Over 30 Years Later, We're Still Talking About Workplace Mistreatment

Workplace mistreatment has been plaguing the nursing profession for far too long, and it's time we come together to change things. This article presents information on workplace mistreatment. It offers a review and some new insights on the topic.

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Over 30 Years Later, We're Still Talking About Workplace Mistreatment

Hearing the word "bullying" probably conjures up images of the tough kid in the schoolyard taking his classmate's lunch money. Unfortunately, growing up and leaving school doesn't necessarily mean one's days of being bullied are behind them, especially if you're a nurse. The Workplace Bullying Institute (WBI) defines bullying as "repeated, health-harming mistreatment of one or more persons by one or more perpetrators". In a recent survey, the WBI (2014) found 27% of adult respondents have either experienced bullying or are currently being bullied at their job. Furthermore, another 47 % have witnessed or were aware of others being bullied. Workplace bullying has been identified as "an important social problem with detrimental implications for those exposed, as well as for organizations and society at large (Nielsen & Einorificen, 2012, p. 309.)"

What's in a name?

Besides bullying, there are other types of workplace mistreatment you've probably heard of such as incivility, horizontal violence, and lateral violence to name a few. Horizontal violence made it's way into the nursing literature over 30 years ago, in an article by Roberts (1983), and it seems not much has changed because it is still a very charged topic among nurses. This type of workplace mistreatment is specific to nurse perpetrator on nurse target, like the infamous, "nurses eat their young", cliche. Experts theorize that nurses belong to an oppressed group dominated by the medical profession and take their frustrations out on a safer target, their peers, rather than confront their oppressors. The jury is out as to weather this holds true with current times as gender roles are changing, and the male doctor and female nurse dynamic is not the norm today as it was when the profession was first starting out.

Workplace mistreatment behaviors range on a continuum from minor snubs such as eye rolling or not greeting somebody, to very severe actions including threats, humiliation, and work sabotage. Whatever the form, workplace mistreatment is disruptive and leads to reduction in productivity for the organization. However, of graver concern is the toll it can take on the health and well-being of not only the direct victims but witnesses of the abuse as well. Nurses have reported feeling isolated, fear asking questions or asking for help, losing sleep, and in extreme cases, some people have reported suicidal ideation after experiencing workplace mistreatment.

The ANA (2013) asserts all nursing personnel have the right work in a healthy work environment, which includes being free of workplace violence, and other abusive behaviors. A healthy work environment is more than the absence of physical harm (World Health Organization, 2010). The WHO defines a healthy workplace as "a place where everyone works together to achieve an agreed vision for the health and well-being of workers and the surrounding community. It provides all members of the workforce with physical, psychological, social and organizational conditions that protect and promote health and safety" (p. 15). In a 2010 bulletin, the WHO called for a concerted effort from policy makers, healthcare providers, and families to address this major public health problem. The bulletin asserts, victims of workplace mistreatment are at risk for health issues including depression and cardiovascular disease (WHO, 2010).

What's being done about it

In an effort to address WPB, some states have introduced the Healthy Workplace Bill (HWB). The HWB gives victims of workplace bullying the opportunity to sue individual perpetrators and employers for lost wages and benefits. As of now, only members of a protected status group (based on race, gender, ethnicity, religion, etc.) can claim harassment or hostile work environment. Therefore, an individual who is not a member of one of these groups is not protected by the law from harassment or other forms of hostility in the workplace. The HWB provides a precise definition of an "abusive work environment." It also gives employers the right, and incentive, to terminate or sanction offenders. If an employer ignores evidence of bullying in the workplace, the company is at risk for being targeted in a lawsuit. Victims must demonstrate harm to their physical or mental health and are required to provide proof from their health care provider.

Twenty-six states have introduced the HWB since 2003, and 14 states still have active bills. Currently there are no anti-bullying laws at the state or federal level (WBI, 2014). In Florida, HB 149 was introduced by Representative Daphne Campbell. Titled the "Safe Work Environment Act.", it was written to protect employees of both public and private sector employers. Another bill, SB 308, titled the "Abusive Workplace Environment Act" was introduced by Senator Oscar Braynon, II (Democratic party Minority Whip). This bill provided protection for workers at state agencies, counties, municipalities, political subdivision, school district, community college or state university. Unfortunately, both bills died in committee hearings.

