Spotlight: Nursing & Bullying

bullying in nursing

photo credit: istockphoto.com

We’ve had several requests to write a story on bullying in nursing. It’s a hot topic these days – workplace bullying, in general, seems to be escalating. Partly, our awareness has increased, so we’re more aware of bullying behaviors that may previously have been accepted, if not acceptable. As our awareness has increased, so has our knowledge of the complexity and subtlety of the many ways that bullying manifests. And, with the rapid evolution of technology, if you don’t know how to control your bullying instincts face-to-face, well, let’s just say, “there’s an app for that.”

What is workplace bullying? The Workplace Bullying Institute uses the following description:

Workplace bullying is the repeated, health-harming mistreatment of one or more persons (targets) by one or more perpetrators. It is abusive conduct that is:

  • Threatening, humiliating, or intimidating, or
  • Work interference — sabotage — which prevents work from getting done, or
  • Verbal abuse

Nursing is a female-dominated profession, and, for better or worse, bullying in nursing is predominantly through typical female patterns of aggression – verbal and relationship bullying, rather than physical bullying. Don’t think male nurses are exempt, however. A Norwegian study from 1999 found male nurses were more likely to be bullied than females (perhaps being the minority in that profession puts them at higher risk)

Here are some examples of what bullying in nursing looks like in action:

  • Yelling
  • Condescending language or tone; Bossy, arrogant
  • Negative body language – eye-rolling, etc
  • Impatient with questions
  • Ignoring questions or request for help; The silent treatment
  • Public belittling and embarrassment (about quality of work or other professional or personal items)
  • Gossip, rumors
  • Work-related interference: removing responsibilities, assigning too-heavy workloads, assigning low-skilled work; withholding information needed for successful completion of job; blocking promotion paths
  • Taking credit for another’s work
  • Exclusion from social events, in and out of work

Bullying can come from all directions – from someone at (approximately) the same level or perceived power, from above, or from below. It’s often called horizontal or vertical bullying (although that over-simplifies a bit). In nursing, horizontal and vertical bullying can take the form of:

  • Nurses of the same level bullying one another
  • More senior nurses bullying nursing students or newly assigned nurses
  • Nurses bullied by physicians
  • Nurses bullied by nursing or administrative supervisors
  • Nurses bully patients or their families
  • Nurses are bullied by patients or patients’ families

Sounds pretty bleak? It’s not all bad, and many of the nurses we know have had wonderful, supportive experiences in nursing school and in their various placements. However, nursing has a bad reputation for bullying, especially nurse-to-nurse.

We know that being a bullied target in a nurse’s uniform has all the same problems as anyone experiencing workplace bullying (or school bullying, for that matter).

  • Health Problems. Depression, anxiety, anger, PTSD, decreased energy, sleep disturbances, appetite changes, to name a few. Family relationships suffer.
  • Work Performance Problems. Lack of initiative, lowered creativity, increased absenteeism, lack of energy, “infectious” bad morale, heavy use of Employee Assistance Programs.
  • Serious Problems Ahead. Bullying, or any type of prolonged excess stress, can also result in very bad “self-calming” behaviors – excess drinking and drug use, for example. These behaviors are bad in anyone, but especially risky in health care professionals.
  • Employers Lose Too. It’s expensive and dangerous for employers (hospitals and other health care organizations) to be routinely short-staffed and constantly needing to scout, hire, and train the revolving door of employees who leave when bullying becomes too bad. The everyday loss to productivity for those dispirited employees remaining on the job, has been estimated as high as 40%. It’s well-known that the brains of employees (or students) in bullying environments are diverted from full attention to their work (or school work). A significant background portion of your brain remains on alert in these unpredictable environments, protecting you, always ready for fight or flight.

Bullying can compromise on-the-job performance in life-threatening ways. Here’s a worrisome finding. A 2004 survey by the Institute for Safe Medication Practices found that workplace bullying in health care posed a critical problem for patient safety: Rather than bring their questions about medications orders to a difficult doctor, almost half of the health care personnel surveyed said they would rather keep silent. Equally concerning, 7 % of the respondents said they had been involved in a medication error in the past year in which intimidation was at least partly responsible. It’s hard enough to be a patient without having to worry that some of the safety mechanisms around you may be disabled.

