The pervasive influence of nurse bullying

Combating bullying in schools and workplaces (the hospital) is a topic that we’ve heard a lot about, especially recently.  When it comes to the work environment, bullying involves an abuse or misuse of power. Specifically, it refers to the repeated, unreasonable actions of an individual directed towards an employee, which are intended to intimidate, degrade, humiliate, undermine, or create a risk to the health or safety of the employee.

Workplace bullying behavior creates feelings of defenselessness and injustice in the victim and undermines an individual’s right to dignity at work. It's important to distinguish bullying from aggression. Whereas aggression may involve a single act, bullying involves repeated attacks against the target, creating an on-going pattern of behavior.

“Tough” or “demanding” bosses are not necessarily bullies as long as they are respectful and fair, and their primary motivation is to obtain the best performance by setting high yet reasonable expectations for working safely.

Horizontal vs. vertical violence

Also sometimes called horizontal violence, horizontal bullying refers to acts perpetrated over time by co-workers on the same level. (e.g., staff nurse to staff nurse, nurse manager to nurse manager).

Vertical bullying, or violence, is defined as acts such as yelling, withholding pertinent information, ignoring, humiliation, or making rude comments, which occur between two or more persons on different levels of the hierarchical system and prohibits professional performance or satisfaction in the work environment. Vertical violence occurs between individuals at different power levels on the nursing hierarchy and may be directed downward (e.g., nurse manager to staff nurse) or upward, (e.g., staff nurse to charge nurse).

Both horizontal and vertical violence is considered nurse-on-nurse aggression, expressed through abusive verbal and nonverbal behaviors intended to inflict psychological pain. Abuse of formal and informal power by individuals or cliques of coworkers are behaviors that undermine the work of a nurses and the entire healthcare team.

Impact of bullying

Some examples of workplace bullying are:

• unwarranted or invalid criticism
• blame without factual justification
• being treated differently than the rest of your work group
• being cursed at
• exclusion or social isolation
• being shouted at or humiliated
• excessive monitoring or micro-managing
• being given unrealistic work deadlines.

Workplace bullying has many negative effects on the entire work team. Feelings of inadequacy and depression may surface after being victimized. These feelings lead the victim to question his/her abilities and whether he/she can care for patients adequately. Physical symptoms may manifest after the act, such as fatigue, insomnia, and an array of other physical and emotional complaints.

Recruitment and retention of the healthcare workforce is also directly impacted by horizontal and vertical violence. Word travels through nursing circles that certain organizations have employees who do not appreciate nurses.

As workplace bullying continues to  plague the nursing profession, the worst-case scenario would be if nurses decide to leave the profession altogether.

Putting a stop to bullying

To halt the progression of the bullying epidemic, the nursing profession and the healthcare system must initiate measures to identify, counsel, and eliminate it. A zero tolerance policy should be adopted to prevent violent behaviors.

Keep the lines of communication open through forums, staff meetings, and educational programs to promote a feeling of obligation to report such violent acts without being fearful of repercussions.

Nurse leaders should constantly be on the lookout for bullying behavior and should initiate counseling of the perpetrator and the victim. Training on how to deal with negative behaviors can promote positive outcomes for the nurses who may have to deal with bullying.

For the perpetrator, counseling should occur in a nonthreatening manner with a collaborative action plan developed to eliminate negative workplace behaviors. There are instances where the perpetrator may be unaware that his/her actions are perceived adversely.

Continuation of these behaviors will leave a negative impact on nursing students, healthcare organizations, and nursing as a whole.

Do you observe bullying in your workplace, or have you ever been a victim?  Leave us a comment below with your thoughts.

For further information, check out the “Horizontal Bullying” course from the Lippincott Professional Development Collection online course library which is CE-accredited for 0.5 contact hours.

To learn more about obtaining the full course library for your facility, click here.