Some experts disagree with using the law as a means to prevent or intervene in workplace bullying but recommend changing the culture of the workplace at the peer and co-worker level (Hinduja, 2012). The American Nurses Association (ANA, 2014) advocates for a policy of zero-tolerance of workplace mistreatment. Some hospitals have instituted strategies that shine a spotlight on bullying behavior in order to defuse it. For example, a code pink is called when a staff member is being verbally abused and colleagues will stop what they are doing to come and stand in support of their peer (Trossman, 2014). It's hard to believe that nurses witnessing workplace mistreatment of a colleague will sit by and do nothing about it, but some fear for their own safety. Other methods to change the culture include training in interpersonal, communication, and collaboration skills (Longo & Sherman, 2007). Can kindness and compassion be taught?

Summary

Providing patient care is a complex responsibility that requires cognitive and interpersonal skills. Experiencing workplace mistreatment can disrupt the nurse's ability to concentrate and impact her ability to deliver high quality, compassionate care. This impairment to nurse well-being may lead to errors and poor patient outcomes and then becomes a safety issue for everyone. This tragic situation has gone on way too long. We will never know just how many nurses, patients, and their family members have suffered because of the perpetuation of negative behavior. Research must continue on this topic so interventions can be developed in order to prevent it and to help nurses deal with it in a healthy manner so as to limit the potential impairment it can cause. It is unethical not to do so.

References

Hinduja, S (2012, November 15). Bullying policies aren't magic bullets. Atlanta Journal-Constitution [Atlanta, GA], p. A18. Retrieved from General OneFile - Document - GUEST COLUMN: Bullying policies aren't magic bullets

Nielsen, M. B., & Einorificen, S. (2012). Outcomes of exposure to workplace bullying: A meta-analytic review. Work & Stress, 26(4), 309-332.

Roberts, S. J. (1983). Oppressed group behavior: Implications for nursing. Advances in Nursing Science, 5(4), 21-30.

Trossman, S. (2014) Toward civility: ANA nurses promote strategies to prevent disruptive behaviors. The American Nurse, 4 (1), 1-6.

Workplace Bullying Institute (WBI) Workplace Bullying Institute - WBI - Help, Education, Research

World Health Organization (WHO) Bulletin of the WHO - Prevention of bullying related morbidity and mortality: A call for public health policies. Retrieved from WHO | Prevention of bullying-related morbidity and mortality: a call for public health policies

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compassionresearcher

About compassionresearcher

My specialties have included pediatrics, women's health, education, diabetes self-management, research, and writing. I am passionate about creating a healthy work environment for all, but specifically for nurses. People spend more time at work than they do with their families, we need to keep them safe and happy. I'm a plant eater and animal lover. I enjoy travel, arts, theater, and humor.

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Specializes in Pediatrics, Women's Health, Education.

Please share your thoughts on how you deal with this issue and what you find works for you and your institution.

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Specializes in ICU, LTACH, Internal Medicine.

I wrote it before and I can repeat:

AMA and other "regulatory agencies" can produce as many recommendations, policies, schmolicies, pacts, memos, etc. as they wish. They have to spend members' monies somehow, so they do it with full knowledge of their powerlessness to change anything anywhere.

The victory over workplace violence will be achived when it starts to be considered a criminal act, like domestic violence. The legal actions should not target facilities because firing one or two people wouldn't solve problem of abusers let loose; they should be personally targeting bullies and abusers. The prospective of losing license, court processings and everything that comes with it will not stop everybody, like it doesn't stop all abusive parents, spouses, drunk drivers, etc., but it will quite probably stop at least some.

Workplace violence happens because it is allowed to happen. It is that plain and simple. We can produce as many interesting theories as we like, but at the end it happens because bullies and abusers are allowed "to be what they are" while they should get a sensible slap after the first episode, and lose their ability to practice after the second one.

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Specializes in ninja nursing.

