Bullying in Nursing

 

Mr. Veeresh VG

PhD Scholar in Nursing, Maharaj Vinayak Global University, Jaipur, Rajasthan

*Corresponding Author Email: veereshvg@gmail.com

 

 


Bullying is the use of force, threat, or coercion to abuse, intimidates, or aggressively dominates others. The behaviour is often repeated and habitual. If bullying is done by a group, it is called mobbing. "Targets" of bullying are also sometimes referred to as "victims" of bullying. Behaviours used to assert such domination can include verbal harassment or threat, physical assault or coercion, and such acts may be directed repeatedly towards particular targets.                  Bullying in health care workplaces has been identified in India and international research reports. It has long been acknowledged that some nurses engage in hostile behaviours toward other nurses, as evidenced by the often repeated expression, “Nurses eat their young”-Bartholomew, 2006

 

Various terms have been used to describe the interpersonal hostility that can occur in the nursing workplace, including bullying, horizontal violence, and verbal abuse-Rowe and Sherlock, 2005. 

 

Bullying behaviour in the workplace is a form of aggression that occurs when employees perceive negative actions directed at them from one or several individuals over time; employees have difficulty defending themselves against these actions -Matthiesen and Einarsen, 2001.

 

An incident cannot be categorized as bullying unless there is a power gradient, perceived or actual, between the individuals involved -Zapf and Gross, 2001.

 

Bullying is distinct from harassment in that it is not distinguished by sexual or racial motives-Pryor and Fitzgerald, 2003.

 

Bullying differs from horizontal or lateral violence in several ways. Horizontal or lateral violence can occur as a single isolated incident, without power gradients between the individuals involved (that is the interaction occurs between peers in a culture that they share) (Duffy,1995). In contrast, bullying is repeated over at least six months.  Horizontal or lateral violence and bullying do, however, share behaviours such as sabotage, infighting, scapegoating, and excessive criticism.

 

DEFINITION OF BULLYING

Bullying may be defined as the activity of repeated, aggressive behaviour intended to hurt another person, physically or mentally. Bullying is characterized by an individual behaving in a certain way to gain power over another person.

 

Workplace bullying is repeated and unreasonable behaviour directed towards a worker or a group of workers that creates a risk to health and safety. 

·   Repeated behaviour is persistent and can involve a range of actions over time.

·   Unreasonable behaviour means actions that a reasonable person in the same circumstances would see as unreasonable. It includes victimising, humiliating, intimidating or threatening a person.

 

A single incident of unreasonable behaviour is not considered workplace bullying, but it could escalate and should not be ignored. Harassment and discrimination, which can be part of bullying, have their own legal remedies. 

 

MEANING OF BULLYING

Norwegian researcher Dan Olweus says bullying occurs when a person is: 'exposed, repeatedly and over time, to negative actions on the part of one or more other persons'. He says a negative action occurs when a person intentionally inflicts injury or discomfort upon another person, through physical contact, through words or in other ways.

 

BULLYING IN NURSING

Bullying in the medical profession is common, particularly of student or trainee doctors and of nurses. Bullying has been identified as being particularly prevalent in the nursing profession. It is said that relational aggression (psychological aspects of bullying such as gossiping and intimidation) are relevant.

 

In nursing workplace bullying means any behaviour that is repeated, systematic and directed towards a nurse or group of nurses that a reasonable person, having regard to the circumstances, would expect to victimise, humiliate, undermine or threaten and which creates a risk to health and safety.

 

Various bullying permutations are possible, such as:

·        Doctor or management bullying a nurse

·        Nurse bullying another nurse

·        Nurse bullying a patient

·        Patient bullying a nurse

·        Nurse bullying other healthcare providers

 

FACTORS CONTRIBUTING TO WORKPLACE BULLYING IN NURSING

There are a variety of reasons why a nurse may bully in the workplace.

 

Power

A person may use their position of power or their physical dominance over those who are perceived to be weaker. The bullying is often dependent upon the perceived power of the bully over their victim.

