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ADVANCE Perspective: Nurses

Confronting the Bullies

Published April 24, 2012 3:40 PM by Rich Krisher
Everybody's talking about it and too few are doing anything about it. "It" is bullying in the nursing workplace.

When we published an article on the subject in January, readers posted an avalanche of responses. Many related personal stories of unresolved bullying at work. One stated she is "ashamed to be part of this profession"; another said "I tell anyone I know: Be a teacher, not a nurse!"

Where does it come from? One theory is the stress experienced by nurses is in many ways unique. Inadequate staffing, lack of autonomy, overwhelming responsibilities and constant life-and-death decision-making in numerous settings can make some nurses feel backed into a corner, and they display displaced aggression. While there might be some truth there, it doesn't help the targets of abuse.

The American Nurses Association has added a new resource on the subject with the recent release of the 28-page book Bullying in the Workplace: Reversing a Culture. Although the price of the brief book raises some eyebrows ($19.95 for ANA members, $29.95 for nonmembers) it's significant the nation's most prominent professional nurses association is acknowledging the problem.

The ANA publication outlines zero-tolerance policies against bullying, which is a sensible step to combat such behavior. Bullying exists within organizations because it's allowed to exist. Most everyone can point them out; bullies are seldom subtle and often flaunt their power. If it's a nurse or nurses on a unit creating a hostile environment for co-workers, it's up to their manager to confront them. If the manager is the problem - and have I ever heard those stories - the manager's direct report is responsible for allowing it to continue. And so it goes up the line.

The buck has to stop somewhere, even in the c-suite. Perhaps workplace atmosphere should be a prominent part of Joint Commission or similar appraisals. If accreditation was on the line, it would be gratifying to see how fast the bad apples would be weeded out.

Have you been a target of horizontal violence at work? What is your idea to put a stop to it?

3 comments

JUST WRITING THIS ASKING FOR HELP.  I AM THE TARGET OF ONE OF OUR PROVIDERS WHO IS AN NP.  I REALIZE I CANNOT CHANGE HER.  SHE IS A TOXIC PERSON AND BRINGS DOWN THE MORALE OF THE NURSING STAFF AND CLINIC AND PATIENTS. IF ANYONE HAS ANY SUGGESTIONS, ADVICE I WOULD APPRECIATE YOUR SHARING.  I HAVE BEEN A NURSE FOR OVER 30 YEARS AND FEEL TRAPPED.  THANK YOU.

EVELYN, HIV - HEAD NURSE, ST.JOHNS RIVERSIDE HOSPITAL May 20, 2012 12:41 PM
YONKERS NY

Rich,

I had been a target at my previous place of employment. Previous employment in that I was ultimately "terminated" based on false, and vague grounds. Unfortunately, I did not have the mental stamina, nor financial means to fight my termination legally.

Ironically, my entire nightmare started six months before Joint Commission implementing the "Zero Tolerance" policy.

Said policy, unlike any other policy initiated by JCAHO, was never revealed and ultimately pounded into heads of employees. I realized the same was occurring at all institutions in which my close peers had worked.

After enduring my limit of bullying, I finally started to point out the fact my institution was not following standards of Zero Tolerance by allowing not only bullying, but a toxic environment to prevail. I discussed this fact directly with my immediate manager, and Director of Nursing, who, indeed were aware of JCAHO's policy.

Despite, said bullying and toxic environment continued. Lateral as well as physician/nurse/ancillary employees.

I, meanwhile, continued to reinforce the fact management was at great fault for not implementing said policy.

It was not until after my termination, and prior to a JCAHO onsite survey, that hospital management made a baby step in addressing the bullying/toxic environment.

Individuals were interviewed on a one on one basis by a leader from the Corporate Ethics committee.

It was apparent, this move was a matter of CYA. If the issue of bullying/existence of toxic environment were to be revealed, a plan of action could at least be shown.

Unfortunately, after JCAHO's survey, no further actions were taken by management and the same toxic environment and bullying continues.

Unfortunately, I also remain an unemployed Registered Nurse. Not even given a chance for an interview by my previous employer's major competitor.

