Hostile Working Environments and Bullying in Nursing

By: Rosabel Zohfeld, MSN-Ed, APRN, FNP-C

Case scenario 

Nurse A, RN is a graduated nurse who is very proud of her education. She finally lands her dream job and is hired as a full-time ER nurse. Nurse B, who shows no respect for her colleague, is training her for her new job; instead, she embarrasses her in front of others in the unit and talks to her in a condescending way. Nurse B even made the comment; “Did you see that new grad nurse? I don’t know why they keep hiring those dummies here!” Nurse A reports the treatment after four days of bullying and harassment, but supervisors disregard what Nurse A tells them. Instead, Nurse A is advised that she needs to grow tough skin and not take things personally. Nurse A goes home questioning the entire nursing profession and doubting her own capacity to be a good nurse. Nurse A decides it is best to quit and she leaves the job with the excuse of being ill and unable to continue to do the job.

Existing Policy

The existing policy says that there is zero tolerance in regard to harassment and/or retaliation. However, this written policy was never put into practice. Managers and supervisors do not seem to have a true understanding of the issue and are quick to dismiss the complaints of the employee. 

Review and Resolution

Even though Nurse A reported the behaviors to her immediate supervisor she did not get any resolution to her situation. There was an implied resolution to not take things personally and continue to do her job. For Nurse A, her personal solution was to leave the job and perhaps go to another place that was not hostile and had a better policy and understanding of the real danger of bullying in the workplace.

Literature Review

The literature review on hostile working environments and bullying in nursing was conducted using the CINAHL® Complete database. The goal of this review was to find literature published within the last five years that highlights the impact that bullying and hostile work environments play in the nursing profession.

Article A

Laws (2016) explored bullying in the nursing profession. Bullying is defined as a set of disruptive behaviors that negatively impact a collaborative working environment. Fear of retaliation is what prevents a worker from reporting bullying behavior. The true prevalence of bullying is unknown because it often goes unrecognized and/or underreported (Laws, 2016).

Article B 

Chapovalov and Hullen (2015) compare bullying in the nursing profession to a third-degree burn, due to the fact that it can be physically and emotionally painful, as well as leaving scars on those who endure it. 

Article C 

Lamberth (2015) discusses the consequences of bullying in health care. Bullying considerably compromises employee and patient safety. It increases staff turnover, decreases morale and productivity, increases costs, and produces potential damage to the organization’s reputation among other things.

Article D 

MacIntosh (2012) discusses how workplace bullying influences women’s engagement in the workforce. Several factors influence a woman’s decision to stay or leave a job when bullying is present, such as health effects and support.

Article E

Matt (2012) explores the ethical and legal issues associated with bullying in the nursing profession. The author explains the provisions of the International Council of Nurses for nurses and coworkers, and how a nurse who perpetrates bullying is clearly violating that particular element. There is also a reference to the American Nurses Association (ANA) code of ethics which mandates that even when faced with frustration and/or anger toward another health care provider a nurse must continue to be respectful and compassionate (Matt, 2012).

Article F

Granstra (2015) explored the increasing problem of horizontal bullying in the nursing profession. Nurses bully each other because they often do not feel valued and respected. Bullying in healthcare is experienced at an alarming rate.

Findings

According to Laws (2016), there are many consequences for the individual, the nursing team, patients, and the organization that results from bullying. Poor patient satisfaction, sleep disorders, lowered self-esteem, increased anxiety, and depression in the victim, are among the negative effects of bullying. Intimidating and disruptive behaviors towards a nurse coworker can also lead to medical errors and /or cause qualified clinicians to seek jobs elsewhere (Laws, 2016). 

Possible signs and symptoms of bullying include work decline in otherwise dedicated and hard-working employees, increased tension among staff members, poor morale, reported fears, increased absenteeism, missed deadlines, and increased errors. 

Many nurses continue to suffer in silence, while others choose to leave to find a better work environment (Chapovalov & Huller, 2015).

Bullying in health care has been documented for over 35 years, but there are far more research studies, employment laws, and literature about bullying in Europe than in the U.S. (Lamberth, 2015). Bullying is often an abuse of power. The primary culprits are typically supervisors, department managers, and executives of the organization. Usually, the perpetrator holds a higher rank than the victim. Even though public awareness of bullying in the workplace continues to grow, approximately 72% of employers, discount, deny and rationalize the disruptive behaviors. Often the bully is the one who receives support from the organization. Bullying victims lose their jobs at a much higher rate than the perpetrators, estimated at 82% versus18%, including voluntary resignation, termination, and/or being forced out of the organization. Bullying has become so concerning that the Joint Commission has implemented two additional leadership standards to address this inappropriate behavior (Lamberth, 2015).

