Nurse Bullied & Burned Out

Nurse burnout and bullying remains a hot topic. While self-care and staff-focused workshops have their place, it is about time our institutions step up to do their part.

Nurse Bullied & Burned Out

Nursing has never been easy. Any student or practicing nurse can testify to the rigor of nursing school. Any nurse with experience of more than 6 months has seen or experienced bullying. Addressing individual behaviors and self-care absolutely have a place in combatting the effects of bullying on nurses. There are articles aplenty which provide excellent insight into individual-focused techniques. What if instead, the focus was shifted to the institutions of nursing? Where is bullying found in nursing education and healthcare systems? How can these institutions take responsibility to improve nurse well-being?

Nursing Schools

The first institution a nurse meets is their nursing school. It is common for students to experience bullying in the classroom. Bullying is also perpetrated by clinical instructors in addition to staff nurses. Grading can be influenced by interpersonal exchanges, and the students are more likely to perform poorly when they are victims of bullying. Training instructors to become aware of and modify bullying behaviors is an obvious solution. 

In preparing students for the workplace, nurse preceptors, instructors, and educators can be positive role models in self- and peer advocacy. Students can be encouraged to internalize the value of the complex work of nursing, and to share that value publicly. When students start to hunt for jobs, these role models can emphasize benefits and compensation beyond hourly rates. Nurses are more than tools for the healthcare machine. Recognizing humanity and advocating for ethical treatment are equally important for patients and nurses. New grads need to know this before their first interview.

In educating nurse managers, the humanity of the staff nurses cannot be emphasized enough. Genuine appreciation and shared decision-making cultivate improved staff retention and patient outcomes. Educating nurse managers in caring for their staff decreases bullying, because the hierarchy is faded, and mutual respect is shared by everyone.

Healthcare Systems

The institution of healthcare is not exempt from bullying nurses. Although an entity is more difficult to hold accountable than an individual, it is no surprise that healthcare systems can be predatory to their staff. Americans spend the most money for the worst healthcare outcomes worldwide. The prioritization of cash over care affects everyone. Luring nurses with sign-on bonuses, and not providing meaningful resources (e.g., orientation, mentors, supplies, PPE) is an insult on par with “Heroes Work Here “banners and stale cookies for frontline workers. A retention bonus, for example, would not be a terrible use of funds.

It is a possibility that healthcare executives do not know what nurses’ work entails. Cynicism may balk at this, but ignorance feigned or genuine is worth addressing. Shadowing a nurse for a day is a neat concept, but licensing and liability allow observers to stay at the patient room door, away from the inner workings of clinical decision-making. Constant contact with nurses from varied departments is a better way for executives to understand what is needed for excellent patient care. This can be accomplished through real face-to-face conversations or anecdotes presented at regular meetings. It is imperative, however, that the gauze of the angelic nurse be left on the floor. An impactful story is filter-free.

Through exposure, administrators can see which characteristics make for an institutional nurse bully and replace those with characteristics which make for a supportive nurse workforce. Some characteristics that may facilitate bullying include role conflict, heavy patient workload (acuity- and ratio-based), and inadequate staffing. Simply hiring more staff only to burn them out will not be enough. Comprehensive, balanced paid-time-off (PTO) and overtime (OT) policies which support work-life balance will do more to retain nurses than any pizza party. Nurses are not asking for the moon. They want supplies and support to give their patients excellent care.  Embracing, rather than preying on the compassion of nurses will show in the profit margin.

Conclusion

As a profession, nurses are known for their tenacity, resilience, and heart. There is always room to grow in compassion for oneself and their peers. Nurses have done more than enough on an individual level to erase uncivil bullying behaviors, and to ameliorate the mounting burnout. After everything that nurses have done since March of 2020, right now is the time for institutions to recognize and repair their bullying behaviors. 

Nursing education can empower staff to advocate for themselves as well as their patients. Nurse management can be taught to build a better foundation at the unit level. Healthcare systems can step away from their C-suites to witness the value of nursing care done well. They can acknowledge that value by providing meaningful resources and comprehensive policies beyond recruitment. Happy nurses make happy patients may be an ignored adage, but it is not a secret. Institutions can and must do better. For everyone.

References

Ariza-Montes A, Muniz NM, Montero-Simó MJ, Araque-Padilla RA. Workplace Bullying among Healthcare Workers. International Journal of Environmental Research and Public Health. 2013; 10(8):3121-3139. 

Blakey, A.G., Anderson, L., Smith-Han, K., Wilkinson, T., Collins, E., Berryman, E. Time to Stop Making Things Worse: An Imperative Focus for Healthcare Student Bullying Research. The New Zealand Medical Journal. 2018; 131(1479): 81-85. 

