May 1, 2018 | Susan Pasley, MS, BSN, RN
Confronting bullying in the nursing profession
To harm or intimidate someone perceived as vulnerable, typically to coerce them
The words bully, or bullying may conjure up the image of a school playground or, in 2018, images of kids being abused through social media or in other cyber settings. But bullying is not limited exclusively to young victims. In fact, it has a long, storied history in the profession of nursing complete with axioms such as, “nurses eat their young.” Just as lore tends to do, it seeped into my consciousness long before I was ever a practicing nurse: passed down from one generation to the next in nursing school. The stark reality is that some nurses bully other nurses.
Over the last decade, there has been a concerted effort in the profession to shed light on this damaging phenomenon that may be labeled as bullying; lateral, horizontal or workplace violence; harassment, etc. In 2015, the American Nurses Association convened a panel to develop a position statement and resources around incivility, bullying and workplace violence.
Despite the focus on reducing these detrimental behaviors, it is still prevalent. I recently spoke with the Chief Nursing Officer of a mid-sized health system. I asked her about lateral violence in the workplace, and she replied that it simply wasn’t a problem in her health system. It sounds lovely, but I was not buying it. The statistics simply don’t support it. We have a long way to go before we eradicate this cancer from the profession.
Statistics on nurse bullying
- In a study of nursing students, Bowen, Curtis & Reid (2007) reported that over half of students experienced or witnessed lateral violence during clinicals.
- In the same study, students who experienced lateral violence in clinicals stated that they felt humiliated, powerless and disrespected.
- In a study by Thomas & Burk (2009), many nursing students reported feeling unwanted, ignored, distrusted, disbelieved, unfairly blamed and publicly humiliated during their clinical rotations.
- 21 percent of all nursing turnover can be attributed to bullying.
- 34 percent of nurses who are bullied consider leaving the profession altogether.
- 36 percent of calls to the Workplace Bullying Institute are from nurses, more than any other profession.
- 48 percent of graduate nurses are afraid of experiencing workplace bullying.
- 60 percent of new nurses leave their first job within six months because of some form of verbal abuse or harsh treatment from a colleague.
- 85 percent of nurses have been verbally abused by another nurse.
Bullying often starts early
You may have noticed from the statistics that many deal with students before they even formally enter the profession. While nursing seems from the outside appears to be a profession comprised of highly intelligent, caring, skilled individuals who must collaborate to succeed, for those subject to lateral violence, it can feel like a lonely, demeaning career option. Unfortunately, for many, this damaging behavior starts at the beginning, in nursing school.
When my daughter entered a four-year university to follow in my footsteps as a nurse, it was a proud moment. However, my pride quickly turned to concern when we attended freshman orientation. The current nursing students who led us through a series of tours, panels and lectures were overly critical of the chances of any one of the prospective student’s ability to gain admissions into the nursing program. They discouraged academic rigor in favor of taking the easiest classes to increase the chances of admission and called my daughter “stupid” for considering an honors English course. They used their position of “authority” to scare the students about the program and made them to feel incompetent. By the end of the day, my daughter already felt defeated before her first day of college. This tone of inadequacy was pervasive throughout her first year while she completed coursework required to apply into the nursing program.
The school of nursing provided us with a document titled “Traits of a Successful Nursing Student.” The last trait they listed for success was courage.
“Some of the situations that nursing students face in clinicals are difficult and challenging. Sometimes verbal abuse occurs as well as patient pain that happens when you are performing a procedure. Nursing students need to find the courage to deal with these situations.”
As an emergency department nurse, I have experienced death threats, been spit on, cursed and kicked by patients. I understand that the school of nursing was trying to prepare students for difficult situations that occur in the profession, but I was disheartened to see that they were subliminally planting a seed that implied verbal abuse is normal and to be expected in nursing. Students who learn early on that abuse is okay have a hard time speaking out against any kind of bullying even that enacted by their peers. The school failed by pointing out a problem without empowering prospective students with solutions.
My daughter did gain acceptance into the nursing program, and I’m happy to report that the school has been much more helpful as she has completed her first year. However, just as the school stepped up their support, some students began to spread abuse through intimidation overtly stating that students who don’t have a 4.0 GPA are not worthy to be a registered nurse. Talk about pressure! To make matters worse, the research and anecdotal evidence points to the fact that nursing students are often harassed by nurses in their clinical rotations through verbal and non-verbal humiliation and disrespect.
Many nurses are indoctrinated into lateral violence before they can even put the credentials, RN, behind their name. This leads to a perception that bullying is a normal part of the profession from early in their careers.
What does bullying look like?
