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Topics About 'Nurse Bullying'.

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  1. 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). 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.
  2. SafetyNurse1968

    What if I'm the Bully?

    Only the light from the bathroom illuminated Jill's room as I walked in as quietly as possible. It was only 7:15 a.m. and I had received report on 4 patients. Two of them were new, but Jill and one other were patients from the previous day. I walked over to check Jill's IV infusions. I had told the night shift nurse in report last night to be sure to DC the antibiotics. I turned on a wall light for a better view and immediately saw a secondary bag hanging down, infusing antibiotics. I had 3 other busy patients and my plans for an organized morning just went all to heck. I closed the clamp on the secondary and made some notes in my notebook about the medication error, since I would not only have to write up an incident report and call the physician, but also tell the patient. I found the night shift nurse who made the error. She was in her early twenties, with a cute brown ponytail, perky personality and had only been off orientation for 3 months. I proceeded to do what I swore I never would...that whole "eat your young" thing. I looked down at her, she was shorter by 4 inches, and in an exasperated tone said, "Katie, I told you to discontinue the antibiotics last night - didn't you see the order?" I could see her shock at being spoken to that way combined with the shock of realizing she had made an error. Her eyes widened and she looked away saying, "I can't believe I forgot, I am so sorry." I started feeling bad about my how I was speaking to her immediately, but also felt powerless to stop it at the time. I know I said something else like, "I will have to fill out the incident report..." with a heavy sigh, so she would understand just how much extra work she was causing me. I stalked off, visibly irritated, and she went home. I recall feeling triggered by worry that I was somehow responsible for the error - that I hadn't been clear at shift change, and that fed my reactivity. I felt like a failure - could I have communicated better the night before? Someone who witnessed the exchange let the supervisor know and she called me in that afternoon and we talked about it. I told her I knew I had been rude, and that I felt terrible. We talked about my stress level and strategies for being direct without being unkind. I found Katie's home phone number and called her late in the day saying, "Katie, I must have made you feel terrible - you are a new nurse and all I want to do is support you. I lost my temper and I was unkind. I am so sorry, and I hope you can forgive me." She said she understood, but an apology doesn't take away the hurt or the damage. I wish I could remember her last name - this incident happened 7 years ago, but it is still so clear in my mind, and I wonder if it is as clear in hers? I wonder if she is still a nurse? I was never rude to her again, but during my career as a nurse, I have had repeated incidents like these where I behaved with incivility. Problems More than half of nurses report being verbally abused at some point in the past year Bullying, workplace incivility, lateral (horizontal) violence - these are hot topics right now, and they should be. There is an urgent reason to change the culture of nursing from one in which "nurses eat their young". The Joint Commission reviewed 936 sentinel events in 2015. Over half of them resulted in patient death. The most frequently reported events were things like leaving a piece of surgical equipment in a patient, doing the wrong procedure on the wrong site of the wrong patient, and patient falls. What does this have to do with bullying? The top three most frequently identified root causes for these events were human factors like competency assessment and staff supervision, leadership issues like complaint resolution and communication among staff, administration and patients and families. From these statistics, we can infer that reducing workplace incivility and lateral violence has the capacity to reduce harm to patients. We have known for a long time that improved communication will result in safer patient care. There is a whole chapter in Robert Wachter's book, Understanding Patient Safety (2012) on teamwork and communication. Every morning I wake up and check Twitter, Linked in and Facebook for patient safety posts, articles and information and many of them are about bullying. I was recently at the North Carolina Nurses Association Conference and there were two workshops on workplace incivility. Browsing through continuing education offerings yields multiple courses available for CE on the topic. There is even nurse bullying specialist, Dr. Renee Thompson. Definitions The ANA defines incivility as rude and discourteous actions, gossiping, spreading rumors, or refusing to assist a coworker. This may include name-calling, using a condescending tone, or expressing public criticism. The dictionary defines a bully as a person who uses strength or power to harm or intimidate those who are weaker. The ANA states bullying is "repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient, including actions that harm, undermine and degrade. Examples include hostile remarks, verbal attacks, threats, taunts, intimidation, and withholding of support." Dr. Renee Thompson, DNP, RN, CMSRN, a bullying specialist (Renee Thompson Speaks), defines bullying as a repeated pattern of destructive behavior with the conscious or unconscious attempt to do harm. It can be overt, as in the case of a nurse criticizing you at the nurses' station, or it can be covert, as in a nurse who offers to help you and then talks about how lazy you are behind your back. Taken a step further bullying can become "mobbing" when more than one person commits egregious acts to