This topic has received a lot of attention over the years. People seem to love it or hate it. Adding compassion to the mix may take it into a new direction.
Now that I am off orientation, I constantly fear getting fired. I swear I hear monitors in my sleep. One time in the last few months, a manager said "good job", it helped. I'm at the mercy of whoever is charge nurse that shift. I never realized it would be this hard to find a mentor. -First-year nurse
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
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
From my experience from reading and writing many papers in graduate school, the problem being studied, as in original research, or being reviewed, as in a literature review, has to be defined very specifically. How it is measured must also be stated, what tools (survey tools) are used; are they valid and reliable? The OP, I am sure, has a faculty member to guide her. Qualitative research involves interviews, among other things, and she has chosen to post here. I have read with great interest many comments here about bullying, lateral violence and horizontal violence, among all the terms used. I have also read about it in the literature. I believe it is alive and well in nursing, although I don't want to debate if it truly is a real problem or if it is more or less prevalent in other professions. I do not think everyone experiences lateral violence, but enough do to be alarming and warrant research, IMHO. To question whether patient care is affected is another important variable.
Her findings will have limitations, as all research does, but I applaud someone who is investigating the problem.
In regards to nurses being afraid to call a doctor at 3am because they aren't okay with confrontation - that issue is on the nurse that they can't handle that confrontation when they may need it for their job.
It depends. I sat next to a nurse who called a physician at my first job. I could clearly hear what he was saying on the phone, because he was screaming. He called her a stupid *insert four letter word that begins with C* and ranted about how he was going to get her fired for at least three minutes. He then hung up and called the house supervisor to complain about her. He then hung up and called our nurse manager at home in the middle of the night to complain about her.
And he didn't even give her any orders. For the record, the man was a new admit trauma patient (car accident) who'd had a 3g drop in his hemoglobin, and it was the attending, a surgeon, she was trying to call.
Being afraid to call a physician can be because of bullying. It's usually not, but sometimes it is. For the record, that was an extraordinarily common thing to happen at that work environment. I had a chart thrown at me once - different physician, but about five of them were known to get physical when they got mad. I would call throwing a chart at someone assault, actually, which goes beyond bullying in my book. The problem was, physicians were basically right up there with God in importance according to administration, so there were never any consequences for them. It was not a pleasant place to work.
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
It depends. I sat next to a nurse who called a physician at my first job. I could clearly hear what he was saying on the phone, because he was screaming. He called her a stupid *insert four letter word that begins with C* and ranted about how he was going to get her fired for at least three minutes. He then hung up and called the house supervisor to complain about her. He then hung up and called our nurse manager at home in the middle of the night to complain about her.
And he didn't even give her any orders. For the record, the man was a new admit trauma patient (car accident) who'd had a 3g drop in his hemoglobin, and it was the attending, a surgeon, she was trying to call.
Being afraid to call a physician can be because of bullying. It's usually not, but sometimes it is. For the record, that was an extraordinarily common thing to happen at that work environment. I had a chart thrown at me once - different physician, but about five of them were known to get physical when they got mad. I would call throwing a chart at someone assault, actually, which goes beyond bullying in my book. The problem was, physicians were basically right up there with God in importance according to administration, so there were never any consequences for them. It was not a pleasant place to work.
Ahhh...a whole other issue. I have also had a chart thrown at me and hung up on, the former being worse. It has not been that long ago that the JC included the behavior you describe above and other MD behaviors as a "hostile environment". I thought that was a victory. There was one physician I knew of whose behavior was so ugly many of the staff, including ICU RNs, were afraid to call him. He lost his privileges for a while, but they were reinstated sometime later. The first and only time I wrote anyone up in my career was for the MD who threw the chart at me. Turns out he had some major problems and left that hospital and was required by the Medical Board to get more training.
Since it is felt that a hostile work environment is felt to affect patient care, (duh!), there has been some progress. I think we've all felt at one time or another that MDs are treated like gods. As I got older I was tempted to say to some of the obnoxious young docs, "I'm sure your mother didn't raise you that way." I've digressed since the the topic was nursing. My apologies.
Specializes in Pediatrics, Women's Health, Education.
