In a time of great competition in the post-pandemic healthcare marketplace, hospitals and other facilities are smart to find ways to differentiate themselves from the many choices consumers can access. We all vote with our feet and wallets when it comes to how we spend our healthcare dollars, and poor treatment at a hospital or clinic is a high likelihood that we’ll seek care elsewhere.
Likewise, employees also vote with their feet, and we can’t retain nurses when, despite special labels like Magnet, we allow bullying and other aberrant behaviors to thrive within a negative workplace culture.
Designations like Magnet status are ways healthcare organizations can demonstrate their striving for excellence. But what happens when an unhealthy or toxic organization hides behind something like a Magnet designation, ignoring systemic issues that fancy words, plaques, and awards won’t fix?
A Fox in the Magnet Henhouse
I recently spoke with a dedicated, well-educated, experienced, intelligent, and successful nurse who, up until earlier this year, worked for a Magnet facility somewhere in the U.S. The Magnet designation is designed to be a magnet for high-quality nurse clinicians, and this nurse is a person of great integrity and professionalism whom this employer was lucky to have on staff.
During her work on several hospital units, this individual was targeted by what we might call a “queen bully.” The bully nurse was highly experienced, had worked for the organization for many years, and was seen as a leader and an indispensable employee by the administration.
Tragically, the nurse I spoke with was psychologically traumatized by the bully and the other employees who colluded with her behavior. This nurse’s reports of being harassed were dismissed and ignored, and she eventually had to take a leave of absence to pursue psychological treatment for post-traumatic stress. Meanwhile, the bully kept her job and faced no consequences whatsoever.
Based on her egregious bullying behavior, this nurse bully should have been fired years ago. Still, managers and executives were likely scared to death of her, and if a union was involved, firing her might have proven a highly challenging avenue they were hesitant to pursue.
Sadly, this nurse was allowed to “rule the roost” for years as a frightening and controlling fox willingly set loose in the hen house, and the nurse whom I spoke with had been one of her main targets for months.
A bully can bring down the morale of an entire or multiple units. If bullies can thrive and spin their nasty webs throughout a facility or organization, the entire workplace ecosystem and culture can be poisoned.
Confronting the Shadows
In the final analysis, a Magnet designation doesn’t make an organization great. Magnet status is also not a magic bullet or blanket blessing from the authorities that deems a facility perfect and free from flaws.
Creating a just, civil, highly functional, and effective organization may be enhanced by designations or awards like Magnet status. Yet, the hard work of making a healthcare institution a safe and happy place to work doesn’t stop when the plaque goes on the wall.
When weeding out bad actors like bullies, the administration must have the will and the backbone to confront the issue head-on. Likewise, employees must feel safe to document and report such issues without fear of retaliation or having their complaints dismissed out of hand.
No matter if a bully is a great clinician with years of experience — there must be zero tolerance for aberrant behavior, and consequences must be swift, decisive, and universally applied.
Every employee deserves to feel supported in doing their best work. They likewise need to be able to trust that they will be protected from those who would do them harm. No staff member should live in fear of bullying, discrimination, harassment, or any other type of negative treatment, and it is the responsibility of the organization to create a culture that affirms positivity and trust and rejects anything less than perfect civility and kindness.
The work of achieving Magnet status is a lovely ideal with very real-world applications when truly operationalized. However, every workplace has a shadow, and it is from confronting that shadow and cleansing the organization’s darkest corners that a more civil, functional, and effective institution arises.
Magnet status is something to reach for, but only in the context of the hard work it takes to create a workplace to be proud of that is safe for all who walk through its doors.
We’ll be at the 2023 ANCC National Magnet Conference® October 12-14 at the at the McCormick Place Convention Center in Chicago, Illinois. Stop by booth #918. We look forward to seeing you there!
Incivility in nursing education has become an increasingly bothersome problem; however, it has especially become a nuisance in online education. Suplee, Lachman, Siebert, and Anselmi (2008) indicated that a faculty witnesses daily encounters in classes and clinical settings. Incivility is defined as behavior that is unprofessional, rude, and disrespectful. It can result in burnout and psychological and physiological distress for the parties on the receiving end, especially if left unaddressed (Butler & Strouse, 2022).
