, AND has been found to cost employers over $4 BILLION dollars yearly (Murray, 2008)! Workers who have witnessed the effects of bullying - or have been a victim their self - can attest to the frustration and even anger that can arise after falling prey to the bully or the "minions" who are in cahoots with the bully.
What to do? I can tell you what I did, and the bullying stopped (for the most part) for me. I say "for the most part" because after this charge nurse was given the choice of being fired or transferring out of our unit, she verbally attacked me when I transferred a patient to her care from the ICU. After the initial degrading in front of my patient's father, I told the nurse, "I want to speak with you in the hallway" in a cordial, calm voice. When we were alone, I addressed the problem head on - again, in a calm and professional manner. I told her, in no uncertain terms, that she would never address me again like that in front of a patient, and if she had anything at all to say about how I provided care that was harmful to the patient, then we could discuss it away from the patient. Surprisingly, this nurse apologized to me.
A few weeks later, the nurse was dismissed from the PICU because of her unethical actions, and given the option to quit or to be reassigned. She chose reassignment. I thought our problem was over and behind us, until I transferred a patient from PICU to her floor, and to her care. After showing the RN the patient (here are her IV's, here is her incision, etc) she accepted the patient in good condition. However, while the patient was in her care, the IV became occluded, her surgical site began bleeding, and she told the surgeon I took the patient to her "gushing blood" and had occluded IV's. Thankfully, I had a witness who was in the room when we went did the patient SBAR handoff and assessment, and she attested to the false accusation.
I love an article written by Malcolm Lewis (2006). This article consists of a table that explains features of bullying activity. Lewis cites bullying activity is planned and deliberate in order to discredit a coworker; undermining, verbally abusive, physically abusive (although this is rare), sarcastic, continuously criticizes, demeaning, fabricates complaints, sets one up to fail, and they are usually aware of the damage they are causing. Interestingly, the time frame for bullying can last from months to years ('serial bullying').
The victim should follow the chain of command when reporting bullying incidents in a timely manner. In the case of vertical bullying (nurse to nurse) the manager should be informed. If the manager is the one who is the bully, documented incidents should be reported to the next level up. It is vitally important for the victim to have written documentation and dates of each incident, as well as the steps taken to report the bully. Additionally, the victim must always act like a professional, so that repercussions will not befall the victim for actions that are unbecoming. The Joint Commission (TJC) cites the bullying behavior must be addressed in the workplace (2008). This can include a "zero tolerance" policy for "intimidating and/or disruptive behaviors" (2008).
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