Many nurses are sensitive to bullying behavior from others in the workplace – fellow nurses, doctors, administrators, and even patients – but not to that of their own. Bully or bullied, it’s no fun to experience a hostile healthcare workplace.
For example, though it’s often said that “nurses eat their young.” Those same recent grads may find themselves more competent in some areas than older nurses, such as being tech-savvy.
They then don’t hesitate to give their elders abuse about discomfort using new technology, say. They may use the impatient, hostile voice, or rude body language (eye rolls?) that they may suffer in their first years on the floor.
Sometimes a nurse can be both a victim and a perpetrator at the same time. Or in different situations. Or with different co-workers. Or on a different shift. Or with a different nurse manager. Or when especially stressed.
It pays to look honestly at how you relate to others in your workplace so that you can stamp out your own bullying behaviors.
Laura A. Stokowski, RN, MS, provides a detailed list of bullying behaviors that many experts have identified in A Matter of Respect and Dignity: Bullying in the Nursing Profession on Medscape Nurses, Here’s a short excerpt from that piece:
Refusing to speak to a colleague, being curt, giving the “silent treatment,” or withholding information (setting someone up to fail);
Unwarranted or invalid criticism, excessively monitoring another’s work;
Physical or verbal innuendo or abuse, foul language/swearing;
Raising one’s voice, shouting at or humiliating someone;
Treating someone differently from the rest of the group, social isolation;
Asking inappropriate and/or excessive questions about personal matters or teasing about personal issues;
If any of these behaviors seem familiar because you yourself tend to resort to them, that’s probably an uncomfortable realization. Give yourself credit, though, for admitting to the truth. Now you can go about fixing the problem, because in the final analysis — even bullies don’t like bullies.
Jebra Turner is a health writer in Portland, Oregon. You can visit her at www.jebra.com.
Brittney Wilson, RN, BSN, also known as “The NerdyNurse,” blogs at thenerdynurse.comand authored The NerdyNurse‘s Guide to Technology. But a love of technology wasn’t the genesis of her blogging journey.
“What led me to starting my blog was a negative experience as a floor nurse. I was bullied by most everyone in the department. I complained to everybody I could, but nothing happened,” she remembers. “Then I went online to see if anyone had experienced some of the same things and could maybe help me. I started compiling information on lateral violence in nursing, and sharing it on my blog.”
Wilson worked on that floor for three years, and finally did see improvement in the bullying situation. But it came after she’d decided to train in clinical informatics as a way of combining her interest in both nursingand technology.
What turned things around? Plenty of difficult conversations with her manager and HR. “My boss got disgruntled with me when I brought up the term harassment. But then she backed off. Basically, when I let her know that I felt she was allowing the situation to occur, and that legally it was an issue, then her tune changed,” she explains.
“Also, I was ultimately moved to night shift. Getting away from the toxic nurses really made a big improvement, and I think being on night shift and being ‘out of sight/out of mind’ of the manager made things much easier for me.”
Wilson encourages nurseswho are being bullied to speak up. Ask co-workers and even patients who witnessed the harassment to speak to management, but don’t count on it. Ask your manager to conduct an investigation into your claims by interviewing other staff members.
What if that doesn’t improve the situation? Wilson suggests a bullied nurse first start with “their manager, then director, then DON, and possible even the CEO. A nurse must make sure he/she has attempted to follow the chain of command before involving someone from outside the organization.”
After that, consider then involving your nursingorganization (if a member), state board of nursing, accrediting agencies, and news organizations.
Wilson believes that blogging about her personal experience of being bullied helped make her stronger as a person and as a nurse. (Sometimes growth is painful.)
Though the treatment she experienced from the bullies on her floor could never be excused, it ultimately led to her new career in informatics and a blog that’s helped other tormented nursesto survive – and thrive.
Jebra Turner is a health writer in Portland, Oregon. You can visit her online at www.jebra.com.
Nurse-on-nurse bullying. Lateral violence. Hostile work environment. These are common terms for what’s sadly a common situation in many health care environments.
If you’re being bullied, it can help to have a “script” that helps you face your harrasser. Peggy Klaus, a Berkeley, California, a leadership and communication coach, has taught courses on difficult conversations for nurses, physicians, and medical students.
Here she offers some recommendations but doesn’t propose a one-size-fits-all solution. “We each have our own level of tolerance,” explains Klaus, “You have to be vigilant and see how it’s affecting you, and how it may be impeding your effectiveness. That’s especially important when you’re working in the crucial role of a nurse.”
