Nurse-to-nurse bullying more than just a sore point
Registered nurse Renee Thompson of South Park will never forget the moment that almost ended her career, but ultimately inspired her to tackle what she calls an unspoken epidemic: nurse-to-nurse bullying.
“When I was just starting out, a supervisor who was always yelling at me called me an idiot in front of a physician I really respected because I could not get a copy machine to work,” Thompson says. “I was on the verge of tears when the doctor took me aside, and said, ‘My dear, why would you ever let anyone less capable and intelligent talk to you in this way?’
“If he hadn’t said that, I might have quit, but he changed my whole attitude.”
Thompson confronted the supervisor about the demeaning behavior, and began to pay more attention to similar incidents among colleagues.
As she moved from bedside to administrative nursing, she realized how prevalent bullying is, Thompson says. “When I’d meet with new nurses, all they wanted to talk about was how poorly they were being treated by other nurses. It reminded me of my own experience and put me on a path of wanting to impact the problem.”
Thompson founded RTConnections, a firm that consults about bullying and other aspects of professional development in the health care field, and recently published “ ‘Do No Harm’ Applies to Nurses, Too: Strategies to Protect and Bully-Proof Yourself at Work.”
Bullying may be universal, says Thompson, “but it is especially perverse when it involves nurses because we’re supposed to be all about caregiving.”
Yet, the issue is so prevalent that 60 percent of new nurses leave a job within six months, according to a study by St. Joseph University in Philadelphia, which found that abusive behaviors like sabotage and insults are perpetrated nurse-to-nurse 80 percent of the time.
So-called horizontal violence is more common than bullying by supervisors, physicians, patients or patient families, the study revealed.
The reasons are complicated, but can be traced, in part, to the sense of powerlessness nurses feel in the command-and-control hospital hierarchy, says Kathleen Bartholomew, a Washington state-based registered nurse and author of books about nurse bullying. “Not having power causes any group to turn on themselves, but there are issues particular to health care that compound hostility in nursing. It is learned behaviors from generations ago and a part of our cultural meme.”
Usually, the most competent workers are the ones who get picked on, according to Gary Namie, a Washington, Pa., native who founded the Workplace Bullying Institute in Bellingham, Wash.
“People are targeted for their strengths, not their weaknesses because they pose the greatest threat,” he says, adding that new nurses are among the most vulnerable.
“Because they are so focused on their patients, they have their backs turned to the political wrangling. By their pro-social natures, they don’t even think in terms of political gamesmanship, which can end up hurting them.”
Backstabbing, unfair assignments and other bullying behaviors among staff can harm patients, too, according to a University of Cincinnati College of Nursing study, in which 25 percent of health-care workers connected bullying to patient mortality, and 75 percent to adverse clinical outcomes.
In an article on bullying and medical errors, Bartholomew indicates that if hospital leadership were to shift power from “a hierarchy to a tribe,” nurses would feel safer in questioning orders, seeking support and reporting medical mistakes.
Registered nurse Dina Sheriff of New Eagle, Washington County, says she came to the realization, after 35 years in critical care — nearly half of it as an emergency-department charge nurse — that her “thick skin and direct demeanor” could be counter-productive.
“I’d never looked at it as bullying, but I had developed a significant reputation for being aggressive and intimidating,” Sheriff says. “I was known as a very good nurse, but nobody sought me out for help or expertise because they were afraid of me. That was my lightbulb. I wondered if I’m that unapproachable, what critical information about a patient isn’t getting where it needs to be.”
Now working in staff development at an area hospital, Sheriff says she addresses bullying’s impacts when educating others. “People who perceive they have no power can sabotage you and make you miserable,” she says. “When you promote effective teamwork, everyone’s job is easier, and it benefits the patient.”
Most hospitals have zero-tolerance-for-bullying policies, but unless they receive formal complaints about a worker’s behavior, the bullying will continue, says Thompson, who believes change best occurs at the grassroots level.
“It takes one manager on one unit to say, ‘OK, we’re going to create a culture of stability and respect,’ and then model that behavior,” Thompson says. “If you don’t want gossip in your unit, don’t gossip.”
It’s understandable that tempers will flare in a life-or-death environment, like a surgery suite or emergency department, but there is a difference between losing it on occasion and constantly demeaning others, Thompson says.
“If your supervisor snaps and apologizes after, that’s having a bad day. Bullies never apologize. They behave badly on a regular basis and rationalize their behavior.”
That makes it important for the target to deal with the problem head-on, rather than vent or complain to co-workers, Thompson says.
“Wait until the incident is over and emotions have cooled, and then ask for some time to talk about what happened. Relate your concerns to the impact on productivity and patient safety.”
It takes courage to stand up to a bully, but we can teach people how to treat us, says Thompson, who remembers a particularly painful incident she had as an administrator.
“I was in a meeting once with a chief nursing officer who went off on me in front of other people. It was all I could do not to cry,” she recalls. “My boss said, ‘If you don’t address this within the next 72 hours, you’ll set the tone that she can treat you this way for the rest of your relationship with her.’ ”
Thompson says she was so nervous she had to write a script and then rehearse it before making the call.
When she told the woman that she’d felt personally attacked in the meeting, she apologized, Thompson says. “Her response was, ‘Oh, Renee, I’m so sorry. I really respect you for calling me on it.’ ”
Deborah Weisberg is a contributing writer to Trib Total Media.