Nurse bullying has been an issue for decades and continued during the COVID-19 pandemic. Now, in the post-pandemic era, allegations of toxic behavior are continuing to climb.
Becker's spoke with Jennifer Woods, MSN, RN, vice president and chief nursing officer at Baptist Health Hardin in Elizabethtown, Ky., and Jamie Payne, chief human resources officer at Saint Francis Health System in Tulsa, Okla., to understand the uptick in nurse bullying and how their health systems are working to address it.
Why nurse bullying is increasing
Overall, about 30% of Americans are bullied at work. This finding is from a 2021 survey from the Workplace Bullying Institute, which also found that 65% of bullies at work are bosses, and 43% of workers get bullied via remote meetings and email.
Bullying exists for a number of reasons. There are more overt behaviors, such as yelling at a colleague, as well as more covert actions which often go undetected, such as gaslighting or withholding information from teammates, three experts wrote in a November 2022 article for Harvard Business Review. The article's authors shared 15 different dimensions, features, and sample behaviors and outcomes of workplace bullying leaders should know.
Ms. Woods said bullying can take all kinds of forms, ranging from incivility to overtly mean.
"It turns into more of a workplace violence situation if it becomes more of a physical occurrence," she told Becker's. "But I think more times than that, what we're talking about with bullying is really that level of incivility that is undercutting meaningful relationships to effective teams. It undermines what we try to do every day with our teams and with our patients."
The workforce shortage has played a role in the uptick of bullying allegations, according to Ms. Payne. Health systems like Saint Francis are hiring more young, inexperienced nurses and relying on external agency staff to fill gaps. Older nurses have taken it upon themselves to "initiate" newcomers.
"There's a long-standing culture within nursing to have a little bit of this lateral bullying, if you will," Ms. Payne said. "They often say nurses 'eat their young.' Seasoned nurses think it's their rite of passage to initiate a recent college graduate or someone new to the organization by putting them through trial-by-fire situations, like they experienced early in their career."
Nurses are working long hours in a high-stress environment, which can also exacerbate tensions, Ms. Payne said. An uptick in violence from patients has made matters worse.
Saint Francis knows this all too well; five people were killed on the hospital's campus in June 2022, when a gunman opened fire inside a medical office building. Events like these create a sense of instability in the workforce, said Ms. Payne. In the aftermath of the shooting, the health system took measures to improve not only physical safety, but the emotional environment people work in.
Ms. Woods noted that compassion fatigue remains a challenge as well.
"It's the loss of that self-awareness," Ms. Woods said. "You may not consciously treat people differently, but your capacity to be compassionate, to have self-awareness about how your interactions and how your behavior is impacting others, [is lower]."
Combating nurse bullying
Coming out of the pandemic, Ms. Woods said nurse leaders have a continued and amplified focus on encouraging their teams and the workforce to be healthy for themselves. This means providing workers with tools and resources to do that self-assessment "when they find themselves in that place where they don't feel like they have that passion that originally brought them into nursing, or that they don't have the ability to relate [to patients and their teams] as they once did."
Health systems should have an anti-bullying/harassment policy and clarify their code of conduct, but they also need to be proactive about addressing issues that will undoubtedly arise, according to Ms. Payne.
Saint Francis Health System offers psychological safety courses and led a campaign to empower individuals to speak up when they feel they've been mistreated. This has created a "see something, say something" mentality around toxic behavior, which has also contributed to the uptick in bullying reports, Ms. Payne said.
When reports come in, it is vital that leaders jump on them and begin investigating as soon as possible. This way, employees know they are being taken seriously and will continue to speak up for themselves and one another, according to Ms. Payne.
And everyone must be held accountable for their actions, Ms. Payne said: patients, clinicians and leaders alike.
"There's no one solution," Ms. Woods said. "But as an organization, understanding what's happening and being able to provide a variety of solutions, so we can meet [workers] where they're at, and provide them opportunity for that self-care."
The importance of stopping nurse bullying
Toxicity in the nursing workforce directly affects the health of the organization, according to Ms. Woods.
"It goes back to our mission of being able to provide excellent care and helping people during some of their most vulnerable times. And in order to be able to do that, we need to be as healthy as we can," she said. "We have the clinical knowledge and capability. But people remember how you make them feel, and they have expectations for how they will be cared for. If we're not healthy and don't have the ability to provide that empathy and be relational in the delivery of that care, then people feel that difference. It impacts their trust in our ability to provide clinical care."
Bullying can also be costly. In an industry plagued by nursing shortages, health systems can't afford the talent drain catalyzed by a toxic environment.
"[It's important to] make employees feel valued, and like they belong in the organization, because that's what impacts retention," Ms. Payne said. "If they can feel like they belong there, they're more likely to stay and be promoted and grow in your organization."
Ms. Woods said at this point, nurse bullying still needs to be worked on, and there's no silver bullet to address the issue.
"It's foundational in human nature. We have to have continuous efforts to raise awareness around how we're perceived and how we're contributing to the work environment," she said.