control, harm and eliminate a targeted individual. It's important to remember that bullying is a behavior, not an identity. That's a quote from Teaching Tolerance (There Are No Bullies | Teaching Tolerance). This article talks about motives of power and control. Bullying behaviors are strategic behaviors that are there for a reason - to fill a need. The author states that there are people who deliberately and intentionally try to hurt others, wanting to dominate and feel powerful. The question is, why do they have this need for control and power? I haven't been able to find any scholarly research on links between bullying behavior and childhood trauma - if you have any information about this, please let me know. Based on my own past and on what I know about trauma-informed care and the Adverse Childhood Events Study (ACEs study; Adverse Childhood Experiences Study - Wikipedia), I do know that trauma in childhood causes lasting changes to the nervous system. It creates reactivity that pre-dispose survivors to a fight or flight response to real and imagined triggers. There are estimates that more than 50% of adults have experienced a traumatic childhood event. There may be a link there. What I have trouble believing is that some people are just "mean". I searched the internet, google scholar and pubmed for information about characteristics of adult bullies, bullying behavior in adults, why do adults bully, and help for bullies and found nothing. One indirect link I found - according to bullying experts Dan Olweus, Sue Limber and Sharon F. Mahalic, 60 percent of boys who bullied others in middle school had at least one criminal conviction by the age of 24; 40 percent had three or more convictions. A recent study published in the Journal of the American Medical Association reported that youth who bully are at increased risk for depression, conduct disorders, substance abuse and suicide. Does the bullying lead to these consequences, or are people with mental health challenges more likely to demonstrate bullying behavior? Expectations The American Nurses Association issued a 23-page position statement in July of 2015 on Incivility, Bullying and Workplace Violence. "As nurses, we are required to create an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employees, students and others with dignity and respect" The expectation is that we behave with professionalism. Where do the rules of professionalism for nursing come from? What are the rules? My husband has been a successful physical therapist for over 10 years, and he suggested that the expectations of professionalism are very specific to the profession. Behavior that would be tolerated, or even expected from a top cardiac surgeon would be grounds for termination for an RN. Professional standards are related to gender, level of experience, how you look, power, position and what you do for a living. Is it any wonder we have difficulty at times knowing what is expected of us? It's hard to watch others getting away with bad behavior day after day with no consequences. Even worse is to experience consequences for that same bad behavior, while watching others continue to "get away with it". Are our expectations too high? Are they wrong? Should we even have them? Who makes the rules? In an ideal world, we would treat each other with respect and kindness all the time. However, we don't live in an ideal world. It seems to get more "un"civil with every passing moment. I'm not suggesting the ANA position statement on workplace behaviors is wrong, I am suggesting that it may be hard to follow. It may be hard to measure up to. And what about the person who is the bully without even know they are a bully? Article after article discusses how to know if you are being bullied and what to do about it, but what about the bully herself? Dr. Renee Thompson has a tool "what if the bully is you" which I took a look at. I answered "sometimes" to 6 of the 15 criteria. Yes, I sometimes roll my eyes or make mean faces behind other people's backs, I sometimes talk about others in a negative way when they aren't around, sometimes other people seem unreasonably upset by the things I say or do, and yes, I have been told I intimidate other people. Worst of all I have actually made people cry at work. This has got to stop - it's not ok. I don't want to make people cry. I don't want to be intimidating. I do need to vent occasionally, but want it to be in a way that doesn't harm anyone else. At the bottom of the survey are these words: "If you answered sometimes or frequently to one or more questions, you are displaying behaviors that could be considered bullying if repeated over time. The first step is self-awareness. The second step is adapting your behavior." Solutions It's tough to figure all this out because we don't talk about it, especially if we are the bully. And we don't have a way to find out because the information is hidden - there is no report of people who have been written up, people who have had coffee talks, people who have been "in trouble" people who have been fired. How do we collect statistics on something for which there is no data? Dr. Thompson is the bullying specialist, and I have read over many of her free materials and resources. She gives straightforward advice on how to handle bullies: document the behaviors, name the behaviors by directly speaking to the bully, and don't tolerate bullying. I highly recommend visiting her website to get bullying resources. We need to open a discussion about prevention. There are tools for identifying if you are at risk for being the bully, and tools for identifying those at risk for being bullied. Dr. Thompson says self-awareness is the first step, followed by adaptation. I am looking for adaptation tools. I have decided (obviously) to keep trying. I won't give up. I'm so interested in body therapies - not the standard talk therapy I have experienced for the past 20 years or so, but techniques that are new to me. I will keep