Clarke, C.M., Kane, D.J., Rajacich, D.L., Lafreniere, K.D. Bullying in Undergraduate Clinical Nursing Education. Journal of Nursing Education. 2012; 51(5). 

Olender, L. The Relationship Between and Factors Influencing Staff Nurses' Perceptions of Nurse Manager Caring and Exposure to Workplace Bullying in Multiple Healthcare Settings. JONA: The Journal of Nursing Administration. 2017; 47(10): 501-507. 

Tomajan, K. Advocating for Nurses and Nursing. The Online Journal of Issues in Nursing. 2012; 17(1): 1-9. 

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Amanda ORourke NP-C

About Amanda ORourke NP-C

Amanda O'Rourke, RN, FNP-C, BSN, MSN is a nurse practitioner with 10 years experience at the bedside in adult acute care nursing. She has worked in nearly every type of medical and surgical unit as a float nurse. Her passion is empowering nurses and patients to live their best lives, with writing as her favored platform. She lives in Southeast Michigan with her husband, pets, and goofy children.

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Specializes in CRRN, COS-C, HCS-D.

Thank you for your article.  It's time for leaders, institutions, management, and government to LISTEN and consider the actual work expected of nurses today and the fact that nurses go above and beyond every day, every shift, and every hour.

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Specializes in Adult Acute Care. Family Nurse Practitioner..

@suhealth21, thank you for your comment! It's important that nurses are heard. We are the hub of the wheel that keeps healthcare spinning!

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Specializes in Psych, Addictions, SOL (Student of Life).

Also I find the article's premis that the nurse meets bullying at every turn from school and through all levels of their career so burn-out due to bullying is a given. There are members of law enforcement who never pull their gun from the holster, there are nurse (myself included) that never experience being bullied. People who believe the lie that they will be bullied will experience bullying. People who have a better undertsanding of human behavior and know that some people can be uncivil and ugly without being bullies do better in a career field filled with strong personalities. Many people raised in the last 20 years seem to have this idea that everyone is supposed to be good, kind and mentoring and not go into nursing for the money will be disapointed. Those who are taught growing up knowing that the world is full of good people and not so good people and learn to deal with multiple personality types and be successful. 

I was bullied in gradeschool and by my mother. My dad told me to go to school and stand up to my bully which I also taught my son. Dealing with my mom revealed my strength.

A good therapist told me "You did not get strong because of your childhood but you survived childhood because you were strong!"

At the facility where I work I am a Master Preceptor and Peer Mentor something I get paid a $1.00/hr when I am doing it.  

My Job in addition to training and mentoring new and career change nurses as well as providing comprehensive care to adolescent psych patient's in crisis. We are each the master of own feelings and once we embrace that we are truely free. 

Hppy

 

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.

Since the author does not give examples of bullying, I don't know the definition that is being used. It is one of the most misinterpreted and overused words around, especially in the nursing community, it seems. Bullying generally involves a threat of physical violence or actual physical intimidation. It isn't people being unpleasant, unsupportive or uncooperative.

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"Bullying generally involves a threat of physical violence or actual physical intimidation. It isn't people being unpleasant, unsupportive or uncooperative". 

The above statement is only partially true. some other examples of bullying in the workplace include unnecessarily interrupting or disrupting someone’s work, inappropriately interfering with a person’s personal property or work equipment, repeatedly discounting a person’s statements in group meetings, unfavorably comparing one person to others, blaming a person for problems they did not cause, taking credit for another’s contributions, spreading misinformation or malicious rumors, an purposefully inappropriately excluding, isolating, or marginalizing a person from normal work activities.

We all have bad days, but routinely being unpleasant, unsupportive or uncooperative is bullying. 

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Specializes in Acute care and diagnostics.

Hi 2BS,

I agree wholeheartedly with you. I have experienced the routinely unpleasant and uncooperative bully in my workplace. I am going to share my story about the persistent toxicity permitted by an apathetic manager.

I worked on a small specialty unit. The knowledge hoarding and favoritism of this individual held many of the nursing staff back from being fully competent with the tools and skills they need to grow in the department and with the ability to provide the best care for our patients. Multiple nurses in the department complained to the manager about this nurses behavior and a union contract was even filed about the power given to this individual such as being taken off the schedule to do "other duties," allowing only this one nurse to train others, being on the UBNPC indefinitely, sharing the managers private office (a tiny room with two desks) and even allowing her to sit in the her office during another nurses annual review. Our complaints about her are exhaustive but nothing is ever done. She frequently is passive-aggressive to those outside the "clique" and when crucially confronted she plays victim..."who me?" This attitude and behavior set creates an environment of competition, gossip, tattling, stress, and leads to other behaviors like misogyny demonstrated by other "untouchable and favorite" staff members. 

