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.
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
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
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 stopbullyingtoolkit.org, 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.
Keep learning with these popular CE topics
WEB332: Empathy 101 for Nurses: How to Care for Yourself While Emotionally Supporting Others
(1 contact hour)
Nurses are called to care. They apply evidence-based practice, clinical knowledge and critical thinking with compassion and empathy. Join this webinar to learn the difference between empathy and sympathy, and how to recharge and take care of yourself in order to better take care of patients.
WEB338: It’s Just a Stage 1 Pressure Injury. Or is it?
(1 contact hour)
The National Pressure Ulcer Advisory Panel modified descriptive language from pressure ulcer to pressure injury in 2016. Since skin can look very different based on an individual’s skin tone, it’s important to fortify assessment skills with tips you can use to help prevent “missed” deeper injuries.
WEB 339: Antimicrobial Resistance and Healthcare Acquired Infections
(1 contact hour)
Rising trends in antimicrobial resistance are a costly and significant contributor to negative health consequences around the globe. The Center for Medicare and Medicaid Services (CMS) recognizes this impact and will now penalize hospitals with high rates of acquired Methicillin-resistant S. aureus (MRSA) and C. difficile infections to promote proper antimicrobial stewardship and infection control policies. With proper education, development and use of effective protocols, and close monitoring, interprofessional care teams can have a substantial impact on improving patient outcomes and reducing healthcare costs.
I was a victim of bullying vpby nurses at a facility when the 2008 housing crash happened. The nurse would verbally tell her colleagues behingpd my back within earshot what a horrible RN I was. I was almost at a point of getting fired and went before the nurse manager. I attempted to get my old position back if I was that inept at this one. I ended up going on stress leave and had a conference call with them including professionals who were on my side. The end result? The nurse manager was laid off, as well as some some old timers ( they make too much money), and I got my dignity back. I have a position now where I have boundaries and am respected by families and nurses alike???!
Every person you encounter within your profession can truly make a difference with how they perceive the value of their contributions and efforts by vesting time, and sharing knowledge and experience. It’s easy to turn a blind eye and allow a fellow colluege to struggle, after all, why should they be worthy of not enduring the struggles and lessons earned like a right of passage. I”ll share my beliefs on this. How are we preserving our profession as nurses, when we judge our own without any regard to how we may potentially impact someone’s dream to make an difference guiding a patient towards restoring their health? The journey and struggles one makes to become a nurse may bring hard life lessons, but the very few who stand out and realize vesting in our professions future are the very few that keep hope..hope for passing knowledge and wisdom, along with passing the torch to the future generations of our nursing profession.
Ironic how Edmunson talks about bullying when it is his own nursing units that are the biggest bullies in the DFW metroplex.
Whoa. That took some guts to make that comment. I was immediately questioning how non empowering this article was. I made the mistake(s) of:
1. Directly communicating with my preceptor result. Made me a bigger target. She even said to my face that she, “Hated people” among other horrible things to me.
2. Went to my supervisor who spoke to her but I became an even bigger target by the other nurses who were close friends with my previous preceptor. My new preceptor berated me so badly that I went into a room to cry. I was followed in by two co-workers who saw what she did and offered comfort, advice and even tips on my charting error, But no one spoke out.
3. I spoke to a Nurse educator as part of the new grad program, but that just made things worse. I was targeted as a problem nurse and all my mistakes were blown out of proportion and I was being “spoken to” during my shifts pulled away from care for the most mundane issues. It got ridiculous.
I could see that the writing on the wall was just to get rid of me. I am not a pushover or a whiner. I am an older new grad. A former professional in law enforcement and a veteran. I cannot believe the change these women had on me. I became a shadow of my former confident self. I was a nervous and terrified version of myself. I am afraid to speak up for myself. I fear repercussions, loss of my job and more. The current system of “follow the chain of command” “go to HR” does not work. IMHO I wish a separate entity like an Internal Affairs in law enforcement would be set up by nurses for nurses from outside the established groups within an organization. In the end I left before they found fired me. And now I fear applying anywhere. I’d rather face ISIS then a pack of nurses.
You just described my experience in my first job in Rockford, IL. I worked in a critical care unit. all you said was my experience including human resources taking sides with the manager because she was an older woman, has spent over 20 years there and the human recourses lady was younger in age also. but in a nutshell I had to quit and lost my retirement benefit because I had only stayed 2 years and I needed to be there for 5 years to cash in. I went to another hospital in the downtown area of Rockford, IL.
I totally agree!! Everything you said has been true for me at every job I’ve had. So tired of the bullying among nurses!!!
In my opinion bullying in healthcare is very prolific because many nurses are great advocates for their patients, but very poor advocates for themselves. While nurse to nurse bullying is bad, what is worst is when the bullying is coming from a nurse manager to a staff nurse. The staff nurse is at a great disadvantage, however, a nurse should persist that any form of bullying in the workplace be from a nurse to nurse bullying or from a nurse manager to a staff nurse, be stopped!!
Some of the nurses came from different country and they have different accent. Locals understand the english and it will not depend on the english. However, nurses do their best to carefully communicate to their patients to assist them right also.
How amazing to see my own story mirrored by others. I also am being targeted and bullied by management. And while nurses may advocate for pts, they are often reluctant to advocate for a nurse being bullied by management. I imagine the power of at least a handful of our 60 RNs speaking up, but how many actually do!? One.. and that is myself . Stepford wives of nursing who pride themselves on their efficiency, yet when it comes to having the integrity to standing up for other nurses , or to management….. good luck!