Another term that has especially been seen in the online realm is bullying, which can occur student-to-faculty and faculty-to-student. Unfortunately, it can also occur in faculty-to-faculty (Butler & Strouse, 2022). There has been an increase seen in student-to-faculty students’ displeasure with their achieved grades.
We must evaluate the reasons that the behavior is happening.
Stress from many walks of life can be the culprit, including working too many hours, mismanagement of work-life balance, stressful work assignments, financial strains, relationship strains, biases, and so on. Butler and Strouse (2022) also indicated that burnout and demanding workloads contribute to the greatest stressors. Personally, I have observed these behaviors displayed when providing constructive criticism. How can we, the faculty, help to ease the burden and create the traditional professional environment that many of us were able to participate in our educational journey?
As a part of a nursing faculty for ten years, I feel it is my calling. I enjoy helping deploy educated and competent novice nurses and advanced practice nurses into the workforce. However, the stress and incivility sometimes make one feel burned out. Many of us ponder going back into the clinical setting, feeling unappreciated and undeserved.
Caputi (2015) reported that the faculty can assist students in engaging in constructive evaluation of themselves and others. One factor is professional maturity, which can allow the students to analyze their own performance. As a faculty, providing feedback that is useful in the workplace and not hurtful can be helpful for growth and development. Self-reflection and guided introspection can be useful (Caputi, 2015). Discussing values, morals, attitudes, and the AACN essentials, pertaining to professionalism and leadership can be useful in developing students with incivility and assisting students in understanding (Caputi, 2015). However, the most important element is support from the administration and the appropriate follow-up and disciplinary actions.
Nursing has a hierarchy of power and experience like any other profession; it also has a hierarchy that sometimes feels akin to the laws of survival on the savanna or in the jungle – the herd mentality at work.
Have you ever observed that the less experienced and more vulnerable nurses frequently get left on the outside, often falling prey to bullies and “predators”? This is the herd mentality at its worst, and many novice nurses are taken down by bullies and power-hungry colleagues who eat them alive when they’re demonstrating the slightest weakness.
Protection and Predation
Out on the African savanna, herds of gazelles keep watch for lions, one of their most fierce predators; the culling of the pack is a natural phenomenon, and lions need to eat just like anyone else. However, some naturalists notice that the sicker, older gazelles are left outside the herd, vulnerable to predation and outside of the safety of the circle. Young gazelles are naturally kept on the inside, their parents and elders protecting them and keeping them close, with the innate understanding that they are the carriers of the gene pool which need to survive into adulthood so that the species can thrive in the future.
In the healthcare environment, we often see a herd mentality; in this scenario, the experienced nurses make up the bones of the innermost circle of safety, and survival of the fittest is frequently the name of the game. But what about the newer nurses? Where are they in the hierarchy?
A Med/Surg Herd
Let’s consider a large Med/Surg unit where we find a mix of older, highly experienced nurses, some nurses two to five years into their careers, and several fresh-faced novice nurses in their first year.
Now let’s imagine a bully in the mix; she’s a nurse with 25 years of experience, a toxic personality, and a stranglehold on the unit culture. The administration is afraid of her, the nurse manager turns a blind eye to her egregious behavior, and most nurses keep their heads down and hope she doesn’t pick on or single them out.
The older, more experienced nurses may be relatively safe from the bully; they’ve known her a while, put up with her toxicity, humor her, or perhaps ignore her as much as they can to not call attention to themselves. Their silence is essentially complicity, and some may play into the bullying and tacitly empower her aberrant behavior. A bully can sometimes be a younger nurse who bullies older nurses, too; this power dynamic can work in both generational directions.
The New Nurse: Falling Prey to the Lion
Meanwhile, the newer nurses are fresh blood for the bully/lion/predator; they are unsure of themselves, need to ask questions, and are vulnerable to being singled out and stalked by the bully and her minions.
If the members of the nursing herd try to stay out of the bully’s way – or support her in being the bully – what does that mean for the newer nurses? It generally means they are kept outside the circle of protection and safety, left to fend for themselves against the nurse predator.
If you think of the nurses on the unit as a herd, the young are left outside to fend for themselves. The elders are primarily held in the center, cushioned against the attacks of the predator/bully; however, an elder nurse can also be deemed weak by the “herd” and thus ostracized to the fringes.
