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Anti-Bullying Workshops

Nursing students learn to better conduct themselves in practice

As nurse educators for almost two decades, we have seen the demoralizing impact of bullying on nursing students including anger management issues, concentration problems, depression, disruptions with family relationships, eating disorders, irritability, and sleep disorders, to name a few. The angst and self-doubt bullying creates is often debilitating, and brings about a paralyzing interference with the facilitation of education and student learning. Whether bullying takes place in didactic or clinical settings, the effects of a hostile learning environment are personalized and long remembered.

These memories of bullying, often stored in bright, primary colors, may precipitate unhealthy habits that ease emotional discomfort, including illicit drug abuse, overeating, securing prescriptions, and the use of energy and sleep aids. Here are some student accounts:

I was called 'stupid' by my clinical instructor, right in front of the client, client's family, and clinical group because I was taking too long to assess. She kept after me, all day, all semester, saying that I didn't know what I was doing; that I was wasting her time. I wanted to die. Before that clinical, I was in the bathroom all night and morning. I couldn't sleep; I was scared to death. My heart raced. I shook all over. I couldn't hear; I could barely see. I was humiliated. When clinical ended, I broke down in the street, crying. That was months ago, and every day since, I've had to take anti-anxiety medication. I feel destroyed, and I'm a nervous wreck. I ask myself, "Is this really worth it? Do I really want to be a nurse, if this is how nurses treat each other?" My heart is no longer in it. 

I consider myself a strong person. But, I cannot handle how some nursing professors have treated me and have treated other students. I find myself getting angrier at the world and more impatient each semester. I don't understand why so many professors are so mean. Don't they remember what it's like to be a student? They look at me and speak to me like I'm a lesser person; as if they know that I am nothing, beneath them. It's terrifying. I shrink in class, afraid to move. I cry all the time, out of nowhere, and I'm eating my stress way. I'm a mess. This is not like me. But, these professors, they can smell my fear. I can never go to office hours. As a woman of color, I'm already abused by society. I shouldn't be paying professors to abuse me, too.  

SEE ALSO: Bullying Interventions E-Book

Background on Bullying
Bullying creates harmful, hostile work environments1,2 making it difficult for victims to cope.3 In the United States, up to 76% of registered nurses (RNs) have been bullied at work4, leading to RN absenteeism, anxiety, emotional distress, job termination, low morale, post-traumatic stress disorder, and psychosomatic illness.5,6 Nursing students in clinical placement settings have reported experiencing or witnessing abuse by and from RNs7, and have reported being bullied by classmates and by nursing faculty.8 Additionally, there is a significantly higher prevalence rate of bullying against minority individuals.9 It is therefore especially critical to try to understand how to improve and sustain a culture that will foster the education, recruitment and retention of minority nursing students.10

To that end, the authors developed workshops on anti-bullying to be incorporated into the nursing curriculum to create an ethically safe and informative learning environment11 regardless of student background.

Anti-Bullying Workshops
Workshops based upon theoretical frameworks of mentoring12 and personal and organizational empowerment 13 were provided to nursing students (n = 230) at a Hispanic-serving institution within a multicultural, urban environment. These workshops were created to facilitate that nursing student learners (a) recognize covert and overt signs of bullying; (b) practice techniques of empowerment through appropriate communication and behavior; and (c) learn negotiation of political landscapes regardless of practice level and specialty.14,11

A variety of high-impact educational practices 15 used to engage affective, cognitive, and psychomotor domains of learning, included case studies, collaborative group work, role-playing, self-reflection, and journaling. Bullying examples and theory, conflict management and resolution, communication, listening enhancement, and healing and self-care strategies were all addressed. The 2-hour workshops were first conducted as part of teaching methodology in the last clinical course in the undergraduate nursing program, and then promoted and extended for the benefit of all nursing students enrolled. Institutional Review Board approval was granted. 11

Participants' Thoughts
Surveyed workshop participants reported up to 33% increases in bullying knowledge. Reflections revealed experiences with bullying, a raised awareness of the bullying phenomenon, and an improved dedication to
fnding bullying with an ownership of leading advocacy in creating culturally competent, ethical, and positive work environments.11 Interestingly, students who participated in workshops and have since graduated have informally reported in return an engagement in regular self-inventory to properly channel anger, step back, and write notes to self on the difference between a manager who leads versus a manager who bullies. While acknowledging that there remains an immense amount of work regarding nurse bullying, former students have expressed that the workshops have taught them to better understand how to recognize the importance in healing themselves as healers of others.