1. Talk to your supervisor. Assume that nursing leadership is going to want to be helpful. (Many hospitals are anxious to put a stop to employee-to-employee harassment, if only because it places them at risk for lawsuits, for allowing a hostile workplace or retaliation if they a nurse who has made a formal complaint.)
One possible script from Klaus…
“Have you ever been bullied? What did you do to solve the problem?”(Makes the conversation more personal, and you’ll be more likely to elicit empathy from your supervisor.)
“I’m concerned because If nurses aren’t being collegial, it greatly affects the hospital.” (Don’t emphasize your own distress as much as downsides your supervisor can relate to.)
“Patients don’t get the kind of care they need, our evaluations as individuals and as a group will suffer. I’ve been thinking a lot about this problem. I would be doing my group a disservice if I didn’t bring this up.”
2. Ignore the bullying. If that’s a possibility for you, you can decide to play along, be civil and respectful, and just go about your business.
“Don’t play low status, though,” says Klaus, “which comes out in verbal and nonverbal behaviors such as having slumped shoulders or ending sentences with an upward inflection as if asking a question or seeking approval.”
3. Confront the bully. Be direct, assertive, and respectful and talk alone in a private, confined space, such as a conference room. Group confrontation doesn’t work, so talk first with the lead bully, and if necessary, repeat with the others.
One possible script from Klaus:
“I’ve recently noticed behavior or signs that you’re trying to bully me and I want it to stop.” (Give a couple of examples and say how it affects you.)
“I really want to work this out between us and not involve higher ups or human resources.”
Ask for the bully’s input and end on a positive, affirming note: “I look forward to working well with you.”
If the behavior changes, but then the bully slips and starts up again, go back and have the conversation again.
“You know, things had gotten better but I noticed that this is increasing and it’s got to stop.”
4. If the bullying doesn’t stop, go higher up the chain of command until you get relief.
Jebra Turner is a health writer in Portland, Oregon. You can visit her online at www.jebra.com.
It’s common knowledge that bullies are mean, manipulative and moody. But do you know what to do when the bully is your boss?
Bullies exist in every workplace, but when nurses harass other nurses their harmful behavior can also affect patient care and safety.
Bullying is described as acts perpetrated by one in a higher level of authority, according to the Center for American Nurses. Workplace bullying includes verbal abuse and offensive conduct such as work sabotage. Abusive behavior from your supervisor or colleagues can make you feel like you are walking around with a bull’s-eye on your back. Being berated repeatedly by a co-worker erodes confidence, leads to mistakes, breeds burnout and affects your health.
So how do you fight back without mimicking the bullying behavior? Here are steps to take to deal with abusive behavior on the job:
• Speak up. Don’t suffer in silence. Ask for help. Go up the chain of command. Report the harassment to human resources if you have exhausted all recourses.
• Learn your organization’s policies about bullying.
• Keep your emotions in check. Bullies enjoy making you lose your cool. Remain rational.
• Protect your health. Take care of yourself to deal with on-the-job stress. Make time to engage in a hobby or an activity that relaxes you. Eat well, exercise regularly and get a good night’s sleep. Doing so will help you better cope with the negativity at work.
• Write down everything. Document incidents and problems. Save emails and other correspondence. Do not leave this information at work.
• Keep interactions professional. Limit your encounters, if possible.
• Create a supportive network at work. Having colleagues to talk to can minimize stress. They may also serve as witnesses.
• Confront the bully. Doing so may send a message that you are not an easy target. When standing up for yourself, try not to act like a bully with your response.
Nurses need a supportive work environment. Do your part to make sure bullies have no place on the job.
As a nurse, people rely on you. So it’s important for you to take care of yourself in order to take care of others – your patients, family, and friends. Workplace stress can derail your best efforts. It impairs your ability to function on the job, and to enjoy your life outside of work.
What do nurses find most stressful about their profession?
According to the National Institutes of Occupational Safety and Health, studies have generally linked these 11 factors with stress for nurses:
1. Work overload (too much to do, not enough time)
2. Time pressure (hurry, hurry, hurry – that’s due yesterday)
3. Lack of social support (particularly from higher-ups)
4. Exposure to infectious diseases
5. Needlestick injuries
6. Exposure to work-related violence or threats
7. Sleep deprivation (especially for shift workers)
8. Role ambiguity and conflict (ironically, “change initiatives” can confuse roles even more)
9. Understaffing (shortage of trained and/or experienced nurses)
10. Lack of career development options (limited opportunities for promotion)
11. Dealing with difficult or deathly ill patients (just a part of nursing, of course, but still stressful)
A dysfunctional organizational climate – conflict between co-workers and friction between management and staff – can cause nurses to feel unsupported and lead to even more workplace stress. On the flip side, nurses may thrive at work, but suffer from conflicting home and family demands on their time and energy.
