Introduction
Workplace bullying is a major problem that has continually escalated in many health care organizations in the United States. Similar to other professions nurses experience bullying in places of work, and this subsequently affects the delivery of services by the affected nurses. Bullying in nursing has various impacts on the working environment of nurses and provision of quality health care to patients. Workplace bullying has adverse effects on the nursing profession. It is described as repetitive abuse whereby the victim suffers from bullying behaviors such as verbal abuse, physical assault, intimidation, humiliation or threats issued by the perpetrator (Murray, 2009). These bullying behaviors adversely interfere with the victim’s job performance and job satisfaction. Consequently, this interferes with the provision of quality health care to the patients that lead to risks in safety of the patient’s health. Additionally, bullying affects the victim’s physical as well as psychological health (Lewis, 2006). For instance, an individual who experience bullying at the place of work may suffer from depression, feelings of isolation and anxiety. Other consequences may include job loss, and one may experience psychosomatic symptoms like sleep disturbances, headaches, nervous tension and eating disorders.
Furthermore, if the victim is subjected to bullying experiences for a long period he/she may develop post-traumatic stress disorders that could have long-term effects on the victim (McKenna et al., 2003). On the other hand, workplace bullying has various effects on health care organizations such as loss of employees and absences from work. Loss of employees due to bullying results to an increase in the health organization’s financial budget; this is mainly due to constant recruitment and training of new employees (Yıldırım, 2009). The purpose of this article is to analyze bullying situation nursing practice and examine the contributing factors to bullying. In addition the article will evaluate the contributing factors to bullying and come up with an action plan aimed at offering potential solutions to such situations.
A case in nursing practice
In my nursing practice, I was involved in a bullying situation while working in the medical-surgical unit. The unit supervisor asked me to document that I had provided care to a patient who had not been assigned to me. Therefore going as per the professional ethics I declined, and the unit supervisor was angered by my reaction and thereafter she continually put me down in the presence of patients and other members of staff. In addition, she started using demeaning language towards me and totally ignored me. Surprisingly she also convinced other members of staff that I was incompetent, and some started putting me down and using abusive language towards me. Moreover, most of the staff members stopped interacting with me in social settings and at work. In addition, despite my efforts to complete tasks on time and learn new procedures the unit supervisor would scold me all the time for no valid reason. These experiences had various effects on my psychological health in that I experienced sleep disturbances, felt depressed and headaches. However, I was able to recover from these experiences when I was shifted to work in the emergency wing that had an understanding supervisor.
In relation to the aforementioned issue, anger was the primary cause of bullying. The unit supervisor was angered by my decision when I refuse to document that I had provided care to a patient who had not been assigned to me. The unit supervisor felt that being an intern I was obligated to follow his instruction without raising any questions. In the event of my refusal to follow her instructions the supervisor raised her voice towards me and falsely accused me of wrongs I had not committed. For instance, she accused me of rudeness, arrogance and incompetence in handling patient. In addition, she started mocking me in front of patients and other members of staff and used demeaning language towards me. Furthermore, the unit supervisor reported me the nurse manager falsely accusing me of various wrongdoings. To my surprise the nurse manager believed that I had committed all the wrongdoings and thus, summoned me to her office. Thereafter, the nurse manager heavily scolded me and threatened me that she would terminate my internship if such a situation arose again.
Additionally, the unit supervisor convinced other members of staff in the unit that I had abused her, and I was incompetent. Furthermore, she completely ignored me and often refused to answer my questions. She would often giggle when she met me, and her behavior made other staff members in the department to believe that I was arrogant, and they stopped socializing with me. On the other hand, I believed that I had correctly acted as per the professional ethics and the organizational regulations. Despite her behavior, I went and apologized to her knowingly that I had not committed any mistake but believed that it was necessary so as to avoid further confrontations with her. However, she retorted back to me and even told me that she believed that I should have chosen another profession. After several weeks of harassment by the supervisor and other members of staff in the department, I developed various psychosomatic symptoms. Luckily, the nurse manager carried out investigations and found out that I had not committed any wrongdoing. Thereafter she shifted me to work in the emergency wing that had an understanding unit supervisor who appreciated my efforts and assisted me in learning new procedures.
Based on the situation I experienced horizontal as well as vertical bullying. Vertical bullying is described as a type of bullying whereby a unit supervisor or nurse managers bullies nurses whom he or she supervises (Randle, 2003). On the other hand, horizontal bullying is described as a type of bullying whereby a nurse may bully their colleagues. This often involves older nurse bullying newer nurses since they are more experienced and believe that newer nurses are incompetent in performing various tasks. Thus, the type of bullying that was subjected to me by the unit supervisor can be described as vertical bullying while that inflicted by other nurses can be termed as horizontal bullying.