Looking Forward
Having anti-bullying workshops for nursing students is a creative way to transform curricula to influence how students think about and conduct themselves in practice. Facilitating how to deal with bullying is particularly salient for minority students feeling a lack of power within their school and/or work environments. All students need role models who support care of the entire self and healing as part of balanced personal and professional growth.11 It is our duty to heal tomorrow's leaders today so that they may heal the future.

References
1. Cleary, M., Hunt, G. E., & Horsfall, J. (2010). Identifying and addressing bullying in nursing. Issues in Mental Health Nursing, 31, 331-335.

2. Luparell, S. (2007). The effects of student incivility on nursing faculty. Journal of  Nursing Education, 46(1), 15-19. Luparell, S. (2011). Incivility in nursing: The connection between academia and clinical settings. Critical Care Nurse, 31, 92- 95.?

3. Hansen, A. M., Hogh, A., & Persson, R. (2011). Frequency of bullying at work, physiological response, and mental health. Journal of Psychosomatic Research70, 19-27.

4. Vessey, J. A., DeMarco, R. F., Gaffney, D., & Budin, W. C. (2009). Bullying of staff nurses in the workplace: A preliminary study for developing personal or organizational strategies for the transformation of hostile to healthy workplace environments. Journal of Professional Nursing, 25, 299-306.

 5. Dellasega, C. (2011). When nurses hurt nurses. Recognizing and overcoming the cycle of nurse bullying. Indianapolis, IN: Sigma Theta Tau International

6. Stokowski, L. A. (2011). A matter of respect and dignity: Bullying in the nursing profession: How common is bullying in nursing? Retrieved from http://www.medscape.com/viewarticle/729474

7. Hinchberger, P. A. (2009). Violence against female student nurses in the workplace. Nursing Forum, 44(1), 37-46.

8. Celik, S. S., & Bayraktar, N. (2004). A study of nursing student abuse in Turkey. Journal of Nursing Education, 43(7), 330-336.

9. Hoel, H., Giga, S. I., & Davidson, M. J. (2007). Expectations and realities of student  nurses' experiences of negative behaviour and bullying in clinical placement and the influences of socialisation processes. Health Services Management Research, 20(4), 270-278.

10. Egues, A. (2010). The relationship between mentoring and level of practice among  Hispanic RNs. International Journal of Environmental, Cultural, Economic and Social Sustainability, 6(2), 293-304.

11. Egues, A.L. & Leinung, E.Z. (2014, October-December). Antibullying workshops: Shaping minority nursing leaders through curriculum innovation. Nursing Forum, 49(4), 240-245.

12. Benner, P. (2001). From novice to expert. Excellence and power in clinical nursing   practice. Commemorative edition. Upper Saddle River, NJ: Prentice-Hall, Inc.

13. Kanter, R. M. (1993). Men and women of the corporation (2nd ed.). New York: Basic  Books.

14. Egues, A. L., & Leinung, E. Z. (2013). The bully within and without: Strategies to address horizontal violence in nursing. Nursing Forum, 48(3), 185-190. doi:10.1111/ nuf.12028

15. Kuh, G. D. (2008). High-impact educational practices: What they are, who has access them, and why they matter. Washington, DC: LEAP Publications of the   Association of American Colleges and Universities.

 Aida L. Egues, is associate professor, Department of Nursing, New York City College of Technology of The City University of New York,. Elaine Z. Leinung, is asssitants professor, Department of Nursing, New York City College of Technology of The City University of New York.

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