writing and hope to hear from others out there who are the mean girls, who are intimidating, who have made people cry. If we hide in shame, we can't improve. If we hate the hater, no one wins. I like to speak my mind, but I wonder if there's a use or space for nurses who speak their mind? My husband reminds me of the many people who succeed in the professional world by keeping their mouths shut. I remember over and over again in nursing school my fellow students would say, "Kristi, stay under the radar!" Flying low has never been my style when confronted with perceived injustice or wrongs. I have been asked to resign, told I am rude, and been written up for insubordination. Should I just quit? Should I just go live in a cave? What is the answer for someone like me with a huge heart and a reactive personality? I think I am worth keeping around. I live in here - in my head and I know what a good person I am. I'm not justifying my behavior or suggesting I should not experience consequences. What I am doing is letting you know what goes on inside the head of someone like me. This is what's happening in the head of this possible bully. My close friends would tell you that I'm worth it. The results I get with my research and the work I do at church suggest to me I'm worth it. I don't want to be seen as a liability, as a difficult person. I challenge people and I don't always do it in a thoughtful or kind manner. I know what is expected of me. I know what I am supposed to do. I continue to struggle with doing it. If I am triggered, I may react. I am so sick and tired of it. I am tired of that reactivity. I have so much to offer and I so want to be a part of the solution; but if I can't get a handle on my behaviors, I will continue to lose credibility. I'm confused and conflicted on several points, which I will present for your consideration. First of all, I have a hard time believing anyone would behave this way intentionally. As a person who has in the past behaved with incivility, I can state from my perspective that it was never on purpose. My intention at the start of each day is to create an ethical environment; a culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect (ANA position statement). I do believe that my history of childhood trauma makes it more likely that I will react to stressful situations with my primitive, sympathetic nervous system - responding in a fight or flight manner that can result in harmful words and actions on my part. I am not making excuses for my behavior, only seeking to understand it, hoping that in understanding I can finally at long last conquer it. As I write these words, I am flooded with shame at the memory of some of the things I have said and done in reaction to a perceived threat, despite lifelong therapy and work towards being a professional who behaves with professionalism. This brings up several more questions that I have asked myself after behaving badly yet again. Are there some people who should just not be nurses, despite feeling called? Are there ways to know early on that you are not suited temperamentally to the job of nursing? What support or resources are there for people like myself who love nursing, are dedicated to the profession, yet who also behave with incivility? Am I the only one? I don't think so. Are there others out there who "get in trouble" for speaking out? Who are counseled on inappropriate behavior? Who has been written up for rudeness? I think there are. And that brings me to the final question. What should nursing do with us? Do we say to all these people, "don't be a nurse if you can't behave"? I get it, I understand that sentiment because I have thought it myself. I wonder if there is perhaps another way? Is there room in nursing for healing? How we approach the bully may be the key to saving ourselves. I am asking you to consider several things as you deal with workplace violence and incivility. Consider how you deal with the perpetrator. It's one thing to recommend or refer to the Employee Assistance Network, it's another to proactively provide tools and information to support healing. I am learning a great deal about bodywork. The person who responds reactively (rudely, with incivility) is often not in control. We say "control yourself" without realizing that isn't possible. The control has to come before the stressor. Those of us with a reactive brain have to retrain ourselves to respond differently so we don't react in the moment, and there are many tools out there to do this - tools which in my 25 years of therapy I am just now finding out about. I have even been reading some research that suggests that talk therapy may interfere with healing from childhood trauma. The discovery that I may have been doing it "wrong" for 25 years Experts in childhood bullying recommend that instead of talking about bullying and labeling people as "bullies" and "victims", we talk about healthy relationships, behaviors, rights, and choices. We tend to assume that people get this information as children, but so many don't. Empathy is key, as well as adopting comprehensive programming designed to promote social and emotional competencies (There Are No Bullies | Teaching Tolerance). What if the next time someone behaves with incivility to me, I approach them with curiosity and an open heart? Instead of thinking "there are just some people who are mean", perhaps I can reframe that to "everyone is hurting from something, and we all manifest it differently". Instead of assuming that we all know "the rules" I could assume we don't and provide support and resources for nurses who are struggling with their behavior. I am not making excuses or asking for special treatment. I am not saying it's ok to be mean, to behave with incivility, or to be a bully. What I am suggesting is that through education and open discussion we can create healing. That's what nursing is all about - creating a healing environment for everyone, including those who challenge us.
