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Bullying Continues to Plague Nursing

Vulnerability in new nurses is unfortunately fertile ground for horizontal violence to grow.

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The saying "nurses eat their young" came to my knowledge one afternoon during a conversation with my mother who had been a nurse for more than 20 years.

Upon doing research, I came to know the meaning of the phrase, and that it is in fact related to a phenomenon that exists in the nursing profession today. Another well known term for this is "workplace bullying."

The issue of bullying is an important area of focus because it is widespread in the nursing profession both domestically and internationally. Researchers in the U.S., U.K., Australia and Canada estimate 80 percent of nurses have experienced bullying, either as a perpetrator, a witness or as a victim.1

Bullying can occur wherever there exists a power difference, as evidenced by an estimated 75 percent to 89 percent of bullying behavior perpetrated by those in authoritative positions.2 The incidents can take place between a newly-hired nurse and an experienced nurse, a nurse manager and a staff nurse, a nurse educator and a nursing student, and student nurse classmates.3

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Bullying has detrimental effects on a culture of safety as it poses a risk to patients by contributing to medication errors, poor patient satisfaction and increased cost of care, according to the Joint Commission.

Furthermore, workplace bullying results in job dissatisfaction, which fosters a reduction of participation, commitment, involvement, expertise, and productivity of the nurses involved.4

Rooted in Oppression

Bullying has been referred to as the nursing profession's "dirty little secret" and sometimes a "silent epidemic," and it often goes unacknowledged by educational institutions and healthcare organizations.5

Factors thought to contribute to the existence of bullying in the nursing profession stem from a concept that nurses are an oppressed group. This concept of oppression is due to fact that nurses were thought to be dependent on medical doctors for directions pertaining to what they do in practice.

The consequence of this educational system caused nurses to lack freedom, and feel inferior and powerless. Often these negative emotions may go unexpressed, and rather silence is promoted by nurse managers and administrators. The internalization of the feelings of powerlessness then contributes to aggression seen between nurses which enables a prevalent culture of sabotage and less respect and integrity for other nurses.6

When this type of behavior is allowed to continue without being corrected for a long time, it can become entwined with the culture. The ultimate display of this bullying being entrenched in a culture happens when nurses begin to think of it as normal.7,8

Staff Awareness

In a research article published earlier this year in the journal Nursing Economic$, "Sadly Caught Up in the Moment: An Exploration of Horizontal Violence," the authors shed light on the fact that nurses are sometimes unaware that they are participating in bullying.9

Study participants completed a nine-item survey (see Table 1) and open-ended qualitative questions to help the researchers further analyze the issue among nurses.9

The results revealed that 28.4 percent to 77 percent of nurses had witnessed many of the bullying behaviors done to a fellow nurse.

More than 70 percent selected behaviors such as backstabbing, lack of respect, negative nonverbal gestures and bickering as the most common acts displayed in the workplace.

To further buttress the findings, the open-ended responses gave an explanation for the frequent, often acceptable and encouraged behaviors. Nurses wrote comments such as:

"It happens so fast!" "Making faces was done in fun." "[We] were only offering constructive criticism." 

Many nurses also expressed that they were surprised at some of the behaviors categorized as bullying in the survey.9

This research shows that bullies at times don't know they are guilty of bullying, and believe that their acts can be summed up as being "sadly caught up in the moment." 

Furthermore, many of these nurses behave in a manner not known as 'bullying' to them as a way to get their work done and promote productivity at their place of work.9

The Bullied Nurse

One group especially vulnerable to bullying is recently graduated and newly-hired registered nurses. Research has shown that bullying is a major reason that accounts for 60 percent of new nurses leaving positions within a few months of beginning their careers.10

The lack of experience and decreased confidence levels can create vulnerability in new nurses and provide a fertile ground for the bully to professionally terrorize them. This results in the new nurse having feelings of worthlessness, job dissatisfaction, and distress, and also impairs learning ability needed to develop skills sets.10