Thankfully, many health care organizations do promote employee health, often with an emphasis on prevention versus patch-up repairs. They want their nurses engaged, enthused, and involved. Check to see if an employee assistance, wellness, or stress reduction program is available to you. (Often they’re free, or at a minimum, low-cost.) Or, if you’d like to access help on an informal basis, reach out to your co-workers and fellow members of professional nursing organizations for support.
So, do you agree with this list of top stressors? What kinds of stress do you face in your work? What methods of coping have you found to be the most effective?
Give us a shout – we’d like to hear your views about stress in the nursing profession.
Jebra Turner is a health reporter and former H.R. director for an ergonomics-focused firm, where she oversaw workplace health and safety training programs for staff and clients. She lives in Portland, Oregon, but you can visit her at www.jebra.com.
Entering the patient’s room, I immediately took note of the look on the elderly woman’s face. There was no way I could look past her grimacing. As an African-American male nurse, I had seen this look before and knew it was in response to my gender, my race or both. Pulling away from the side of the bed where I was standing, she demanded: “Where are all the white people?”
Busy and rushed for time as most nurses are, I was not sure how to handle this situation and still get my medication pass done in a timely manner. I did not think therapeutic communication or touch would work in this particular case. She would not let me get that close to her, either physically or emotionally. Acting as if I could not comprehend her, I offered her the medications that were ordered. She looked at the medicine cup and abruptly said, “I’m not going to take that!” Now the dilemma had evolved into how to distribute medication to this patient.
Who knows what was going through this woman’s mind? Maybe she thought that my being alone with her in her room was a perfect opportunity for racial retaliation: Here was this black man who was finally going to pay her back for centuries of racial injustices. More than likely, she felt I was not intelligent enough to follow the physician’s orders and that the meds I was offering her were incorrect. At this point, it was all irrelevant. My intention was to help her, but in her mind I only represented someone from a race she considered inferior and had spent a lifetime hating.
This patient may not have known the date, or what the name of the health care facility was, or even her own name, but she could and did hold on to racial intolerance. Years of other life training may have abandoned her, but the training she had received about race remained intact. I saw in her face what could only be described as a mixture of hate, fear and anxiety. The year was 2004, but in my mind this incident transported me back to our nation’s past and gave me a taste of how ugly and complicated life must have been for past generations of black and white Americans.
Frustrated with my inability to administer medications to this patient, I exited her room and searched for the other nurse on duty. She was also African American, but I thought there was a chance she would fare better because she was female. This nurse was not new to the ward and she was not surprised by the patient’s reaction to me. When I asked her how I should handle this matter, she replied, “She won’t take medications from me either.”
Needless to say, this patient did not receive her medication that particular shift. I documented the incident and continued to care for the patients who would allow me to.
Unfortunately, it seems the only repercussions that resulted from this incident of racism were the painful feelings that have continued to stay with me. Nothing was ever addressed on any other level that I was made aware of. My employer’s apparent reluctance to acknowledge the problem disappointed me. It seems that even the most liberal and up-to-date facilities fall short when it comes to addressing this issue.
“Get Over It”
Another of my notable experiences involving racism in a patient care situation was an encounter I had with a veteran. This incident affected me deeply for two reasons. First, I am a veteran myself, having served eight years in the U.S. Air Force. Veterans usually feel a kinship toward other vets, regardless of their background, branch of service or duration of service. Secondly, I had taken care of this particular patient for some time and thought that our relationship had somehow transcended race. Until this incident occurred, our interactions had always been very cordial and respectful.
This was a patient who needed total care. He was paralyzed on his left side from a stroke and needed another’s help for even his most basic needs. The incident occurred on evening shift. Because of our limited staffing, once the total care patients were put to bed for the night it was our practice to leave them in the bed until morning. But on evenings when bingo was being played, I would help this patient get dressed again, put him in a wheelchair and push him to wherever the game was located.
He was prone to fits of yelling and anger, but in the past I had always been able to calm him down. Entering the room this particular night, I could tell that he was not in the best of moods, but I was not expecting the encounter that ensued. All of my attempts to calm him failed. In fact, they seemed to just heighten his anger. And at the apex of his anger, he yelled, “N- – – – -, get out of my room!”