I think that was a great article and well researched. So here is my story. I've been in my unit since january and I'm the only guy besides the doctors. The first two weeks I was told by two separate co-workers that men are ran off and that the charge nurses don't like me and want me to fail. Good times. Out of a staff of 13 nurses, 5 have left since March including my preceptor who shocked all of us and put in her two week notice as she was leaving for the weekend. I'll keep this brief. She told me a lot of things that have put a bad taste in my mouth. I'm just trying to survive my year so I can leave. I often get stuck in an OR suite for the whole shift while several people don't get assignments and get to hang out at the nurse's station. I'm scared to ask questions like the author mentioned. My actions are scrutinized and I have anxiety making simple decisions knowing that whatever I do will be "wrong". A few weeks ago a charge nurse told me "shut up and use your f**king brain!". Can anything be resolved? I seriously doubt it. The sad thing is that my hospital is magnet and rated as one of the best hospitals to work at nationally. I miss working with my old unit. This toxic environment is completely foreign to me. I talked to my manager and she apologized and said she would fix it by sitting out at the nurse's station. That lasted about a week and she's back in her office now.

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Specializes in Pediatrics, Women's Health, Education.

Thank you for sharing and I'm sorry about your situation. How did you respond when the charge nurse yelled at you? Have you thought about reporting the behavior?

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Specializes in M/S, Pulmonary, Travel, Homecare, Psych..

I've talked about workplace bullying and don't see much of a chance of it going away. Reason is, we are exerting our efforts onto the wrong population.

Healthcare is (too much of) a business to stop and address the issue. It's lost, wasted time in the eyes of the decision makers. Whether you feel safe from bullying or not in their eyes does not affect profit so, it will never be a priority to them.

The culture in healthcare I've witnessed is: Company sends out an email stating it will not be tolerated. Whether or not it has occurred though is subjective, and the institution uses this to select when they wish to intervene and when they don't. If the bullying seems to be something that will affect the bottom line, they will act swiftly and harshly. If they don't see any threat to profit, it gets handled by middle management. More often than not, the response to complaints is to tell the recipient of the bullying that they are over reacting or being over sensitive. If the person being bullied is a favorite of the manager, something will be done. If the bully is the one the manager likes, there is no chance of the incident being looked at objectively.

That is what has to change. That culture. Only way to motivate profit minded individuals and companies is to affect their profit. So, don't just go after the bully and offer "assertiveness classes" to the bullied. Fine the institution that allows for an environment in which bullying is a problem.

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Tacomaster,

It is really, really difficult to get out from under a bullying supervisor. I know because my partner (who is in the trades, not nursing) was bullied by a crappy middle manager like your charge nurse. I am in programs to become a masters-trained occupational health nurse and psych np and I have studied this issue a lot. It is super stressful on staff (the targets and witnesses), adds to turnover, and is bad for patient care. Unfortunately, as noted above there are not protections for people not in protected classes at this time. Hopefully soon. My partner fought and fought with the help of his union, but still got ran out of there (despite being an exemplary employee).

I would take very careful, detailed notes. I would look into company policies. I would see if your union (if you have one) can help. I would also start looking for another job. If you can find support from your colleagues, this would help, too. Perhaps the team can approach the charge nurse's boss together. One thing that has worked for me is to say (in a neutral tone) "excuse me?", "sorry, didn't hear you. Can you repeat that?" or "Please don't address me that way." or "Is there a more respectful way you can say that?" I have used all of those in the past. I haven't got in trouble from using those lines. And it usually stops the behavior.

You can use what is comfortable for you. Or not respond at all. Whatever you do in response, it is not your fault. But I have found that bullies often knock it off when people show even an iota of resistance.

Good luck.

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It largely depends on the organization you work for, the team you work with, and the physicians / NP you work with.

It is really the culture that sets the tone. I worked at major teaching hospitals - one mostly ok in terms of workplace violence, one were nurses were cut throat with each other in a passive aggressive way, and one I loved for their overall culture. Oh - another one who is considered a teaching hospital and treating nurses "fair" but they also accept some bizarre behavior from physicians (not from nurses though).

I work for a community hospital now that is not small and has magnet status and I find that the nurses treat each other with respect - I have not heard too much about lateral violence though I know that sometimes there is some "they dumped a patient on us" from med/surg against critical care with retaliation through the means of incident reports or complains against critical care. It is still civilized though as compared to other places I worked at. But - physicians in this setting are not held accountable enough IMO with nurses being scolded for calling or belittled or put down. Especially new nurses have a hard time with that.

