"It felt like Lord of the Flies around here last Fall. The staff split into two fractions and we had overt arguments and name calling as well as lots of gossip and incivility."
A nurse recently described the environment in her hospital. Is nurse bullying and incivility an issue at your hospital? In September, 2016, Heather Punke's article in Becker's Hospital Review, "The pervasiveness of nurse bullying: 7 key thoughts," focused on OR nurses and their experiences, but bullying can happen to any nurse anywhere in the hospital. As noted in the article, bullying has repercussions for nurses both personally and professionally -- and it ultimately impacts patient safety when bullying happens after a nurse speaks up for a patient or observes that patient safety measures were not followed.
Through the iVantage INFORM KnowledgeWeb collaboration platform, we recently asked nurses about their experiences with bullying. Close to 60 nurses from hospitals (Critical Access Hospitals to academic medical centers) across the US shared their thoughts and experiences. A slight majority of responding nurses reported that bullying/incivility is an issue in their hospital. The good news is that there was an almost equal number who said that bullying is not an issue in their hospitals. Here's what nurses said about the bullying:
• Bullying may be more of a factor in certain units or departments.
• Leadership may be involved in the bullying.
• Longer term nurses may bully newer nurses.
• Bullying may go beyond nurse to nurse.
• Bullying may be subtle.
• Different cultures may have different perceptions of bullying.
• Miscommunication feeds into bullying.
So, what are hospitals doing to curb bullying? Here's what the nurse community recommends:
1. Embed expectations into culture
o Establish clear language of acceptable behavior
o Create a respectful work environment & code of conduct
o Have a "speak up" culture & no tolerance policy
o Foster a "Be One" attitude in our culture
o Adhere to the "Commitment to Co-Workers" mantra
o Create a zero-tolerance culture (concerns escalated w/ HR)
o Ensure the Code of conduct addresses bullying and retaliation
o Establish standards of performance including a pledge of commitment, signed by staff members
o Have a service standard that nurses are held to
o Hold each other to service excellence
o Place offenders on a Performance Improvement plan
o Tie behavior to job performance; annual review (and review w/ any infraction)
2. Train/educate staff and leadership
• Conduct yearly "abuse training" - verbal, physical, and financial
• Educate staff about bullying
• Send a health stream on bullying
• Mandate articles about bullying
• Online education
• Provide in-services provided each year
• Email to all staff
• Send a multidisciplinary team to Teamsteps.
• Introduce outside agencies to figure out what the issues are.
3. Implement open-door policies
• Define with unit/department leadership what bullying means/feels like - it may be different for different people
• Encourage nurses to talk to administration (though one nurse notes "some of the directors tell others & then it causes more problems.")
• Ask leadership to hold discussions with staff
• Have an open-door policy to HR and with senior leadership
• Hold regular team & one-to-one meetings with managers; address issues as they arise; bring affected parties together
• Discipline enacted when bullying occurs; individual coaching as necessary
The good news is that more than 70 percent of nurses indicated that they think the anti-bullying measures in place at their hospital are working.
Through our INFORM KnowledgeWeb community, we hear from thousands of nursing professionals working in hospitals, large and small, rural and urban, across the country. They often seek advice, lessons learned and ideas from colleagues and peers on how to tackle the many things that get in the way as they strive to improve the quality, efficiency and effectiveness of their hospital. Using various methods such as surveys, conference calls and networking events, we've engaged this knowledge community in an in-depth discussion and most importantly, strategies for addressing these challenges.
Author bio:
Michelle Gray-Bernhardt has been with iVantage Health Analytics since 2011. Previously, she worked for the Healthcare Management Council, Inc. In her role as a Senior Knowledge Manager, she facilitates iVantage's Knowledge Communities -- groups of peers from hospitals across the US who come together to work through common healthcare challenges. She works with a variety of healthcare personnel from floor staff to executives, with the ultimate goal of generating actionable improvement ideas for hospitals ranging from critical access hospitals to large academic medical centers.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.