Nursing school is a competitive and high stress environment. Unfortunately, nurse faculty do not always model behavior that is respectful and supportive. Is this harsh environment producing future nurse bullies?
Bullying and nursing have a long and well documented history. The American Nurses Association defines nurse bullying as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient”.
"I easily recall my first nursing job and my assigned preceptor. During the first week, my preceptor instructed me to call the on-call cardiologist to report a patient’s conversion to atrial fibrillation. However, she provided no guidance on the assessment data (including vital sign trends, labs and medications) I needed to have ready for the notoriously thorough and rude physician. I remember hanging up the phone- red faced and teary eyed- as my preceptor stated “congratulations on your first initiation”.
My experience is not unique. Research has shown 85% of all nurses have been bullied at some point in their career. In addition, 60% of new nurses leave their first nursing job due to some form of harsh treatment from other nurses.
When I taught my first nursing course and clinical, I quickly identified potential future nurse bullies. The humiliation and distressed inflicted by these students caused the same level of damage and distress as in other nurse settings. I also discovered some faculty failed to model desired civil behaviors. Instead, faculty modeled bullying behavior through rigidity, being over critical and treating students unfairly. Do you remember hearing these words in nursing orientation, “look to your left then right and understand most at least 1 of you will not be here at the end of the semester”? As if nursing school wasn’t competitive enough, faculty introduce the fear of failure into an already stressful environment. And so it begins.
If you are a current nursing student this article provides you an opportunity to reflect and evaluate if you have behaviors that could lead to future bullying. You may also identify bullying at the hands of a classmate. Let’s look at common characteristics of bullying and relate to the experience of nursing school.
Have you ever tried to control or dominate other nursing students?
Examples of this bullying behavior:
Interrupting another student in class, lab or clinical.
Encouraging another student to break rules or act in an unprofessional manner.
Asking another student to not tell or report behavior such as cheating, clinical errors or other rule infractions.
Providing unsolicited criticism of another student’s performance.
Have you ever verbally intimidated another student?
Examples of this bullying behavior:
Assigning an unfavorable or offensive nickname to another student (often timid or weak) or simply engaging in name calling
Making insults under the guise of a “joke”
Telling ethnic jokes or using slurs
Gossiping about other students or sharing information told in confidence
Making outward signs of frustration with another student such as inappropriate sighing or laughing
Speaking in a loud or aggressive manner
Have you ever blamed another student for your poor performance?
Examples of this bullying behavior:
“Thanks for asking so many ridiculous questions in class. I failed the test because you were so distracting.”
“I studied with you and look what happened!”
Have you ever found fault, sabotaged or withheld important information from another classmate?
Examples include:
“John thinks we have an hour for lunch instead of 30 minutes- let’s not tell him. Jokes on him!”
“Why are you always nervous before clinical? No one else is acting like you.”
Making unfair assignments in group projects or clinicals
Withholding information that would be helpful/beneficial to another student.
Have you ever intentionally or unintentionally demonstrate behaviors of cyberbullying?
Examples include:
Confronting another student on public online social media
Singling out another student by excluding on message boards, chats and class-related media
Using social media to gossip or talk negatively about another student?
Other covert forms of bullying:
Eye Rolling or other gestures for the purpose of intimidation, embarrassment or threat
Excluding a student from a group (i.e. cliques)
Using profanity
Being confrontational
There are overt bullying characteristics that lack subtlety and are easier to recognize and often occurs in front of other people. Threatening is a direct form of bullying and is intended to scare or coerce an individual into certain actions. Coerced actions may be engaging in verbal and physical altercations, withdrawal or avoidance of people and places.
Note: This article focused on subtle bullying behaviors that are sometimes difficult to recognize. Physical violence is a clear and dangerous form of bullying. It is also less common because the consequences are higher- being expelled, arrested or other legal issues.
Did you experience bullying behaviors in nursing school or are you experiencing as a student now? Share your experience.
I disagree with some of this. Eye rolling is not bullying. Excluding a person from a clique, not bullying. Not everyone has to like you. As the person being excluded does not have to like everyone.
I have friends that I like to be around. We hang out in a group. There are other people I really can’t stand to be around. Maybe they are negative, maybe our personalities don’t mesh. It does not make me a bully to not invite them into my group. Nor does it make the other groups bullies to me for not inviting me with them.
Lots of my coworkers hang out after work. I’m usually not invited. A, I don’t want to go. I have a family to get home to. B, I have absolutely nothing in common with them outside of work. C, it’s not my idea of a good time to go out and drink after work in my scrubs. I want to shower, put on my pjs and see my husband. It’s not bullying to not invite me.
The term bullying has gotten way over used and is losing its meaning and significance.