The calculus of this situation is untenable and unhealthy, with certain nurses receiving the short end of the stick; vulnerable novice nurses need nurturing and support, not the feeling of being thrown to the lion(s).
Extending the Circle of Safety
To counteract a situation that lends itself to the burnout and attrition of newer nurses (as well as those seasoned nurses who are vulnerable to bullies), the circle of safety needs to extend its protection to everyone. Rather than leaving more vulnerable colleagues to be picked off the edge by predators and bullies, the circle closes around those needing its reassuring sanctuary, whether older, younger, or somewhere in between.
Dr. Renee Thompson, one of the world’s foremost experts on nurse bullying and incivility in the healthcare workplace, has documented and communicated the subtleties and vicissitudes of this scourge through books, blog posts, articles, podcasts, keynote speeches, videos, social media, and the powerful work of the faculty of her Healthy Workforce Institute. As Dr. Thompson informs us, we must learn to speak up in the face of bullying and to protect those members of our team who are susceptible to a form of professional predation that sends many a nurse running for the exit, often leaving the profession altogether.
We must reject the adage that nurses eat our young; we can create and embrace a new paradigm where nurses nurture and empower their young instead.
This isn’t rocket science, but we nurses need to learn the skills that will help us to bully-proof ourselves, speak up in the face of bullying, end nurse predation, and enclose our colleagues in a circle of safety that keeps the lions on the outside and the vulnerable protected from harm.
We can make different choices, and it’s our daily decision regarding our path. I implore you to extend the circle of safety, protect the vulnerable, and bring a sense of community, safety, and symbiotic togetherness to your corner of the nursing world.
Minority Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
It is generally agreed that a vast majority of nurses choose the profession because they find fulfillment in being of service to others in their time of need.
Compassion, empathy, and kindness are hallmarks of what “nursesness” is all about, and even members of the general public are likely to associate those characteristics with nurses. And by now, we’re all aware that nurses have been at the top of the Gallup poll as the most trusted professionals in the U.S. every year for two decades.
In light of the mystique of compassion and kindness that surrounds nurses like a golden aura, why is it that stories of nurses being unkind to one another are so rampant? What about nurses making us treat one another so poorly, leading many nurses to leave the profession altogether?
Incivility Abounds
Stories of incivility, bullying and other unfortunate experiences are ubiquitous among nurses, and common refrains repeated again and again within the nursing sphere tell us that something is wrong out there.
A new grad nurse tells the story of a preceptor who seems determined to sabotage her orientation period, assuredly setting her up for failure and job loss.
A quiet, hardworking nurse becomes the undeserving target of rude and demeaning behavior by the “queen bully” on her unit. Other nurses follow the bully’s lead when it comes to treating this nurse with disrespect.
Several student nurses realize that their clinical instructor has it in for them, ignoring their requests for help during clinical rotations and harshly criticizing them in front of patients and peers.
Nurse bullying has received significant study, including the National Library of Medicine’s documentation of this unfortunate phenomenon:
Nurse bullying is a systemic, pervasive problem that begins well before nursing school and continues throughout a nurse’s career. A significant percentage of nurses leave their first job due to the negative behaviors of their coworkers, and bullying is likely to exacerbate the growing nurse shortage. A bullying culture contributes to a poor nurse work environment, increased risk to patients, lower Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores, and greater nurse turnover, which costs the average hospital $4 million to $7 million a year. Addressing nurse bullying begins with acknowledging the problem, raising awareness, mitigating contributing factors, and creating and enforcing a strong antibullying policy. Nurses and stakeholders also must actively work to change the culture, and understand that bullying has no place in the nursing profession or anywhere else in health care.
These statements are sadly true, and the problem is too well documented to ignore.
A Cultural Transformation
Within the nursing profession, a cultural transformation is desperately needed. Rather than nurses internalizing their oppression and taking it out on one another, members of this most trusted profession could choose to individually and collectively examine how they feel oppressed, mistreated, and otherwise overlooked. This type of examination can lead nurses to band together to create workable solutions without turning on one another like crabs boiling in a pot.