 

Self-Esteem

Bullies may put down others to boost their own self-esteem and confidence to help deal with personal feelings of inadequacy.

 

Difference

An individual or group may become targets of workplace bullying because others perceive them as being new or different.

 

Perceived Threat

Some people bully others because the other person is perceived as a threat to them either personally or to their position within the organization.

 

Organisational Culture

The culture of a workplace is often shown by its values, beliefs and what is considered to be normal behaviour. When the culture is positive, it encourages individuals to adopt appropriate behaviours that promote respect of others.

 

Conversely, employees may find themselves in a negative culture where inappropriate behaviours and attitudes are encouraged or condoned by management and bullying is seen as normal behaviour for the majority of people in the workplace.

 

Organisational Factors

People may harass or bully others due to dissatisfaction with organisational arrangements.

Factors may include:

·        Job insecurity

·        Restructuring or downsizing

·        Changes such as a new manager/supervisor,

·        New rosters or new procedures

·        Inadequate supervision

·        Introduction of new technology

·        Inappropriate initiation practices

·        Inadequate support or training

·        Poor skills and practices in client management.

 

Working Arrangements

Some working arrangements mean that individual employees or workgroups are separated from supervisors and others in the workplace. This can allow bullying to go undetected and prevent effective monitoring and leadership.

Examples include:

·        The physical work layout

·        Employees located in different offices or work locations

·        Work scheduling including shift work

·        People in positions of authority separating

·        Individuals from co-workers.

 

Client contact

In some institutes it is the client or customer who threatens or bullies nurses. 

 

SPECTRUM OF BULLYING

Bullying has been viewed from the perspective of the “bully” vs. the “victim.” However, bullying can best be understood as operating along a continuum.

 

A bullying incident does not happen in a vacuum, but rather appears along an escalating path of progressive behaviours. When these unconscious patterns of behaviour are identified within the spectrum, new behavioural choices become available, which then leads to a powerful framework for cultural change.

 

Using a holistic approach, the program then creates a community of support including students, faculty, administrative staff and family.


 

 


BULLYING BEHAVIOURS    

Bullying behaviours in two main categories- attacks that are direct and personal, or indirect and task-related.

Bullying behaviours- personal and task related

PERSONAL ATTACKS (DIRECT)

TASK-RELATED ATTACKS (INDIRECT)

Belittling remarks-undermining integrity-lies being told-sense of judgement questioned-opinions marginalised

Giving unachievable tasks-impossible deadlines-unmanageable workloads-overloading-‘setting up to fail’

Ignoring-excluding-silent treatment-isolating

Meaningless tasks-unpleasant jobs-belittling a person’s ability-undermining

Attacking a person’s beliefs, attitude, lifestyle or appearance-gender references-accusations of being mentally disturbed

Withholding or concealing information-information goes missing-failing to return calls or pass on messages

Ridiculing-insulting-teasing-jokes-‘funny surprises’-sarcasm

Undervaluing contribution-no credit where it’s due-taking credit for work that’s not their own

Shouted or yelled at

Constant criticism of work

Threats of violence

Under work-working below competence-removing responsibility-demotion

Insulting comments about private life

Unreasonable or inappropriate monitoring

Physical attacks

Offensive sanctions-example denying leave

Public humiliation

Excluding-isolating-ignoring views

Persistent and/or public criticism

Changing goalposts or targets

Using obscene or offensive language, gestures, material

Not giving enough training or resources

Ganging up-colleagues/clients encouraged to criticise you or spy on you-witch hunt-dirty tricks campaign-singled out

Reducing opportunities for expression-interrupting when speaking

Intimidation-acting in a condescending manner

Sabotage

Intruding on privacy, eg spying, stalking, harassed by calls when on leave or at weekends

Supplying incorrect or unclear information

Unwanted sexual approaches, offers, or physical contact

Making hints or threats about job security

Verbal abuse

No support from manager

Inaccurate accusation

Scapegoating

Suggestive glances, gestures, or dirty looks

Denial of opportunity

Tampering with personal effects-theft-destruction of property

Judging wrongly

Encouraged to feel guilty

Forced or unjustified disciplinary hearings

 

Lack of role clarity

 

Not trusting

 

WHAT IS NOT BULLYING 

Bullying is not any of these:

·        One-off or occasional instances of forgetfulness, rudeness or tactlessness

·        Setting high performance standards because of quality or safety

·        Constructive feedback and legitimate advice or peer review

·        A management requiring reasonable verbal or written work instructions to be carried out

·        Warning or disciplining employees in line with the workplace’s code of conduct

·        A single incident of unreasonable behaviour.