We are allowed to disagree and not like everyone. Everything does not have to include every single person. This piggybacks on the other thread that people these days can not cope with life. They cannot cope with the fact that not everyone is meant to be your BFF. But you can still be civil to everyone with expecting lifelong friendships.
I think a lot of people misinterpret assertive behavior for bullying or being mean. Which if you think about it is crazy because as nurses we HAVE to be assertive to do our jobs.
I also think that being strict and having high standards is good for our profession and our patients we are dealing with peoples lives after all. Being tough of students and orientees helps to drive home the seriousness and importance of our responsibilities when it comes to managing patient care.
When I was a new nurse on orientation, my preceptor had to call a physician with a nasty disposition, prior to the call she asked me what I would say regarding the issue we had then without warning handed me the phone after she dialed the number. I was terrified! I stuttered and stammered, my heart was pounding I just knew I was going to make a butt out of myself and I'm sure I probably did but I got through the call somehow. At first I was mortified at what she did but I soon saw that that baptism by fire was actually really good for me because it allowed me to get through what I feared doing the most as a nurse and gave me the confidence to continue on. I'm sorry but that is NOT bullying, that's being an effective preceptor.
Don't get me wrong, bullying does happen in our profession and we certainly don't have the camaraderie that some of our healthcare counter parts do (cough cough physicians cough) and I do hope that we become more supportive of one another even if we don't like one another.
Even if I don't like you, even if I sometimes fantasize about using you as a human speed bump in the parking lot, I'm still going to be kind to you at work. I will still ask you if you need help and jump in if you require assistance. I will still be respectful even if I think you're a complete jerk. I will however be assertive and not allow myself to be walked all over, that is not bullying.
Any tips on becoming a little more assertive? I just applied to nursing school and will find out next month if i have been accepted.
This is honestly one of my fears. I am a pretty passive person although i am much better than I used to be. I realize that i need to grow a back bone and stick up for myself. I absolutely expect to deal with difficult patients, but i really dont understand why so many nurses and nursing students are so catty to each other. I get that things are competetive, but so often i hear about behavior that reminds me of being in junior high again. There are alot of people that i have worked with that i dont care for, but you still have to behave like adults. We dont have to be best friends, we dont have to hang out. Hell i am sure when i get home ill bug my husband complaining about you for two hours. Call me old fashioned, I just try and treat people the way I would want to be treated, it just sucks that not everyone will treat you that way back. Oh well i guess thats life, and if i want to cut it, I have to learn to let things roll off my back.
Sure to be a much discussed post. Quite the story about the preceptor who said "congratulations on your first initiation." I just thought I would add, for what it's worth, there are difficult and rude people wherever you go. While it wasn't perhaps smart or even nice of the nurse to do that to a new hire- it was also rude and unprofessional of the physician. Perhaps time needs to be spent on discussions for new nurses or even those long in the profession about how it is ok to stand up for yourself -professionally and with dignity. In other words-it's not just the "bully's fault." Everyone has choices and not allowing yourself to be the victim can also be a choice. There are tools as well that can help with that such as conversation classes etc. where conflict management and difficult conversations are role played.
Specializes in Med/Surge, Psych, LTC, Home Health.
10 hours ago, OldDude said:
You struck a cord with me with this and I'm sure it will "trigger" (our new term we just learned) some females out there...but my Sweet Petunia grew up in a house full of girls. She married up with me and became the mother of 4 boys followed by our adoption of a daughter. She will tell anyone willing to listen the effort associated with parenting a girl collectively outweighs the effort associated with parenting 4 boys.
I entered nursing school as an OldDude and I saw a lot of the stuff itemized above; Fortunately, I recognized a lot of it and didn't go there...it's certainly alive and well, and as you reference, I think it permeates through human nature.
I dunno, I think it depends on the kid. My son causes me way more worry and grief than my daughter does. It's not really his fault, the poor kid was born with ADHD and then when he was 8, we found out he had a seizure disorder. Plus, all in all, the kid is way more emotionally complex and sensitive than my daughter.
My girl has mostly been the easy child whom I haven't had to worry much about.
Specializes in Clinical Leadership, Staff Development, Education.
9 hours ago, mtmkjr said:
No absolutely I believe you are correct - the definition does not change.
The two lists are specific examples of behavior. One list is what you might see among adult students and nurses, the other is what you would more likely see among children (and adults acting like children ?)
My main point is probably the same as yours... Not to take any rude/mean behavior and calling it bullying.
You said some of the behaviors in the article would not count as bullying. I would just say any of those could count as long as they were in a bigger picture and not taken in isolation.
I agree. I am certainly guilty of "isolated" incidents of rude behavior. I think it crosses over into bullying when it is a pattern of behavior with the intent of shaming, embarrassing or humiliating. Great discussion by all.