Many emotions ran through me at that moment-certainly too many to count. What I did next escapes me. I assume I must have straightened his blankets and did what I thought would make him comfortable. I do know that I exited his room angry and told the charge nurse about the encounter.
The nurse in charge was totally sympathetic but at a total loss as to how she should handle the situation. I was sitting in the staff break room obviously angry and frustrated, with my arms crossed on top of my chest. She under- stood that she could not just let this incident go without some intervention on her part. Her decision was to call the house supervisor.
I had what I thought was a decent working relationship with the house supervisor, so I was not against discussing this incident with her. When the evening supervisor arrived on the ward, I was still in the break room fuming from the incident. She came in and asked me to explain what had happened; I gave her my interpretation of the incident. Her reply did nothing to soothe my anger. She basically said, “Get over it.”
She then began to relate some incidents of disrespect she had encountered in her own journey through nursing. Being called out of her name, having her level of intelligence questioned and being touched inappropriately were all situations she described. She seemed to indicate that this was part of our job and we had to take it.
I sat there listening, refusing to believe what I was hearing. I also refused to accept her personal doctrine that this type of treatment was “normal” and that nurses should accept it. I sat there respectfully, but her words did nothing to redeem my dignity or help repair my relationship with this patient.
The incident did send some minor ripples toward the higher-ups at the facility. They never spoke to me directly, but their messages found a way to me somehow. The messages consisted of blaming the occurrence on the patient’s condition, saying that stroke patients sometimes react that way. The patient’s medication was also increased, especially his psychiatric medications.
A Gesture of Healing
The one person who truly seemed to understand how much this incident had hurt me was the patient’s wife. His wife, who was a volunteer at the facility, was tireless in her efforts to continue caring for him and many other veterans. She seemed to be his exact opposite in terms of temperament. She volunteered mainly on the day shift, but our paths crossed as the day shift ended and the evening shift began. She too had always been very cordial and respectful to me. The day she confronted me about this incident was no different. I did not intentionally avoid her, but I was not looking forward to encountering her either.
Our discussion took place in the doorway of the patient dayroom. She had always been very direct and that part of her personality was very much in evidence now. She looked me straight in the eyes and said, “I heard about what happened between you and my husband, and I would like to apologize for the awful word he called you.”
I immediately dropped my head and was silent, not because I was ashamed but because I was so full of anger. She continued, “My husband was not a man who used that type of language when he younger, and we did not raise our children to use that type of language either.”
I was still silent, but now we were staring into each other’s eyes. We could both see how deeply this incident had touched me. “I have offered an apology and I can not force you to take it,” she said, “but I hope that you will and that you will continue to care for my husband in the same manner as you have always done.” That was her last statement to me as she gently patted my hand and walked away.
We did speak again after that, but the subject of what happened that day was never touched on. Our conversations were genuine and honest, but I believe we both felt that enough had been said on the subject. Even though I never said anything to her about the incident, she comprehended the depth of the damage her husband had caused by uttering that offensive word.
Emotional Scars
As much as I would like to say that my treatment of that patient did not change, the truth is that it did. I was still very professional and considerate to him. But all of the things one would describe as “extras” ceased. I never got him up for bingo again and my conversations with him held brevity in my tone.
Time passed and I was transferred to another unit at the facility. But I never forgot that patient or that painful incident. Any time I visited that unit to see past co-workers, I would always peek into his room just to see how he was managing.
I began to hear that his health was declining. By the time I had gathered enough courage to actually step into his room, he had deteriorated to the point where he was alert only to himself and being fed by a nasogastric feeding tube. I stood at his bedside and asked him how he was doing, but all he could do was gaze up at the ceiling and mumble incoherent words. He continued to steadily decline until a co-worker notified me of his death.
Later that week I read his obituary. I was surprised at the sterility of the announcement. There he was in an old picture from his military days, hat cocked to the side, smiling. The obituary mentioned a lifetime of loved ones and military service. It was brief and to the point. He existed, but now he was gone.
I was not sure of my feelings then and I am still not sure of them now. All I knew was that he was dead and our joint legacy of pain had died with him. But it still lives in me.
The point of this personal reminiscence is that we in the nursing profession must ask ourselves how to handle the issue of racism in the nursing workplace, and more specifically, how to handle racism when it is expressed by patients. I guess the first step is to admit that the problem exists. Even when they are in a hospital receiving care for the effects of diseases, aging or traumatic physical injuries, there will always be some individuals who will put their racial ideology above anything they are confronted with. That is their right.
But we professional caregivers of color also have the right and the obligation to stand against such behavior and demand to be treated with respect and dignity.