I’m going through this as an OT with another OT colleague..horrific sociopath of a bully and sleeps in her car instead of seeing patients.
I am being bullied by management and by the staff. Other nurses do not stick up for you they just stand by and watch. Some participate in bullying. There is no support from management, human resources or anyone. When you report it you get labeled and you are treated as if you are not credible and they attack your character. Wish there was somewhere you can go to get help.
The problem is the “insubordination” accusation. You learn in high school how to talk back to bullies, but if there is a shouting match on the unit, it’s the crime of the century. Instead, I think hospitals should not retaliate when nurses hit back at bullies or if staff argues with the supervisor. Insubordination on an employee’s record should be liable to slander/ libel lawsuit.
I am a 59 year old RN who has worked my entire nursing career without experiencing bullying until recently. I was employed by a health care system as a supervisor of a psychiatric facility in central PA. I worked there for 6 months on a 12 hour weekend option. During that time I began to be harassed, bullied and reported multiple times by three older new RN’s from the Child Adolescent Unit. All three have had other careers and when they finished orientation the DON felt they should be cross trained to cover the hospital as supervisor. Administration paid them ten dollars an hour on top of their regular salary when they covered the facility. This was enough financial incentive as well as them wanting my weekend option position. All three were all on a 5 day per week schedule rotating shifts. I reported the bullying and it was dismissed by nursing administration and so I took it to Hospital Administration. After that I was assaulted by a teenager and was on workman’s comp for a week and when I returned I was treated even worse by Nursing Administration. The bullying went as far as me having my car tire slashed while at work. I realize now that not every nurse who works at a psychiatric facility has good mental health and administration does not like anyone shining a bright light on situations where experienced supervisors are bullied by staff. Eventually I wrote a letter to the CEO of the health system. I did receive a meeting at corporate headquarters and a sincere apology from the corporate level administrators, however the real issue still remains that I have PTSD from such a traumatic work experience and the psychiatric hospital now has one of the three young inexperienced nurses as the supervisor in my old position and they continue to bully older professional employees. Sometimes we must realize that bullying is a corporate culture and it was not only allowed it was fostered and those who engaged it in at every level realized this too. The entire staff at this hospital now know that it will be tolerated and maybe even applauded.
I hope you also made a police report for teenager assaulting you, which i feel was planned, and the tire slashing. Horrible nurse administration treating you like that after you returned to work. Did they send a get well card when you were off injured? Did hospital corps discipline nurse administration the way they treated you? You have my emphathy.
I believe a person is NEVER “too old” to do what they want as long as they are physically capable. I think it is better to give whatever you want a try- than to wonder if you might have made it. I am 64 -in great health and my weight is always between 110 -120. I recently was admitted to Campbellsville University R N program.( I went there because I had a BA in another area) I did well on everything except Math, which I was required to make 100 %. I didn’t achieve the 100 % so I was given the option of just taking the Math until I could make the 100- a remedial, in which I could not continue with clinicals, or be dropped from the program. I choose to stop. I am still not sure that was the right choice. I knew I had to make a 100 % going in, so I don’t assign any blame to anyone except myself. I have been an LPN for about 16 years, before that a teacher. The Math is called Dimensional Analysis- I didn’t quite get it, BUT at least I tried. It doesn’t matter that drams, grains, minims, are not used today- the calculations were requirements that I didn’t master. Also, if I ever have a doubt, I call the pharmacy. I admit that I am frustrated because new RNs come to work with me, and they are not sure when to call the Dr., how to write nursing notes, can’t write care plans, don’t know what a lot of drugs are for, are taking “breaks” all the time. I guess, in a nutshell, it’s what we as individuals, have to offer our patients. Do we listen? Do we show them they are important? Do we record and report information to the doctor accurately? Are we assessing all the time? Do we do what we say we will do? How do we present ourselves?
I have been a victim of bullying on many occasions as an immigration in a new working environment that was never reported. I was very fearful that if I reported the perpetrator when I needed support as it relates to patient care I would be ignored. Not reporting the situation from when it all started I later realized it continues. The bullying experiences were humiliating and interferes with my performance due to the ongoing gossiping, belittlement, eye rolling, unfriendly work environment and other such like behaviors from all levels of staff but especially nurses. I never expected that so much incivility could be in health care with all the knowledge of the different disciplines. The main focus in healthcare is to maintain patient safety so they can have a good health experience. However, so often some health care workers damage the confidence, credibility and the well-being of there own colleagues just to gain power and control over others. For patients to receive the quality care they deserve and the care we are all working to achieve, incivility in the workplace must be address. Until uncivilize behaviors are treated with high level of urgency and not as soft issues the turnover rate will continues to increase along with recruitment and retention cost.
Hi I’ve recently joined The NHS as a healthcare worker. I was really excited to had passed my interview and couldn’t wait to start. I was placed in a clinic with 3 other nurses but straight away was made to feel segregated from them. They took a photo of all of us but when they WhatsApp the photo I was cut out of it. One nurse constantly badgered me to the point that I questioned my ability and I had to ask myself ‘surely I’m not that bad’. I have lost all confidence and all I can hear is the nurses voice in my head, she just wouldn’t leave me alone. I haven’t told anyone as I have asked my line manager to move me she is but said that if I don’t like it I’d have to resign.