Okay, I do have something productive to say, but that was my first reaction and yes it was in regards to the constant barrage of commentary on this topic.
I have some major issues with the ANAs tackling of the subject.
First, I completely disagree that "incivility and bullying" issues should be comingled with that of violence against nurses/HCWs. VIOLENCE. It is ridiculously irresponsible and I think it should be obvious why it is - this article provides examples. On the one hand you have people who bring weapons into care areas or who become violent in care areas even without weapons, and on the other hand you have Joe Blow who thinks Susie Q may have rolled her eyes.
I will be blunt: *THIS* apparent inability to discern and to discuss issues clearly and tackle them reasonably and factually and without constant exaggeration-to-the-point-of-disingenuousness is embarrassing.
It's such a trainwreck handling of the separate issues and a really funky way to focus on low-level employees and conflate only their behaviors with violence. I mean, this is so trainwreck that even in trying to explain it I feel "all over the place." Well, that's because it is. It's "all over the the place" in a very convenient way, though.
This is an utterly opportunistic theft of a serious issue in order to further an agenda.
What it boils down to is that, although nurses and HCWs may be subject to physical violence and threats in the course of duty, we are going to conflate that with eye-rolling behavior, and we're also leaving the employer out of it for the most part - - their job is to have more policies and make it look like people have a voice, and to tell people about their policies. They aren't even remotely implicated as having more to do with this than that. Sure, they're supposed to treat every episode of "violence" swiftly and the same regardless of who is involved, but since they don't see themselves as being involved, they're off scot-free while nurses read and do millions and gazillions of articles, papers, power points, posters and projects about huffing, sighing, eye-rolling, cliques, exclusion, pressuring, threatening, "failing to help," withholding information, and anything else that individual low-level employees can be blamed for.
My statements are not to be taken as an attempt to defend selfish, jealous, catty, mean, or otherwise impolite behavior. Just the same, nearly all HCWs are working in conditions that involve at least some compromise that could be considered serious or ethically troublesome. Is there any good reason on earth that we can't discuss that and people's reactions to it, and then also (separately) make strides to control and utterly not tolerate things like punching, kicking, scratching, pinching, spitting, shoving, slapping, and use of weapons (at times) - you know, guns, knives/blades of various kinds, home implements, against nurses/HCWs??
VIOLENCE.
Check Maslow.
???
Totally agree with you. I keep receiving emails from ANA re: "incivility, bullying and violence." The three can not be lumped together. Violence is not bullying or incivility. Incivility is rudeness which I'm sorry to say has been taken to a whole new level. People need to get over themselves. We now have a country of entitled spoiled people - we need to get outside ourselves and see situations thru the eyes of others:
Several of my pts are very poor, they have lived a very tough life either thru the choices of their parents or choices they have made. However, their entire outlook on life differs completely from me who was raised going to private schools, getting my own car at 16, always basically getting whatever I wanted. Of course, I'm going to view their swearing at me as "incivility". However, taken in the context of THEIR life in which they view healthcare as just another stressor in an already stressful world, it is just their reaction.
Violence, on the other hand, is physical, emotional, financial exploitation. Its healthcare staff being hit, spit on, bit, etc.. I can't equate someone swearing at me or even disagreeing with me as violence.
And "triggers".....well don't even get me started....
Specializes in Cardiology, School Nursing, General.
It honestly depends on the person. I'm a sensitive person by nature, I take things seriously and as such, I overthink especially with anxiety.
So if someone tells me something, it depends on my day, and depends on my mood. If I been having a really bad day, I'll take it personally. If I'm okay, I'll take it as a joke. Honestly it was worse as a kid, but lately I learned how to control my thoughts.
Normally I get along with others, but like someone said, not every needs to like me. I have my own friends and my family.
The main problem for me in an academic setting, is my ADHD. I don't know why, but my blurting gets worse. Which causes me to have a lot of people that don't like me for that reason. I try to control it, but it's a struggle.
I hope if I get into a nursing program I get these in check, but honestly I don't know how things will go.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
On 2/20/2019 at 9:14 AM, Emergent said:
This was a good, comprehensive list, thanks.
I personally don't think nursing school causes this. Instead, it is human nature. Call it original sin, if you like.
And, disagree if you like, I find many of these traits more common in the the female side of the human species. For me, a natural born tomboy who preferred the simplicity of playing with the boys, I found the complexity of female society daunting when I entered nursing. Over many years I learned to play the game better, and survived.
I agree that nursing school doesn't cause bullying; bullies cause bullying and there are just as many of them in the general population as there are in nursing school.