  3. You might think that bullying only happens inside the walls of schools. We often hear stories about bullying between younger children and even teenagers. But, if you've been a nurse for any amount of time, you've probably experienced nurse bullying yourself or witnessed it on your unit. In fact, one study reported that 45% of nurses have been verbally harassed or bullied by other nurses. You might be thinking that you've heard so much about bullying in recent years that you no longer need more education. Renee Thompson, DNP, RN, CMSRN, owner of the Healthy Workforce Institute and bullying subject-matter expert, has this to say about continuing the fight against bullying, "It's just like anything else you want to master - you can't just attend one workshop on a particular topic and then check a box...yep, mastered that! If we really want to eradicate bullying and incivility from the healthcare work culture, we must engage in consistent, ongoing education and training related to disruptive behaviors." This is precisely why every October, our nation comes together to recognize bullying across all settings during National Bullying Prevention Month. Organizations such as STOMP Out Bullying and the National Association of People Against Bullying educate others on this community problem in the hope of curing our culture. What is Nurse Bullying? According to stopbullying.gov, bullying is unwanted, aggressive behavior. Renee has described bullying as having three components: it's targeted, meant to cause harm, and it happens over time. Not all unwanted or mean behaviors are considered bullying. Some actions may be classified as incivility. For example, if you've had a particularly bad day at work and get a little testy with a co-worker, this might be incivility. But, if a co-worker continuously yells at you, picks on you, or turns others against you - this could be a classic case of nurse bullying. Recognizing the Behavior Do you remember the playground bullies you dealt with in elementary school? They would pick on you or others only when the teachers weren't around or paying attention. Bullying in nursing isn't much different. There may be times when the bullying is overt, such as another nurse who yells at you, insults you, or lets you know in no uncertain terms that they don't care for you. However, often the bullying is a bit more subtle and may even leave you wondering if you're interpreting the actions by others correctly. A few examples of subtle bullying include: Others not helping you, even to the point of putting patients in unsafe situations to avoid lending you a hand Not giving you all of the information you need to perform your duties in hopes that you make a mistake Spreading rumors about others Excluding certain nurses from activities on the unit What to do if You're Being Bullied If you find yourself in a bullying situation, you need to speak with your nurse manager. Renee offers this advice to anyone breaching this difficult conversation, "The first action is to get clear on the specific behaviors of that nurse. Instead of saying to your manager, "she's bullying me," try saying, "she refused to take report from me, yet she takes report from everyone else." This takes the emphasis off of the person and places it firmly on the behaviors. Renee went on to say, "Once you're clear on the behaviors, start a documentation trail. Include date, time, location, an objective account of the incident, and most importantly, link that behavior to a patient safety, quality, or satisfaction concern. If done well, documentation can increase the chance that your manager will take action." The last thing to do if you're being bullied is to confront the person. Renee said that she shares many scripting techniques that work well. "Most importantly," she shared, "is that if you're being bullied, you must do SOMETHING about it." How to be a Positive Influence Even if it's never happened to you, there are things you can do to improve the healthcare culture. Try one of these simple actions that let others know that you support a kind, caring nursing environment: If you witness one nurse bullying another, intervene on the target's behalf. You don't have to get in the middle of the situation, but you can redirect the behavior. Befriend and mentor new nurses on your unit. Notify your supervisor if you witness bullying or incivility. Be kind to others, treating them how you expect to be treated. Be positive. Recognize others for the behaviors you want to see on your unit. Have you ever experienced or witnessed bullying? We invite you to share your story to bring more awareness to this problem by placing your thoughts in a comment below.
