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Bullying on the unit

Lockhart, Lisa MHA, MSN, RN, NE-BC; Davis, Charlotte BSN, RN, CCRN

doi: 10.1097/01.NME.0000521809.84893.ae
Online exclusive

Develop healthy work environments to combat bullying; improve communication; increase retention; and promote safe, patient-centered care.

Lisa Lockhart is the Emergency Services Director at KentuckyOne Health, Saint Joseph Health System, in Lexington, Ky., and a Nursing made Incredibly Easy! Editorial Board Member. Charlotte Davis is a Surgical-Trauma ICU Nurse Educator at Ocala Regional Medical Center in Ocala, Fla., a Clinical Adjunct Faculty Member at Clayton State University in Morrow, Ga., and the Clinical Editor of Nursing made Incredibly Easy!

The authors have disclosed no financial relationships related to this article.

Bullying is defined as the usage of direct or indirect influence to intimidate, harass, oppress, or embarrass another. It's prevalent in our society, whether in person or over social media, and the clinical nursing setting is no exception.

The question is why is bullying so widespread in nursing? Girl Wars and Mean Girls Grown Up author Cheryl Dellasega states, “Nurses are really vicious to each other. It's not one hospital. It's not one type of nurse. It's the new nurse, it's the nurse who transferred from another floor, it's the ICU nurses feeling superior to the med-surg nurses—it's endless.”

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What's bullying...really?

Bullying is any unwanted hostile behavior, such as verbal comments, actions, or gestures, that affects an employee's dignity, professional reputation, or psychological or physical well-being. Bullying in the workplace takes many forms: eye rolling, shunning new employees, refusing to assist, unfair assignments and/or scheduling, aggression, poor evaluations, sabotage, gossip, and more. Seasoned nurses sometimes refer to this as “eating our young,” but it isn't just new nurses who are affected. According to the website www.stopbullyingnurses.com, 90% of nursing students reported being bullied by their instructors; 73% of new nurses felt that they had been bullied within the last month and 58% felt that they were a direct target of a bully or bullies. However, 44% of experienced nurses also felt that they were bullied by a peer within the last year.

In 2012, the American Nurses Association (ANA) published the book Bullying in the Workplace: Reversing a Culture. In 2015, it released the position statement Incivility, Bullying, and Workplace Violence, and developed a 25-member panel to work on prevention, causes, and effects of workplace bullying. According to the ANA, 21% of surveyed nurses reported that they were at a “significant level of risk” for violence at work. Almost half of the nurses reported experiencing various instances of bullying in their workplace, with 50% indicating that they had experienced verbal or nonverbal aggression from a peer and 42% experiencing bullying by a person in a higher level of authority. And bullies aren't just colleagues; the same survey revealed that 43% of nurses had been verbally and/or physically threatened by a patient or a patient's family member.

The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence or bullying as “physically and/or psychologically damaging actions that occur in the workplace or while on duty.” NIOSH classifies workplace violence into four separate categories: criminal intent, customer versus client, coworker to coworker, and personal relationships.

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Why do nurses bully?

One author believes that the issue is relational aggression. This refers to the way in which individuals interact during conflict or tension. Nursing is also a high-stress work environment, with long hours and few opportunities to take a break from the setting and colleagues. This combination is a perfect storm for the creation of a bullying environment.

Studies have connected bullying and relational aggression with fear of and anxiety over social interactions in people of all ages. Nurses often perceive themselves as powerless over their environment, their work assignments, the stressors of healthcare, and organizational requirements.

Bullying may also be demographic in nature and vary depending on the work environment and environmental stress. One study found that although bullying can happen in any area, it occurred most often in medical-surgical care (23%), critical care (18%), emergency areas (12%), OR/postanesthesia care units (9%), and obstetric care (7%). This study also looked at who did the bullying and found that the perpetrators were senior nurses (24%), charge nurses (17%), nurse managers (14%), and physicians (8%).

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Do you know the signs?

