Bullying In Nursing

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Introduction   

In a time when bullying has become one of the most frowned upon behaviors, why is it thriving in the world of nursing? We’ve all heard the saying that “nurses eat their young”. It is a term that has been passed down the nursing ranks as each generation of nurses enters the workplace; unchanged and still true. We, as nurses, cannot permit such unhealthy and detrimental behavior to continue. In this course, we will discuss nurse bullying, why it happens and what we can do to break the curse. 

Definitions 

To fully understand nurse bullying and the issues that come with it, we must define some terms and phrases so that we are all on the same page.  

Nurse Bully 

A nurse bully is someone who repeatedly harasses and/or harms other nurses whom they believe they can dominate; they may also see them as less skilled or incompetent (5).  

Incivility 

Incivility is a type of lower-level bullying that entails more passive types of behavior. This is your mocking, gossiping, alienation, and general rudeness. The difference between incivility and actual bullying is that incivility may not actually harm the victim (6). 

Harassment 

Harassment is when someone torments or intimidates another person (4). 

Incidence Rate 

The nursing profession has historically been known as the most trusted profession. Nursing is also synonymous with caring and compassion. From the outside looking in, it may be difficult to believe that bullying could exist in such a respected and revered profession. The prevalence of bullying in nursing is staggering. Both new and seasoned nurses; young and old; nurses of every gender; and nurses of every walk of life report that they have been bullied on the job. These instances represent a wide variety of bullying behaviors which include verbal abuse, threatening, scapegoating, sabotage, and physical abuse (5). 

Incidence rates of bullying in nursing, as documented in a variety of studies, ranging from 17-85%. This includes incidents of verbal abuse, threatening, belittling, and even physical abuse.  With the prevalence of bullying so high among nurses, it is safe to say that virtually every nurse has been touched by bullying, whether victim, perpetrator, or observer (5). 

Why Does It Occur? 

What drives bullying behaviors? What makes a bully? There are a myriad of factors that come into play when discussing why bullying occurs.  

Anger and frustration are two strong emotions that can contribute to bullying behaviors. In today’s nursing work environment, anger and frustration are at the forefront of many nursing units. Nursing shortages have left many units understaffed and the nurses overworked. This frustration leads to anger when the nurses who have remained loyal, full-time staff see travelers come into their areas making higher pay. Lack of resources and the belief that they are unheard of also contribute to feelings of frustration (5). 

The belief that another nurse is less competent or altogether incompetent can also lead to bullying. When it is perceived that another nurse can’t do their job and therefore may leave tasks for the oncoming shift, the above-mentioned frustration sets in and bullying may result. Just the feeling of superiority over another nurse can have bullying effects on the nursing environment (1). 

Risk Factors 

There are some circumstances that contribute to the bullying climate. These are not excuses that give permission to the bullies, rather they are risk factors that have been identified as possible catalysts to bullying behaviors. 

Seniority 

Some nurses may feel that they have “paid their dues” and should have authority over their less-experienced peers. If this authority is not granted, the senior nurse may harbor feelings of underappreciation and lash out by being unhelpful or, to the extreme, harmful. The aim is to show how much this nurse is needed; they will refrain from helping the newer nurse or giving any advice (5). 

Insecurity 

When new nurses come into the workplace, the existing nurses may feel that they will be replaced. Nursing is an ever-evolving occupation with new technologies and treatments being developed all the time. A new nurse who was taught the most up-to-date trends in nursing may pose a threat to their job. This is when the nurse may start to bully the new nurse joining the team (1). 

Protection 

Some nurses become very attached to their patients. They may feel that no one else can give the same level of care that they can. As a result, they may see other nurses as incapable of providing care that is up to their standards. Only they can provide the care that their patients require. These perceived inadequacies can quickly turn into bullying behaviors (1). 

Education 

Differences in levels of education may also contribute to bullying. Nursing has many different levels of education and nurses from all these levels may work together on a single unit. Nurses with higher levels of education may feel superior and lash out at those with less education. RNs may treat LVNs differently than their RN peers (3).  

Types of Bullying 

It is important to note that not every bullying-type behavior can be construed as actual bullying. We all have bad days when things just don’t seem to be going right and we may react inappropriately. One of the key factors that differentiates bullying from a lapse in judgment is that bullying is a repeated or habitual behavior.  

This does not excuse the one-time behavior however, we must realize that not all poor behaviors are bullying. Nurse bullying may manifest itself in a variety of different behaviors. Below, we will discuss a few of these types of bullying. This is by no means an exhaustive list of all possible bullying behaviors; they are some of the behaviors that you may commonly see in the healthcare environment (5). 

Verbal abuse 

This may include being rude, belittling, criticizing, and threatening. We’ve all heard “sticks and stones may break my bones, but words will never hurt me”. This is a false saying as constant verbal abuse plays with our psyche as we rerun the taunts in our heads over and over. If heard enough, we may start to believe the bully’s words. 

Controlling 

Constantly telling another nurse what to do and how to do it. This is unsolicited advice that if not taken may escalate bullying behaviors. Controlling behaviors may also include certain “looks” and intimidating posturing. 

Ignoring/excluding 

Ignoring requests for help. Ignoring any suggestions to better provide care to the patients. Excluding that one nurse from lunch plans, work-related activities, or any after-work gatherings. 

Assigning heavy workloads 

Repeatedly assigning a nurse a heavy workload while everyone else’s load is relatively light. All the other nurses have time to sit and document while the one nurse is overwhelmed. 

