By Debra Wood, RN, contributor
April 12, 2012 - A cocked eyebrow, a raised voice, false accusations, humiliation, sabotage--in other words bullying--may become so much a part of the workplace culture that nurses simply accept it as the norm, but that’s dangerous.
“Bullying is a barrier to achieving excellence,” said Terri Gaffney, MPA, RN, senior director for new product development at the American Nurses Association (ANA), which has released the second edition of Bullying in the Workplace: Reversing a Culture, calling attention to the problem, with suggestions for leaders and staff nurses to address it. “We hope people start having a dialogue and cultures will change.”
Disruptive behavior can result in physical and psychological consequences for the victim, such as a reduced sense of self-worth; decreased nurse retention; and a more dangerous environment for patients.
“Bullying incidents have an immediate effect on communication within the team, and it has lasting consequences,” Gaffney said.
Rebecca M. Patton, MSN, RN, CNOR, FAAN, considers stopping bullying important for improving patient safety.
Rebecca M. Patton, MSN, RN, CNOR, FAAN, the Lucy Jo Atkinson Scholar in perioperative nursing at Case Western Reserve University in Cleveland, Ohio, explained that bullying can adversely affect staff dynamics.
“Studies have talked about how the culture of a work environment directly has an effect on patient outcomes and keeping the patient safe,” said Patton, a past president of ANA.
The Joint Commission issued a Sentinel Alert about disruptive behavior, which includes bullying, in 2008 and has created a leadership standard about issues that affect patient safety. It recommends facilities maintain and follow a code of conduct, defining appropriate and inappropriate behaviors, a mechanism for reporting an incident and a policy that outlines the procedures to address breaches in the code.
“That’s key: the organization has to be behind it 100 percent,” said ANA booklet author Joy Longo, DSN, MS, RN, an assistant professor at the Christine E. Lynn College of Nursing at Florida Atlantic University in Boca Raton, Fla.
The nurse bullying problem
For more than 75 years, nurses have dealt with horizontal bullying and the “eat-their-young” model of initiation into the profession.
“Bullying in health care becomes the social norm,” said Peggy Berry, RN, MSN, a Ph.D. candidate at the University of Cincinnati College of Nursing who is investigating the issue. “We pass it on by older nurses demonstrating it to newer nurses who go on to demonstrate it to the next nurses in line.”
Engrained in the culture, nurses may not recognize bullying behaviors as something adverse, Longo said.
“We’re trying to get the message out that this is not OK and not behavior you have to accept,” Longo said.
Research suggests between 18 percent and 30 percent of nurses feel bullied, according to different samples cited in the ANA publication.
However, Berry’s study, reported in 2012, found that 57.9 percent of novice nurses reported being the target of bullying behavior in the prior month. Additionally, 14.7 percent described witnessing behaviors that fell into the bullying category.
“We’ve been doing this together for a long time,” Berry said. “But we should not haze our new people.”
To help prepare novice nurses for this environment, Case Western Reserve undergraduates learn about bullying and steps to take to put a stop to it--both as students and as new graduates.
Strategies for employers
Changing the culture will take effort.
“This is a very complex problem and that are no easy solutions,” Gaffney said.
Organizations need to support staff and be clear about policies addressing what behaviors will be tolerated, identify causes and consequences, and deal with instances of bullying as they occur. If administration does not address an incident, nurses will hesitate to report again, Longo said.
“There should be zero tolerance,” said Patton, adding that many organizations deal with it well while others do not.
Patton said nurses need training to recognize bullying behaviors, which can range from mild incidents to nurses feeling unsafe at work, and the effect it has on patients and team members. Bullying may occur when people feel stressed, but acting out only will exacerbate a poor work climate.
“It’s not just the individual impacted by it, but it’s those that see it happen and are drawn into being worried for themselves and if they will be next,” Patton said.
Berry agreed that stressful situations may garble communication, and those that witness bullying may become fearful. She added that bullied nurses, typically, have had four options when dealing with a frequent bully: reporting, ignoring, seeking outside counseling or leaving the job, and frequently nurses opt for quitting the job rather than trying to deal with it.
Strategies for nurses
Education must include how to manage and de-escalate situations, Gaffney said. She suggested nurses learn how to manage conflict effectively to improve patient and team outcomes.
“Nurses should confront the behavior, but that is very difficult to do,” Gaffney said.
Patton recommended the bullied nurse talk with the bully directly, if able, using “I” words. At other times, the nurse may need to talk with a supervisor, a well-respected senior nurse or the clinical nurse specialist on the unit.
The nurse subject to frequent bullying can practice ahead of time what to say to the person the next time it happens, Berry said.
“You can tell the person, ‘You are bullying me,’ and push back respectfully,” Berry said. “In some instances, the nurse doing the bullying wasn’t aware it was having that effect on the novice nurse.”
Berry cautioned nurses not to try to retaliate, which will only make the situation worse.
The ANA booklet includes additional suggestions for how victims and witnesses can respond, including role modeling appropriate behaviors, which Gaffney called the first step in changing the behavior.
“Employers and leaders set the stage for this,” Berry added. “Leaders need to issue corporate statements against this type of behavior.”
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