By Amanda Sounart, associate editor
Nurse Zone
April 4, 2008
Constant harassment by a bully is no longer something relegated to the school yard. Tales of workplace bullying are making headlines across the U.S., particularly in a hospital setting. A new study has found that up to 90 percent of nurses have witnessed or were the target of workplace bullying, and some experts fear this trend could push more nurses out of the clinical setting.
In an article published in the March issue of the Journal of Obstetric, Gynecologic and Neonatal Nursing, results of a recent national survey conducted by the Joint Commission on Accreditation of Healthcare Organizations were analyzed to determine how workplace incivility can affect the subjects of abuse and their patients.
"The workplace culture fosters cut-throat competition," said Gary Namie, Ph.D., director of the Workplace Bullying Institute. "It's rampant in health care because of scarce resources. People are pitted against one another for funding, status and acknowledgement. It seems to be endemic in the profession."
The Joint Commission's survey found that more than 50 percent of nurses have been the target of some form of abuse at work and more than 90 percent report having witnessed abusive behavior. Furthermore, 75 percent of nurses who responded believed that this type of behavior can reduce patient satisfaction and disrupt care.
According to the survey, nurses are primarily bullied by physicians.
"You have a situation with people who are highly educated, highly skilled and have high egos, coupled with a pool of readily accessible, easily exploitable targets," said Namie. "There are so many nurses that say they'll never do institutional nursing again. The recruitment and retention of nurses hinges on whether they treat bullying as a workplace hazard, but the physicians see no need to put a stop to it."
Physicians are not the only ones to blame, however. "Lateral bullying" among nurses was also noted in the survey. This type of behavior can include making inappropriate remarks about other nurses' skills in front of patients, doctors or other staff members, refusing to assist a fellow nurse or making inappropriate personal comments.
"The problem that facilitates bullying in nursing is that a lot of nurses foster it," added Namie. "Nurses themselves say things like 'We eat our young,' or 'This is just the way things are.' They make it acceptable and let it go on."
According to researchers, nurses who are the target of bullying are prone to developing psychological side effects including post-traumatic stress disorder, anxiety, depression or insomnia, all of which can lead to poor work performance. The study's author, Diane Felblinger, an associate professor at the University of Cincinnati, notes that many nurses may be unaware of the impact bullying has on them and allow the behavior to continue. Over time, bullying can push nurses out of the clinical setting.
Following publication of Felblinger's article, the Center for American Nurses posted a position statement saying that, "Bullying, lateral violence and all forms of disruptive behaviors have a negative impact on the retention of nursing staff and the quality and safety of patient care."
Because workplace bullying can cause so much disruption for nurses and patients, health care leaders are looking for ways to eliminate it from the clinical care setting.
In the report, Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis, the Joint Commission suggests facilities that find bullying and intimidation to be a problem should adopt a zero-tolerance policy to enforce proper behavior in the workplace. The report also calls for the hospital to be held accountable for educational initiatives so all staff members understand what is considered inappropriate behavior.
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