·        Reasonable action taken in a reasonable manner by an employer to transfer, demote, discipline, counsel, retrench or dismiss an employee.

·        A decision by an employer, based on reasonable grounds, not to award or provide a promotion, transfer, or benefit in connection with an employee’s employment

 

BULLYING ACTS

Lewis identifies the following bullying acts in Nursing as:

·        Undermining of work

·        Disadvantaging the target

·        Physical abuse (rare)

·        Verbal abuse

·        Isolating individuals

·        Interfering in work practices

·        Continual criticism

·        Sarcasm

·        Demeaning

·        Destroying confidence

·        Fabricating complaints (false accusations)

·        Setting up to fail

 

Such acts are frequently insidious, continuing over periods of time that may be years. Bullies are often serial bullies. The bullies are invariably aware of the damage they are doing. They undertake such actions basically to gain control and power.

 

Bullying from senior

A senior deliberately and repeatedly targets sub-ordinates. In the most extreme progression of events, this may come to the point where the sub-ordinates feel isolated, powerless and worthless. When the sub-ordinate eventually resigns, the senior finds another employee to target. This is often the most visible and well-defined type of bullying. Serial bullying is when this pattern is repeated and a senior picks on one person after another, leading to a string of resignations.

 

Bullying of senior

The most common form of employees bullying senior is the withdrawal of cooperation or communication. It’s estimated that 15 per cent of all bullying falls into this category and is often a response to institutional bullying. Individual employees can also behave in a bullying manner to seniors.

·        Bullying by colleagues

·        This is among colleagues who work at the same or similar level and includes ongoing:

·        Unwelcome comments, gestures or conduct

·        Physical, degrading or threatening behaviour

·        Abuse of power

·        Isolation, discrimination

·        Put downs.

 

Bullying by clients

·        In this situation employee are bullied by those they serve. Often the client is claiming their perceived right (example to better service) in an abusive, or sometimes physically violent way. Examples include nurses bullied by patients and their relatives, social workers bullied by their clients, and shop staff bullied by customers.

·        Employers need to adequately protect employees from clients’ undesirable behaviour, as they also have to protect clients from similar behaviour from their employees.

 

Bullying of nurses by manager

In 2003 the Community Practitioners and Health Visitors Association in the UK carried out a survey showing that half of health visitors, school nurses and community nurses working in the National Health Service (NHS) have been bullied by their managers. One in three of the 563 people questioned said the bullying was so bad they had to take time off work. Constant criticism and humiliation were the most common complaints. Others said they were shouted at or marginalised.

 

IMPACT OF BULLYING ON NURSING

EFFECTS OF BULLYING

Positive side of Bullying

§  Bullying develops Positive development: Some have argued that bullying can teach life lessons and instill strength. Bullying teaches how to manage disputes and boost their ability to interact with others.

§  Bullying develop various coping strategies which included "standing up for themselves" in ways which acted to "re-balance" former imbalances of power and helps in "becoming a better person".

 

Negative effects of Bullying

§  Bullying can cause loneliness, depression, anxiety, lead to low self esteem and increased susceptibility to illness.

§  Long term emotional and behavioral problems.

§  Bullying has also been shown to cause maladjustment and exhibit greater social difficulties.

§  Bullying increases the risk of suicide called Bullycide

§  Bullying increases Violence.

§  High nurse turnover rates and the related rise in patient-to-nurse ratios correlate with the integrity and maturity of nursing organizations and patient safety issues.