Physical abuse 

Unwanted physical contact is usually violent in nature.  

Mobbing

This happens when a group of bullies band together to create an environment to force the victim to resign (2).  

Characteristics of a Nurse Bully 

Nurse bullies come in all shapes and sizes and come from all walks of life. There isn’t necessarily a template for what a nurse bully will look like. However, there are some characteristics that may help identify a nurse bully.  

You may encounter a nurse who bullies out of a sense of superiority. They will be condescending and have an entitled attitude. You will also recognize them by their “correcting comments” often spoken where others can hear. Next, we have nurses who bully because they have been offended by something said or done. They bully with an ax to grind. They may hold on to the grudge for a long time. Creating drama with the victim at the center will be their course of action; they will try to pull in other nurses to help ostracize their victim. Other nurse bullies will use rumors and gossip to bully their victim (3) 

These bullies love to dish out the put-downs but can’t take any back. They will become offended at the slightest criticism. There are others who will be very friendly at first. Bringing the victim in close to learn details of their lives and then using that information against them. They will weaponize all obtained information to lift themselves up.  Another characteristic is envy. There are those bullies who are envious of others. The envy could stem from something totally unrelated to nursing or the workplace. The victim, however, will most likely possess the item or characteristic that the bully is envious of. This bully is very bitter. Finally, there is the bully who plays favorites. They will favor their clique and ignore or exclude the victim (3). 

What Can You Do? 

There are many actions that you can take when you are either the witness or victim of nurse bullying. Though some bullies may be intentionally trying to intimidate a fellow nurse, there are those who are oblivious to the fact that they are bullies. They behave like a bully without knowing that they are perceived as such.  

The first action that you may want to take is to talk with the bully about the behavior. The bullying may end there. Once it has been brought to the bully’s attention that the behavior is being taken as bullying, change can occur. Communication may be all that is needed (5). Prior to speaking with the bully, try using empathy. Put yourself in the bully’s shoes to figure out what the motive for the behaviors may be. This may aid you in both the tone and direction of the conversation. 

Identifying a mentor in the workplace can also help you through a bullying situation. Having someone that you can talk to about the issue and seek their advice about how to handle the situation. Look for those nurses who can’t be bullied. Why do the bullies not prey on them? Why are they not intimidated? Often, these nurses are focused on the patient’s needs above all else and refuse to allow any situation to be about them or the bully (3). 

Talking with your manager or director is another prudent course of action. It is possible that these nurse leaders have the best vantage point to deal with and prevent nurse bullying. They work closely with the front-line staff nurses and should have the pulse of the unit. In their position of authority, they are also able to investigate and, if needed, conduct disciplinary actions.  

Unless your manager or director is the bully, a meeting with them to discuss any instances of bullying is needed. Contacting the Human Resources department is another step that can be taken. No matter the situation, it is always important to follow your facility’s policies and procedures and chain of command (3). 

Solutions to Nurse Bullying 

Nurse bullying has repercussions throughout the entire facility. According to a study from 2012, the cost for each individual who is bullied can be from thirty thousand to one hundred thousand dollars (3). This includes the cost of absenteeism, lower work performance, any therapies needed for physical and psychological issues, and increased turnover due to ongoing bullying.  

Nurse bullying can also play a big part in the overall feeling of “burnout” among nurses. Nurse bullying can lead to workplace errors which means it is crucial that organizations have strategies to combat any kind of bullying in the workplace. As nursing accounts for the majority of employees at most hospitals, curbing nurse bullying should be in the forefront. Here are some organizational strategies that should be considered: 

Culture of Safety 

Many organizations have adopted a “Culture of Safety”. The Culture of Safety promotes patient and colleague safety. It is the shared beliefs and values of the organization that influence behaviors and actions. Principles such as non-punitive reporting, communication of policies and expectations, recognition, and leadership modeling of behaviors all come into play in the Culture of Safety. All reports of bullying should be taken seriously (3). 

Admit that there is a problem 

Like any issue, the first step in fixing it is admitting that the problem exists in the first place. Bullying thrives in the darkness. Once it is brought to light and people are talking about it, it can be addressed. Even if there is no evidence of nurse bullying in your area, talking about and discouraging it may stop it from even starting (3). 

Elimination 

Try to eliminate factors that promote an environment of bullying. 

Commitment 

The organization should commit to a zero-tolerance policy when it comes to bullying. The policy on bullying should outline clear expectations along with the consequences that will be enforced if the policy is not followed. The policy should also include the organization’s social and online media sites (3). 

Accountability 

Nurses should be encouraged to hold each other accountable. You promote what you permit. As there are generally more bullying witnesses than actual bullies, nurses must be empowered to call out bullying. This can lead to a true change in the culture of an organization (3). 

Conclusion

Nurse bullying is a real problem that can affect any unit in any hospital. It creates a toxic work environment that we, as nurses, can no longer tolerate. In this post-COVID time, nursing shortages and nurse burnout are rapidly depleting the nursing ranks. It is time for nurses to call out bullying when they see it. It is time for nurse leaders to enforce the organizational consequences of nurse bullying.  

We must create safe environments for our new nurses (all nurses) to thrive. It is the only way that our profession will survive. Know the signs of nurse bullying and become the change within your organization. Empower your colleagues to do the same. Together, we can see an end to nurse bullying. 

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