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How to Recognize and Prevent Bullying in Nursing


Differentiate between this type of lateral violence and incivility

It's the end of a grueling workday and you're still on edge, not yet recovered from the sting of a colleague's tongue lashing. And it's not the first time. Is this just another "bad day" on the job, or are you experiencing a form of workplace violence, aka bullying? Forty-five percent of nurses have been verbally harassed or bullied by other nurses, while 41% have been verbally harassed or bullied by managers or administrators, according to a 2017 survey by RNnetwork. [caption id="attachment_50726" align="alignleft" width="300"]Renee Thompson, RN Renee Thompson, RN[/caption] Being the object of a co-worker's venting is hardly uncommon, but is it categorized as workplace violence? Renee Thompson, DNP, RN, CMSRN, said bullying has three components: It's targeted, it's meant to cause harm and it happens over time. Some types of mistreatment or unkind acts on the job can actually be classified as incivility, but not necessarily bullying, she said. These include eye rolling, disrespect, gossip or general unfriendliness. "If I get testy with you in a crisis situation, it's not bullying," she explained. "It's a stress response." Thompson, an author and speaker on workplace bullying, said most bullying is nurse to nurse, but other healthcare staff can also be bullies: the nursing assistant who's been on the unit for 40 years and targets the new RN, or unit secretaries who victimize a particular nurse. Cole Edmondson, DNP, RN, FACHE, NEA-BC, FAAN, CNO at Texas Health Presbyterian Hospital Dallas, agreed most nurses are bullied by other nurses, and most often through verbal abuse. He cited a December 2016 Texas Department of State Health Services study on workplace violence against nurses that revealed 82% of Texas nurses surveyed had experienced workplace violence, ranging from verbal abuse to physical acts.

It's a group thing

[caption id="attachment_50725" align="alignright" width="300"]Cole Edmonson, RN Cole Edmonson, RN[/caption] Edmonson added bullying can target groups as well as individuals and is really a group phenomenon: one unit taking out their aggressions on another unit, or nurses on a unit bullying new hires or new graduates. Nurses in some areas or specialties may perceive or believe they are superior or "better than" another unit or specialty and degrade them, their care, their education or specialty. Bullying isn't just detrimental to the person being targeted, Thompson said. "If I withhold information from you and it causes you to make a mistake with a patient, or if yell at you or criticize you in front of a patient, it's potentially harmful to patient care," she said. "When you're being treated in a way that is making you feel badly, it stops the flow of information. When we're not freely communicating with members of the healthcare team, it ultimately affects outcomes." Edmondson said in the literature and in practice "it's known that nurse bullying ultimately impacts the quality and safety of patient care being provided, as 75% of nurses state they are aware of errors in patient care or issues created when nurse bullying occurs." Many organizations have chosen to take the journey to Magnet designation to work on improving work environments, empowering nurses and creating excellent outcomes. In 2015, the ANA, which defines bullying as "repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient," issued a position statement saying bullying "is a very serious issue that threatens patient safety, RN safety and the nursing professional as a whole."

Time to take a stand

[caption id="attachment_50727" align="alignleft" width="242"]Linda Olender, RN Linda Olender, RN[/caption] Some healthcare institutions are facing bullying head on, while others are reducing the incidence through cultivating a certain culture, said Lynda Olender, PhD, RN, MA, NEA-BC, associate dean, Hunter-Bellvue School of Nursing (New York) Graduate Programs, and a Distinguished Lecturer in Nursing. Olender said organizations with caring cultures that follow the code of ethics and practice shared governance have a lower incidence of perceived bullying. Such organizations would experience fewer grievances overall because staff feel more valued, she said. Edmonson asserted leadership should handle bullying by empowering workers through policies and procedures, making them aware bullying is not okay. One reason bullying continues is that often those who witness or suspect the adverse behavior look the other way or decline to become involved. Nurses can and should stop that malicious pattern. "If you see a co-worker bullied, step in and say wait a minute -- time out," said Thompson. "Intervene in that kind of experience. Typically no one is speaking up. The no. 1 most powerful behavior is for the witness to speak up and support the person who is being targeted." Rather than turn away, reach out to a colleague who is the target of a bully. "We can all be 'upstanders' by intervening in situations or reaching out to a colleague who is the target of a bully," said Edmonson. "These situations don't just stop when the bullying behavior is over. They have long lasting effects on mental health and one's feelings of safety and security." As nurses learn to identify and confront harmful behaviors toward themselves and coworkers, workplace violence, including bullying of nurses, will not be allowed to persist. Nurses -- and patients -- will be safer and secure.

Be proactive when being bullied

According to a fact sheet on, 21% of nurses leave their jobs due to incivility and bullying. Rather than becoming a part of this group of nurses, Edmondson said the problem must be confronted at all levels across the organization. "It creates an untenable situation for nurses and those who witness it, including patients and visitors." If a nurse feels he or she is being bullied, it's important to let the bully know how that behavior makes him or her feel, said Olender. "Think of yourself as a professional with the goal of being educated about bullying and how to handle it." "Pause and take a deep breath," said Edmonson. "You want to act professionally, not let the situation cause you to decompensate." Practice self awareness, observing how the situation is provoking an emotional response, recommended Olender. Edmonson said if a nurse is comfortable doing so, he or she can address it directly with the person. If that's not possible, Olender recommended practicing a response using role play on his or her own or with a friend. If the nurse is not comfortable with the direct approach or if a direct discussion does not work, report it to a manager, supervisor or preceptor. If the manager is the problem, said Olender, seek the support of someone else, an educator or someone in human resources. The nurse should find out the organization's policy that addresses behaviors that undermine a culture of safety, and make sure he or she is clear on how the person has violated that policy. Then document the experiences with that person, stated Thompson. Always document the situation: What happened, who said what and who witnessed the incident. Edmondson stresses that documenting needs to happen immediately since one's impressions and memories are often less precise over time. New nurses are an easy target for bullies, just because they're new, noted Thompson. Preventing this starts with the job hunt, so new nurses should do their homework about the healthcare organization to which they are applying, said Olender. "Do they have a caring culture, a code of ethics, policies and procedure in place? Do they have shared governance?" If they do, the likelihood of bullying is probably lower, she said. Some units can be toxic, Olender said. Ask the right questions in the interview process, such as how scheduling conflicts are handled. She said it's a positive sign if unit nursing staff are part of the interviewing process, as it shows the organization is empowering the staff to make decisions about colleagues. Ask if there are policies and procedures for workplace violence. Look at their orientation -- what do they do to insure a healthy work environment? Practice prevention personally as well. "Know what bullies look for in a target," said Renee Thompson. Bullies look for "nurses who they don't think will confront or challenge them, who seem insecure or nervous, who are passive communicators -- anything that makes them different," she said. For example, a BSN new hire might find him or herself as a target because most of the other nurses on the unit have associate's degrees. A nurse should act confident when starting a new position, Thompson said. Hold your head high. Shake hands of new people with confidence. Look up the free online resource, the Civility Tool-kit, which addresses bullying behavior across the continuum.

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