There have been a lot of threads on bullying lately and some of the advice given has been less than ideal. Bullying is world wide (isn't THAT depressing) and is not confined to nursing but if we never action it, it will never go away. The other day I attended a workshop on bullying and I thought I might be able to translate some of that here.
My Aim in starting this thread is to get everyone to participate in a discussion about what exactly is bullying, then we can, together look at ways to stop it. Throughout the thread I will add links to websites such as http://www.workplacebullying.co.uk/
So that this can become a resource for all of us.
What is Bullying??
Bullies rarely see themselves in that role and sometimes what you think is an innocent action can be seen by another person as bullying. Below I have listed some statements/behaviours that may or may not constitute bullying.( You can add your own if you like;)) Have a look through them and decide if they are bullying or not - there are no real wrong answers - the idea is to have some fun. You don't have to answer all of these - you can pick out those you feel comfortable answering.
A) Do you ALWAYS leave that monitor off?
B) making eye contact with someone
C) The reason why we do that this way is............
D) Standing with your arms crossed while talking to someone else
E) Making personal comments about how someone walks
F) Standing with hands on hips while talking to someone
G) Pointing your finger at another person
H) "A lot of people here don't like how you work"
I) "Did you realise that it is policy here that we do things X way and not Y way"
J) "The other day you left things in a mess - you didn't date your fluid chart, you didn't put a time on that entry, you didn't fill in this form completely you didn'twash your coffee cup, you didn't tidy up. you didn't write in this book you didn't..............."
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
Why do nurses have to behave this way? Why is 'professionalism' NOT drilled into nursing students in every course, clinical and patient encounter during school? While I was in school, an ADN program, there was one clinical instructor who stressed the need for professionalism and peer support. One. Just. One. The rest were more concerned with care maps and care plans.
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I don't think education has anything to do with bullying. I think it's a personality trait. You can teach people the importance of professionalism, but some people will always feel their behaviour is justifiable. Some people were raised well, and some weren't.
I don't think education has anything to do with bullying. I think it's a personality trait. You can teach people the importance of professionalism, but some people will always feel their behaviour is justifiable. Some people were raised well, and some weren't.
I think bullying has more to do with insecurities (on the part of the bully) than anything else. Thinking back to my study of narcissism, there seemed to be a concensus that a lot of that was compensation for low self-esteem, although what struck me most was the utter lack of empathy. Indeed, there were several disorders that seemed to have in common the inability to see things from another's point of view.
Maybe antisocial behaviors are no more prevelant in nursing than elsewhere, but we who place so much value on empathy are more appalled when we see them. Then, too, I think we have all seen situations where we didn't feel we could be assertive--abusive patients, obnoxious family members of patients, overbearing bosses, etc. Maybe swallowing too much of that creates the stresses that lead to bullying and acting out.
In that light, I can think of several classes I took in support of the nursing program that might profitably have been replaced by an assertiveness training course. In fact, I think I'll write to my program director about that. In the meantime, I think one can learn an awful lot from these discussions.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
I agree about the insecurities. I've noticed that bullies are 1) very good at their job, knowledgeable and efficient -or- 2) not all that smart, and spend a lot of time shifting the focus onto other people's mistakes.
My theory on #1 is that nursing is the only thing they feel good at. Maybe they are bullied at home by a spouse. Maybe they feel inadequate in other ways. So they vent their frustration at work.
This is a great thread! I've visited that Canadian site when my children had problems with bullies and found it helpful. I would also recommend that book Queen Bees and Wannabes WITH A GRAIN OF SALT. It gives some good illustrations of group dynamics, in particular when it points out that bullies need tacit consent from those around them to function. When a bully is isolated socially or for instance by a manager who calls them into their office, they often change their tune. In an ideal world everyone would have a good supervisor/manager who would force parties who are disputing to get in a room together and talk it out. But, alas, a lot of people in management aren't so skilled. At work I find that reverting to cold professionalism will help with a bully, but that only works if you have a thick skin. I think in any environment we all have a responsibility to watch out for that less-assertive person who lets themselves be bullied because it at least makes them part of the group. This can be done by standing up to the bully for them, deserting the bully socially, or by comforting the victim afterwards in a non-gossipy way.
I find that when I feel hurt or upset by others' behavior, the best thing is to step back and concentrate on my responsibilities and moral obligations. I don't have to let myself be diverted from what is the right thing to do.
My ADN program did deal somewhat with issues of professionalism and with leadership styles, and quite a bit with appropriate delegation. A lot of it seemed like "common" sense, but I've lived enough to put "common" in quotation marks.
Our clinical instructors demanded a high level of professionalism every moment in the clinical setting. There were moments of levity, but you didn't dare disrespect anyone.
