Zero Tolerance: Stopping Nurse Bullying Begins With Leadership
No longer simply accepted as part of the culture of nursing, bullying must be acknowledged and addressed. It starts with education and a commitment to a healthy work environment.
Renee Thompson, DNP, RN, CMSRN
"Nurses eat their young." "Grow a thicker skin." "Nursing's always been like this—it's just the way it is."
Sadly, most nurses hear phrases like these before they even graduate from nursing school. It’s expected that new nurses will experience some type of bullying from their coworkers, physicians, and even from their managers as they transition from the classroom to the floor. There is also the unspoken expectation that nurses should just put up with it and deal with it. Countless nurses stay quiet about this insidious type of workplace behavior because, in many cases, speaking up leads to more problems.
Bullying has been accepted for decades as a part of the culture of nursing. It’s viewed as part of the rite of passage from student nurse to professional nurse. Now, older, more experienced nurses are becoming the targets of bullying from younger nurses who are trying to assert dominance in a progressively chaotic and stressful healthcare workplace. Regardless of age, nurses worldwide are being confronted with this dangerously toxic form of intimidation, ultimately affecting their confidence, happiness, and ability to practice nursing safely and competently.
BULLYING AND BURNOUT
Bullying isn’t confined to the United States. Globally, it’s reported that about 37% of nurses experience some form of bullying.1 Different from isolated violent incidents, workplace bullying among nurses is defined as a variety of subtler, but sabotaging, behaviors that occur over a time period of at least 6 months.2 These behaviors are used to destroy a nurse’s credibility and confidence.2 Bullying includes, but is not limited to, infighting, intimidation, scapegoating, passive aggressiveness, excessive criticism, and withholding assistance.2,3
Did You Know?
Bullying in the workplace is one of the main factors behind nurse burnout and increased rates of staff turnover.
The impact of bullying on nurses, both young and experienced, is increasingly well documented. Bullying in the workplace is one of the main causative factors in nurse burnout and increased rates of staff turnover. This leads to increased operating costs for healthcare systems due to absenteeism, staff replacement, and mediation and arbitration.4 Perhaps most disturbingly, there is mounting evidence demonstrating the relationship between nurse bullying and negative patient outcomes. Bullying in the workplace has been shown to decrease the quality of care patients receive, causing a very real threat to patient safety and reducing the likelihood of positive patient care results.5
THE ROLE OF NURSING LEADERSHIP
Ineffective nurse leadership contributes to the problem of bullying. Many nurses describe a lack of managerial support and intervention for situations involving bullying.6 Even when nurse managers listen to complaints about bullying, often little or no action is taken to resolve the situation.
Research has identified several managerial problems, including nurse leaders who use silence, censorship, and self-protection tactics as methods of avoiding the problem of nurse bullying.5 Further, management that is either unfair or unpredictable has been shown to be the strongest predictor of workplace bullying.5 Renee Thompson, DNP, RN, CMSRN, a leading authority and speaker on nurse bullying, describes the problem: “What is sometimes shocking to me is how leaders just turn a blind eye. Leaders use silence as a strategy. Nobody’s addressing it. Everybody knows it’s happening, but nobody’s doing anything about it.”
“You have a lot of nurses who are excellent clinicians...but they’re toxic to an organization. What happens is, leaders justify it, they ignore it, or they sweep it under the rug. I’ve talked to many leaders who say a particular nurse is so good, they are so competent, and the patients love them. However, if you can’t keep [other] nurses employed on that unit because of that 1 toxic nurse, that nurse needs to go. It doesn’t matter how clinically competent they are,” says Thompson.
EDUCATING LEADERS TO END BULLYING
“Bullying has to be attacked from multiple levels,” explains Thompson. “First, you need leadership commitment—an executive leadership team that takes a stand on this. You also need frontline managers, those who are responsible for the day-to-day operations and the behaviors of their employees, to be provided the training and education they need to develop the skills to be able to address destructive behaviors.”
American Nurses Association has set a “zero tolerance” policy for workplace violence and bullying from any source, and its “Incivility, Bullying, and Workplace Violence” resources include downloadable graphics spotlighting best practices for preventing bullying and promoting civility, handbooks, and tip cards on how to respond to bullying in the workplace.
The Joint Commission launched an online Workplace Violence Prevention Resources Center last fall, following research, including a 2014 Health Risk Appraisal by the American Nurses Association, which found that 21% of registered nurses and nursing students reported being physically assaulted, and more than 50% were verbally abused within a 12-month period.
Healthy Workforce Institute provides an array of resources, articles and blog posts from author, speaker, and anti-bullying expert Renee Thompson, DNP, RN, CMSRN.
Indeed, effective nursing leadership may be the missing link in the successful mitigation of bullying,3 but a substantial barrier to more effective nurse management is education. Education to develop leadership and management skills must be provided in order to create healthy work environments,3 but training programs that actually address workplace bullying are lacking.
“In my experience, I’d say 95% of all managers have never been trained on how to deal with bullying behavior,” Thompson noted. “There needs to be curriculum for leadership development that’s specific on how to deal with disruptive behaviors. We need to do a much better job supporting frontline managers and teaching them how to set behavioral expectations, hold people accountable, and confront bullying behavior.”
Many nurses and nurse leaders are currently working to stop the cycle of bullying, but it is difficult due to the pervasiveness of the problem. Communication techniques, conflict management skills, and positive self-care activities can be taught to individual nurses, but without both individual and managerial interest and investment in such programs, the problem of nurse bullying will only continue to worsen. As Thompson stressed, “There needs to be individual, practice-wide accountability. Eliminating bullying isn’t just the boss’ job. It’s everybody’s job.”
1. Spector PE, Zhou ZE, Che XX. Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review. Int J Nurs Stud. 2014;51(1):72-84. doi: 10.1016/j.ijnurstu.2013.01.010.
2. Simons SR, Mawn B. Bullying in the workplace—a qualitative study of newly licensed registered nurses. AAOHN. 2010;58(7):305-311. doi: 10.3928/08910162-20100616-02.
3. Hutchinson M, Hurley J. Exploring leadership capability and emotional intelligence as moderators of workplace bullying. J Nurs Manag. 2013; 21(3):553-562. doi: 10.1111/j.1365-2834.2012.01372.x.
4. Rocker CF. Responsibility of a frontline manager regarding staff bullying. Online J Issues Nurs. 2012;17(3):6.
5. Gaffney DA, Demarco RF, Hofmeyer A, Vessey JA, Budin WC. Making things right: nurses’ experiences with workplace bullying—a grounded theory. Nurs Res Pract. 2012;2012:243210. doi: 10.1155/2012/243210.
6. Lux KM, Hutcheson JB, Peden AR. Ending disruptive behavior: staff nurse recommendations to nurse educators. Nurse Educ Pract. 2014;14(1):37-42. doi: 10.1016/j.nepr.2013.06.014.