  4. 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 & Einarsen, 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., & Einarsen, 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
  5. allnurses

    Addressing Bullying in the ED

    allnurses.com staff recently had the opportunity to interview Lisa Wolf, PhD, RN, CEN, FAEN, Director of ENA's Institute for Emergency Nursing Research. She has published research about bullying and how it affects nurses patient care. How does bullying in the ED manifest itself? Bullying can manifest as the dynamics of aggression, which includes overt hostility, denigrating comments, giving inappropriate assignments for the nurses' experience and expertise, and selective reporting. More difficult to identify and call out, however, are the dynamics of exclusion, which is marked by a withdrawal of help, support, and information. These types of behaviors often result in a nurse being "set up to fail", which has consequences for patient care. How does this differ from bullying in other departments? I don't know that it is very different in other departments, but the constant flow of patients, the short turnaround times, and the initial lack of knowledge about patient conditions make the emergency department a particularly high-risk area for this dynamic to manifest. What kind of collateral damage results from bullying in the ED? Workplace bullying is a significant factor in the dynamics of patient care, nursing work culture, and nursing retention. The impact on patient care cannot be overestimated, both in terms of errors, substandard care, and the negative effects of high turnover of experienced RNs who leave, compounded by the inexperience of newly hired RNs What methods did you find to be the most effective in addressing/decreasing bullying? Our respondents report that a "calling it out" strategy by both staff and management is the most effective way to reduce bullying and its consequences. An assessment of hospital work environments should include nurse perceptions of workplace bullying, and interventions should focus on effective managerial processes for handling workplace bullying As a result of your research, what type of training do you recommend? Given that management is the key role in mitigating bullying behaviors, education in the identification of bullying behaviors (especially those marked by the dynamic of exclusion) and in addressing them with staff is probably the most effective way to reduce workplace bullying. Bullying is becoming more pervasive in our culture as a whole. However, as nurses on the forefront of life and death decisions, it is imperative that nurses have a toolkit to deal with bullying at work. The American Nurses Association published a position paper on this in 2015 with a goal; "to create and sustain a culture of respect, free of incivility, bullying and workplace violence." ENA has also published guidelines to deal with and curb lateral violence which is defined as; "violence, or bullying, between colleagues (e.g. nurse/nurse, doctor/nurse, etc.)." "According to a 2011 study by the Emergency Nurses Association (ENA), 54.5 percent out of 6,504 emergency nurses experienced physical violence and/or verbal abuse from a patient and/or visitor during the past week. The actual rate of incidences of violence is much higher as many incidents go unreported, due in part to the perception that assaults are "part of the job"." ENA offers a toolkit with six distinct steps to address workplace violence. The first step is acknowledging that it exists and that nurses have the capability to decrease the incidence. There are many shareholders in this initiative including the front line staff but managers and administrators also have a key role in this. JCAHO, OSHA and other governmental agencies require documentation of a safe workplace and offer recommendations as well. Violence should never be tolerated. Do you feel safe from lateral violence in your emergency department? What has your ED done to combat lateral violence?