§  Bullying activities can be overt and intimidating or comparatively invisible to others. Nurses who work in a culture of bullying may experience job dissatisfaction and physiological and psychological consequences.

§  Failure to adhere to professional responsibilities and engage in acceptable interpersonal behaviors sets the scene for unhealthy workplaces.

§  Bullying is also costly to organizations due to increased leave and nurse attrition and decreased nurse productivity, satisfaction, and morale. 

§  The victims of bullying are subjected to being terrorized, annoyed, excluded, belittled, deprived of resources, isolated and prevented from claiming rights. The victims of bullying have decreased job satisfaction, work performance, motivation and productivity.

§  Bullying also negatively affects victims' social relationships inside and outside the institution. depression, lowered work motivation, decreased ability to concentrate, poor productivity, lack of commitment to work, and poor relationships with patients, managers and colleagues.

 

Effects of bullying on a person

§  Bullying has been associated with threats to personal identity and can affect a person’s quality of life outside of work.

§  It has varied and substantial negative effects including:

§  Low self-esteem, negative emotions and depression

§  Anxiety, stress, fatigue and burnout

§  Feelings of reduced personal control and helplessness

§  Post-traumatic stress disorder

§  Deterioration in health

§  Increased likelihood of drug and alcohol abuse as a coping mechanism

§  Possible serious physical, emotional and mental health issues or suicide attempts.

§  Some employees suffer a ‘double whammy effect’ of being targeted and also witnessing bullying. This can result in a hostile work environment and greater levels of stress leading to vicious cycles of aggressive and counter-productive behaviours.

 

Effects of bullying on a workplace

Bullying also negatively impacts on workplaces. 

§  Decrease employee health and wellbeing, motivation, performance and commitment

§  Cause staff to attend work while sick, or take more sick leave to distance themselves

§  Lead to increased resignations

§  Lead to poor customer service and product quality

§  Diminish company reputation (the bad employer view) and create difficulty with recruiting.

 

PREVENTION OF BULLYING IN NURSING

Responsibilities of employers and managers

§  Be mindful of your duties 

§  Develop a culture where bullying cannot thrive, including bullying from clients or customers.

§  Create, reinforce, monitor and review policies and processes against bullying.

§  Identify hazards associated with bullying and put controls in place.

§  Create complaint-handling processes.

§  Take complaints seriously and listen without judgement.

§  Ensure all staff, especially managers, is trained in bullying policies and processes.

§  Ensure an effective and timely response to allegations.

§  Record and investigate complaints fairly and in line with the workplace’s policies and processes.

§  Look for informal solutions before escalating an issue to higher levels, example: mediation or investigation.

§  Support positive culture-change programmes.

§  Lead by example, Seek help if you don’t know what to do.

Responsibilities of Human Resources

§  Use recruitment practices to hire the right people for the role and minimise the risk of hiring bullies.

§  Ensure references are checked.

§  Use pre-employment tools including appropriate psychometric tests.

§  Raise awareness of bullying behaviours by ensuring staff are educated about them.

§  Establish open communication systems.

§  Maintain and update bullying policies and processes and ensure staffs are trained in them.

§  Have performance management processes that measure behaviour against the code of conduct.

§  Ensure managers and supervisors are properly trained in people management, and keep the training records.

§  Have processes for both informal resolutions and formal investigations.

§  Follow up on complaint responses and be proactive with solutions.

§  Analyse workplace information (example: absenteeism records, exit interviews) for indicators of bullying. 

 

Responsibilities of employees

§  Report incidents of bullying against yourself or a colleague, and keep records of behaviours.

§  Support fellow workers experiencing bullying.

§  Where possible, speak up about instances of bullying or inappropriate behaviour you may witness.

§  Look for informal ways to resolve incidents.

§  Learn and follow the policies and processes that limit bullying.

§  Contribute to a positive workplace by demonstrating positive behaviours.

 

Responsibilities of health and safety representatives and unions

§  Understand bullying issues and where to get information and support.

§  Help to develop the organisation’s policies and processes that limit bullying.

§  Support people who report a bullying incident.