When I encounter some behavior towards me that is aggressive from other nurses or physicians - which does not happen that often - I take a step back and de-escalate the situation. It is also good to work on having a good baseline relationship with other employees and that includes CNA, food service, cleaning and so on. For my job I collaborate with everybody who takes care of the patient and I often ask CNA and sitters for their input as they provide a lot of hands on care. Since I am not young anymore and now middle aged it has become a rare event that a physician escalates towards me - aging has definitely worked in my favor in addition to having solid nursing experience !

I try to work things out. If there is some obvious craziness from anybody I de-escalate and stay calm, perform my job and try to re-connect with that person later. I am not very judgmental by nature, which seems to help somewhat and do not tend to take stuff personal. Sometimes if somebody is in my face and "accusative" or "confrontational" it works best for me to say "Can you tell me more about why you feel this way or what your concerns are" which often points to the real problem or underlying stress.

The whole "culture of safety" and "zero tolerance" idea is something that leadership puts out and that sounds good but in my experience rarely translates into appropriate action when things go wrong. And nursing leadership will still through the nurse under the bus before taking it up with a physician who is irate or not held accountable.

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Specializes in Emergency Department.

I just wanted to piggyback on this great advice! My first nursing job (at a Magnet Hospital on a Med-Surg/Tele floor) was hell all due to the bullying. I left after 8 months and a new place felt I had enough experience to hire me. I was so angry about the behavior of my coworkers and manager at my first job. Even more angry at myself, for letting them get to me and not doin anything about things they said and did. I was 30 years old, a mother, a veteran, and am not easily intimidated, but because it was my first nursing job, I was scared and did not know how I should have handled things. So much regret.

So when I started my second job as a nurse, there were still some bullies but it was not nearly as bad as the first job. I decided to handle it much differently. I asked for help to clean up a quadriplegic patient that also needed sacral wound care. No CNA available so I asked my co-worker who was also one of the night supervisors if she could help me. I forget what she said exactly, but she gave me a hard time and in front of our co-workers. So I said "I asked for help not for a bunch of attitude. If you can't help or don't want to, then just say that". You know what happened? She smiled and said, "let me finish up this chart and then I'll be right there." After she walked away, another nurse came up to me, was super excited, and said "I can't believe you said that to her! She always talks to everyone like that and no one says anything! I'm so glad you didn't put up with it." The bully ended up becoming one of my work friends after that. But I let her know that she can't talk to people like that. She seemed to settle down somewhat.

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Specializes in ninja nursing.

Since I posted that reply comment things have gotten worse. I've been keeping dates and times of conversations in a notebook and plan on going to HR tomorrow. I'm going to try to transfer to another hospital within our system.

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Specializes in Pediatrics, Women's Health, Education.

Good luck tacomaster, and kudos for standing up and not accepting this poor behavior. Please let us know how it goes!

Praying for you!

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Good article Compassionresearcher!

Renee Thompson at Nurses Do No Harm - RTConnections - Anti-Bullying is excellent on this topic!!

Nursing is a strange field in that bullying is one of the biggest fears a brand new RN or seasoned RN changing jobs has, right up there with harming your patient. A least when there is a sentinel event, there is root cause analysis and sometimes the RN(s) get some counseling but with bullying there is little to no compassion given to the victim and they leave the scene of crime far before the perpetrator.

I was a teacher of kids for a long times so you see it in the schools and learn how to deal with it through various classes and workshops as all schools in America have a school/district wide anti-bullying curriculum or program. It is so odd for me to now be in a field where it is my peers that I have to watch for.

On this very site there are too high of a number of seasoned nurses, some referring to themselves as Crusty Old Bats (as well as those who don't) replying frequently who outright deny the very existence of nurses bullying other nurses and NETY.

When a nurse comes here to get support, they are immediately told by them that they weren't bullied and NETY doesn't exist and they have to toughen up or that they brought it on themselves. Then the instigators (their sidekicks) follow up with unhelpful yet gleeful comments about getting their popcorn to watch the original poster get slammed by all of the posts that will surely follow to make the nurse feel even worse about themselves. It's disgusting and happens all too frequently here.

Like other assaults that people have faced for years and have only been fairly recently taken seriously, those of us with compassion and empathy, who are forward thinking, have to stand up and say that whether certain nurses believe it exists or not or it isn't that big of deal, we are not going to allow it to occur when we see it in person or online. Tell the truth and shame the devil.

It will be interesting to see which of them will reply my post but since they are being stood up to, probably none of them.

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