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Most say they are bullied by other nurses
Four years after a groundbreaking study found that more than three-quarters of nurses experienced bullying in the workplace, Dellasega says little has changed. Moreover, she noted, most nurses are bullied by other nurses, not doctors.
“It’s not punching or hitting or kicking,” said Dellasega, Ph.D., RN, CRNP, co-author of Toxic Nursing: Managing Bullying, Bad Attitudes, and Total Turmoil (Sigma Theta Tau International, 2013). “It’s using words, rolling your eyes, crossing your arms, the silent treatment. If you’re new on my unit and I make a big, exaggerated sigh and put my hands on my hips in front of a group when you’re around, that’s bullying.”
A 2012 study confirms Dellasega’s observation: “Workplace civility ratings were surprisingly low for supervisors and co-workers,” according to research on hospital nurses conducted by graduate student Tammy Guerrattaz at Indiana’s Ball State University. “Seventy-eight percent of nurses reported some variety of incivility from their supervisor, and 77.6 percent reported incivility from co-workers.”
Guerrattaz’s research replicated a landmark 2009 study of 612 Canadian staff nurses. The study, Workplace Empowerment, Incivility, and Burnout: Impact on Staff Nurse Recruitment and Retention Outcomes, was published in the Journal of Nursing Management. It also found that 77.6 percent of nurses reported some level of co-worker incivility. The researchers, from universities in Ontario and London, defined workplace incivility as “low-intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect. Uncivil behaviors are characteristically rude, discourteous, displaying a lack of respect for others.”
In 2010 the Workplace Bullying Institute found that 35 percent of American workers had experienced bullying firsthand, which means nurses experience bullying at twice the rate of most U.S. workers, Dellasega said.
Although some nurses endure bullying from physicians, most endure it from other nurses or from patients and their families, said Beth Ulrich, RN, senior partner at Houston-based Innovative Health Resources.
“Patients are sick, going on medication or coming off medication, vulnerable, hurt and scared,” said Ulrich, who recently co-wrote a study with the American Association of Critical Care Nurses that surveyed 8,444 nurses. “Same with families. Your child’s in an auto accident and you’re not in a position to be nice and courteous.”
Stress Is Big Factor in Bullying
Experts suggest part of the reason for nurse-on-nurse bullying is that the job’s physical and mental demands cause tremendous stress. The demands only increased during the recent recession, Ulrich said. In addition, the profession faces an increasing shortage of registered nurses, with fewer people entering the nursing profession at a time when large numbers of retiring Boomers need more medical attention, she noted. The Department of Labor predicts a 22 percent increase in the demand for registered nurses by the year 2018.
“If you look at the recession and the pressures on the health care system in the past five years, there’s a lot of stress there,” Ulrich said. “They’re working with more staff shortages than a few years ago, and the patients are sicker.”
Research shows that the average nurse performs 160 tasks in an eight-hour shift and is interrupted 19 times, said Kathleen Bartholomew, RN, author of Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other (HCPro Inc., 2006). She explained that only 40 percent of the modern nurse’s time is spent with patients, while the rest is spent filling out paperwork or charts, sitting in meetings or doing data entry, which has ballooned with technological advances.
“If there’s a code going on and all kinds of emergencies and you’re in the midst of drama with a co-worker, you can’t leave” a conflict with that co-worker, Dellasega said. “Sometimes [nurses] don’t get lunch all day or a break—even to go to the bathroom. When things are crazy, you can imagine, it becomes very tense. That’s a breeding ground for relational aggression.”
Typically, the targets are new nurses.
“Being new is a vulnerable time, and a lot of nurses experience relational aggression then,” Dellasega said. “The long-timers aren’t always educated on how to be good [mentors] to new nurses. It could be you wanted the same job as someone, so you sabotage the new girl. Or you find out someone is making more money, and you won’t answer her call lights because they’re her patients.”
Bullying can lead to compromised patient safety, said Bartholomew, who was a nurse in North Carolina and Seattle from 1994 to 2005 and saw many nurses make mistakes when they were upset by bullying.
“People can’t think straight when they’re upset,” she said.
How to Address Nurse Bullying
While reporting abuse to higher-ups is a must, the three women say, it’s not always effective. Ulrich’s research found that many hospitals have policies against verbal abuse and disruptive behavior; however, nurses say such behavior is tolerated. “There’s a real gap between policy and reality in many hospitals,” she said. Sometimes, she added, staffers look the other way if an abusive physician brings the hospital a lot of revenue.
Part of the reason the problem persists, Ulrich explained, is that nurses are trained to “cope.”
“Some nurses think they have to take abuse because they’re supposed to take care of everybody,” she said. Bartholomew says that although her research indicates that nurses tend to have passive-aggressive communication styles and are reluctant to speak up about bullying, “communication classes are noticeably absent from both medical and nursing school curricula.” Such classes could provide assertiveness training, she said.
“They can provide the skills to say, ‘Excuse me, I just heard you say I was a slacker,’ or to call out nonverbal behavior such as eye-rolling.”
Allowing employees to anonymously review managers might also reveal bullying behavior, Bartholomew suggested.
Ulrich said discussions about bullying should always be held out of patients’ earshot: “You say to the abuser, ‘We can talk about this another time, but now I need to take care of my patient.’ Then you follow up and talk about it. Some hospitals have adopted what they call a Code Pink. If a nurse sees another nurse being verbally abused, she calls a Code Pink, and any nurse who’s free comes to where the abuse is happening and stands there to support” the victim.
Dellasega believes that as more Millennials and Gen X’ers join the nursing ranks, bullying behavior “may change because of the different way they’ve grown up.”
“Younger women may be acculturated to discuss conflict more openly, to speak up when they feel they’re not being treated correctly and to be less retiring in the face of conflict,” she said.
Dana Wilkie is an online editor/manager for SHRM.
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