But I disagree that women are the problem. That's a misogynistic point of view. I usually respect what you have to say, but misogyny is ugly.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
On 2/20/2019 at 12:18 PM, JKL33 said:
Make it stop.
?
Okay, I do have something productive to say, but that was my first reaction and yes it was in regards to the constant barrage of commentary on this topic.
I have some major issues with the ANAs tackling of the subject.
First, I completely disagree that "incivility and bullying" issues should be comingled with that of violence against nurses/HCWs. VIOLENCE. It is ridiculously irresponsible and I think it should be obvious why it is - this article provides examples. On the one hand you have people who bring weapons into care areas or who become violent in care areas even without weapons, and on the other hand you have Joe Blow who thinks Susie Q may have rolled her eyes.
I will be blunt: *THIS* apparent inability to discern and to discuss issues clearly and tackle them reasonably and factually and without constant exaggeration-to-the-point-of-disingenuousness is embarrassing.
It's such a trainwreck handling of the separate issues and a really funky way to focus on low-level employees and conflate only their behaviors with violence. I mean, this is so trainwreck that even in trying to explain it I feel "all over the place." Well, that's because it is. It's "all over the the place" in a very convenient way, though.
This is an utterly opportunistic theft of a serious issue in order to further an agenda.
What it boils down to is that, although nurses and HCWs may be subject to physical violence and threats in the course of duty, we are going to conflate that with eye-rolling behavior, and we're also leaving the employer out of it for the most part - - their job is to have more policies and make it look like people have a voice, and to tell people about their policies. They aren't even remotely implicated as having more to do with this than that. Sure, they're supposed to treat every episode of "violence" swiftly and the same regardless of who is involved, but since they don't see themselves as being involved, they're off scot-free while nurses read and do millions and gazillions of articles, papers, power points, posters and projects about huffing, sighing, eye-rolling, cliques, exclusion, pressuring, threatening, "failing to help," withholding information, and anything else that individual low-level employees can be blamed for.
My statements are not to be taken as an attempt to defend selfish, jealous, catty, mean, or otherwise impolite behavior. Just the same, nearly all HCWs are working in conditions that involve at least some compromise that could be considered serious or ethically troublesome. Is there any good reason on earth that we can't discuss that and people's reactions to it, and then also (separately) make strides to control and utterly not tolerate things like punching, kicking, scratching, pinching, spitting, shoving, slapping, and use of weapons (at times) - you know, guns, knives/blades of various kinds, home implements, against nurses/HCWs??
VIOLENCE.
Check Maslow.
???
It is absolutely ludicrous to lump incivility, bullying and VIOLENCE together. Violence is violence. The patient who shot his physician, the physician who punched the nurse, the nurse who kicked in the screen of the Pyxis and the RT who perched on the highway outside of work, aiming his handgun and random drivers leaving work -- THAT was violence. It's in a whole different ballpark from bullying, and THAT is in a whole different ballpark from incivility.
I agree that nursing school doesn't cause bullying; bullies cause bullying and there are just as many of them in the general population as there are in nursing school.
But I disagree that women are the problem. That's a misogynistic point of view. I usually respect what you have to say, but misogyny is ugly.
I respect you as well, but stand by my statement, based on my experience. I don't agree that pointing out general differences between females and males is misogynistic.
For what it's worth, men are responsible for most homicides and rapes and seem more prone to overt violence, serial killings, mass murders, etc..
A lot of what is called bullying is probably just really bad incivility, although it is a fine line. If the motive is to belittle and humiliate, then I call it bullying.
I was a victim of it in my RN career on more than one occasion, but never as an NP.
In my opinion, that's one of the many perks of the career. It's not just about a larger salary!
LovingLife123
1,592 Posts
I disagree with some of this. Eye rolling is not bullying. Excluding a person from a clique, not bullying. Not everyone has to like you. As the person being excluded does not have to like everyone.
I have friends that I like to be around. We hang out in a group. There are other people I really can’t stand to be around. Maybe they are negative, maybe our personalities don’t mesh. It does not make me a bully to not invite them into my group. Nor does it make the other groups bullies to me for not inviting me with them.
Lots of my coworkers hang out after work. I’m usually not invited. A, I don’t want to go. I have a family to get home to. B, I have absolutely nothing in common with them outside of work. C, it’s not my idea of a good time to go out and drink after work in my scrubs. I want to shower, put on my pjs and see my husband. It’s not bullying to not invite me.
The term bullying has gotten way over used and is losing its meaning and significance.
We are allowed to disagree and not like everyone. Everything does not have to include every single person. This piggybacks on the other thread that people these days can not cope with life. They cannot cope with the fact that not everyone is meant to be your BFF. But you can still be civil to everyone with expecting lifelong friendships.