From my experience from reading and writing many papers in graduate school, the problem being studied, as in original research, or being reviewed, as in a literature review, has to be defined very specifically. How it is measured must also be stated, what tools (survey tools) are used; are they valid and reliable? The OP, I am sure, has a faculty member to guide her. Qualitative research involves interviews, among other things, and she has chosen to post here.
Her findings will have limitations, as all research does, but I applaud someone who is investigating the problem.
Thank you for your comments! Yes my protocol and methods have been vetted by my committee members, the dean of research, the IRB, and the allnurses.com editors. The survey instruments have been deemed valid and reliable by prior researchers. This information will be available when the whole dissertation is published, but it is not somethingI can post prior to that. People accessing the survey are given an overview of the types of questions they'll be asked and the time commitment required to respond.
I know people are concerned about perpetuating NETY but it's like that. The stories being collected discuss aggressive behaviors from doctors, admin., nurses, and UAPs. And it's not just young complaining about seasoned. An array of age groups and years experience are represented in the sample so far.
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
Thank you for your comments! Yes my protocol and methods have bthis si for your doctoral dissertaioneen vetted by my committee members, the dean of research, the IRB, and the allnurses.com editors. The survey instruments have been deemed valid and reliable by prior researchers. This information will be available when the whole dissertation is published, but it is not somethingI can post prior to that. People accessing the survey are given an overview of the types of questions they'll be asked and the time commitment required to respond.
I know people are concerned about perpetuating NETY but it's like that. The stories being collected discuss aggressive behaviors from doctors, admin., nurses, and UAPs. And it's not just young complaining about seasoned. An array of age groups and years experience are represented in the sample so far.
Thank you for verifying about your protocols and methods for all to read here. I am assuming this is for your doctorate. I understand that what you post now is limited. I wish you luck on finishing your dissertation.
I have no doubts about the existence of horizontal violence, as I have witnessed it first hand in my career, although rarely was it directed toward me. In my experience it has gotten worse, and my theory, and only my theory, is that as the "nursing shortage" has eased, nurses did not have to be as welcoming to both new grads and new experienced nurses. So why does that happen? I also feel it happens more often in an environment with weak nursing leadership. Again, just my opinion. I hope your findings can help with this disturbing problem.
Specializes in Pediatrics, Women's Health, Education.
Boomer, thank you again! I'm sure there are several underlying causes for it, some of which you mention.
My point is that it shouldn't be tolerated. It's interesting that some people think the quieter, non-confrontational type needs to toughen up, and the "inherently mean" person (as described by a previous poster) is to be accepted for who they are. Why not just expect a certain level of respect and professionalism from everybody, regardless of their nature...
Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
Boomer, thank you again! I'm sure there are several underlying causes for it, some of which you mention.
My point is that it shouldn't be tolerated. It's interesting that some people think the quieter, non-confrontational type needs to toughen up, and the "inherently mean" person (as described by a previous poster) is to be accepted for who they are. Why not just expect a certain level of respect and professionalism from everybody, regardless of their nature...
Even with that being said, I don't believe those instances necessarily count as bullying when you compare it to other non-nursing examples of bullying in the world that has lead to extremes such as suicide.
According to Mirriam-Webster, bully is defined as "to frighten, hurt, or threaten (a smaller or weaker person) : to act like a bully toward (someone) : to cause (someone) to do something by making threats or insults or by using force." Is gossiping and making unbalanced assignments right? Absolutely not, but that doesn't mean that it is bullying.
In regards to nurses being afraid to call a doctor at 3am because they aren't okay with confrontation - that issue is on the nurse that they can't handle that confrontation when they may need it for their job.
Finally, as Ruby Vee has mentioned, I agree that people who look for bullies are going to find them where they don't necessarily exist. I'm not disagreeing that there aren't true bullies who happen to be in the nursing field, I am just saying based on my experience, interactions, and readings on AN I don't believe it is as prevalent as people make it seem. Furthermore I truly believe that only certain people can be "bullied," you can guarantee that if I encountered someone who truly was a bully that they wouldn't be bullying me because my personality just doesn't allow for that.
Really? Gossiping and intimidation haven't led to suicide? You're username says it all. I would just stop. You clearly have no concept of this very serious issue. Sn issue near and dear to my heart bc I was torn down and somehow, SOMEHOW, managed to build myself back up, have a semblance of self esteem and remain in the field. That doesn't make me weak. That doesn't make me whiny. That makes me strong.