"in fact, the subtle underlying message when any women says anything to me is that she wants me"
I'm not sure, but I think it may just be possible to have too much self-esteem. In psych nsg, we did group presentations of psychiatric disorders. My group did narcissism, and I was the star.
We have a problem with one of our Drs. Actually he is the head of our department and should not be acting this way but what do do about it? We had an incident where one of our nurses was on orientation and one of our pts was going in the crapper and he was giving orders as they do in this situation. He assumed the orientee pushed calcium cloride in the PIV and started screaming at him. The male orientee said to the male Dr that he did not do this and an arguement ensued. The Dr said to the nurse: "Listen here you little f***er....." We nurses are horrified at this behavior of theis "professional". He is our department head as I said. What can we do? The Dr did apoligize the following day but the damage had been done. Any advice?
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
Go above his head. We have a couple of doctor like that. They get all bent out of shape and say stupid things. Ranting and raving. Then they apologize later. Once, sure - everybody reaches their boiling point - but not over and over. They get into the habit of blowing up and then apologizing - thinking they're erasing the damage. Every time one of our "problem" docs loses it, we write him up. Enough is enough. He may be your department head, but there is always someone up higher on the ladder. Public beratings like that do ALOT of damage to people, especially new nurses. Like my mom always said - Words are like toothpaste, once they're out of your mouth, you can't put them back in.
Go above his head. We have a couple of doctor like that. They get all bent out of shape and say stupid things. Ranting and raving. Then they apologize later. Once, sure - everybody reaches their boiling point - but not over and over. They get into the habit of blowing up and then apologizing - thinking they're erasing the damage. Every time one of our "problem" docs loses it, we write him up. Enough is enough. He may be your department head, but there is always someone up higher on the ladder. Public beratings like that do ALOT of damage to people, especially new nurses. Like my mom always said - Words are like toothpaste, once they're out of your mouth, you can't put them back in.Jen
Your mother sounds like a wise, and possibly slightly weird, woman. Love that analogy.
I agree that appealing to higher authority is a better approach than just taking it, or catching the doc in the parking lot with a baseball bat, but I think we are all in general agreement that higher authority doesn't always come through as it should. After all, if they were really on top of these things, they wouldn't happen as much to begin with. Then, too, it would often be preferrable to correct the offense without getting the offender in trouble, which runs the risk of further hard feelings.
I wonder what would happen if the victim graciously accepted the apology, but emphasized that future repeats of the same behavior are completely unacceptable, and that the damage such outbursts does is not easily repaired.
I also saw mention on another thread of a "code white," which is apparently where other nurses gather around the nurse being attacked in a silent, but visible, show of support. (Thinking of a couple of guys on my floor, that could be downright intimidating, but witnesses of any sort should give the bully something to think about.)
Then again, there's always the nuclear option. If, as it sounds, the doctor slandered the orientee by accusing him publicly of malpractice, he left himself liable to legal action.
A nurse's reputation has cash value, and there are plenty of hungry lawyers out there.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
I've never witnessed a code white. Well, maybe in a way. We had a code the other morning, and had to call anesthesia to intubate. It was a big mess - ambiguous family, dragging out making a decision on code status. Bad time of day - right around 630. Anesthesia was really POd at having to "waste my time doing this" There were about 5 nurses and 2 RTs around, plus lab. I couldn't believe the stuff that was coming out of this guy's mouth. "I don't make enough money to have to do s*** like this" Unbelievably condecending comments directed at everybody in general. We were all just standing there staring at him through the whole thing. Someone asked about putting in lines, and he spouted "I shouldn't even have had to do this, get someone else to do it" Eventually, I guess he decided he would go ahead and do it, and was reportedly very nice about it. I don't know if he is used to acting like that in OR and getting everybody to lick his feet, or what, but I think all of us staring at him with our jaws on the floor made him feel like an idiot. We don't see him in ICU very often, so maybe he doesn't know that we don't usually kowtow on command! I'm just soo glad there was no family around to hear it.
PS: My mom heard it from her mom. I also got a lot of "Well, that's the way the cookie crumbles!" As in "tough s***"!
We have a problem with one of our Drs. Actually he is the head of our department and should not be acting this way but what do do about it? We had an incident where one of our nurses was on orientation and one of our pts was going in the crapper and he was giving orders as they do in this situation. He assumed the orientee pushed calcium cloride in the PIV and started screaming at him. The male orientee said to the male Dr that he did not do this and an arguement ensued. The Dr said to the nurse: "Listen here you little f***er....." We nurses are horrified at this behavior of theis "professional". He is our department head as I said. What can we do? The Dr did apoligize the following day but the damage had been done. Any advice?
