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