Specializes in Pediatrics, Women's Health, Education.
Thanks for sharing your experience, Orion! I'm of the mindset that a healthy work environment is better for the nurses and better for the patients, and it's been shown to be better for the bottom line. So shouldn't it be expected that people refrain from rude (or worse) behaviors?
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
Really? Gossiping and intimidation haven't led to suicide? You're username says it all. I would just stop. You clearly have no concept of this very serious issue. Sn issue near and dear to my heart bc I was torn down and somehow, SOMEHOW, managed to build myself back up, have a semblance of self esteem and remain in the field. That doesn't make me weak. That doesn't make me whiny. That makes me strong.
I actually have, what I feel, is a very good concept of bullying in general as I lost a sibling years ago to suicide that was brought on by very legitimate bullying. So maybe you shouldn't jump to conclusions about others. That is why I get irritated when hearing people complain about "bullying" and NETY by giving examples of other nurses not including them in their social outings, as an example. I've never denied that bullying exists.
And Lol my username is just a username . One could interpret your response as bullying...
P.S. congratulations to you for rising above that.
According to Mirriam-Webster, bully is defined as "to frighten, hurt, or threaten (a smaller or weaker person) : to act like a bully toward (someone) : to cause (someone) to do something by making threats or insults or by using force." Is gossiping and making unbalanced assignments right? Absolutely not, but that doesn't mean that it is bullying.
In regards to nurses being afraid to call a doctor at 3am because they aren't okay with confrontation - that issue is on the nurse that they can't handle that confrontation when they may need it for their job.
There different definitions of bullying in the literature as to what constitutes it. I'm actually looking at the continuum of mistreatment from incivility to bullying. I use the term here because it is recognizable by more people than workplace mistreatment.
I disagree with you about the comment on the nurse uncomfortable with confrontation. I think the job is stressful enough without dealing with inappropriate behavior, it's about maintaining a healthy work environment. You may be right that certain people are easier to bully, I don't see how that makes it okay.
I agree with you that no one has to put up with inappropriate behavior. A one time or out-of-character occurence is one thing, but continuous misbehavior is another. I know some doctors that nurses are so intimidated by because their behavior is awful, and therefore, those nurses are afraid to ask for orders that are indicated. They are often denied requests or the doctor will order something different, just for spite. We can say "be strong" and "be the patient's advocate" but in many cases, if someone is going to be sanctioned it's the nurse.
Bullying is readily recognizable and while no one wants to be called a bully, bullies know who they are. This is different from someone reporting they were 'yelled at." We've all heard this when someone was rebuked, even in a whispered tone. Bullying is distressing to the recipient and observable by observers.
Those of us who have stronger personalities should stand up for those who are vulnerable for bullying, report misbehavior to administration (there are forms available), and make sure that our own behavior does not rise to that level.
Bullying happens in nursing. Nurses are dealing with life and death. The stress can build and not all people know how to handle it so they bully and intimidate others. We are put in a position to deal with unreasonable expectations, and tend to hear the negatives or what we must do better with. There is no such thing as a fairy-tale land of nursing where it doesn't happen. If people say it doesn't happen, they are in denial. I have yet to work anywhere and not see it. Some places have it worst than others.
For the record, the man was a new admit trauma patient (car accident) who'd had a 3g drop in his hemoglobin, and it was the attending, a surgeon, she was trying to call.
. One could interpret your response as bullying...
Boomer MS, RN
511 Posts
From my experience from reading and writing many papers in graduate school, the problem being studied, as in original research, or being reviewed, as in a literature review, has to be defined very specifically. How it is measured must also be stated, what tools (survey tools) are used; are they valid and reliable? The OP, I am sure, has a faculty member to guide her. Qualitative research involves interviews, among other things, and she has chosen to post here. I have read with great interest many comments here about bullying, lateral violence and horizontal violence, among all the terms used. I have also read about it in the literature. I believe it is alive and well in nursing, although I don't want to debate if it truly is a real problem or if it is more or less prevalent in other professions. I do not think everyone experiences lateral violence, but enough do to be alarming and warrant research, IMHO. To question whether patient care is affected is another important variable.
Her findings will have limitations, as all research does, but I applaud someone who is investigating the problem.