  6. Julie Reyes

    Bullying in the Workplace

    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). references.txt
  7. Kyrshamarks

    Sure to Get Flamed for This

    I am sure I am about to get flamed for posting this, but I feel the need to anyways. I have been seeing these threads talking about bullying and teachers or preceptors hating the students, and new nurses or abusing them because of some perceived slight or injustice. Well guess what? The world is a hard cold nasty place that does not need to be polite to you or worry whether your feelings got hurt and you feel offended. You need to grow up and realize that the abuse that you claim is rampant, or the bullying that you experience all the time is not their problem, but rather your problem. I see so many posts about this and I wonder how some of these people have survived as long as they have. School is tough? Deal with it. You think that someone else is getting it easier? Well too bad, they may be but no one ever promised you everything would be fair. You have to learn that there is inequality in life. It's how you overcome that inequality that matters. It teaches perseverance. Abusive teachers? Maybe they are trying to get the best in you to come out. What you think is abuse maybe is pushing you to your limits, to get you further along in your potential. So your feelings got hurt at school, grow up, feelings get hurt every day. Your preceptor is unorganized and does not like you and bad mouths you to your manager, and all your patients love you but no one at the hospital sees how great you really are? Well your preceptor may actually have great time management skill, but when having to slow down and teach someone their job, things do tend to get disorganized. You may be part of the blame there. Did you ever stop to think that you are the proverbial monkey wrench in a well oiled machine? The need to teach you, and I realize you do need to learn, can be very time consuming. They may tell your manager that you need improving or that you are not advancing fast enough. They may be all smiles to you, because they want to support you and keep you positive, but they need to tell the manager how you really are. Speaking of orientation, how often have I seen statements that say the other nurses are not supportive and will not answer questions. Have you ever thought that maybe you are asking TOO MANY questions? After a bit it may seem that you are not retaining the info provided and everyone gets tired of answering the same questions over and over. Part of learning is knowing when to shut your mouth and just watch. It has been said by people wiser than me that the only question you should ask is the question that you already know the answer to. If that does not make sense to you, think about it for a while and you might just be surprised that a light comes on. So basically what i am saying is grow up and act like the adult that you are. Life is not fair, school is not fair, work is not fair. You just have to learn to deal with it.
  8. I hear too often in the nursing world that we "eat our young". This is not OK on quite a few levels, but the biggest concern is how often this happens and, despite the fact that so many of us disagree with this behavior and this sentiment, it still occurs frequently. The fancy term for the behavior of "eating our young" is lateral violence. I have been thinking about this a lot lately: Is that mentality different from other professions where people will clamor all over each other to get ahead? Not entirely, but it seems totally out of character for nurses, who give care to others and are healers for a living, to be laterally violent to each other. There may be times where we may, perhaps, be a bit short with an MD when we disagree upon a plan/intervention for a patient, or not be best friends with one of our coworkers, that is part of human nature, especially when working in a stressful environment. Who hasn't been under a lot of stress in the middle of an insanely busy shift, and maybe come across as less than pleasant to a co-worker? Saving lives can be stressful business, but that doesn't mean that we should demean one another. Lateral violence refers to a person of higher "power" or status on a unit, bullying or demeaning a co-worker, either through verbal or non-verbally aggressive acts. Usually, if you snap at someone because you are stressed, you will address it and apologize, or make some sort of note that you didn't intend to come across as you did. Lateral violence is a continued trend of behavior that makes others feel uncomfortable, demeaned, and of less value. The thing about lateral violence is that some of the acts that constitute it, are so subtle. While any administration for any hospital or other healthcare arena would tell you that they take a stance on anti-bullying and/or lateral violence, the behavior and actions can be really tough to nail down, and it has been so long accepted in our culture that it goes under-reported. It's not just the senior nurse on your unit that might get snappy or yell at a newer nurse for not being able to read their mind during an emergent situation, it could be the resource nurse that doesn't schedule a break/lunch time any time that you work with them, or doesn't offer you help when you are drowning in your assignment, but seems to offer to help everyone else out. It's the charge nurse that gives you the heaviest assignment every single shift. It's the person who runs the schedule and they put you on every single shift that you request off. It's the co-worker that ignores you, or rolls their eyes at you, when you ask for help. If you have ever been in a situation at work where you've felt distressed by how you have been treated, you may have been the victim of lateral violence. These actions are what create a toxic environment that leads to a high turnover of nurses, and severely unhappy nurses on the unit in their short time there. And not only do the clinical staff suffer, but the patients suffer as well. When clinical staff are not working as a team, helping each other when they need it, and giving unequal patient assignments, it can be hard to meet the needs of our patients. If I can't find a co-worker willing to help me reposition my bed bound patients, they are at a higher risk of pressure ulcers, right? And if my assignment is so heavy I don't have time to change out that IV that was due to be changed at the beginning of my shift, that patient is at a much higher risk for phlebitis. What can we, as a culture of nurses, do about lateral violence? Just saying we won't tolerate it isn't enough. One of the biggest ways to prevent it is to educate staff on what lateral violence actually is; once behaviors are pointed out, and it becomes a part of the culture that those behaviors will be scrutinized and not tolerated, people tend to have more self awareness of their actions. We also need to speak out when we see it occur to others, or experience it directly, and report it. Nurse leaders on units should lead by example and set the tone for their unit, not only that they don't bully their own staff or colleagues, but that they are supported by the policies set forth by their institution, and enforce a culture of anti-lateral violence. And when staff report lateral violence to their managers/directors, they need to feel comfortable and that there will be no repercussions for their actions, and that the person reported will actually be dealt with. None of us should feel uncomfortable or scared going to work, for any reason, and if you do, you need to speak out about it, and report it higher and higher in your institution until someone listens! Feel empowered to stand up for yourself, your colleagues, and our community.