In terms of nursing education, schools of nursing need to confront bullying and incivility head-on. And since schools are so keenly focused on NCLEX preparation, this topic needs to become a part of the licensing exam curriculum so that schools have no choice but to talk about it. This ever-present reality must be thoroughly acknowledged, and schools should teach nursing students how to recognize such behavior and respond appropriately. And if clinical instructors and nursing professors are identified as perpetrators, they should be disciplined and fired if their behavior does not change.
There is no silver bullet that can singlehandedly change these dynamics overnight. However, one action by a nurse, executive, instructor, or manager can have a significant ripple effect. Nursing is uniquely positioned to be the largest segment of the healthcare workforce. We can squander or harness our potential power for our well-being. Nurses join collective action, striking for safe staffing, patient safety, or other needed changes. Positive change can be hard-won, but the camaraderie and unity it engenders are priceless.
Nurses deserve better from one another, and we can only effect change if we’re willing to do the work to dismantle a professional culture that looks the other way. Unfortunately, ignoring the problem won’t get rid of it, so let’s tackle it head-on and stop the hemorrhaging of nurses who would likely remain on the job if they were simply treated like the valuable human beings they truly are.
Minority Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
Nurse bullying is a big problem in the profession, but it’s under reported and not addressed as effectively as possible. And the reason isn’t as simple as nurses not wanting to speak up.
Sometimes nurses aren’t even sure the horrible behavior they are being subject to is actually bullying, says Dr. Renee Thompson, DNP, RN, CMSRN, and CEO and president of RT Connections, LLC, and author of “Do No Harm” Applies to Nurses, Too!,.
Bullying behavior can be quite obvious, but it’s just as often something so subtle the target isn’t even sure if the actions are intended. “Bullies will test the waters,” she says. “They will do something and see the reaction they get. If they are resisted, they will usually, but not always, stop it.” But if the behavior isn’t addressed immediately, the bully takes on power and the behavior can escalate.
What are some things to watch out for?
True nurse bullying behaviors and unintended coincidences can be separated by the pattern and the repetition you will see over time.
The most obvious, and for some nurses easiest to deal with, bullying is the in-your-face colleague who is yelling at you and insulting you. There’s no doubt what’s going on there.
But other things are much harder to really pin down. Dr. Thompson recalls hearing a story from a nurse who won an award and soon found herself with the most acute patients and more cases than any other nurses on the floor during her shifts. The nurse wasn’t sure if she just had a bad luck of the draw, but then she overheard a charge nurse indicating that it was on purpose to bring her down a few notches from her award. Startled, the nurse identified what was really happening.
Other times, nurses create situations to have other nurses fail. Maybe during hand off you weren’t given all the information you needed. “They set you up to make a mistake and then write you up for it,” says Dr. Thompson.
And what about the times when all the nurses wear the same jacket or they all order out lunch together and exclude one person? Or if a few nurses gossip at work and spread rumors? All these behaviors seem petty, but they really happen at some workplaces.
If you have ever seen or experienced these behaviors, Dr. Thompson says it’s a good idea to track what you see. Carry a small notebook and jot things down over a couple of weeks. “You are looking for a pattern,” she says, “not a one-time incident.” Even if you end up doing nothing with the information, Dr. Thompson says the very act of documenting can help you because it can help you establish a clear pattern of bullying. It can be a relief to know it’s not just your imagination.
Then you can choose a few options. You can confront the person in a respectful manner that’s supported with facts (which you now have thanks to that handy notebook!). You can say something like, “I noticed this is the fifth time in a row when you were in charge that I got all the patients with the highest acuity. Can you help me to understand why that is?”
If you aren’t comfortable going to your direct supervisor, you can consider going to your supervisor’s supervisor. You can also approach human resources, says Dr. Thompson. Check your company’s policy on destructive behaviors so you can present a clear case on what specific behaviors have been violated.
And, of course, if you can relate what is happening to how it impacts patient safety or patient care, you have a greater chance of someone doing something about it, says Dr. Thompson. If you went to a charge nurse at 2 am and asked about a patient in crisis and were told to handle it yourself, you have a clear example of how the actions are impacting patient care.
And Dr. Thompson doesn’t wear rose-colored glasses when it comes to nurse bullying. If your boss is best friends with the VP of human resources or with everyone in her line of command, you might want to just leave. “Get out,” says Dr. Thompson. “It’s just not worth it and you can go find a better place. You deserve to work in a great place.”