According to the Center for American Nurses, staff impacted by bullying can "experience physical symptoms, such as frequent headaches, gastrointestinal problems, sleep disturbances, and fatigue" as well as "psychological symptoms such as fear, depression, sadness, anxiety, nervousness, and mistrust."11

In their work, "Novice Nurse Productivity Following Workplace Bullying," Berry et.al (2012) conducted research with 197 nurses who had been in practice for less than 3 years and defined as "novice nurses" to determine the prevalence of bullying and its effects on nurses' productivity at work.12

The researcher's findings revealed that 84 percent of the participants had experienced being bullied in the forms of withheld information by other staff nurses, gossiping, and much more since they'd begun working. What's more, 75 percent of the nurses in the study indicated that they experienced bullying within the month immediately prior to the start of the study.

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Confronting Horizontal Violence

Creating awareness helps curb hostilities on nursing units.

Bullying, especially when exhibited by nurse leaders, was found to have a negative impact on the productivity of the new nurses; this caused many to consider leaving their jobs as well. For the bullied nurse, there is a great demand for all to recognize and understand that bullying exists, and should not be tolerated.

Zero Tolerance for Bullying

The lack of knowledge or acknowledgement concerning this issue is proving unfavorable to the nursing profession. Finding a solution calls for facing the fact that it does exist.

Education and preparation is required for all who are involved in nursing, be it as a student, an instructor, a staff nurse, a nursing leader or an administrator.

Fortunately, some measures are already in place as the Joint Commission has set a new standard for healthcare workplaces to define behaviors such as bullying and other disruptive ones. This will promote a "culture of safety" and enforce a "zero tolerance" for such conducts.

Meanwhile, each and every nurse must not only take responsibility for her behavior toward colleagues but ensure others are made personally aware when they are guilty of bullying.

References for this article can be accessed here.
 
Eunice Ayansola is a student and Margaret Quinn is assistant clinical professor-nursing, both at Rutgers, The State University of New Jersey, Newark, NJ.


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I am glad to see this topic come out of the closet. I have been in healthcare for 23+ years. I have seen this happen in the workplace. It is important for facilities including hospitals to address this problem when someone reports. It can lead to deadly consequences.

Claudette Singleton,  LPNSeptember 19, 2014
Wenonah , NJ



As the song goes, 'Ah yes, I remember it well.' My first few months on a busy pediatric med-surg floor, and I was an older nurse just out of school with a brand spanking new license. My preceptor was wonderful, but after that. . . Let's just say that even though I'd been a sargeant in the US Army and could take a lot from my male counterparts (and give it back to them) my supposed colleagues, many of them younger than me, made my subsequent weeks an endurance test with their criticisms, hurtful comments, and sniping. I and a fellow newbie often compared notes, wondering if we'd made a mistake coming into that particular venue with such hopes and aspirations. I nearly hung it up, too. However, several years down the road, I took a lot of pride in being a resource for student nurses coming on our floor, pointed out by their instructors as one of the few go-to people for their questions and problems, because I was determined not to carry on such a heinous 'tradition'. Bullying can be ended, but only if we make a concerted effort to do so.

Bonnie ,  Registered Nurse,  HealthwaysOctober 27, 2012
San Antonio, TX



Before I started working, the then nurse mgr told me people were very cliquish. While in the GN program I had two preceptors - one on the weekends and one in the week. If I breathed the wrong way, it turned into a complaint. Almost every other week, I had to have a meeting with someone. After the GN program, I switched from days to nights. Same problem. The assist nurse mgr wanted me to do things (like give prn narcotic pain meds 1/2 hour before due and give more than 7mg of morphine in 5 hours). She didn't want to overridew my decisions, just complain that O didn't do what she asked. When I pushed back in writing, they claimed that what I wrote could be taken as a threat and accused me of using drugs and being crazy. I wanted to be a nurse for years, even before getting a BS in something else. However, now I am sorry that I spent my hard earned money on nursing school because it was a big mistake and I could really use that money right now. It was the worst experience of my life and I am very jaded.

Moe October 25, 2012



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