Application of Literature
According to Murray (2009) workplace bullying can b e described as repetitive abuse whereby the victim suffers intimidating, verbal abuse, threats and humiliating behaviors caused by the perpetrator. Subsequently, this interferes with the victim’s job performance and risks the safety as well as the victim’s health. Additionally, bullying demoralizes the victim’s dignity and makes an individual feel defenseless in the workplace (Vessey et al., 2009). Subsequently, this may cause an individual to quit the profession or seek employment elsewhere. Similarly, the National Institute for Occupational Safety and health (NIOSH) describes workplace bullying as any form of physical assault, verbal abuse or threatening behavior in places of work. The aforementioned behaviors are caused by the perpetrator towards the victims may have adverse effects towards the performance and physical as well as psychological health of the victim. The American Nurses Association (ANA) recognizes that nurses have the fundamental right to perform their duties in healthy working environments that are free of any form of abusive behaviors. In addition, ANA provides various resources to the health care system in the United States aimed at protecting nurses from bullying. According to ANA abusive behaviors common in places of work include intimidation, bullying, lateral abuse, sexual harassment, hostility and abuse of authority. Studies carried out by ANA show that between eighteen and thirty-one percent of registered nurses in the United States have been victims of bullying behaviors in their places of work. Various factors have been identified as the main reasons as to why some individuals bully others. The first reason is the perpetrator’s need to be in charge of all or various aspects in the working environment (Quine, 2001). Secondly bullying may be due to the perpetrator’s personality flaws. This includes exaggerated self-sense, the need to be charmed by others or lack of guilt. However, despite various efforts by ANA and other key players in the health care sector to protect nurses from victimization in places of work, numerous cases of bullying have been recorded. On the other hand, some cases of bullying are not reported since the victims fear losing their jobs or experiencing further harassment in instances where the authorities may support the perpetrators (Vessey et al., 2010).
Therefore, all the stakeholders in the health care industry should work together to stop bullying in places of work and ensure that nurses work in healthy working environments. Health care organizations should develop and implement zero-tolerance legislation and policies to any form of abuse in places of work (Rocker, 2008). Moreover, nurses should work together in cooperation to avoid horizontal and vertical bullying. However, the process of implementing these policies requires a multidisciplinary approach thus all team players should work together to ensure their success (Rippon, 2000).
Therefore, in order to stop bullying all the team players in health care organizations should acknowledge that bullying exists and work collaboratively to bring to an end such cases. The first step that should be undertaken to decrease or end bullying of nurses is educating nurses on their rights and the appropriate actions to take when such bullying situations exist. For instance, an individual can seek help from federal and state professional organizations such as ANA, the justice department or state nursing associations (Randle et al., 2007). In addition, nurses should familiarize with the organizational procedures and policies in relation to harassment and bullying. Having knowledge of the policies and procedures laid down by the organizations helps nurses to know the appropriate action when one is confronted by a bully. The other step to take is the a nurse should document bullying incidences that he/she encounters including the occurrence site, date, witnesses and the time of occurrence (Johnston et al., 2009). This provides supporting evidence to ensure that necessary legal actions are taken against the perpetrator. In addition, nurses should “report bullying incidences using the appropriate channels within the health care organization and if need be to outside agencies such as professional nursing organizations”. Nurses should also cooperate with each other to prevent horizontal and vertical bullying (Johnson et al., 2009). For instance, a nurse should call for immediate help when he/she witnesses a co-worker being bullied and offer to provide evidence as a witness in a meeting that is called to address the situation. This can be effectively done by documenting the events or through sworn testimonies in support of the bullied co-worker (Johnson, 2009). Nurses should also be actively involved in the development of anti-bullying programs since majority cases of bullying involve nurses in health care organizations. Additionally, the involvement of nurse in the development of anti-bullying policies enables them to take responsibility and ownership in implementing these policies in the working environments (Jackson et al., 2002). Nurse Managers play a critical role in addressing issues of workplace bullying and should work collaboratively with nurses to ensure that bullying cases are prevented in health care institutions. Nursing leaders should prevent bullying by encouraging team work as well as team building between nurses as a way of promoting sensitivity and flexibility to each other’s needs (Cleary et al., 2010). Nurse Managers should develop a code of conduct that is unit-based that should be written in collaboration with nurses aimed at eliminating bullying or harassment. In addition nursing, leaders should empower members of staff to report the perpetrators of bullying without fear of being retaliated. Leaders should also discuss incidents of bullying in staff meetings so as to address these incidences (Dellasega, 2009). Moreover, nursing managers should provide staff with effective strategies and skills in conflict management aimed at eliminating bullying incidences. Nurse leaders should also promote a culture that condemns any form of bullying and ensure openness and trust to enable staff members report bullying incidences without fear of victimization (Beech and Leather, 2006). Additionally, nursing leaders should positively celebrate bully-free working environments as a way of promoting healthy working environments in the health care system. For instance, the leaders can organize an awareness week aimed at creating awareness in regard to bullying and ensure healthy working environment. Thus, nurses should understand that silence encourages bullying and therefore it is the responsibility of every nurse to report incidences bullying incidences either as a victim or witness.