You may know all too well that you are the victim of workplace violence, but some of you may be experiencing bullying without even realizing it. The first step to changing something is to recognize it and put the right label on it. It is also important to realize that bullying can come from your peers or your superiors. Charge nurses, supervisors and managers are just as capable of bullying as a fellow bedside nurse. Lateral violence can rear its ugly head in many form, but they are all unacceptable.
- Withholding information critical to your job
- Refusing to help
- Finding fault (see the story of Nurse Jane above)
- Ethnic or racial jokes or slurs
- Unfair assignments
- Betraying confidence or gossiping
- Physical harm
- Exclusion and silence
- Eye rolling or other demeaning non-verbal behaviors
Why is bullying so prevalent in nursing?
It is widely accepted that lateral violence is a real problem in the profession, but what are the root causes that drive it? It is important to recognize that bullying is about control and power. There are many theories that aim to explain bullying in the nursing profession. Here are a few:
- Although more men are entering the profession, nursing is dominated by females. Dr. Renee Thompson hypothesizes that this is a major factor in the phenomenon. Women are often negative towards other women, not just in nursing, but in life. This behavior can spill over into the workplace as females compete over status, respect and position.
- Nursing has been called the silent majority. There are more nurses in the healthcare workforce than physicians, physical therapists, pharmacists, etc., and yet nursing has remained an oppressed and subservient profession. Despite being highly skilled and knowledgeable, nurses are largely paid by the hour, underrepresented in decision-making roles and treated as a commodity. Dr. Thompson theorizes that frustrations that build up in this stressful environment are sometimes released on other nurses.
- Dr. Cheryl Dellasega, GNP, PhD theorizes that the educational system for nursing has a big role to play in the epidemic. She notes that nurses are trained to be subservient and uncertain instead of independent and confident. This is vastly different from medical schools that teach students to project confidence even when they aren’t; to always have an answer to the question; and to stay calm and collected.
- Dr. Dellasega also notes that bedside nurses are confined for the whole shift, often times 12 hours, to the unit. When tempers flare, when stress is overwhelming, there is no place to go, no place to decompress. That pent-up stress is redirected towards other nurses.
What can you do about bullying?
- If you are the victim of workplace harassment, report it. Under reporting is pervasive in the nursing profession.
- If you are the victim, label the behavior and call it out when it happens.
- Keep a clear record of bullying incidents including dates, times, witnesses, etc. Your organization will be interested in any behaviors that compromise a culture of safety.
- Establish programs in your organization or unit to create awareness about and provide tools to address lateral violence.
- Leaders should establish a zero-tolerance policy.
- Make it a point to compliment a fellow nurse everyday.
- Mentor student and new nurses.
- Empower yourself by learning to articulate your value and the value of the profession. Use that power to participate in decision making roles within your organization.
Bullying not only demeans and humiliates a colleague, it also negatively impacts patient outcomes. Next week we celebrate Nurses Week. It is a time to acknowledge the profession and all the great work nurses do to care for patients. Perhaps this Nurses Week it is time to reflect on how to create a bully free workplace for the 3 million+ nurses in the United States. Nursing is a tough profession, and to make it worse by bullying one another is a travesty. It is time to take measures to stop bullying and to turn that energy into building each other up instead of knocking each other down. This Nurses Week be especially #NiceToYourNurse, including your colleagues.
- Thompson, R. Dr. Renee Thompson’s series on nurse bullying. American Sentinel University. Accessed on 4/25/18 https://ppc.americansentinel.edu/wp-content/uploads/Dr-Renee-Thompson-Series-on-Nurse-Bullying-1-22-2016.pdf.
- Ariza-Montes A. Workplace bullying among healthcare workers. International Journal of Environmental Research & Public Health, 2013;10:3121-3139
- Thomas, S.P., & Burk, R. (2009). Junior nursing students experiences of vertical violence during clinical rotations. Nursing Outlook, 57, 226-231.
- Bowen, I., Curtis, J. & Reid, A. (2007). You have no credibility: nursing student’s experiences of horizontal violence. Nurse Education in Practice. 7, 156-163.
- Johnson, S., & Rea, R. (2009). Workplace bullying: Concerns for nursing leaders. JONA, 39(2), 84-90.
- Robbins, A. (2015). Mean girls of the ER: The alarming nurse culture of bullying and hazing. Marie Claire. https://www.marieclaire.com/culture/news/a14211/mean-girls-of-the-er/.
- Stokowski, L. A. (2010). A matter of respect and dignity: Bullying in the nursing profession. Medscape Nurses. https://www.medscape.com/viewarticle/729474.