Nursing – and health care, in general – is a stressful occupation. Literal life-and-death decisions are routinely made. Health care providers, especially those who work in hospitals, including the subset of surgeons, surgical nurses and technicians, ER personnel, ICU, CC, NICU, and first responders, etc, have above average stress coping skills and the ability to function well in a routinely high-pressure, high speed environment. Clearly, they don’t faint the sight of blood, but there is a limit for even the most stress-hardy individuals.

Do we really want people who make key, life-influencing decisions to be (1) extra stressed from working in bully-filled environments or (2) afraid to speak up, ask questions or clarify, even when they know the need to be clear and select the right treatment is important, perhaps crucial, to a patient’s well-being?

Sleepless nights, rotating shift work, long shifts, filling in during times of short-staffing, etc all add structural stress to the content stress of the job. Employers need to be aware of the additional stress they may be contributing, either by ratcheting up the stress of the work schedule or by allowing bullying to continue once management becomes aware there’s a bullying issue brewing.

Stress fuels bullying. In everyone’s life, stress undermines performance AND it makes you more likely to become a bully. When you‘re at the edge of your ability to handle your own stress, it’s very easy to slip across the line into being a bully yourself, without intending to or recognizing it. Stress handling is a key skill, for bully and target, especially in environments where high stress comes with the job. Meditation, exercise, healthy eating, and laughter do a lot to help improve the brain’s ability to handle stress.

Temporary Coping Strategies. While we’re trying to shift the culture, we need to have some protective policies in place. For example, some hospitals have a “code pink” for nurses in trouble or being bullied. That’s a coping strategy. The best strategy, however, is heading it off much earlier, before the problem needs a full-scale intervention.

Let’s continue the conversation. This article has focused on understanding the nature and cause of bullying in nursing. Next Step: What’s the cure?

For those of you who are (or have been) nurses or other health care providers, or those of you who have worked with nurses, here are some of the questions we want to hear about from you:

  • What type of bullying do you see most in nursing? Is it vertical (nurses to physicians or supervisors) or horizontal (nurses to other nurses)? Where does nurse-patient (or patient’s family) bullying fit in?

Note: It’s never exactly vertical or horizontal, but what’s key is the real or perceived power differentials. Use your own experience to describe the key issues and symptoms

  • What do you think is causing bullying in nursing?
  • Can you make a few suggestions for how to prevent it?
  • Make some suggestions for how to manage the problem while we’re trying to shift the culture? For example, “code pink,” mentioned earlier, is a coping strategy.

Send us your thoughts and watch for our next article on bullying in nursing, which will focus on prevention and repair strategies.

Learn More:

L Blumen, Bullying Epidemic: Not Just Child’s Play, Camberley Press, 2011

Cheryl Dellasega, Bullying Among Nurses, American J Nursing, Vol 109, No 1, p 52-58, Jan 2009

Institute for Safe Medication Practices, Survey Shows Workplace Intimidation Adversely Affects Patient Safety, Mar 31, 2004

Workplace Bullying Institute

Permanent link to this article: http://bullyingepidemic.com/spotlight-nursing-bullying/

7 comments

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    • Leslie Mashmann on November 6, 2015 at 11:37 pm
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    There is a quote that something like “If you love the work you do, you will never work a day in you life”. That was me. I have loved my job for almost 35 years In the past I saw bullying, but in the past two years it has increased to become a bit excessive. I will not say what hospitals I worked in, nor what union I belonged too. I would, however like to talk a little bit about what nursing meant to me. Back when I began we took care of patients. Our eyes were always open and re assessment was frequent.. We did not have angiography, cats scans.MRI, clot busters – when someone was very ill, we would know by their physical symptoms, not by film and pieces of paper. Touching, listening and communication, both with fellow staff, doctors, and especially the patient. Our patients easily died of trauma, heart attacks, dissecting aneurysm – all of those awful things, the patient would die, because there was nothing we could do. Holding them, making them comfortable and keeping the family in the plan of care was so important. Now we have everything {just about} to save the lives of the people who we once watched die. We can save many lives now. Which is great. But the patient as an individual is gone. We are now all the computer. We can’t start testing until they are in the computer. Doctor’s don’t talk about their cases “it’s in the computer”. Speed is of the utmost – from the moment the patient is put in the computer, the clock starts ticking. If someone is sent in for a specific test and rule out – well the specific ruled our, no one cares what else the problem could be. With the rushing around infection control is at the wayside. I’ve seen many problems this year, but the worst was when a lady was bleeding out in the Or, the Er doctor laughed “we didn’t even see her for 2 1/2 hours” Not funny – you can help her now. When I kept trying to work patient’s first, I became a pariah for some. For the charge nurse, I could do nothing right. I would hear that I had said and done things, that I had not done. I was sent home and the charge nurse told my husban.d that I was suicidal. This went around like wild fire. I was scared. I was afraid to go to work, afraid not to I would ask what I was doing wrong and was told “nothing”. The criticism was frequent, and I did cry at times. I made my own appointment with EAP. Got loads of sympathy but no solution. My confidence as in the pits of hell. I could get no help from managemen. No help from my union. In fact I was ignored by the union. Finally came the night when I broke into a million pieces. I had to quit. That night, I called one of the staff that I loved. I told her I would miss the patients and staff. I didn’t know what I was going to do with myself – I had been doing this for thirty six years. I was to call her back at home. She told the charge nurse. It was after midnight and I was sitting in the living room with my family. Knock, knock – there were four police officers at my door. The hospital had called them and told them I was suicide. I spent 23 hours in a hospital only to be told that I was not suicidal. The hell I went through, the cruel bulling. my complete loss of confidence – I will never be able to work again. The reason for all of the suicide stuff – my mother had committed suicide when I was young. There was no help for me, and yes I miss the patients very much. Leslie Mashmann