Therefore based on the analysis I would take the following measures if such a situation arose again. First is that I would document the bullying incident taking into account the time, witnesses, date and site of occurrence. The second step is that I would report the incident with documented evidence to the nurse manager and if no action is undertaken report the incident to the appropriate federal or state organizations for assistance.
Conclusion
In conclusion, nurses and health care leaders should work in collaboratively to ensure healthy working environment for nurses that if free from harassment and abuse. Therefore, nurses and nurse managers should recognize that harassment and bullying is a problem that affects nurses. As such there is a need to work together in developing and implementing procedures and policies that promote healthy working environment for nurses (Brink, 2009). Additionally, nurses should promptly report all bullying incidences whether directly or indirectly affected and understand that silence perpetuates further bullying by empowering the perpetrators to continue with their actions. Nursing leaders and all key players in the health care system should promote teamwork in places of work and adopt a culture that condemns bullying as a way of preventing harassment and bullying. Lastly nurses and all stakeholders in the health care industry should promote dignity among all the health care professionals. This is important since dignity encourages respect that is the most important attribute towards eliminating bullying in places of work.
References
Beech, B., & Leather, P. (2006). Workplace violence in the health care sector: A review of staff training and integration of training evaluation models.Aggression and violent behavior, 11(1), 27-43.
Brink, A. (2009). The bully at work: What you can do to stop the hurt and reclaim your dignity on the job. Sourcebooks, Inc..
Cleary, M., Hunt, G. E., & Horsfall, J. (2010). Identifying and addressing bullying in nursing. Issues in mental health nursing, 31(5), 331-335.
Dellasega, C. A. (2009). Bullying among nurses. AJN The American Journal of Nursing, 109(1), 52-58.
Flateau-Lux, L. R., & Gravel, T. (2014). Put a Stop to Bullying New Nurses.Home healthcare nurse, 32(4), 225-229.
Jackson, D., Clare, J., & Mannix, J. (2002). Who would want to be a nurse? Violence in the workplace–a factor in recruitment and retention. Journal of nursing management, 10(1), 13-20.
Johnson, S. L. (2009). International perspectives on workplace bullying among nurses: a review. International Nursing Review, 56(1), 34-40.
Johnson, S. L., & Rea, R. E. (2009). Workplace bullying: Concerns for nurse leaders. Journal of Nursing Administration, 39(2), 84-90.
Johnston, M., Phanhtharath, P., & Jackson, B. S. (2009). The bullying aspect of workplace violence in nursing. Critical Care Nursing Quarterly, 32(4), 287-295.
Lewis, M. A. (2006). Nurse bullying: organizational considerations in the maintenance and perpetration of health care bullying cultures. Journal of Nursing Management, 14(1), 52-58.
McKenna, B. G., Smith, N. A., Poole, S. J., & Coverdale, J. H. (2003). Horizontal violence: experiences of registered nurses in their first year of practice. Journal of advanced nursing, 42(1), 90-96.
Murray, J. S. (2009). Workplace bullying in nursing: A problem that can’t be ignored. Medsurg Nursing, 18(5), 273-276.
Quine, L. (2001). Workplace bullying in nurses. Journal of Health Psychology,6(1), 73-84.
Randle, J. (2003). Bullying in the nursing profession. Journal of Advanced Nursing, 43(4), 395-401.
Randle, J., Stevenson, K., & Grayling, I. (2007). Reducing workplace bullying in healthcare organisations. Nursing Standard, 21(22), 49-56.
Rippon, T. J. (2000). Aggression and violence in health care professions.Journal of advanced nursing, 31(2), 452-460.
Rocker, C. F. (2008). Addressing nurse-to-nurse bullying to promote nurse retention. Online Journal of Issues in Nursing, 13(3).
Vessey, J. A., DeMarco, R. F., Gaffney, D. A., & Budin, W. C. (2009). Bullying of staff registered nurses in the workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments. Journal of Professional Nursing, 25(5), 299-306.
Vessey, J. A., DeMarco, R., & DiFazio, R. (2010). Bullying, Harassment, and Horizontal Violence in the Nursing Workforce The State of the Science. Annual review of nursing research, 28(1), 133-157.
Yıldırım, D. (2009). Bullying among nurses and its effects. International Nursing Review, 56(4), 504-511.