  9. compassionresearcher

    Why Bother Studying Workplace Bullying?

    The old saying goes "if you want to hear God laugh tell him your plans." Early in my doctoral program, I had planned on studying healthy aging, as in what do people who age well do that the rest of us don't. But an assignment in a theory class changed my course. We had to interview and write up a case study of one participant and I interviewed the novice nurse quoted above. It was sad and disheartening and made me want to hug her and tell her it would all be okay soon, but I couldn't promise that. Of course, she reminded me of myself as a new grad. My own experience When I got into nursing I had no idea about the potential for mistreatment. Perhaps I was young and naive, but I can't be accused of having preconceived notions or self-fulfilling prophesies for bullying. I had taken a job 1500 miles from home where I didn't know a soul except for the guy I moved there with. There was no work for new graduates in the mid-'90s, in the city where I lived. I took a job on nights in the float-pool -- what was I thinking? Again, had no idea that float nurses notoriously get very difficult assignments with minimal orientation. I won't bore you with the details but it was the hardest year of my life. Things at home were bad, things at work were unbearable, and I had bad insomnia because I couldn't sleep during the day. I'm pretty sure there were some patients and their families that didn't get the best possible care because of all these factors, though I meant well. Luckily after my one year, I got a new job in a much healthier environment and could recover. Not everyone is that lucky. Nurses leave their units, hospitals, and careers because of scenarios like these. And in extreme cases hurt or kill themselves. You never know what someone is going through outside of work, and it takes little effort to make them feel cared for or like they don't matter. I know there are nurses out there who hate this topic because they think it's untrue, exaggerated, or gives nursing a bad rap. I myself cringe when people say women can't work together. Even if it's 10 percent of us who face it, that's 300,000 people's lives and the patients and families that are touched by this! It's not enough to be neutral To do no harm is extremely important, but what about kindness and be compassion for our co-workers? We must lift each other up. Have you ever seen two firefighters meet each other for the first time? Instant brothers, no matter where they work. Why can't nursing be that way? A study (Barsade & O'Neill, 2014) out of Wharton School of Business studied compassion in nursing home employees. Units scored by staff as compassionate demonstrated less absenteeism and more favorable reviews from residents and family. The numbers are in The current study I'm working on (Exploring Nurse Bullying [horizontal violence, lateral violence, incivility] and Quality Patient Care Survey) combines these two concepts, bullying and compassionate environment. I'm looking to see if patient care is affected by either or both. Preliminary results show nurses from all over the country and outside the country, with wide ranges of age and years of experience, are reporting being bullied. And it is impacting the care they can give. I'm still collecting surveys, so if you care to join please see my post on allnurses: Bullying at Work: What is Your Experience? And, share with any nurses you know. I will give a final report when the study is concluded. Reference Barsade, S. G., & O'Neill, O. A. (2014). What's love got to do with it? A longitudinal study of the culture of compassionate love and employee and client outcomes in a long-term care setting. Administrative Science Quarterly, 59(4), 551-551. doi:10.1177/0001839214538636
  10. There may be a few people reading this who have never experienced bullying. But, I'm pretty sure every organization of every type, has had to address the subject on some level. Just read or watch the news and you'll see where victims of bullying act out as a last resort, sometimes, resulting in extreme cases of violence. As a nation, we had to fight to get where we are today, and we still employ the willingness to fight to stay there. Fighting is not new. However, in the workplace, it has apparently become so prevalent that policies have, and are being developed to deal with this issue. As a nurse, I've heard the phrase "eating our young" in so many leadership classes that it almost feels superfluous. I've been