Workplace bullying has detrimental effects on employers’ costs and productivity. Nearly 70% of employees bullied at work eventually leave their jobs. MacIntosh (2012) found that health effects were among the most important reasons women decided to leave their jobs. Some women experienced new health problems caused mainly by stress and other women found themselves concerned about the impact of leaving their jobs and the reduction in their income. For many women, being bullied often included physical manifestations such as headaches and migraines, and also psoriasis, colitis, and stomach ulcers. Sleep disturbances were also reported which resulted in a lack of concentration, fatigue, changes in eating habits, and changes in weight. Emotional outbursts, crying, depression, panic attacks, posttraumatic stress disorder, and suicidal ideation were also results of women being bullied at work. Some women even reported feeling unsafe, decreased self-esteem, isolated, and feeling withdrawn from coworkers. MacIntosh (2012) also found that women who decided to remain in bullying environments were at risk of becoming sicker; some chose to take early retirement or long-term disability. Furthermore, early intervention against bullying in the workplace remains the simplest and most appropriate way to limit the escalation of health effects on the victims and the increased costs for employers (MacIntosh, 2012).

According to Gransta (2015), horizontal bullying is growing at an alarming rate and continues to increase. Such negative behaviors are commonly known as “nurses eating their young.” Seniority also plays a role where the senior nurses feel that they have authority over less experienced nurses. Some nurses also feel threatened by their coworkers. Gransta (2015) believes the solution should not be focused directly on nurses, but actually on the entire healthcare industry, which must be restructured as a whole in order to solve the problem. 

Cultural, Quality, Safety, and Advance Nursing roles

The impacts of bullying on the victim are physical, emotional, and work-related. Bullying is an organization affects the culture, cost, productivity, reputation, and quality of care. Medical errors are more prominent when there is bullying involved. For the advanced nurse, is it important to be aware of the negative impacts of such behavior? Leaders and managers play a role in eliminating bullying from their units and work in general. Early recognition and preventing the behaviors from going further into team dynamics are critical (Chapovalov & Hulle, 2015).

Ethical and Legal Implications

Ethical considerations

According to Matt (2012), virtues of moral character such as compassion, discernment, integrity, and conscience should be role models for health professionals. Nurses that engage in bullying behaviors violate the ethical principles of non-maleficence, beneficence, justice, and autonomy in an individual.

The International Council for Nurses (ICN) addresses four elements: nurse and people, nurse and practice, nurses and the profession, and nurses and coworkers. This fourth element is the most relevant to bullying, as it indicates that nurses must sustain cooperative relationships with other nurses and with other fields. Also, nurses must take the appropriate actions to safeguard families, individuals, and communities whenever their health is being endangered by a coworker or any other person (Matt, 2012).

The American Nurses Association (ANA) also addresses these attitudes and behaviors in its most recent publication of 2008. According to the ANA code of ethics, a nurse must present him or herself in all professional relationships with compassion and respect towards the dignity, worth, and uniqueness of every individual. The nurse must do so independent of the social or economic status of the individual as well as their personal attributes and/or the nature of their health problems (Matt, 2012).

Legal Considerations

Even though there are no current laws in the United States that specifically target bullying in the workplace, both perpetrators and employers who do not address the issue of bullying are subject to legal consequences. The Occupational Safety and Health Act of 1970 (OSHA) at the federal level does mandate that employers must furnish a place of employment that is free of hazards that may be likely to cause death or serious physical harm to the employees. Also, according to the criminal statute harassment, it is a criminal violation and the perpetrator is subject to criminal penalties. Furthermore, any individual who spreads rumors about a coworker might be sued on the basis of defamation of character (Matt, 2012).

References

Chapovalov, O., & Van Hulle, H. (2015). Workplace Bullying in Nursing – Part 1: Prevention Through Awareness. OOHNA Journal, 34(2), 20-24 5p.

Granstra, K. (2015). Nurse Against Nurse: Horizontal Bullying in the Nursing Profession. Journal Of Healthcare Management, 60(4), 249-257 9p.

Lamberth, B. B. (2015). Workplace Bullying in Healthcare: Part 3. Radiology Management, 37(3), 18-25 7p.

Laws, L. (2016). Bullying in the Workplace. Texas Board Of Nursing Bulletin, 47(1), 4-6 3p.

MacIntosh, J. (2012). Workplace Bullying Influences Women's Engagement in the Workforce. Issues In Mental Health Nursing, 33(11), 762-768 7p. doi:10.3109/01612840.2012.708701

Matt, S. B. (2012). Ethical and Legal Issues Associated With Bullying in the Nursing Profession. Journal Of Nursing Law, 15(1), 9-13 5p. doi:10.1891/1073-7472.15.1.9

Questions

1. What do you think is the main factor contributing to a hostile work environment?

2. What would be the main factor contributing to bullying in the workplace and especially in the nursing profession?

3. What is horizontal bullying and how does it affect the nursing profession?

4. Why do you think nurses tend to be non-confrontational?

5. Why do you think most managers seem to ignore the issue of bullying and why is it that bullying has been known to be underreported or not reported at all?

6. What are some things that need to be done in order to prevent bullying in the nursing profession?

7. How can you as a nurse deal with bullying at your workplace?