Bullying from Above: Working in a Hostile Environment as a Nurse Leader

[Deb_Aston, MSN, RN]

Zero Tolerance

Many organizations are focusing on implementing a zero-tolerance policy for bullying behavior that has historically been done at the staff nurse level. New nurses enter the workforce, eager to begin their professional journey, and then are faced with the harsh reality that “nurses eat their young”. They are met with criticism and intolerance; sometimes even cruelty. We have all gone through it at varying degrees; most of us developed a “thicker skin” until we proved ourselves to be competent, and were gradually accepted into the team. It is not an easy process and some nurses don’t even last a year; they decide that this was not what they signed-up for, and opt to transfer to another unit, another organization, or even decide to leave nursing altogether.

When bullying or incivility is tolerated in the work environment, job satisfaction and retention are affected (Lachman, 2014). Smart organizations are proactively focusing on retention, and are inviting staff nurses to become part of the solution through peer mentoring and retention committees.

Upper Level Administration Incivility

But what if the bullying is being done from above, at the administrative level? Nurse leaders are not all created equal. There are many levels to leadership roles, from a Manager or Supervisor, to Chief Nursing Officer, or Vice President of an organization. To presume that hospital administrators and nurse leaders are above bullying behavior is a great falsehood; it happens all the time in competitive organizations. I’ve witnessed it firsthand, and it left quite an impression; it makes one question the integrity of the entire organization. While some leaders “talk the talk” about transformational leadership and anti-bullying initiatives, they do not always “walk the walk” when it comes to their own behavior to other managers and leaders. The environment can become hostile, and many mid-manager level leaders are unable to speak-up for themselves out of fear of making a mistake, and concern over job security. While nurse leaders must try to follow the vision and goals of the organization to implement changes that ensure patient safety and improve outcomes, they still face obstacles on a day-to-day basis that can be challenging to overcome. The most justifiable and well-intentioned suggestions can fall on deaf ears from the powers that be when one is working in an environment that doesn’t foster collaborative change. Even very experienced leaders can feel pressured by upper administration to perform tasks that are above and beyond realistic expectations, often without help or support.

Are Our Jobs Safe?

When someone from administration decides that the organization wants to “go in a different direction”, no one’s job is safe. The Union does not protect managers, and leadership jobs can be filled quickly, with enthusiastic candidates looking for a new opportunity and career advancement. In fact, other leaders from within the organization can often begin to sense when a colleague is being left out from the “inner circle” and start to distance themselves from you in fear of being connected to the outcast. You begin to wonder when and how you will be “let go”, or asked to resign with reputation intact, so it is easier to find another job, as if it was your idea to leave instead of being fired. Sometimes, a small severance package may be offered to make the dismissal somehow less offensive.

Change is Needed!

If bullying is being tolerated at the administrative level, what options do we have? Casale (2017) states that if incivility is not being addressed in the workplace at the highest level, it projects a general acceptance of bad behavior that provides the bully with a degree of power and control. For change to occur, administrators need to model, and commit to, a culture of respect and civility to ensure a healthy work environment (Casale, 2017).

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References

Casale, K.R. (2017). Exploring nurse faculty incivility and resonant leadership. Nursing Education Perspective, 38(4), 177-181.

Lachman, V.D. (2014). Ethical issues in the disruptive behaviors of incivility, bullying, and horizontal/lateral violence. MedSurg Nursing, 23(1), 56-60.

[laurie alvey]

I have been a victim of nurse bullying by a Facity Administrator (RN)

My question is how do I report the FA for inappropriate delegation of UAP. She allows the UAP or PCTs to make clinical decisions, give medications for hypotension, and delegate to the nurses patient care.

[Snatchedwig, BSN, CNA, LPN, RN]

46 minutes ago, laurie alvey said:

I have been a victim of nurse bullying by a Facity Administrator (RN)

My question is how do I report the FA for inappropriate delegation of UAP. She allows the UAP or PCTs to make clinical decisions, give medications for hypotension, and delegate to the nurses patient care.

First thing, are they your patient? No one should be medicating your patients besides you and your expressed input. The whole 'allow' stuff won't work for me and that would be addressed. People have this crazy idea that their BS facility policy supersedes the nurse practice act and regulations.

[Deb_Aston, MSN, RN]

If the PCTs or UAPs are not licensed providers, they should not be allowed to administer medications, or "assess" a need for BP meds (or any meds for that matter). They are not trained to make clinical decisions. If these actions are being allowed, it puts the entire organization and more importantly, the patients who trust the organization to safely care for them, in danger. I would share your concerns with the Chief Nursing or Medical Officer, and if that doesn't work, report your concerns to the Dept of Health and Human Safety.

Good luck!

[Davey Do]

On 8/27/2019 at 3:01 PM, Deb_Aston said:

But what if the bullying is being done from above, at the administrative level? Nurse leaders are not all created equal. There are many levels to leadership roles, from a Manager or Supervisor, to Chief Nursing Officer, or Vice President of an organization. To presume that hospital administrators and nurse leaders are above bullying behavior is a great falsehood; it happens all the time in competitive organizations.

I keep a few chickens, and have witnessed pecking parties. When one hen is weakened or sick, or if a pullet is attempted to be introduced into the brood, the other hens will peck at it, sometimes it to death. Hence, the term "pecking party".

After a hen is dead, no matter what the cause, the others apathetically go about their business as if nothing ever happened.

Management at Wrongway Regional Medical Center (WRMC) behaves in a similar fashion.

Case in point: The previous manager of my home geriatric psych unit, Margie, was a devoted employee, having worked at WRMC for over 20 years. Margie would come in early, stay late, help out on the floor if needed, and worked with her subordinates on scheduling. She went as far as to do spontaneously things for WRMC, like buy walkers at yard sales and give them to needy patients. All in all, Margie was a pretty darn good employee.

Margie once talked about the management meetings where the supervisors openly criticized each other, much like a pecking party.

Margie had a penchant for sometimes making slightly inappropriate comments off the cuff. I called her on her inappropriate comments twice in the 14 years we worked together, Margie apologized, and we more or less went about our business.

However, one time Margie made a slightly inappropriate comment to a tech in the presence of one of the very higher ups, and was suspended. The tech stood up for Margie, saying she knew Margie was only kidding and took no offense at her slightly inappropriate comment.

To our dismay, Margie ended up resigning. Amy, the director of the psych division, and Candida, the supervisor of the psych unit managers, went about their business as if nothing ever happened. No formal statement- just a response of "Margie is no longer employed here".

Yes, Deb_Aston, hospital administrators and nurse leaders are not above bullying behavior!

[Deb_Aston, MSN, RN]

Wow...I'm sorry that happened. Unfortunately, I have seen similar situations.