a nurse for 27 years and I ask myself 'how are we changing and growing as a profession if we're still discussing the same issues?' We identify it as an issue, but are we any closer to dealing with it? Does bullying play any part in job satisfaction or employee turnover? Do we owe it to our profession to look at these questions closer? I would like to direct myself today in a slightly different direction...instead of looking at how to stop it; I want to simply try to understand what it is. Can a person think they are always right? Do adults have bad moments and have adult temper tantrums? Does having a difficult personal situation cause someone to act out? I think the answer to all of these is quite simply, yes. But does feeling your always right, or having a bad day, or an occasional crying spell at work make you a bully? No. I have worked with many people who thought they were always right. Some of those people were very eloquent at explaining themselves, and I respect them for taking the time to explain. Does that make them a bully, no? In the ever-growing field of healthcare, change is inevitable. We all get frustrated at times, and we try to navigate the safest and most effective options for our clients. This frustration sometimes bleeds into their interactions with one another. Does that make them a bully, no? A quick I'm sorry or 'I get it' has fixed those hurt feelings easily. I myself have shed tears at work as I have a mother with Alzheimer's Disease. There have been times where the drive was too short from home to work, or my mom hadn't eaten for days without choking, that triggered those feelings of sadness, loss, and feeling overwhelmed. I'm fortunate because these are the moments my coworkers are my family and take care of me by offering me a hug, allowing me a crying spell in the bathroom, or just listening for a few minutes as I vent. Does that make me a bully, I certainly hope not. So what is a bully? Bully: a cruel and brutal fellow; be bossy towards; discourage or frighten with threats or a domineering manner; intimidate. I see the key words here being cruel and intimidating. Because bossy, really, I can live with; bossy: offensively self-assured or given to exercising usually unwarranted power. A person can easily be bossy without being a bully, it may be aggravating to deal with that on a daily basis but it is not something I personally would go home upset about. But cruel: able or disposed to inflict pain or suffering; and intimidate: to compel or deter if by threats. Wow! Those are powerful words! What drives a person to want to inflict pain or suffering in a threatening manner? Like seriously, who does that? And can you tell in an interview that they're like that? Or, if they're not 'like' that then, how do they become that? If we identify them, is there a potential to get them into classes about appropriate interactions and dealings with people. I think we need to recognize that there are people with great skill sets and poor people skills. How do we appropriately verbalize our concerns, or report bullying to a manager without coming across too 'soft' or too 'sensitive'? One time, I witnessed a coworker call another coworker an idiot, in a group, in a mental health facility, in front of patients. Talk about cruel, it totally undermined this persons authority as a healer. I have personally experienced bullying in my past, by a leader. As a leader, she was put in a position by our direct supervisor to mentor me and guide me. All of which she did none of! Actually, she did the opposite, she would set me up for failure, not speak to me, and physically separate me from the person I was to be directly shadowing. And when I did speak to my manager about it, my concerns were dismissed, saying I wasn't there long enough to have any "concerns". I quit that job. We've all read the research articles in our professional nursing journals stating being a victim of bullying can lead to depression, job dissatisfaction, psychosomatic and psychological concerns. When are we going to change our thinking from defensive to offensive? What can we do to foster a more supportive and nurturing environment for victims to speak up? As a profession, I feel we need to rethink how we deal with bullying. I feel we need to cast a wider net, not just look at how to handle the end result, but also how to identify it, how to report it, and most importantly, how to support its victims. We need our playgrounds back.

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