    • Leslie Mashmann on November 6, 2015 at 11:46 pm
    • Reply

    Please remember that the most important job you do is to care for patients. Group meetings to discus cases could bring us back to the team concept. Patient’s do not like it when your chattering around the desk with pictures in the phone with constant phone conversations. Resourse staff should be in place to assist specific bullying problems. Is it school that certain nurses learn to one up every other nurse, that high acheivers are a problem to the. Open door policies to address problems as soon as they start. A voluntary committ of nurses to find the root of this. And to remember, we are all taking care of the same patients. “not my patient is a line that should never be said. “not my patient but how can I help you” is much better. Leslie Mashmann

    • Leslie Mashmann on November 6, 2015 at 11:47 pm
    • Reply

    I did.

    • Juan on July 10, 2016 at 5:54 pm
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    I have also work in health care 13 years as a male nurse and I would always see other nurses being bullied or harassed but I never thought it would be my turn to go thru it . A certain doctor would always be name callin me she didn’t care who was around so I reported her to my supervisor and tha was a bad choice I took . Anyways she threat in me to keep mouth shut i refuse when the to HR another bad choice things got worse now more doctors would intimidate me humiliated me and all this were female doctors in different occasions they would leave tampons or Kotex on my chair or desk . I mean it was crazy then they stared blamin me for wrong shoots given when I was off them days they were desperate to fire me then they accuse me of trying to kill one of them that’s when I dicided to take time off but the union did not help me or HR even when I had witnesses proofs so I come back a year later only to be suspended on my 3 rd day back for what they did not want to tell me but I love my job and patients but with out help I think I will not be doing this anymore. some people could be real evil and they supposably take care of patients because it’s in there. Blood yeah right all doctors are Hippocrates.

    • Juan on July 18, 2016 at 3:37 pm
    • Reply

    I just hope that more people stand up for there rights. So they can see that we also deserve respect like they want respect its sad that people are treated like a file being categorized as if we don’t have felines we all want to be respected but the people who choose to disrespect there peers soon things will change in there be half

    • Juan on July 18, 2016 at 4:49 pm
    • Reply

    Peace

    • A patient on August 18, 2016 at 2:20 pm
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    I’m a patient who has been bullied by nurses. I have met too many who take pride with a very militant attitude of “don’t mess with nurses or else”. It’s scary how they blanket every complaints from patients towards unethical nursing as just patients being difficult and that said nurses try and create a martyr narrative for themselves in defense. Also just as scary how they feel the need to derail the conversation of nurses bullying non-nurses by constantly brining up how they are the victim of doctors and patients as if that conversation isn’t already being had everywhere else. There need to be a safe and nonjudgmental space for patients and non-nurses to speak about the harsh victimization they have gone through through the hands of nurses without nurses making it about themselves.

    I advocate for myself as a patient that nurses take a good look at themselves and have an honest conversation about the perpetuation and enabling of bullying towards patients and non-nurses deeply rooted in the nursing discipline. I demand that instead of pointing fingers and dismissing the conversation with platitudes such as “no profession should bully another”, take an honest look at your discipline and have conversation of the problem that is UNIQUE of the nursing discipline. It is time that patients are heard BY patients and not dictated by those who harm them.

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