I am a very competent, knowledgeable, skilled seasoned nurse. To prove blackballing is extremely difficult yet it is a known fact the act occurs.

Though I find myself struggling financially, wondering if I will ever gain employment as an R.N. again, and experiencing periods of extreme bitterness toward my former employer for their blatant wrong doing,  I can hold my head high, knowing I DID NOTHING WRONG. What I did do was strive to protect myself, and my peers by standing up for our rights to a healthy work environment.

Bullying is alive and kicking in healthcare. I have done a great deal of research not only to help understand the dynamics behind my nightmare, but to educate and fight to eliminate this extremely crippling problem in workplaces.

I have concluded, the issue is extremely complex. I truly believe since healthcare/nursing is predominately a female profession, and women are notoriously backstabbers and catty, this fact alone contributes to bullying.

I have also concluded, there are an extreme amount of dysfunctional personalities who have gone into the nursing profession. Not only as staff members, but managers.

After stepping aside and looking back at many of those bullies, I see a great deal of personality disorders. Narcissistic, borderline personality disease, to name a few.

Both in general staffing, and unfortunately, in management.

Management sadly being those who should be our role models, leaders and catalyst in molding a healthy work environment.

Not only do I see a need for Joint Commission STRONGLY enforcing and investigating complaints of an organization breaking "Zero Tolerance", but I believe those candidates for management need to be screened more thoroughly.

Many people can take on a management role. I have witnessed repeatedly staff R.N.'s pulled into management positions.

Not many are capable of being effective leaders however.  Effective, successful leaders require strong interpersonal communication skills, a healthy mental state of mind, lack of bias, a knowledge base surrounding team dynamics including means to deal with conflict among staff members before a flame turns into a roaring fire, a basic understanding of human psychology, good listening skills, to name just a few.

Bulling and conflict will always exist. It is my hope, health care governing bodies including Joint Commission, labor committees at  national and state levels, and, higher management of institutions start enforcing anti-bulling and toxic environment policies.

Educating staff, managers, Employee Assistance personnel is a must. Rallying and persistence by those who believe and desire a change is also necessary. IE, SPEAKING UP and WITHOUT risks of retaliation.

Most workers spend approximately one third of their lives at their place of employment.

Work should not be TOXIC.

Cara , RN April 25, 2012 2:37 PM

Thank you for your post.  The more we talk about this issue, the more likely it is that we will arrive at a solution.  While I agree with you that bullying is a major issue in healthcare, I believe that it falls under a larger umbrella of issues related to incivility, in general.

Incivility encompasses:

- Using demeaning or disparaging language, gestures or behaviors, such as eye rolling and sarcasm.

- Participating in gossip or slander.

- Using fear or power to intimidate others.

- Intentionally sabotaging others.

- Bullying or using misguided power to control others.

- Putting offensive language in writing, such as in email or Facebook posts.

- Participating in "hate-ism" or targeting people based on rank, age, gender, race or sexual orientation.

Sadly, civility has been overlooked and undervalued for far too long among healthcare professionals.  The solution to this is lies in providing civility training for all healthcare professionals.  Civility training in the healthcare setting has the potential to improve patient care, strengthen team relationships and create an atmosphere that energizes and inspires those who are in it. Healthcare professionals who embrace civility are less likely to quit or "job hop," and are less likely to burn out, bully or “eat their young!”

The ANA's book is a great place to start.  Their information is reliable and reputable.  However, the brevity (only 28 pages) may leave readers wanting more.

A fellow nurse and I co-wrote a book called, "The Real Healthcare Reform: How Embracing Civility Can Beat Back Burnout and Revive Your Healthcare Career."  This 150 page book provides targeted, action-oriented information and specific exercises that can help healthcare workers understand what is going on, why it’s happening and what they can do right now to make it stop.

Feel free to contact me personally if you'd like more information about this resource.  I can be reached at staceyturnure@knowingmore.com

Stacey Turnure, RN April 25, 2012 9:21 AM
Durham NC

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