Our hands feel tied due to the unresponsiveness of the manager. "Did you talk to (this person) about that?" is her typical response. Everyone truly has talked to this nurse, as a matter of fact, when I "just in time" confronted her about her passive aggressiveness I ended up with a coaching in my file that will be there for two years! 

I am gone now and the hierarchical environment of toxicity perpetuates. The grievance is about to be reopened after a year because the manager has not followed through with any of the agreed upon terms.

Why does this manager allow this to happen? Her dismissiveness is disrespectful and malignant.

Above Amanda discusses how shared-decision making and caring for staff improves the workplace on many levels:

"In educating nurse managers, the humanity of the staff nurses cannot be emphasized enough. Genuine appreciation and shared decision-making cultivate improved staff retention and patient outcomes. Educating nurse managers in caring for their staff decreases bullying, because the hierarchy is faded, and mutual respect is shared by everyone."

This is not the first time I've experienced this. As a nursing student I was involved in nurse bullying at an even bigger level at the National Student Nurses Association (NSNA) annual conference. If you are interested I attached my story, in which I was interviewed about these events when I was a student nurse and my programs SNA Chapter President.

https://confidentvoices.com/www.confidentvoices.com/CV_V3_I5_Liz_McPhee.html

I disagree with your definition of bullying Orca. Due to its pervasiveness and safety concerns The Joint Commission (JC) updated an article, Quick Safety 24: Bullying has no place in health care, on June 2021 defines it like this:

"Workplace bullying (also referred to as lateral or horizontal violence) is repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators. Bullying is abusive conduct that takes one or more of the following forms (2021, pg 1):

  • Verbal abuse
  • Threatening, intimidating or humiliating behaviors (including nonverbal)
  • Work interference – sabotage – which prevents work from getting done"

Further, the JC reports that, "The Workplace Bullying Institute estimates that 65.6 million U.S. workers are directly impacted by or have witnessed bullying" (2021, pg 1).

Amanda also wrote above that: "Nursing education can empower staff to advocate for themselves as well as their patients." I agree! AND we need to! disruptive behaviors like this has a tremendous effect on patient care as referenced in the Joint Commission issue. It is time for more nursing advocacy leadership courses to be impregnated within our learning institutions and organizations. Starting from our nursing schools and ongoing throughout our careers. On page 3 of the JC report, they also highlight some safety actions to consider.

It's time for the hazing and lateral violence to stop. Lets also look at positive workplaces in healthcare where team-work, respect and collaboration occur. Let's learn how they do it. I believe it begins with leadership and I don't mean top-down!

Sincerely,

Advocate 

References:

The Joint Commission. (2021, June). Quick Safety: an advisory and safety and quality issues, (24), 1-4. https://www.jointcommission.org/-/media/tjc/newsletters/quick-safety-issue-24-June-2016-6-2-21-update.pdf

 

Quick Safety Issue 24 June 2016 6 2 21 Update.pdf

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Specializes in NICU, PICU, Transport, L&D, Hospice.
On 11/4/2021 at 11:37 AM, Orca said:

Since the author does not give examples of bullying, I don't know the definition that is being used. It is one of the most misinterpreted and overused words around, especially in the nursing community, it seems. Bullying generally involves a threat of physical violence or actual physical intimidation. It isn't people being unpleasant, unsupportive or uncooperative.

The definition of bullying includes intimidation and coercion, neither of which are by necessity physical. A great deal of bullying is verbal and emotional intimidation and violence. 

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Specializes in Adult Acute Care. Family Nurse Practitioner..

A genuine thank you to each of you who commented. You all bring up excellent points about defining bullying,  looking closer at that experience (if applicable), and how to address it personally as well as professionally. As one who will write ad nauseum if you let me, I left a lot behind in my editing.

I'm glad to see the conversation is continuing!

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Specializes in NICU.

Lovely to sit home and write cute little articles about the big elephant in the room that every institution is unwilling to address, leaving nurses floundering in the do nothing arms of HR. Seems like nurses still prefer to leave the bedside and write than stay and make change happen. The closest I have seen nurse unity ,empowerment was through strong labor organizations. The rest just pretend they are unions  taking your dues money while telling you "do as you are told".Many nurses cry alone in the bathroom after being subjected to abuse by mgrs, supv, doctors,staff.If they stand up they risk being labeled aggressive,trouble maker,poor evaluations.I do not have an answer but I have always held my ground,stuck my neck and supported my Labor union as imperfect as they might be. A word to the wise......

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Specializes in Hospice, corrections, psychiatry, rehab, LTC.
On 11/4/2021 at 7:53 PM, 2BS Nurse said:

We all have bad days, but routinely being unpleasant, unsupportive or uncooperative is bullying. 

I totally disagree, and so does Webster's.

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Orca, you can to to stopbullying.gov and see some of the above behaviors. I would choose not to work with someone like that. Hopefully you are a team player.

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