Bullying in Nursing and its Impact on Healthcare Essay Example

also prevents the delivery of quality care to patients leading to poor outcomes (Rocker, 2008). Therefore, it is imperative that nursing leadership in clinical settings strive to promote a healthy and safe work environment for nurses as this will improve the quality of healthcare delivered. This paper presents the problem and effects of workplace bullying in the nursing profession and offers potential solutions on how to eliminate the practice for the improvement of the quality of healthcare delivered to patients.

Bullying in Nursing

Workplace bullying refers to any repetitive mistreatment comprising of harmful actions such as verbal abuse and threats intended to humiliate or intimidate a worker and interfere with his/her to job performance (American Nurses Association, 2015). Bullying actions are extensive and include those that harm, undermine or degrade a worker. For example, hostile remarks directed to an employee, verbal abuse, threats, taunts, intimidation, and withholding much-needed support (Rocker, 2008). Specific organizational factors such as power distribution, policies, procedures, tolerance to bullying over time and informal groupings are crucial precursors to workplace bullying. Mostly, bullying results from abuse or misuse of authority.

A real or perceived gap in status cause top employees to bully their juniors (top down bullying). Top down bullying by organizational managers allows acceptance of the practice as a workplace norm. Employees may also gang up against their employers (bottom up bullying) or colleagues (horizontal bullying) (Rocker, 2008). All in all, bullying behavior is driven by the perpetrator’s need to feel in complete control of a person regardless of the pain and suffering endured by the victim.

Bullying affects a broad range of staff in the nursing profession. The culture of the healthcare setting has

most of the times portrayed nurses as “handmaidens” in the patriarchal society. As a result, the balance of power is never in the favor of the nurse (American Nurses Association, 2015). This has acquiesced nurses as servants of the physicians and other medical personnel thus predisposing them to bullies. Nurses usually experience various bullying actions such as physical violence, verbal abuse, and mobbing as well as sexual assault.

Verbal abuse has the highest rate with 48% of nurses reporting to have experienced it. Working the night shift increases the risk of sexual harassment. Perpetrators of these actions are mostly senior and experienced nurses (24%), nursing unit in charges (17%), nurse managers (14%).” This had led to the famous phrase that “nurses eat their young” (Dellasega, 2011). Physicians (8%) are also responsible for nurse bullying (Vessey, 2009). Newly licensed nurses are more vulnerable to bullying before they get socialized to the healthcare work environment.

There are several bullying acts directed to nurses. The actions are usually insidious and take place for an extended period. They include continued criticism, sarcasm, demeaning comments, false accusations, and complaints, being set up to fail, isolation, verbal and physical abuse (Yildirim, 2009). Constant criticism and humiliation are the most frequent acts of nurse bullying experienced in the United States. The bullying actions take place in various nursing care delivery areas. According to Vessey (2009), “bullying occurs most frequently in the medical, surgical care (23%), critical care (18%) emergency areas (12%), operating room/post anesthesia care unit (9%) and obstetric care (7%) areas.” Most nurses (67%) report experiencing bullying from their supervisors and coworkers (77%). Some nurse supervisors are always harsh and correct inevitable mistakes

done by juniors publicly. They also withhold much-needed support to the newer nurses making it difficult for them to become effective in their work. Additionally, nurse coworkers are abusive to each other thus sabotage the nursing profession and reduce the quality of patient care.

Impact of Nurse Bullying on Healthcare

Bullying has serious safety and health issues and can have a lifetime physical and psychological effects on the victim (Rocker, 2008). Nurse victims of bullying are terrorized, belittled, excluded from the rest of the healthcare working force, and denied essential rights and resources. This has significant physiological and psychological impact on the victims which affect patient care. Bullying threatens the well-being of nurses. Nurses who continuously experience workplace bullying are more likely to have decreased morale to work and job satisfaction than respected ones (Yildirim, 2009).

This translates to poor job performance and reduced productivity since such nurses spend more time on leave and miss work more often. This lowers the standards of care delivered to patients threatening their health as such nurses are unable to provide competent care (American Nurses Association, 2015). Nurse maltreatment also leads to the erosion of professional competence with affects patient care negatively. Additionally, nurse bullying creates a dangerous work environment for other healthcare providers endangering their lives and that of the patients.