That is so completly unprofessional that I think I'd take organized, drastic action: put your thoughts in a memo to him and copy the chief of staff. Then send same memo, cc'd of course, to your state's department of professional regulation. It will get everyone's attention, unless you live in IL as I do, where the IDPR is only concerned with collecting fees to renew your license.
I had a doc scream at me, use foul language and name calling when I expressed my disappointment about an infertility procedure (long story). He really did become verbally abusive -- my husband was able to hear him screaming at me on the phone from the other room.
Needless to say, I told him that further dealings with his office would not be possible; I would not allow him to proceed with this procedure (an IVF embryo transfer) and that I'd be withholding payment until a written apology was forthcoming. Then I wrote all this up, got a copy of my chart (that was entertaining) and wrote down my thoughts, experiences and reactions. Then I sent the entire package back to the doc, copied the IDPR, and got nowhere.
However, I did have my say, the Professional Reg ppl will have the sacred 'paper trail' and this might result in a pattern of behavior documentation.
Eventually, the karma you create catches up with you, sooner or later.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
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However, I did have my say, the Professional Reg ppl will have the sacred 'paper trail' and this might result in a pattern of behavior documentation.
Eventually, the karma you create catches up with you, sooner or later.
Exactly. If nothing else formal write-ups, letters to administration, whatever - at least there is documentation on the incidents. I know one doc in particular who was especially abusive while on call one weekend, who was written up by a few of the many people he abused over the weekend. He wrote a formal apology letter to the staff. It hasn't happened again, but I think it takes a ton of self-control on his part. He still gets pretty grumpy when he's on call, especially if a patient isn't doing well. But he knows better.
I think hospitals (or employers) should be taking this kind of thing much more seriously these days. Some are. This kind of behaviour could technically be verbal assault. It contributes to a hostile environment, which most employers want to avoid these days. Ignoring it could set them up for legal action down the road. Especially if there is documentation of complaints that weren't followed up on.
Just make sure to make copies of written documentation for yourself. I might even go so far at to have my supervisor sign it as "received" before copying it.
Jen -- you've made excellent points about hostile work environments (I'm personally allergic to 'buzzwords' but this one strikes a chord for me).
Also, abusive behavior, no matter where it occurs, escalates. It starts out as name calling / cussing / overall obnoxiousness, and can, and has, resulted in chart/instrument/chair throwing when certain overly ego-ed medical deities really lose it. Or even those bullying co-workers. It can get physical, and that means I'd be calling 911 and having the offender dragged off in handcuffs.
Then my evil twin would take pictures, and I'd send those in with my next pain in the tushie letter to the IDPR to see if the sacred paper trail has become a bit more attention - getting!
Here's some good news:
When I was at my last job, I did have a doc who got mad at me (justifiably) because of a missed ABG; I was really hesitant to perform this on this particular patient. He went to the charge RN, who came to me, and I told the Charge RN what was going on. He (Charge RN) was pretty cool about it and came in and we did a fem stick successfully. I apologized to the doc and explained that I was having a hard time with the procedure. He in turn apologized for not coming directly to me about the issue and said next time we'll work together if you're having trouble with something.
Another miraculous incident, although somewhat less impressive:
I had a patient with back pain and a doc who did all of the usual stuff for back pain -- hold off on the narcs as long as possible. When some labs came back it showed really high pancreatic enzyme levels and a huge WBC (like 25,000) His temp was drifting upward and I had a feeling we had a pancreatitis thing going on. Well, I went to get the doc with the lab results, as he had asked me to do, and I found him walking out of the break area. I said "Kevin, I have those results for 4" and he snapped at me "I'm still eating". (I had no idea he was eating.) Well, the look on my face must have been one I'd like to patent (lousy poker player, I am) because he immediately apologized for his tone/demeanor/etc. That one rolled right off me because we're all a bit cranky when we're tired, overworked, and hungry. Ever since that day he treated me with the utmost courtesy and even comradarie, as if he still feels bad about his previous behavior.
Anyway, we're all different, and I think that if you cut the head off the bully snake ASAP -- even getting the official state-complaint paper-trail smackdown -- eventually the docs will 'get it' that that behavior is no longer acceptable in today's practice, especially close relationship, high-stress environments like ED, Cath, ICU's and OR.
This is a great thread. It's making me think about the good occasions as well as the bad ones, with a completely different perspective.
pricklypear
1,060 Posts
I don't think education has anything to do with bullying. I think it's a personality trait. You can teach people the importance of professionalism, but some people will always feel their behaviour is justifiable. Some people were raised well, and some weren't.