§  Advise management about any factors that could lead to bullying.

§  Promote a positive work culture and help in any initiatives to improve it.

 

REMEDIAL ACTION

§  Educate staff and health care team members on how to improve social interactions, proper business etiquette, and foster positive people skills in the work environment. Nurses are entitled to monetary compensation for bullying.

§  Champion respect and set the tone and expectation for behaviors essential for fostering a harmonious and collaborative environment.

§  The role of the leader/manager is crucial in developing a positive workplace culture that supports a high level of professionalism and a culture of zero tolerance toward bullying.

§  Help in raise awareness regarding bullying its identification, analysis and remedial measures and solution.

§  Training staff in dealing with difficult clients, procedures for withdrawal from potentially risky situations and access to counselling/debriefing can all assist to control this risk.

 

CONCLUSION:

The nursing organization workplace has been identified as one in which workplace bullying occurs quite frequently. Bullying prevention is the collective effort to prevent, reduce, and stop bullying. Many campaigns and events are designated to bullying prevention throughout the world. Bullying prevention campaign and events include: Anti-Bullying Day, Anti-Bullying Week, International Day of Pink, International STAND UP to Bullying Day, and National Bullying Prevention Month. Anti-Bullying laws have also been enacted but still bullying prevails.

 

REFERENCES:

Research report: Bullying at work: A review of the literature Health and Safety Executive. London, England.2003. 

Foster B, Mackie B, Barnett N. Bullying in the health sector: A study of bullying of nursing students. New Zealand Journal of Employment Relations, 29, 67–83:2004.

Bentley T, Catley B, Cooper Thomas H, Gardner D, O Driscoll M, Trenberth L. Understanding stress and bullying in New Zealand workplaces. Auckland, New Zealand: Massey University;2009.

Catley B. Perspectives on bullying in the New Zealand health and hospitality sectors. The Journal of Occupational Health and Safety-Australia and New Zealand, 25, 363–373;2009.

Hansen A, Hogh A, Persson R, Karlson B. Bullying at work, health outcomes, and physiological stress response. Journal of Psychosomatic Research, 60(1), 63–72;2006.

Janson GR, Hazler RJ. Trauma reactions of bystanders and victims to repetitive abuse experiences. Violence and Victims, 19(2), 239–255;2004.

Safe Work Australia. (2011). Draft model code of practice: Workplace bullying. Canberra, Australia: Author.

http//www.Preventing and responding to workplace bullying   Worksafe.htm

Valerie E. Besag. Bullies and victims in schools: a guide to understanding and management. Open University Press. ISBN 978-0-335-09542-1. Retrieved 2013-10-29.

Ann Richards, Sharon L. Edwards. A Nurse's Survival Guide to the Ward. Churchill Livingstone;2008. ISBN 978-0-443-06897-3. Retrieved 2013-10-29.

Dellasega, Cheryl A. "Bullying Among Nurses". American Journal of Nursing(Lippincott Williams and Wilkins) 109 (1): 2009.52–58.doi:10.1097/01.NAJ.0000344039.11651.08PMID 19112267. Retrieved 2013-10-28.

Kim YS, Leventhal B. Bullying and suicide-A review. International Journal of Adolescent Medicine and Health 20 (2):133 54;2008.doi:10.1515/IJAMH.2008.20.2.133PMID 18714552.

Tanya News. "Child Development Academician Says Bullying Is Beneficial To Kids". Med India (Medindia) (2009-02-02) . Retrieved 2013-10-29.

Cleary M, Hunt GE, Horsfall J. Identifying and addressing bullying in nursing. Int Nurs Rev. 2009 Dec;56(4):504-11.

Porter O grady T. Transforming work environments. Interview by Diane E Scott and Amanda Rosenkranz: The American nurse 40 (2): 7; 2008. PMID 18494401.

 

 

 

Received on 30.04.2014           Modified on 24.09.2014

Accepted on 16.10.2014           © A&V Publication all right reserved

Int. J. Adv. Nur. Management 2(4): Oct. - Dec., 2014; Page 277-282