Bullying also leads to physical symptoms such as headaches, disturbed sleep patterns, and gastrointestinal problems among nurses. It also precipitates psychological conditions such as anxiety, increased stress levels and depressive episodes. These symptoms frequently advance to post-traumatic stress disorder and depression in some nurse practitioners (Rocker, 2008). Such physical and psychological effects have a negative impact on the quality of care

delivered. They impair judgment and substantially reduce the performance of a nurse.

For instance, a study conducted on registered nurses discovered that 7% had medication errors as a result of intimidation (American Nurses Association, 2015). Research has also shown that nurse bullying increases errors related to patient safety leading to an increase in the incidence of patient falls, higher rates delayed medication administration and more cases of patients developing pressure ulcers due to lack of frequent turning. Therefore, nurse managers should develop ways of eliminating bullying in their work areas as it decreases staff confidence and competence which adversely affects the quality of patient care and outcomes in the clinical setting.

Additionally, bullying destroys the self-confidence and image of a nurse forcing them to resign their position eventually and move to other professions. Bullying is one of the primary reasons as to why nurses leave the profession in large numbers (American Nurses Association, 2015). As a result, nurse bullying in the workforce has a significant contribution to the current nursing shortage experienced. It creates feelings of defenselessness which significantly reduces the motivation to work as a nurse (Yildirim, 2009). As a result, most nurses leave their faculty positions and move to other professions with less bullying.

Studies prove that 60 percent of new nurses typically leave their first position within six months as a result of some form of verbal abuse, harsh treatment and lack of adequate on the job support and training (Rocker, 2008). Others take early retirement to avoid the bullying actions. Additionally, nurse bullying also causes burnout forcing nurses to take some time off work forcing the working nurses to take care of additional patients.

All these have led to a significant shortage of nurses increasing the nurse patient ration in the healthcare setting and reducing the quality of nursing care.

Additionally, nurse bullying contributes to unhealthy work environments that ultimately hurt the quality and safety of healthcare given to patients. It is important to have a safe working environment as it promotes the physical and psychological well-being of workers. Nurses who do not feel safe in the health care team are more likely to leave an unsafe work environment compromising the safety of the patients and other healthcare workers (Dellasega, 2011). Nurse bullying also has an adverse impact on communication in the clinical setting.

The sharing of patient information is severely affected in bullying situations. Nurse bullying prevents victims from asking questions regarding patient care, providing useful feedback, giving advice, clarifying or validating the best treatment modality (Yildirim, 2009). Such decreased communication among the healthcare providers has a negative impact and threaten the quality of care delivered to patients. Therefore, nursing leadership should create a healthy working environment for nurses by establishing a positive culture of respect and mutual communication through the by prevention of workplace bullying.

Personal Feelings about Bullying in Nursing

Currently, I am not competent enough to deal with bullying scenarios in the clinical settings. Being novice to the issue of nurse bullying, I lack adequate skills to handle it if directed to me. As a student, I have had little experience in the clinical setting compared to the senior nurses. Therefore, I am expected to bow down to authority so that they can teach me whatever I need to learn. Therefore, tolerating bullying in the clinical setting seems like

the better alternative for a student or a new nurse to gain much-needed experience, knowledge, and skills that are commonly taught by the senior nurses.

However, this should not be the case. I am sure that it does a patient who is struggling to breathe in an ICU no good to hear nurses fight over his/her care. Additionally, reporting a nurse bully to the superior rarely yields little positive outcomes. Therefore, I plan on investing in myself and work hard to acquire the confidence and skills to deal with bullying especially when it is from the superior nurse leaders. I also seek to understand the truth about bullying in the clinical setting and collaborate with nursing leaders to develop effective solutions against bullying.

I feel that it true that most “nurses eat their young.” In the course of my practice, I have encountered several bullying scenarios. I hear coworkers hassling each other and passing the blame game at the end of the shift for activities not completed. Most of them are harsh sometimes abusive to new nurses who are struggling to learn and adapt quickly to the demanding work environment. This culture starts at the nursing school whereas students encounter hostile treatment during clinical rotations. Senior nurses have a habit of looking down upon students and new nurses.

Having experienced hostile treatment myself, I can attest to the fact that nursing leadership plays a huge role in perpetrating bullying behavior against younger nurses. Therefore, the nursing leadership has a vital role to play in ending bullying in their work areas. They should teach respect and compassion between nurses so as to prevent horizontal bullying. Nursing leaders should also

mentor new nurses continuously and passionately as they cannot get through a shift without their support (Rocker, 2008). This will help them in developing practical skills, knowledge and experience that translates to higher quality care.