There are many behaviors that we associate with bullying. The actions can be subtle or blatant, by peers, managers, physicians, or patients:

  • making direct or indirect unfavorable comments either openly or in small groups
  • eye rolling, back turning, or aggressive body posture
  • joking inappropriately at another person's expense
  • cursing/swearing or using inappropriate language
  • humiliating or embarrassing a person
  • shouting at or intimidating a person
  • openly demeaning another person's work, input, or comments
  • constantly criticizing
  • spreading rumors or gossiping
  • withholding needed information
  • denying promotions and/or vacations
  • impeding/undermining another person's work
  • excluding a person on social occasions, meal breaks, or work gatherings
  • invading a person's privacy
  • making unfair assignments.

The results of bullying are felt both personally and professionally. When left unchallenged, bullying can increase turnover, lower patient and staff satisfaction, and decrease work quality. Productivity within the clinical work area is also impacted. Bullying derails recruitment and retention, and may even lead to physical and/or psychological harm.

Nurses who are bullied will show signs if you watch. They may stop engaging in staff meetings or committees. You'll notice that they don't socialize on the unit and there may be increased absenteeism and tardiness, or the perception that they're depressed or not feeling well. You may become aware that they're looking for a new position or seeking a transfer. The victim of bullying may also turn his or her powerlessness into power by bullying someone else. When bullying is allowed to perpetuate, we all lose.

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How do we manage bullying?

The development of healthy work environments is our most powerful tool to combat bullying; improve communication; increase retention; and promote safe, patient-centered care.

Consider these factors to improve communication:

  • becoming aware of self-deception. This is the process of acknowledging a misconception. We must be able to see and acknowledge wrong within ourselves.
  • becoming reflective. This is the process of pondering or consideration. Thoughtfully and carefully examining the meaning of an experience, we must be able to create personal meaning from past or current events that guide future behavior. This also involves self-questioning so that situations become more clear and coherent.
  • becoming authentic. This is the process of self-discovery. We develop an understanding of our own purpose, practicing professional and personal values that are true to ourselves.
  • becoming mindful. This is the process of developing a heightened awareness of verbal and nonverbal communication. We develop present-centeredness, acknowledging and accepting thoughts and feelings as they are.
  • becoming candid. This is the process of purposefully speaking in an unbiased manner, taking the risk of speaking and hearing the truth.
  • becoming accountable. This is the process of taking ownership of the behaviors tolerated within the work environment. Team members must hold each other accountable and speak up to create the desired positive culture.

Communication must be open, respectful, and free of aggression and judgment. These strategies work because they empower every individual and place importance and value on what we feel, share, and observe.

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Culture change

Change the culture of your clinical work area to one that embraces and values the skills and assets of each team member. Model the behavior that you wish to see as you set the professional bar higher.

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REFERENCES

American Nurses Association. ANA panel aims to prevent violence, bullying in health care facilities. http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2015-NR/ANA-Panel-Aims-to-Prevent-Violence-Bullying-in-Health-Care-Facilities.html.
    American Nurses Association. Bullying in the workplace: reversing a culture. http://www.nursingworld.org/EspeciallyForYou/Staff-Nurses/Staff-Nurse-News/ANA-Bullying-in-the-Workplace-Publication.html.
      American Nurses Association. Incivility, bullying, and workplace violence. http://www.nursingworld.org/Bullying-Workplace-Violence.
        Dellasega C. Why nurses bully and what you can do about it. http://nursing.advanceweb.com/Features/Articles/Why-Nurses-Bully-What-You-Can-Do-About-It.aspx.
          Harris H, Smith CJ. Workplace bullying in nursing. http://nursing.advanceweb.com/Features/Articles/Workplace-Bullying-in-Nursing.aspx.
            Kupperschmidt B, Kientz E, Ward J, Reinholz B. A healthy work environment: it begins with you. http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No1Jan2010/A-Healthy-Work-Environment-and-You.html.
              National Institute for Occupational Safety and Health. https://http://www.cdc.gov/niosh/index.htm.
                Sherman RO. When the nurse leader is the bully. http://www.emergingrnleader.com/nurseleaderbullies.
                  Stokowski LA. A matter of respect and dignity: bullying in the nursing profession. http://www.medscape.com/viewarticle/729474.
                    Townsend T. Break the bullying cycle. http://www.americannursetoday.com/break-the-bullying-cycle.
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