How to Best Address Bullying in Nursing

The issue of nurse bullying can be best addressed by not condoning the practice in the clinical settings. There should be the visible participation of the nursing leadership in addressing bullying (American Nurses Association, 2015). Managers should foster commitment, engagement, and trust for front-line workers. They should develop a zero tolerance policy to nurse bullying. Effective policies should be established with proper disciplinary measures for bullies. All cases of bullying should be handled the same way without favor regardless of who is involved.

The leadership has a duty to design policies that have corrective actions to mitigate the consequences of bullying in a timely and efficient manner (Yildirim, 2009). The policies should promote favorable reporting mechanisms. An ombudsman situated within the nursing organization can help nurses to report cases of bullying without fear of backlash. Victims ought to be protected from retribution after reporting. This will encourage others to report bullying cases for timely intervention and institution of the disciplinary action. Additionally, nursing managers need to lay out an investigation protocol to be followed in bullying cases.

Effective interventions also require an ongoing commitment by the management as well as the staff nurses. Managers should model the desired actions against bullying (Townsend, 2012). Managers in nursing should create a culture of respect for all nurses despite the level of competence. The nursing leadership should advocate for bullying prevention in the workplace. They should encourage flexibility and sensitivity

to each other as there is a need for a shared understanding to curb workplace bullying.

Such a commitment can only be instilled through the provision of education to all then staff members whether victims, bullies or bystanders (American Nurses Association, 2015). Education helps staff in recognizing and preventing bullying before it becomes chronic. It also equips nurses with the necessary skills to handle workplace bullying if they encounter it. Therefore, nursing schools should introduce a course bullying identification and prevention education in the academic curriculum used to prepare graduates better for the nursing clinical area. Also, the nursing leadership should orient new nurses to the existing policies and procedures.

The improvement of interpersonal relationships in the workplace can also help reduce cases of bullying (Rocker, 2008). The nursing leadership should organize team building activities that help colleagues to interact and bond with each other. Promoting collegiality in the workplace can be a major way to fight horizontal bullying (Townsend, 2012). Nurses should also mentor their young by treating them with respect, dignity and kindness despite their gaps in their knowledge and skills. They should nature these skills and offer assistance when needed.

Providing such support encourages the new nurses to learn effectively and deliver their duties. Nurses should also insist on and participate in such communication building activities as they help in promoting diversity and inclusiveness in the workplace. Excellent communication entails using clear words, listening to others and demonstrating openness to their ideas, being polite and apologizing when required to (Townsend, 2012). Such healthy interpersonal relationships help in establishing perfect conflict negotiation and resolution practices. This leads to the creation and maintenance of healthy professional relationships

that are translated to the clinical areas thus prevent bullying and improve patient care.

Conclusion

In conclusion, nurse bullying is a serious problem plaguing the contemporary healthcare era. It creates and sustains a toxic work environment for all nurses impacting negatively on the quality of healthcare delivered. It leads to job dissatisfaction, increases the staff attrition rate, and reduces motivation to work and productivity. It also impairs communication in the clinical setting impeding the delivery of quality care to patients thus causes to poor outcomes. Bullying also increases errors when caring for a patient that could be life threating. Additionally, nurse bullying interferes with the recruitment and retention of nursing staff leading to a considerable shortage and a high nurse to patient ratio that impairs the delivery of quality care.

Therefore, it is imperative that nursing leadership in health care organizations strive to promote a healthy and safe work environment for nurses as this will improve the quality of healthcare delivered. Being role models and creators of work group culture, nurse leaders play a crucial role in combating bullying. They should, therefore, educate their staff on how to identify and stop bullying. Managers should also develop effective policies and programs that address bullying behaviors. Finally, they should endeavor to create better interpersonal communication in their organizations by promoting teamwork. This will prevent and effectively tackle the problem of nurse bullying and improve the quality of care delivered to patients in the process.

References

1. American Nurses Association, (2015). Incivility, Bullying, and Workplace Violence, 1-29. Retrieved from https://www.aorn.org/-/media/aorn/guidelines/position-statements/posstat-endorsed-ana-incivility-bullying-violence.pdf
2. Dellasega, C. (2011). When nurses hurt nurses. Indianapolis, Ind.: Sigma Theta Tau International.
3. Rocker, C. (2008). Addressing Nurse-to-Nurse Bullying to Promote Nurse Retention. Nursingworld.org. Retrieved
   

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